Therapists at Hamilton mental health clinic describe exodus of staff, tears at office, 'oppressive' meetings

This is Part 2 of an in-depth look at changes to a leading child and youth mental health clinic in Hamilton, and the impact they've had on families and mental health practitioners. Read Part 1 here.

When registered psychotherapist Louise Oke shared an article on her Facebook page about toxic workplaces, she figured others who were also struggling on the job might relate.

Oke, who spent 20 years at Child and Adolescent Services — a city-run mental health clinic, didn't mention her workplace or make any comments with the August 2019 post. A few colleagues "liked" it.

A month later, one of her supervisors called her out of a meeting, telling her she had to meet with management and the union in 10 minutes.

"She was just super serious and wouldn't say anything else," said Oke.  

Oke said she was then grilled over why she would post something like that about the City of Hamilton and was told to take the post down. 

A week later, she said, she was told management had placed a "letter" on her personnel file stating expectations for her going forward, such as not posting anything related to work on social media, staying positive in meetings and "never say too much, never say too little." 

That meeting was one of many actions Oke described as "oppressive" after a change in clinic management in 2018. She said staff came to feel as though advocating for themselves would get them branded as "troublemakers" and it impacted her mental health.

"They were acting like it was [a disciplinary letter] and they scared the shit out of me." 

After that, Oke took a two-month sick leave. "I needed some time away to get my head together and figure out how I'm going to survive this."  

She returned for several months, but left her job completely the next year after what she describes as "a steady, systematic devaluing of me and my work" — foregoing the full pension she would get if she stayed five more years. 

She was one of at least 11 therapists to leave the Hamilton Public Health-run clinic over three years after the change in management, according to nine former clinic staffers who spoke with CBC Hamilton as part of its months-long investigation into the clinic. The vast majority left voluntarily, while at least one was laid off.

Previously, it had been a sought-after job where people stayed for years, said Oke. Many of those who left said they had planned to work there until retirement before the change in the work environment. 

CBC Hamilton does not, however, know how many people left in the preceding years.

Many health-care workers across Canada have described feeling stressed in their workplaces, and it was exacerbated by the pandemic. 

The employees at the Hamilton clinic point to specific changes that began well before the emergence of COVID-19 that had an impact on their well-being and the care they were able to give. 

They said the fallout shows how the leadership of a leading mental health facility affected the mental health of its own employees, many of whom are still struggling. 

Many of them said they are speaking out to highlight the importance of mental health for the practitioners who provide that care and to see the City of Hamilton show accountability — or, at least, acknowledge what happened.

'Not on the same team'

"We call ourselves the Exiles on Main Street," said Oke, a reference to the clinic's downtown Hamilton location, the exodus of staff in recent years and the 1972 Rolling Stones album Exile on Main St.

The former clinic staffers said the therapist complement around 2018 was about 14, and many of them had decades of experience and special expertise. 

Many of the 11 who left did not have other jobs lined up. Of those who spoke with CBC, almost all said they left "because of the work environment" and several said they felt "forced out" by how they were treated at work. Several described the clinic as a "toxic" workplace where employees who voiced concerns were "targeted" or punished, staff were increasingly taking leaves to deal with the stress, and the departures of longtime colleagues weren't addressed by management.

"They started just treating us as though we were not trustworthy, not on the same team and not having the best interests of clients at heart," said Oke, describing management prohibiting therapists from consulting each other on cases, or being derisive of therapists who couldn't solve a client's issues after a few sessions. 

Some therapists described policies and procedures that would change so frequently in that period that they would have trouble keeping up on their paperwork, and then be reprimanded for falling behind by management.

They started just treating us as though we were not trustworthy, not on the same team and not having the best interests of clients at heart.- Louise Oke, registered psychotherapist

"It went from mutual respect and shared expertise" to a top-down management style that felt "oppressive … about leave time, staying late and like all these little nitpicky rules," said Oke. She said leadership stopped consulting the clinic's committees, made up of subject-matter experts, before making changes to service delivery. 

Several of the clinic's former therapists cried when speaking to CBC while they described meetings with management in which they said they were made to feel as though they were performing poorly at their jobs or were seen as problematic colleagues. All who spoke with CBC said they either cried at work or had seen colleagues crying. Many said both were regular occurrences.

CBC Hamilton sent a detailed list of the former's staffers' allegations to clinic manager Lynn Foye and City of Hamilton media relations. We requested interviews with Foye and public health, but they were declined.

Antonella Giancarlo, senior communications officer in the city manager's office, responded by email saying the clinic underwent a review in 2018 "aimed at improving service delivery and changing the in-clinic approach" to align with provincial guidance.

She declined to comment on personnel issues, "due to legal and ethical obligations, and also due to the sensitive nature of the work of those employees," but said the city "has robust policies and procedures in place to investigate and address issues in the workplace."

Several of the workers described their union as often supporting management's actions or failing to speak up on their behalf.

The union representing city employees, CUPE 5167, did not respond to several requests from CBC Hamilton for comment. 

Letter with allegations sent to public health, ex-mayor 

Joanne Robinson, who holds a master's degree in social work and worked at the clinic for 10 years, was laid off in 2021. She said it was because she refused to go from part time to full time, even though, she added, it was clinic management who had reduced her hours to part time previously. 

After her layoff, she wrote a detailed exit letter describing problems with the workplace culture and sent it to numerous city officials, including then Mayor Fred Eisenberger, Ward 1 Coun. Maureen Wilson, Medical Officer of Health Dr. Elizabeth Richardson, director of human resources Lora Fontana and former city manager Janette Smith. CBC obtained a copy of the letter, dated Nov. 5, 2021.

In it, Robinson calls the workplace "the most toxic I have experienced in my 38 years in the workforce." 

She listed workplace issues she said were allowed to "flourish" since 2018, including: 

• A lack of management transparency, leading to low levels of trust. 
• A culture that isolates employees from the support of colleagues. 
• Employees who are unhappy, disengaged and demoralized. 
• Employees who are fearful about expressing their concerns and feelings.
• Inadequate resources to meet the demands and volume of the work.
• Chronic stress and burnout.  

"How is it that management, especially within the field of mental health, seems to have no awareness that failing to support staff mental health makes it extraordinarily difficult for staff to support the mental health of their clients?" Robinson wrote. 

Robinson noted internal surveys conducted before her departure found 90 per cent of staff were looking for other employment and "many indicated that their mental health had deteriorated quite significantly as a result of the workplace culture."

The letter references exit letters sent by other former staffers to human resources, clinic management and the city's director of healthy families, Jennifer Vickers-Manzin, whose division of Public Health oversees the clinic.

Eisenberger responded the same day, saying he was "confident [the] comments will be reviewed by all and appropriate action taken. I look forward to that."

The city's director of employee health and labour relations, Matthew Sutcliffe, responded later that month in an email seen by CBC Hamilton, saying he didn't have proof to back up Robinson's allegations, but would review employee survey data to determine next steps.

"While I appreciate your belief that the culture is toxic, we don't have the information to support that allegation," he wrote in an email dated Nov. 30, 2021. "We will be working with some survey materials generated independently by CUPE in combination with the city's Our People Survey results. These two sources of anonymous information should assist in determining next steps, and certainly provide any insight into potential areas of concern in C&AS."

Sutcliffe also noted it is against the law to punish employees who bring concerns forward in good faith.

Strategies to 'get us to keep our heads down'

In interviews with CBC, many former staffers described a tense online meeting at the start of the COVID-19 pandemic during which they were informed they would no longer be seeing their regular clients, focusing instead on patients in urgent crisis. It was a proposal that would have effectively cut clients off from their trusted, longtime therapists. 

Oke said several staffers spoke up against the proposal during the meeting and it was rolled back before being enacted. 

But those who had spoken up were later called into meetings where they were criticized for their behaviour, Oke said.

"They just power-tripped on us," she recalled, saying she was not formally disciplined, but felt the meetings were meant "to get us to shut up: 'If you speak up and disagree with us and make us look bad, you will be in trouble.'

"They were using all these strategies to get us to keep our heads down."

Oke, Robinson and others who spoke with CBC Hamilton said the massive turnover of staff at the clinic, resulting in the loss of decades of specialized experience, means it will never go back to what it was. 

They said they'd like to see the city held accountable for what happened and for the public to know how the city treats its staff.

"I went from being a valued, trusted employee to being made to feel like my work was of no value and that I was a negative, problematic employee that they would be better off without," said Oke.  

"They barely acknowledged any of us leaving, starting with me. Sometimes staff didn't even know who still worked there.... If that's not toxic, I'm not sure what is."