London psychiatrists sound alarm over deteriorating mental health system

Psychiatrists at the London Health Sciences Centre are going straight to the top, reaching out to the hospital's CEO and its board of directors, sounding the alarm about deteriorating mental health care in the city. 

"The purpose of this letter is to express our deep concern with the state of mental health services at LHSC and its continued deterioration," the letter, obtained by CBC News, begins.

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"It is no secret that it has been a challenge for the hospital to manage the volume of patients seeking mental health care — and that the challenge is only becoming more intense." 

The letter, written by "the vast majority of LHSC psychiatrists," was delivered to top hospital officials on Monday. 

But it's unclear what action, if any, will be taken as a result.

The letter decries the lack of transparency from hospital administrators who take a "top down" approach to leadership, ignore doctors' and nurses' suggestions and pressure young psychiatrists to discharge patients. 

"There has not been a time in recent history when the physician body has felt so disconnected from hospital leadership," the doctors write. "It has become an extremely dysfunctional system and patient care, including access and flow, is suffering." 

The hospital refused to comment to CBC News about the letter, saying it will not respond in the media. 

CBC News has also made repeated requests to speak with LHSC's new CEO Paul Woods, but those have all been declined. 

Systemic issues plague hospital: docs

Problems with access to Parkwood Institute Mental Health Care, lack of outpatient resources at LHSC and a lack of resources in the community are contributing to the problem within the psychiatric system, the doctors warn. 

"The increasing rates of substance abuse, including crystal methamphetamine, have contributed to increasing demands on our already stretched system," they write. 

The doctors say LHSC's focus on emergency care and inpatient services is "expensive and inefficient" and that they've increased their presence in the ER by 50 per cent. 

They also suggest: 

• The hospital should focus on a short-stay unit, a day hospital and outpatient services which would reduce the number of patients that have to be admitted for longer stays. 
• The hospital implement suggestions recommended by a consultant who said programs and discharge planning should be redesigned for longer-stay patients, among other things. "Much of what (the consultant) recommended has not been implemented," the psychiatrists say. 
• Hire more nurses, social workers and occupational therapists.
• Revisit suggestions made by doctors at a hospital-mandated brainstorming retreat that happened in November 2017. "Since that meeting, we have not heard of any of the solutions that we proposed being implemented." 

The letter also expresses concern over the 24 mental health beds recently funded by the province and set to open this month saying it is "the wrong way to spend mental health dollars" because it commits the LHSC to manage more inpatients while stretching "already inadequate" outpatient services. "In other words,' the psychiatrists write," the front door is open wider while the back door remains closed." 

The hospital has blamed psychiatrists for "the lack of progress on improving the delivery of mental health care at LHSC," the doctors write. 

On top of additional hiring, the hospital should bolster outpatient services so people don't have to be admitted from the ER, and to have a place to which patients can be discharged. 

"Given the increase in patient volumes, and the increased workload, LHSC psychiatrists are stretched very thin and we are beyond capacity to add to our clinical responsibilities," the doctors write.