Riley Brandt

Lack of resources kneecaps the effectiveness of orders, says Fay Herrick of the Schizophrenia Society of Alberta

Aimed at stopping the revolving door for people suffering from serious and persistent mental disorders, changes to Alberta’s Mental Health Act look good on paper but seem to lack adequate resources.

On January 1, the province introduced community treatment orders (CTOs), which are intended to help mentally ill individuals comply with treatment following hospitalization and prevent them from deteriorating in the community and being readmitted.

In severe cases, two doctors can issue CTOs — ideally one being a psychiatrist. An ill person must have a history of being in a hospital or jail, due to their condition. Consent from the individual is not required, particularly if the individual has evaded treatment while in the community and poses a risk to others if their condition deteriorates.

A CTO will specify a person’s treatment, such as medications and medical appointments. The order is for six months, at which point physicians could renew it for another six months. The goal is to give the severely mentally ill an opportunity to live in the community rather than be hospitalized.

However, the manager for the Calgary chapter of the Schizophrenia Society of Alberta cautions there is a severe lack of community support systems to achieve these changes. Fay Herrick points to the World Psychiatric Association, which advises that an assertive community treatment team should be in place for every 100,000 population in order to properly serve the mental health community. Calgary has one team for more than one million people.

“This gives you some idea as to how far the government is behind in their thinking for the need to care for people,” says Herrick. “We don’t have anything that is long-term care or support.”

In theory, the plan could be beneficial, especially for schizophrenics who suffer from anosognosia — a disorder in which individuals don’t comprehend or acknowledge their illness. “For that population, until they gain some insight, which can come over time and with a lot of help from the medical professionals, the CTOs are worthwhile and should be used,” says Herrick.

Ever since former premier Ralph Klein used slash-and-burn tactics on the provincial budget in the mid-’90s, there has been a lack of psychiatric hospital beds throughout Alberta. In fact, a leaked Alberta Health report showed that in 2005 the province had 0.45 psychiatric beds per 1,000 people — well below the national average of 1.9 beds per 1,000. In July 2008, the province shelved plans for a 60-bed psychiatric unit in south Calgary’s unfinished hospital, attributing the decision to rising construction costs.

For this CTO program, a provincial committee spent more than two years studying and developing the changes to the act and consulted with the Ontario government, which implemented a similar program a decade ago. Despite this, a government spokesperson says they don’t know how much it will cost taxpayers and it is too early to determine how many people will benefit.

“We might have just said, “Yes, we’re going to do this,’” says Howard May, a spokesperson for Alberta Health and Wellness. “You would have to sit down and estimate how many people you think are going to get involved before you could come up with a representative budget figure.”

Benjamin Maze, Calgary Mental Health Association’s advocacy co-ordinator for Calgary, says the number of living spaces is “grossly inadequate” in Calgary; his organization often has to wait up to six months for a bed. With few support systems in place, Maze says the number of CTOs could be limited because physicians “can’t put anything on a community treatment order that is not available.” This, in turn, will cause uncertainty among doctors as to how and when CTOs should be issued.

For example, a doctor may think it’s best for a patient to be enrolled in a hospital’s day program. But if no space were available, would a CTO force the hospital to make space? Or would the patient go on a waiting list?

“That’s what people are waiting to find out when these (CTOs) start being written because nobody really knows that yet,” says Maze. “It would be nice if this would force the hand of the government to provide the services that are clearly being defined by doctors that are needed for individuals.”

Tom Shand, executive director of the CMHA and chair of the umbrella group Alberta Alliance of Mental Illness and Mental Health, is more optimistic than some of his colleagues and is confident the plan is “structurally good.” Shand, who sat in on the government’s CTO implementation committee, says it will help many people get treatment, while keeping scarce psychiatric beds open.

“(Hospitalization) prevents somebody else from getting access to those beds… but more importantly they can have a better ongoing quality of life with the proper supports in the community,” says Shand, adding it costs about $1,000 a day for hospital treatment.

This year will be a trial period, providing the government with a clear idea if and how the changes need to be tweaked, says Dr. Michael Trew, the province’s senior medical director of addiction and mental health.

“Whatever we do, we need to keep watching and asking the people involved whether this works for them,” says Trew, who anticipates about 50 people will be issued CTOs this year. “It’s all in the details. Did we get the details quite right? I’m not sure. If we didn’t get it quite right we need to modify it.”