Report released on Janeway Psychiatry Unit

Steve
Steve Bartlett
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A report released Friday on the Janeway Psychiatry Unit (J4D) makes a dozen-and-a-half recommendations to improve mental health services for youth.

The document is the result of an investigation by the Child and Youth Advocate's office.

John Rorke, acting child and youth advocate, declined interview requests. In a release, he said he hoped the work clarifies problems and leads "to improved services and resources to assist those charged with the responsibility of caring for the most vulnerable group of persons in our society."

A report released Friday on the Janeway Psychiatry Unit (J4D) makes a dozen-and-a-half recommendations to improve mental health services for youth.

The document is the result of an investigation by the Child and Youth Advocate's office.

John Rorke, acting child and youth advocate, declined interview requests. In a release, he said he hoped the work clarifies problems and leads "to improved services and resources to assist those charged with the responsibility of caring for the most vulnerable group of persons in our society."

The advocate's office launched an investigation in December 2008, after the unit was temporarily closed because enough nurses couldn't be secured to operate it.

The shutdown saw two teens sent to the Waterford Hospital, an adult facility.

The Royal Newfoundland Constabulary escorted them and handcuffs were used as restraints.

The advocate's probe looked into psychiatric services and programs provided in 2008.

It revealed, according to the report, "a unit in crisis and in need of intervention. "

The advocate said several concerns led to the closure of J4D.

Among them were problems with inconsistency, communication, team cohesiveness and low morale, as well as human resource challenges.

The resulting recommendations include revising policies so they are relevant to the unit's patients and ensuring consistency in the implementation of policies and procedures.

The suggestions also address the communications, morale and human resource issues.

The report says all staff need the education to ensure people have the latest evidence, information and treatment techniques.

A key finding, according to the advocate, was there is no requirement to hire trained psychiatric nurses.

Throughout the investigation, the document states, it has been clear that significant changes are required to move J4D forward.

"The unit needs to be more patient-centred, flexible and adaptable. A mindset shift needs to occur."

According to Eastern Health, a shift is taking place.

The health authority responded Friday afternoon.

"We welcome the report of the advocate," Louise Jones, senior vice-president and chief nursing officer, told reporters.

She said the document is complimentary to its external review of J4D issues. That analysis was prompted by challenges the unit faced in fall 2008 and was completed last year.

"Since receiving the report of our own operational review we have been working very hard to implement the recommendations that it contained," Jones said.

"In fact, you will note throughout the report of the advocate, that the advocate references to issues that Eastern Health has already taken action on."

Material handed out to reporters listed the advocate's recommendations and what was already being done in each area.

A review of mental health and addictions policies has been done, and staff are being educated on revised policies.

As well, an occupational therapist has been hired, and youth care workers, an advanced practical nurse and a new psychologist are being recruited.

The number of psychiatrists on the unit has been streamlined from eight to two to ensure treatment consistency, and a steering committee focused on improving staff communication has been struck.

As well, staff sessions have been held to identify the unit's mandate and employees have been offered de-briefing because of what transpired in 2008.

Jones noted a new model of care that clarifies staff responsibilities is being implemented and that training on change management and team effectiveness is being developed.

Kim Baldwin, acting director of mental health and addictions programs, said the atmosphere amongst the people who work on J4D is improving.

"We are hearing, certainly, that there have been significant improvements (in morale) among staff of the unit," she said.

As for the advocate pointing out there is no requirement to hire trained pyschiatric nurses, Jones said they need some clarity.

She explained they have no objection to increased education, but noted that post-basic training for nurses isn't offered in the province.

"Do we need to do more? Do we need to ask the university? Do we need to look at post-basics again? Sure. And that's something we will take under advisement, if that is, in fact, what the child advocate is indicating here."

The Eastern Health officials were also asked to explain how streamlining the number of pyschiatrists works better.

Dr. David Attwood, Eastern Health's clinical chief of psychiatry, explained the measure was taken to ensure treatment consistency as there are differences of opinion amongst pyschiatrists.

"You can just imagine if you had seven different plumbers coming to your house telling you have to fix the pipes. There's always going to be a difference of approach and I think this is a way of bringing some consistency and allowing (us) to focus our resources a little more," he said, noting the other psychiatrists are focused on other needs.

Reporters also asked if a situation like the one that arose in the fall of 2008 could happen again.

Attwood said it's important to remember that was an extraordinary set of circumstances.

He said he didn't think he would ever guarantee a repeat wasn't possible, what they are trying to is reduce the probability.

"To underestimate the severity and magnitude of what our staff are faced with is probably what hasn't come out in this," he said.

"This was an overwhelming experience for everyone involved and what happens to our patients was very difficult and hard for them to manage, but it's also quite traumatizing for staff as well. And that seems to have gotten lost in this process."

sbartlett@thetelegram.com

Organizations: Janeway Psychiatry Unit, Waterford Hospital

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Recent comments

  • Bonnie
    July 02, 2010 - 13:11

    Had to comment on this, because of last comment in article.
    It is difficult on the patient with a mental illness,I know because I live with one,but staff that treat them should not be forgotten.
    The dedicated who give of themselves in order to help patients are mothers,fathers and parents themselves. They put themselves in danger everyday,as patients in a crisis can be unpredictable.They are in crisis,or they wouldn't be in the hospital.
    Let's stop finger pointing and blaming, and strive to remember something. While things need to be changed to protect and help patients,they also have to include all who are involved with them.
    You can't forget that it is not just the patients going through the crisis,everyone and anyone involved is affected as well.
    Great Kudos from me for anyone that dedicates themselves to helping with mental illnesses,and a big thank you as well.

  • curious
    July 02, 2010 - 13:09

    this is interesting.... it is now 2010 and although I don't know what it was like in 2008 for people in this situation, I do know what it was like in 2009 and 2010, to date. I don't see anything positive about the way the youth mental health issues are treated here! As a parent of a child who has been in the care of the Janeway for mental health issues, I have been shocked by the way, my child and us as parents have been handled. our story is long and scary. If you can imagine, you are sitting in emerg at the Janeway after your child has just tried to take his/her own life (not for the 1st time), you are waiting and waiting after 2 residents and 1 on duty Dr. asks you and your child the same questions over and over, then leave you in a room to return and tell you, they have to wait for a pyschiatrist to come in.... when you do get to see the psychiatrist to your surprise they just want to send you home to deal with it? It may be a common situation for them, but its a nightmare while going through it. We just about begged for our child to be admitted and were so shocked to hear that there may be no room for them, and that it may not be a good idea to have someone who doesn't have severe problems yet to stay on a ward with patients that are much worse and could pass some of their bad behaviours/habits on to your child and they could leave the ward worse off! Ok, so maybe others see this as normal, I don't! Well, then you wait your way through the system to get referred to some professional to help your child ... months later you get a call, weeks or months later you get to see someone on an outpatient basis, so that's great your child (and family) have lived in a hellish fear during these months, not knowing what to do what might happen next. When you finally get your child in to see someone that they are willing to talk to, and things start to look a little better as this person is making a difference, you see light at the end of the tunnel the child you knew is starting to surface again.... then you receive a call saying your child's appt is cancelled and you will get a call to re-schedule, 2 weeks - no call, so you call again to find out that this Dr. is away for a while , when will he/she return? we have no idea , oh, so what does your child do now? you could see another Dr.? Problem is it took months to get your child to trust the first Dr. and convince them to get help and continue (because once they are 16, it is their choice to go, no one can force them). So, no one knows where this Dr. went, when he/she will be back or IF they'll be back... no one can give you a solution--- back to square one again. So I ask, how can Eastern Health let this happen? There must be something they can do. In teens with these problems, my experience has taught me that consistency in treatment is key, but that is now out of your control... what do you tell your child? If something happens, who is responsible? If I had not followed up, they'd never had contacted me, my child lost due to the lack of mental health care for youth in this province.... So, whatever improvements they have made or plan to make, I don't see it, my child doesn't see it for sure! This situation is not acceptable, Eastern Health needs to get to the grass roots of the issue, the staff at the Janeway in the psychiatry dept are trying their best in most cases, but they need adminstration's support. I guess no one at the top has gone through this hell, otherwise, they'd not be able to sit back while our youth just slip through cracks meanwhile, their health deteriorating unecessarily... the thing is if it is not an outward visible disease and its not something a lot of us talk about everyting looks fine to the outside world; but if something soon doesn't change, something tragic will happen, and then its a public relations nightmare then they fire a few people, cover up and move on while children and families still suffer. Someone needs to listen, someone needs to fix this system, listen to the children, their families etc. listen to the Dr's and mental health professionals dealing with this all the time - they have the answers.
    I lie awake worried every night and pray that something will change for real so my child and all the other children living in their own hell of mental illness, can get some help... put politics and egos aside for the sake of our youth, they are crying out for help. This is simply my opinion on the situation, based on experience - I thank everyone that is trying to help!

  • Bonnie
    July 01, 2010 - 19:47

    Had to comment on this, because of last comment in article.
    It is difficult on the patient with a mental illness,I know because I live with one,but staff that treat them should not be forgotten.
    The dedicated who give of themselves in order to help patients are mothers,fathers and parents themselves. They put themselves in danger everyday,as patients in a crisis can be unpredictable.They are in crisis,or they wouldn't be in the hospital.
    Let's stop finger pointing and blaming, and strive to remember something. While things need to be changed to protect and help patients,they also have to include all who are involved with them.
    You can't forget that it is not just the patients going through the crisis,everyone and anyone involved is affected as well.
    Great Kudos from me for anyone that dedicates themselves to helping with mental illnesses,and a big thank you as well.

  • curious
    July 01, 2010 - 19:44

    this is interesting.... it is now 2010 and although I don't know what it was like in 2008 for people in this situation, I do know what it was like in 2009 and 2010, to date. I don't see anything positive about the way the youth mental health issues are treated here! As a parent of a child who has been in the care of the Janeway for mental health issues, I have been shocked by the way, my child and us as parents have been handled. our story is long and scary. If you can imagine, you are sitting in emerg at the Janeway after your child has just tried to take his/her own life (not for the 1st time), you are waiting and waiting after 2 residents and 1 on duty Dr. asks you and your child the same questions over and over, then leave you in a room to return and tell you, they have to wait for a pyschiatrist to come in.... when you do get to see the psychiatrist to your surprise they just want to send you home to deal with it? It may be a common situation for them, but its a nightmare while going through it. We just about begged for our child to be admitted and were so shocked to hear that there may be no room for them, and that it may not be a good idea to have someone who doesn't have severe problems yet to stay on a ward with patients that are much worse and could pass some of their bad behaviours/habits on to your child and they could leave the ward worse off! Ok, so maybe others see this as normal, I don't! Well, then you wait your way through the system to get referred to some professional to help your child ... months later you get a call, weeks or months later you get to see someone on an outpatient basis, so that's great your child (and family) have lived in a hellish fear during these months, not knowing what to do what might happen next. When you finally get your child in to see someone that they are willing to talk to, and things start to look a little better as this person is making a difference, you see light at the end of the tunnel the child you knew is starting to surface again.... then you receive a call saying your child's appt is cancelled and you will get a call to re-schedule, 2 weeks - no call, so you call again to find out that this Dr. is away for a while , when will he/she return? we have no idea , oh, so what does your child do now? you could see another Dr.? Problem is it took months to get your child to trust the first Dr. and convince them to get help and continue (because once they are 16, it is their choice to go, no one can force them). So, no one knows where this Dr. went, when he/she will be back or IF they'll be back... no one can give you a solution--- back to square one again. So I ask, how can Eastern Health let this happen? There must be something they can do. In teens with these problems, my experience has taught me that consistency in treatment is key, but that is now out of your control... what do you tell your child? If something happens, who is responsible? If I had not followed up, they'd never had contacted me, my child lost due to the lack of mental health care for youth in this province.... So, whatever improvements they have made or plan to make, I don't see it, my child doesn't see it for sure! This situation is not acceptable, Eastern Health needs to get to the grass roots of the issue, the staff at the Janeway in the psychiatry dept are trying their best in most cases, but they need adminstration's support. I guess no one at the top has gone through this hell, otherwise, they'd not be able to sit back while our youth just slip through cracks meanwhile, their health deteriorating unecessarily... the thing is if it is not an outward visible disease and its not something a lot of us talk about everyting looks fine to the outside world; but if something soon doesn't change, something tragic will happen, and then its a public relations nightmare then they fire a few people, cover up and move on while children and families still suffer. Someone needs to listen, someone needs to fix this system, listen to the children, their families etc. listen to the Dr's and mental health professionals dealing with this all the time - they have the answers.
    I lie awake worried every night and pray that something will change for real so my child and all the other children living in their own hell of mental illness, can get some help... put politics and egos aside for the sake of our youth, they are crying out for help. This is simply my opinion on the situation, based on experience - I thank everyone that is trying to help!