By Published On: April 7th, 20087 Comments

and the Laurel House saga continues…

Laurel House is safe. It seems. For now.

Six months of closed-door negotiations between the Capital Mental Health Association, Vancouver Island Health Authority, and Laurel House users who staged a sit-in last September ended with a verbal commitment from VIHA that, “Laurel house will not be closed in the foreseeable future,” says Laurel House user-negotiator Kathleen Sumilas.

“It’s absolutely awesome,” she adds, noting that the sudden last minute agreement after six weeks of utter silence from VIHA “was quite unexpected.”

However, as of Focus’ press time, VIHA had provided no details in writing, and had pledged only that the users would be “consulted” about what Laurel House programming would look like. In light of VIHA and CMHA’s past poor record of conducting and respecting consultations, does it cause her concern? Worry? “Yes…” Sumilas responds slowly. “Yes, it does…”

Regardless of the outcome, however, one astonishing fact emerged during the process, with repercussions far beyond this individual issue.

From the beginning, the closure of Laurel House, a comfortable home used by people diagnosed with mental illnesses for socializing, meal sharing and learning crafts and skills, was immensely controversial. This was because no users of mental health services were ever consulted. However, it has now emerged that VIHA decision-makers didn’t even consult their own psychiatrists or case managers, either. And VIHA psychiatrists have been irate.

This became clear in February when Dr. Andre Masters raised Laurel House at the monthly meeting of VIHA’s South Island psychiatrists. Masters is a Victoria Mental Health Centre psychiatrist who treats some Laurel House members, publicly supports Laurel House, and has participated in the negotiations.

With negotiations stalling, Masters proposed advising VIHA management to extend the negotiating period three months.

VIHA’s psychiatrists passed the motion unanimously.

Then, Masters was surprised by what else got said at the meeting, and afterwards.

Some psychiatrists said they felt VIHA had mishandled the Laurel House situation, says Masters, while others expressed how upset they were with VIHA management generally.

“It opened the can of worms,” says Masters. “I was surprised how much they were festering with their anger.”

The issue, according to Masters, is that VIHA management has been frequently bypassing its psychiatrists during mental health programming decisions.

“There’s supposed to be an administrative manager-psychiatrist team in every area,” says Masters. “Well, too many decisions are being made by the administrative managers without proper consultation with the psychiatrists.”

And that’s not just budget discussions; the psychiatrists are often ignored “on clinical issues” that directly affect patients’ wellbeing, too, says Masters.

He doesn’t want to speak for specific individuals, but Masters’ assessment of the collective message is clear: “Many psychiatrists are just fed up with the whole thing.”

Masters claims this same frustration is widespread amongst nurses and case managers, too. The public is in the dark, however, due to employee fears for jobs and VIHA contracts restricting rights to speak publicly.

As a VIHA contractor, Masters doesn’t have the same restrictions. Also, at 71 and semi-retired, he says he’s more drawn to defending his clients needs than tolerating this objectionable situation.

“They’re gagged,” says Masters. “I’m not.”

VIHA suffers from an ever-expanding, top-down “pathological bureaucracy”, he argues, which is increasingly out of touch with front line realities.

“I worked in Regina for 27 years,” says Masters, a former health district head of psychiatry. “There was nothing like this. People tended to work together. Here, no, it doesn’t happen. Not as much as it should.”

Indeed, as the deadline approached for saving Laurel House with nothing but silence emerging from VIHA, Masters suggested the negotiations were likely just a “smokescreen” to quiet the public outrage, and that this lack of proper consultations was “symptomatic of a malaise that occurs throughout VIHA.”

Though Laurel House apparently dodged that bullet, all of this raises serious questions about other community-based mental health programming changes; the most significant recent one being VIHA’s decision to attack homelessness with costly psychiatric Assertive Community Treatment programs.

While the successes of ACT in Ontario are frequently touted, it’s rarely mentioned that there, ACT works with people who have homes, and then functions entirely through the use of court orders, lifestyle constraints and forced treatment, effectively becoming a system of mobile padded handcuffs. Can that truly help Victoria’s homeless?

In Masters’ opinion, we’ve grossly overestimated the percentage of mentally ill homeless, anyway. Through his work and personal time spent downtown, Masters says he knows the street people who are actually seriously mentally ill.

“They’re a fraction of the problem,” he asserts. “A small fraction.” Instead, Masters accuses governments of opportunistically “blaming” the mentally ill, to excuse their own poor policies with regard to housing, unemployment, welfare, crime and addiction.

Which raises the question: Were the psychiatrists, nurses and case managers who actually work with street people and the mentally ill in Victoria ever consulted about ACT? The VIHA representatives involved in the city-organized homelessness initiative were managers.

In any case, what VIHA’s psychiatrists have definitely shown support for isn’t ACT. At their mid-March meeting, they unanimously advised VIHA management to commit to continuing voluntary, community-based mental health social programs before the Laurel House negotiations ended.

Was this a turning point? And could VIHA’s turnaround mean management is starting to truly listen to both its psychiatrists and program clients?

“Time will tell,” answers Sumilas, before returning to basking in the glory of at least this one battle won. “I’m feeling wonderful. But it all feels very surreal as well.”

7 Comments

  1. bev honold April 8, 2008 at 12:39 am

    Hi Rob,
    I am burning the midnight oil on these very questions.It seems that psychiatry and the law will be as always allies in this societies attempt to limit diversity ,calling this a public health crisis.Mental illness is- I agree with Dr Masters who is very astute in his efforts -very seriously been over-estimated in the thinking about homelessness This trend in our social policy thinking, as reflected in VIHA,s over-confidence in non-expert managers,ignoring their own people nurses and psychiatrists has been a frightening development to me! On behalf of person’s with these diagnosis’ as it appears to be a witch-hunt similiar to the hunting od communists during the 50s in the US.
    thanks,a timely and trenchant commentary…………….

    Bev

  2. rob April 10, 2008 at 4:17 am

    Yes, Bev, I’ve been thinking more and more myself lately about the need to separate “the law and corrections system” from “mental health care”…

  3. bev honold April 20, 2008 at 12:19 pm

    Hi Rob,
    The emphasis would be on Care not Intimidation and certainly not Erasure.As this could be our last chapter as a society,would be good if we took care of each other “weller”.

    Bev

  4. scs October 1, 2008 at 10:28 pm

    [**NOTE FROM ROB WIPOND: THIS COMMENT HAS BEEN EDITED BY ME WITH “***” TO REMOVE IDENTIFYING NAMES AND PLACES.]

    A mental Health Consumer Provider’s experience working on two Programs of Assertive Community Treatment

    After an accident I was disabled for five years. During this time I received Social Security Disability Income and counseling. I joined a club house in Newton Massachusetts for vocational counseling. After volunteering there I got a temporary employment placement. I did janitorial work on two days each week for two hour shifts at some group homes. On one night each week I attended a vocational support group to discuss issues related to the job. After this I found a part time telemarketing job. This independent employment was a step in the right direction. I had an excellent college education and had difficulty getting hired. I thought this could be related to having been disabled. Employers are careful in hireling people and this can exclude people who can do the job but have been unemployed. I was grateful that a program was available in my community to help disabled people get jobs. Being excluded from the work force creates a unique poverty of the soul. I vowed that someday I would help disabled people with finding jobs.

    A year and six months into my recovery I got a residential counselor job working with individuals called mentally retarded. I slept overnight three nights. This was an excellent situation for someone with depression. I got off public assistance and was self supporting, productive and responsible member of society. After you worked for a year at the agency you were eligible for tuition reimbursement. I took advantage of this and enrolled in the U Mass Boston’s Rehabilitation Counseling program.

    After taking one course a semester for a few years I moved into a therapeutic community where I worked as a counselor with mental health clients. Working in a supportive environment as a counselor and learning about mental health counseling helped me grow as a person and nurture the growth of people I worked with. I worked in this position and studied rehabilitation counseling for five years. After I earned a Masters in Counseling I got certified as a rehabilitation counselor.

    Then I took a job with a Program of Assertive Community Treatment (PACT) in central Massachusetts. I was able to advocate for clients and help them with a lot of problems. I liked the fact that we did outreach and helped clients where ever they were. This type of work brought me to homeless shelters, schools, work places, hospitals, jails and client’s homes. The psychiatrist and staff were supportive. Because the program was associated with a University teaching and learning were emphasized. I received good performance reviews over my four years of employment. I handled numerous crisis situations effectively. I helped clients to find jobs.

    After four years I was offered a better paying position at another PACT. I had twelve years experience and not one complaint on my record. I moved near to *** to take a position as a Vocational Counselor with a PACT in *** at **** . The company was merging with ****. This was because *the company* had committed fraud in billing Medicaid and the director of rehabilitation stole from clients. I understood that the company was in transition. I was confident in my ability to help clients and I knew I had a good work ethic and thought that would be enough to succeed. No one new I had a disability when I took the job. I had the experience of being on an effectively operated PACT. This experience was needed because the program had problems.

    After taking the job I saw that clients were not getting services they needed with housing and employment. Clients needed help. Staff would say that clients were to “symptomatic” to benefit from help with these important issues. Staff treated clients in a condescending manner. I raised my concerns about client treatment with A*** the new program director. A*** did not have the required credentials or experience to manage the program. This program was designed to serve the most disabled and vulnerable mental health consumers in the area. The response I got was “mind your own place and business”. I could see his approach to management was to bully subordinates, use intimidation and push people around. For example he and another manager would co supervise a counselor while A*** sat at a computer taking notes like it was a disposition. You never knew what was being written. I asked if I could take notes during a meeting but was told this was not allowed. I do not respond well to this approach by a manager.

    In my first month of employment I was asked to take a client to get a toxicology screen. The test results could get the client in legal trouble. I thought that this task was a bad idea for our first meeting. I found out latter this client had been charged with attempted murder. I was not told about his background but just to take him to get tested. I refused to do this. This is just one example of a number of problems where clients and staff were put at odds because of poor management. (Reports to DMH never told what was going on.) In a PACT program clients are often under court order to get treatment and have the program manage their money. The only way to be sure clients are not coerced and staff is acting ethically is for there to be effective communication between all staff and management. However this was not possible at the *** PACT all communication was one way. A*** gave orders and expected staff to obey his orders without question. It was as if the clients weren’t people but animals to be feed anti-psychotic medications. A*** the program director would say “I have to micromanage everything”. If a team meeting was going on counselors were expected to raise there hand and ask permission to go to the bathroom. We were in team meetings ten hours a week.

    The work place became hostile. I think it was because other staff saw that I advocated for clients in meetings and management felt threatened. I got the “you aren’t fitting in talk” from the manager. Then I got a written warning that threatened termination. This was for late paper work. Some of the paper work was the program directors **** responsibility. I explained that I had dyslexia and I asked for some extra time to complete the paper works. I advocated for my self and asked for the accommodations that I am entitled to under the American’s with Disabilities Act. Other than this minor issue I had demonstrated leadership in important matters. I helped client’s find jobs and housing. I managed crisis situations. My request for more time to do paper work was denied by A***.

    Then after a client in crisis did not get help from management in a timely manner a blame game started. I had brought the client in crisis to meet the manager. I got blamed because this client who needed to be hospitalized ended up driving in ***. This happened after I warned the manager that he needed help. A staff person from the day program was in his car. He could have crashed his car into someone. But I was blamed for this management neglect. I filed two grievances with the SEUI union. Management ignored them. I developed health problems as a result of the stress I was under. The management created a hostile work place. I even got treatment for job related stress. I let A*** and M*** a senior manager know I was being treated for job related stress. The work place got more hostile. I requested time off but this was denied. Even though I had a doctors note as evidence that I had job related stress and both vacation and personal time.

    Basically I was thrown out like the trash. The reason was because I advocated for clients, workers rights and would not accept unethical behavior by management. *** management contested my unemployment claim. At hearings M*** and A**** committed perjury. After four hearings the Massachusetts Department of Employment and Training found I had an urgent and compelling reason for ending the job. I was paid unemployment compensation. *** management also refused to pay me for my last two weeks work. I went to small claims court and named *** the Human Resources Director in my complaint. I had an excellent case but the hearing officer was a **** court clerk named ***. Without considering the facts I lost my case.

    Because of all this I lost my health insurance and couldn’t continue treatment. Now, I can not get a good job because I do not have a reference from my last employer. My health problems have not been treated. I am applying for Social Security Disability. I found management’s main interest was in misleading the Massachusetts Department of Mental Health about how the PACT was operated. Ethical issues were not to be discussed. Dishonesty and hostility were the foundations of management’s practice. They treat counselors like dogs and laugh at the SEUI union.

    Signed,
    Dog Meat

  5. Rob Wipond October 2, 2008 at 11:08 pm

    Thanks for your comments. I’m sorry to hear your story. I had to edit it a little just for potential libel considerations; laws aren’t as liberal in Canada as those in the United States. If you prefer that I delete your comment entirely rather than leave it edited in this way, just let me know. But your story provides a very powerful example of how assertive community treatment can be either extremely helpful or extremely harmful, depending on who’s managing the program and with what intent. The clients’ health and safety are at the whim of those managers.

  6. bev honold October 28, 2008 at 7:31 pm

    ACT programmes still seem poor substitutes for adequate services.?How many teams does Victoria need-2more teams ready in March seems like over-kill,given there aren’t that many persons on extended leave in the community?
    On a positive note Laurel House works at about a hundred visits per week.Agreat place to drop-in and we sure enjoy that wonderful yard and house….

  7. C October 28, 2015 at 4:29 pm

    Dr. Andre Masters was a psychiatrist who worked for the SAHO insurance company in Regina, SK. He was not an advocate for the mentally ill at all he was a hired gun for the insurance company. I believe that says enough about him.

Leave A Comment