[ Page 6395 ]

CONTENTS

Routine Proceedings

Committee of Supply: Ministry of Health (Hon. Mr. Dueck)

On vote 35: minister's office –– 6395

Mr. Clark

Mr. Perry

Mrs. Boone

Mr. Cashore

Mr. Loenen

The House met at 10:06 a.m.

Prayers.

Orders of the Day

HON. MR. RICHMOND: Committee of Supply, Mr. Speaker.

The House in Committee of Supply; Mr. Pelton in the chair.

ESTIMATES: MINISTRY OF HEALTH

On vote 35: minister's office, $333,960 (continued).

MR. CLARK: I will have many things to say, but I want to give the minister notice that I'll be saying them after question period. I want to canvass with the minister issues arising out of the court case with respect to the Children's Hospital pathology lab. There were, as you know, many allegations in the trial, and there were also public policy decisions arising out of that trial. I will be canvassing — at some length, I think — a range of detailed questions about actions the ministry may have taken or should have taken, in my view, to deal with allegations raised there.

I just want to make sure that your staff is aware that I'll be raising this, because some of the questions regarding specific allegations will be fairly detailed, and I didn't expect you to answer instantly. But because health estimates may well be over by the end of today, obviously your staff won't have the luxury of days of preparation for my remarks. I apologize for not giving you earlier notice, but at least you have a few hours to try and get some staff people in here who might be able to better answer some of the questions.

With that, I'll defer to the second member for Vancouver-Point Grey to continue with estimates.

MR. PERRY: It's nice to be back to the important business of the province again. I'm sure the Minister of Health (Hon. Mr. Dueck) will agree with me on that.

I want to begin a debate in which several members from this side will participate today on one of the most important topics in the health field: mental health. I think there is interesting symbolism here. This debate is taking place with an empty press gallery, relatively empty public galleries and a relatively empty House. The attention of the nation is focused instead on the leaked budget rather than on a matter that's ultimately of far greater importance. I think it's interesting symbolism because we had planned this debate for a different day, and for various reasons — through nobody's fault in particular — it ends up at this time when so few people here seem to be interested. It's symbolic because this is the usual fate of mental health and mental illness, and this has been its fate throughout the history of medicine or of health in a broader sense. This is the chronic problem which patients with mental illnesses and their families face and, to a lesser extent, which health care professionals face in dealing with problems which are devastating to the individuals and the families involved, extremely costly, in many senses devastating to society at large, poorly understood and often conveniently ignored.

I know that the minister shares this concern. We want to focus debate this morning on the issues of mental health, and I hope that this will help the minister in his difficult job of focusing the government's attention on this issue. From what I have read, I think that this Health minister is concerned about this topic, but he faces an almost insurmountable problem in convincing his government colleagues to give it the attention it is due. I hope this debate will help.

Let me begin by reading from a letter I received from Lee Horvat of Vancouver, dated April 5, 1989. This is a form letter, which I assume the minister has received many copies of and I expect I will receive more of, which says in part:

"Dear Dr. Perry:

"After four years of consultation, the mental health plan is expected to come before cabinet now and before the House this session.

"As a member of the Vancouver branch of Friends of Schizophrenics, I strongly advocate that tax dollars go into direct services to the mentally ill, not to an increase in the number of committees and to 'liaison' among professionals. I would like to see family doctors central in the care of mentally ill persons. Public health nurses, I believe, could be involved in outreach, particularly in schools.

"You have seen our homeless mentally ill roaming our streets and sleeping in our parks. They also clog the justice system at the rate of ten to 15 per day. In Vancouver, 259 persons are waiting for subsidized apartments and 150 are waiting for boarding-home 'beds.' We want more than such 'beds' for our relatives and friends who have a devastating, chronic illness. We are asking for 'a room of one's own' for each mentally ill person. Imagine trying to live two or three to a room while suffering from a mental illness."

Let me read briefly from one other personal letter I received from two parents of a schizophrenic in Sidney, B.C. It's dated April 6, 1989.

"Dear Dr. Perry:

"As parents of a son who suffers schizophrenia, we ask your assistance in getting the government of B.C. to move positively to adopt the new Mental Health Act. This document was readied" — I think they're referring to the mental health plan — "in 1987, with input from many, including parents and families through the Friends of Schizophrenics Society. It was" — they underlined "was" — "to be put to cabinet in the spring of 1988, the fall of 1988, the spring of 1989 Delays. Why? Because of the government disrupting, retiring, downsizing and generally gutting the civil service, key personnel were affected. It's time to get on with this crucial bill."

[10:15]

I think those two letters summarize perhaps the feelings of patients and their families with chronic serious mental illnesses. I surmise that they would

[ Page 6396 ]

summarize the feelings of the Minister of Health and some of his frustrations in addressing this problem

I fear, given what we have heard so far about the federal budget — or non-budget or whatever the status of the document is at this time — that because of reductions in transfer payments to British Columbia, we will now find an excuse why the legitimate needs of these patients cannot be met for another few years.

Therefore I want to review very briefly — and I'll attempt to be concise — some of the recent history of the delivery of mental health services in British Columbia and the problems that have been engendered. I will start the story in 1958, when the first large downsizing of Riverview Hospital occurred; one might call it a deportation.

I hadn't been aware of this, but I learned this from a senior official who knows the history of that institution. In 1958, 300 men and 300 women were, in effect, deported from Riverview. All were over the age of 65 and without relatives to support them. The 300 men were sent to Terrace by train and the 300 women were sent to Vernon by train, with very limited support for them in the hospitals where they arrived.

I raise that anecdote because in some ways it is symbolic of the phenomenon we're seeing again in the delivery of mental health services in British Columbia. We have to remember that a major revolution in the treatment of mental illnesses in the 1950s was the discovery of anti-psychotic drugs which made it possible for many patients with chronic mental illnesses to be effectively treated for the first time in world history. Mental hospitals all over the globe lost large numbers of patients who were able to return to society. That began in 1952 with the discovery of chlorpromazine, and it accelerated in 1958 with the discovery of haloperidol. No similar discovery has been made since then. No major advance has occurred in the treatment of mental illness since the introduction of lithium in the 1960s. No major advance is on the horizon in the treatment of mental illness. This major pharmacological revolution which occurred in the 1950s did allow us to downsize our chronic mental institutions for very good reasons. But we now face a continuation of the same trend, without the same change in our ability to cope with the problems of these patients.

From 1974 to 1985, for example, the number of beds at Valleyview, the geriatric component of the provincial mental hospital specifically set up to handle late-onset psychiatric illness above age 65, declined from about 700 to about 400 beds. Many of these people were returned to their communities and looked after in extended-care units, but in some cases the extended-care units were not fully prepared for the difficult problems posed by these patients.

Since 1977, despite the growth of the population in the lower mainland and the continual influx of people, including many with severe mental illnesses who gravitate towards large cities with relatively warm climates, like Vancouver, no additional psychiatric beds have been provided in the city of Vancouver. That's 12 years now. The community care team system has remained unchanged since 1977.

In the ten years from 1977 to 1987, the number of beds for chronic psychiatric patients at Riverview — not the geriatric but the general population — decreased by 600. Yet at the same time, nothing new replaced them in the Vancouver area. In other words, the number of beds has continued to decrease year by year, without the provision of alternative treatment facilities, and there has been no change in the effectiveness of medical treatment which would have allowed us to reduce the supply of treatment beds. Therefore the whole system of care for the mentally ill in B.C. has objectively changed for the worse since 1977, not simply stagnated. This is in sharp contradistinction to the care of patients with all other illnesses.

What has the Ministry of Health done to address this problem? The ministry first acknowledged the problem in 1985; that's four years ago. Long after the problem had become severe it was officially acknowledged, and the need for a plan was acknowledged. The stimulus for this was the fact that Riverview Hospital was be coming outdated and unsafe, and potentially would be condemned. It was recognized that either that hospital had to be brought up to standard or alternative resources had to be provided.

From mid-1985 to the fall of 1987 the consultative process proceeded, a widespread consultative process — referred to, I think, in one of the letters I read from — that led to the "Mental Health Consultation Report" of 1987, subtitled "A Draft Plan to Replace Riverview." In the meantime, since 1985 we have not actually seen any action, whereas the bed count at Riverview has continued to decrease, from 1,300 to 1,400 beds, to 1,000 beds at the present.

One of the other problems we face currently, which has developed contemporaneously with this same trend, is the shrinkage since 1980 of the boarding-home base for chronic psychiatric patients. In the first great real estate boom in Vancouver — of my lifetime, anyway — of 1980 and '81, many boarding homes were lost because of the sharp rise in property values. This was a major loss of boarding-home beds. We now see this being repeated. When I prepared these notes, only 12 days ago, I had written: will this be repeated? When I spoke to the medical officer of health for the city of Vancouver yesterday, the question had evaporated. This is being repeated. Boarding-homes are closing down right now due to the rise in property values in Vancouver and the speculative pressure driving people to sell.

MR. CHAIRMAN: Sorry, hon. member, your time has expired under standing order 45.

MRS. BOONE: My colleague was making such a wonderful speech, I would gladly give up my time to have him speak some more.

MR. PERRY: Let me look at some of the other problems which have developed in the system in the last few years. One is the lack of a coordinated relationship between the hospitals supplying services for acutely ill psychiatric patients.

[ Page 6397 ]

Vancouver is important, not because I represent part of that constituency, but because it is the health capital of the province, and because it's a place where chronically ill patients gravitate. Vancouver has some problems peculiar to it, and as the minister knows, it is not necessarily representative of the rest of the province.

As an example, the Vancouver General Hospital has the only adolescent unit in Vancouver; yet this was closed a couple of summers ago, I guess it was, without any consultation with other hospitals. The hospital took the position that it had run out of money and had no alternative but to close the unit.

What happens when seriously ill teenagers — teenagers with serious mental illnesses and psychiatric problems — suddenly have no hospital where they can find respite? I'll tell you what happens. There is no other place for them to go. Their problems get worse. Their problems are not attended to. They may end up in a general ward in an adult hospital, such as the hospital where I work. They cannot be effectively treated there. They are baby-sat, perhaps, but not adequately looked after. The competence to deal with their problems is so specialized, it only exists in certain units, and when those units close these kids are not looked after.

The ministry has taken the position that this is not its responsibility; that the hospitals can coordinate things themselves or stay within their budget. Clearly this has not worked. There have been some signs of increasing coordination between hospitals in the Vancouver area, and I hope the ministry will encourage this. Inevitably, in inter-hospital competition of that kind, the children with serious psychiatric problems have lost out in the past.

Let me look at another example of how needs that are obvious have not been met and are still not being met. In 1987, the psychiatric assessment unit at the Vancouver General Hospital emergency department began to go on "diversion". That's a very nice euphemism, but what does it actually mean? In this case it means that because there are no other resources capable of accepting acutely psychotic patients, they are in effect diverted to the streets. There is no place for them to go.

I saw an example of this during my own election campaign, when a severely psychotic patient, a violent one, arrived at the hospital where I work and required four people full-time to pin him down on the floor. This is a hospital where there are no male orderlies, even very few male nurses, and no large people of either sex to deal with a violent patient. This is the kind of patient sufficiently violent that he threatened to tear my face off while I examined him.

Not an easy problem to deal with. Yet when the VGH psychiatric assessment unit is on "diversion" — which they are now between a third and a half of the time, if you look at their monthly statistics — where are these people going? If you talk to the physicians involved in the delivery of mental health in Vancouver, the reality is that patients who are committed That means they have the signatures of two physicians on a legal document stating that the patient must urgently be hospitalized for his or her own safety or for the safety of society. When a patient is committed, it is a medical and social emergency. Patients who are actually committed to hospital frequently can't get into hospital. This is a major problem that the mental health medical officers face in Vancouver: they commit patients and there is no place for them to go.

[10:30]

MR. CHAIRMAN: Hon. members, the first member for Langley has asked leave to make an introduction.

Leave granted.

MRS. GRAN: On the Deputy Speaker's behalf, I'd like to recognize that visiting from Gatineau, Quebec, are Diane Renault and her daughter, Michelle, along with Joan Reager from Cadboro Bay. Would the House please make them welcome.

MR. PERRY: I'd like to continue these points, but I am going to yield to the member for Prince George North.

MRS. BOONE: I have a lot of concerns about mental health. I expressed some of them last year, but they've increased considerably over the past year.

I have a report, Mr. Minister, "Child and Youth Mental Health Services: Hospital Survey on Psychiatric Care," which took place in the spring of 1988. As you know, there is a review being done of the services that exist throughout the province.

One of the major concerns that I have is the lack of facilities for our young people. I have mentioned this on several different occasions. The survey that took place clearly outlines that there is a severe problem in this province: "All acute-care beds specifically designated for children and youth are located within hospitals in the Victoria and greater Vancouver area." They go on to mention a whole pile of things to do with urban centralization, and then it goes on to waiting-lists. "As these are the only specialized facilities for children and youth in British Columbia, they serve as referral sources for the entire province. Waitlists for admission range from three months to one year." These are for the youth of our province.

In British Columbia, child and adolescent psychiatrists are primarily located in the lower mainland and Victoria. There are five- to ten-month waiting-lists for assessment and treatment by child psychiatrists in designated child and adolescent beds.

This is a real problem, Mr. Minister, and I haven't seen any action taken over the past years. Despite the fact that last year you mentioned there were teams being set up and various things like that, there is nothing out there for children. I know personally of a young fellow who has been coming down to a facility here in Victoria and actually living here for the past few months and going back on weekends.

This young fellow is very lucky in that his parents are able to support this, are able to come down frequently to visit him and to bring him back to visit

[ Page 6398 ]

with them as well. I might add that these people adopted this young fellow with no knowledge that he had any emotional problems. They have stood by this fellow, and he is lucky they are able to do so.

In the Vancouver Sun on April 22, they mention that an adoptive pair had to give back a handicapped daughter because there was nothing to help them out there. These people could very easily have been in the same situation if they were not in the financial position to handle it. I know there are many people throughout the north and interior of this province who have no resources to go to. They can't afford to bring their child down. They can't afford to visit the child or have the child come back and forth, and so these children go without any treatment whatsoever.

If you look in that same edition of the Sun, you will see similar headlines: "School System Fails to Aid Troubled Boy"; "Tiny Troubled Students Have Few Treatment Options." This has been going on not just this year or just last year but for many years. As a school trustee, I sat in Prince George and made decisions that were sometimes similar to this one here, where we had to ban a child from attending school because he was a danger to himself, to other students and to the teachers as well. I can tell you that this did not sit well with the trustees, and it certainly didn't sit well with the family when they understood there was no place for this child to go.

We have failed our young people who are having social, mental and emotional problems. We do not have the facilities for them. There are very few of us in this House who haven't had members of our community come to us with personal stories relative to a family situation and try to get assistance to deal with a child who is having some severe problems. In many cases parents are very concerned because they feel that their child may be suicidal. We cannot afford to ignore the plight of these students any longer.

Last year I mentioned the problems that were being faced in a small community to the north, Mackenzie, where you came to open the hospital, and the fact that they are looking for a full-time counsellor They are still to this day looking for a full-time counsellor there. They have no facilities, and once again we are faced with the situation of young people or even adults in that community being told they must either wait for a month for a visiting mental health person or go elsewhere.

In our community we have the teen crisis line, which the ministry funded to a small degree, but not to a degree where they were able to keep It up. They got some money from the city and from local people who got together and raised enough money to keep the teen crisis line open.

We also have in our community an extremely valuable service called Survivors of Sexual Abuse, which provides a children's program for young people from the ages of four to 14. They do group counselling, individual counselling and play therapy; all of these things assist young children who have been victims of sexual abuse. They have been trying to get some funding from the provincial government to keep that program going, and the Survivors of Sexual Abuse program has actually received no government funding from the very beginning of their whole program. They have been operating off bingo moneys. Now they've asked for funding of $35,000 from the provincial government to keep that program going which helps children who have been victims of sexual abuse, and there's no money available to them. They are actually eighth on the priority list from the mental health group there. This group is providing a service to people who are referred to them from mental health, Social Services and Housing, Attorney-General, doctors and self-help people. They are providing a supplementary service to the government, yet there is no funding for them. When this service ends — and they are saying now that they will be closing the service for sexually abused children as of May 31 — there will be no place for children in our area.

Mr. Minister, we have severe problems in dealing with young people who are having mental health and emotional problems. I think it's time that this government acknowledged the problems there and really set out to establish programs and provide the necessary funds to do these things.

We see no increase in the mental health budgets to allow us to do those things. When you talk to the regional managers, they throw their hands up and say: "I've got a priority list of eight, and the survivors of sexual abuse program is eighth on the list." I don't question their judgment. I'm sure they are probably eighth, and I'm sure there are people above them who are as in need of funding as everyone else. But they are doing the best they can with very limited funds at the local level.

If we truly believe in giving families the support they need, then we ought to be providing the necessary funds so that people can get the assistance they need, and families will not be torn apart and torn down to Vancouver or Victoria. Parents need to know that their children are going to get the assistance they require and not have things happen such as a year ago when I was trying to find assistance for somebody, and they said: "Well, this kid will end up in jail anyway, and when he gets into the A-G's department, he'll get the help he needs."

That's not adequate at all; we need that assistance now. We need it at the provincial level, and I would like to hear from the minister just what he plans to do, and what is going to happen to those people out there. The budget that has been presented really doesn't acknowledge any of the requirements in the rural and urban areas.

MR. CHAIRMAN: The first member for Langley asks leave to make an introduction. Shall leave be granted?

Leave granted.

MRS. GRAN: Mr. Chairman, in the House today and listening to the debate on the Health minister's estimates are a very special group of students from Langley, from the Credo Christian High School. They are visiting with their teachers, Mr. De Jong and Mr.

[ Page 6399 ]

Ludwig. Would the House please make them welcome.

HON. MR. DUECK: Before I begin I would ask the member opposite for patience. I want to get something into the record; I did not have the information the other day. At the present time, you may know, we are beginning our process of allocating funds, because the budget has just been brought down. I know the moneys I have. It's a big ministry, so it takes a while to know exactly where the moneys will go and to what extent. This news release was yesterday, but I will put it into the record today. This Is in reply to the second member for Vancouver-Point Grey (Mr. Perry). He asked about the waiting-list for cancer patients at the A. Maxwell Evans Clinic.

"Two additional radiotherapy units will be added to the A. Maxwell Evans cancer clinic in Vancouver.... Planning funds of $250,000 have been set aside for the initial phase of the project. Project costs of $6.2 million — $3.2 million for equipment and $3 million for construction and installation — will be paid 100 percent by the provincial government."

In other words, there is no sharing with the regional district.

Then it explains the equipment; I won't go into all that. "In medicine's continuing battle against cancer, radiotherapy treatment has become an increasingly important and effective weapon " At one point it appeared that that particular type of treatment was actually decreasing, but we find that it is quite effective and it is increasing more and more. "We hope to have these two additional units operational by the 1990-91 fiscal year" — in other words, beginning next year.

"The Cancer Control Agency has six radiotherapy units now in use. In the last fiscal year the Health ministry gave the CCABC a supplementary annual budget of $638,000 In other words, we added $638,000 to recruit more radiation technologists so that two radiation therapy units could be used on a double shift. That's when the money was made avail able to start the double shift.

[10:45]

"The additional two units will offer patients improved access to radiation treatment and services The CCABC received 1988-89 operating funds of $51.7 million from the ministry's hospital programs division and $4.6 million from the ministry's Medical Services Commission." So there we have $55 million in that alone.

We have to be very careful when we say this government does nothing. I think that when you replied to the budget speech — or the throne speech, I'm not sure — you mentioned at least six times, Mr. Member, that this government has done nothing. I think that is very dangerous. You can criticize me personally; you can criticize the ministry; you can criticize the government for not doing enough or perhaps allocating funds improperly. Maybe the priorities are mixed up according to your estimation, and you may be right But to say that this government does nothing is not realistic. There is another word that could be used, but I am not going to use it, because I will be ruled out of order. It's not right to say that this government does nothing.

Interjection.

HON. MR. DUECK: He's not even here.

The A. Maxwell Evans Clinic handles about 100,000 out-patient visits and sees almost 6,000 new patients a year. So we know that there is an apparent increase in this illness. We are certainly addressing it. If there is any constructive criticism as to how we can improve that area — of course, other than the limited funding that is available

I think there were a number of questions. I will now address the crisis line that was referred to. I think this particular organization does a fabulous job. I am not critical of the work they are doing. Last year, other than the crisis line, we also provided $64,000 to the Prince George Crisis Intervention Society. That we funded last year and are funding again.

The crisis line itself was funded by a different ministry last year. We have picked it up — $18,000 worth. Again I want to refer to the statement you made that this government does nothing. I even go one further. Another ministry funded it one year, saying: "That was a one-shot deal. We have no money. Find it wherever you can." We stepped in and said: "Look, if the municipal government can put some money towards that, perhaps the community " We've offered $18,000, and the line will remain open.

On total funding to crisis lines by way of grants this year around the province — again, just to put it on the record and to put it in perspective — we can be criticized; but to say this government does nothing is erroneous. just for crisis lines around the province, this government has a budget of $858,000. I'm not saying that's enough; don't get me wrong. I'm not trying to be defensive and say: "So what?" Not at all. We are doing whatever we can, and I put emphasis on the areas of priority as they come to light. I certainly know that it's a very important part of your area and many other areas.

As I mentioned earlier, we're just starting to allocate funds to the areas of the province in the various departments. I would like to put this in the record again. For Victoria — and this release will be going out today.... More than $1 million will be directed to strengthen mental health services, staffing levels and facilities in the greater Vancouver and lower mainland communities. The funding will be used to provide extra community mental health staffing in Vancouver and the Fraser Valley to a value of $600,000. A range of housing options for people with mental illness will be developed over the next year to a value of $500,000.

This funding is intended to provide short-term solutions to the most pressing mental health service needs in that area. The demand for mental health services in this province is increasing. I think you mentioned that. We don't rightly know why, but it is increasing, and we're very much concerned that the people who need that assistance have it provided.

[ Page 6400 ]

The provision of these additional services for Vancouver and the lower mainland is not a substitute for the Riverview replacement plan. I think this is very Important. All the money we're spending on facilities or for extra outreach has nothing to do with the consultation process plan released here some time ago. The commitment I made in the "Mental Health Consultation Report" released in 1987 still stands Riverview Hospital will not be downsized until cabinet has approved a long-range mental health plan and community-based services are In place. I made that commitment last year; it still stands.

Another release will be going out today, which is appropriate, since we're talking about mental health today Mental health services will be strengthened in the north, the Okanagan-Kootenays and the Vancouver Island region. Funds of $250,000 will be made available for mental health counselling and support services in the northern regions.

There will be $130,000 targeted for the development of specialized geriatric mental health outreach, for a team based in the south Okanagan, to provide regional service throughout the Okanagan and Kootenays. This is a pilot project which recognizes the growing number of elderly who need that service

Recognizing the preference for community beds as an alternative to hospital beds at Eric Martin Pavilion, the ministry will provide funding of another $150,000 to develop community residential options This will allow the Greater Victoria Hospital Society greater flexibility in responding to people with emergency psychiatric problems.

The demand for mental health services in this province is increasing, as I mentioned earlier, and that's why we are looking at the whole area of mental health — these teams for outreach programs and also some bed facilities.

Community residential beds were mentioned earlier. I'm sorry that the other member from Point Grey is not here. He said that it's not just status quo, that it is decreasing. In 1985 we had 1,497 community residential beds for the mentally handicapped; we now have 1,850. So it is not decreasing, as was mentioned Group homes: 110 in 1984; we now have 152. That's a total increase from 1,811 in 1985 to 2,201. I'm just trying to point out that it's not a decrease; it's an increase. But perhaps the increase is not sufficient, and I accept that as a constructive criticism.

MRS. BOONE: It's nice to hear that there is going to be some money coming into the regions to increase the services there. From my experience, though, I think I'll just wait to see how that money is divvied up. There seems to be a trickle-down factor, and very little of it reaches down into the actual services When we get a counsellor in Mackenzie, then I'll know that it has trickled down. An easy way to keep me quiet, Mr. Minister, is to put a counsellor in Mackenzie.

Interjection.

MRS. BOONE: That will do it, yes — for the time being.

Interjection.

MRS. BOONE: They're jumping at it? Good.

I'd like to ask the minister: what sort of interaction has the ministry had with the minister of state and with the various committees that the ministries of state have set up throughout the province?

HON. MR. DUECK: As the member knows, Mr. Chairman, we are working on a regional basis more all the time. We're not operating in isolation, even with hospitals. We're trying to work for that particular catchment area, or the region. We're doing a major study for your total area, the Kootenays, Prince George.... It's not complete yet. That was done specifically — exactly the question you asked — for that total region: what are the services required and where are some of the deficiencies, rather than looking at that area.... You mentioned a counsellor for that particular area; it is for the total region. I know there are some gaps. When this study comes in, hopefully it will give us a better insight into what Is required for that area.

I should mention that last year we announced that we are putting coordinators in the various mental health centres. In the past year, child and youth program coordinators have been placed in each of the 36 mental health centres across the province. These senior clinical staff provide individual assessment and treatment services to youngsters in need. They also provide community education and consultation services, to increase support and public understanding for the mental health needs of children and youth. Child and youth program coordinators have established a clear priority in setting guidelines to ensure that youngsters who are referred to mental health centres with emergent or life-threatening conditions receive immediate service. The Ministry of Health now has a child and youth mental health specialist in each of the 36 mental health centres across the province. This increase in service capacity may well serve to increase waiting-lists. We believe there were some out there that perhaps didn't even have the opportunity, at least initially. As latent demand is called out in various communities around the province, clear priority-setting is in place to ensure that the most serious needs are addressed immediately and the others as soon as possible. There is a waiting-list in some cases that are not considered urgent or emergent. However, I think it's a great improvement on what we had.

I believe a statement was made by the member for Vancouver-Point Grey that mental health services have deteriorated. I think they have improved dramatically over the last few years, and I stand on that. They have improved, but illness, has increased. But we have more people out there. We have far more money in that area, and....

[ Page 6401 ]

I just got a note here. In Mackenzie, one counsellor to provide family mental health counselling services for the local area has been allocated for $48,000.

MRS. BOONE: In keeping with that promise, Mr. Minister, and given that, thank you very much.

MR. CASHORE: It's good to know that we're going to get instantaneous results throughout the remainder of these estimates. Everything we ask for is going to be provided. There just needs to be a few moments to work out a few figures.

[11:00]

It's good to be able to rise and speak on the issue of mental health. It's an issue that we as a society bear responsibility for, and I think it's a responsibility that goes far beyond the purview of the Ministry of Health. It's something that involves us in our homes and in the neighbourhoods in which we live. It's an issue that requires a great deal of understanding and compassion, and any process of being aware of the situation with regard to mental illness recognizes that there really is no family that has not been personally affected by the effects of mental illness. So we certainly start to address this issue from a basis where we realize we have a collective responsibility.

Some matters were canvassed by the second member for Vancouver-Point Grey (Mr. Perry). I wasn't able to hear all of the things that he said, but I've been listening carefully to some of the things the minister has been saying. I do want to come back to the process whereby we have been developing a mental health plan within the province and ask the minister, really in all seriousness, what has happened to the mental health plan.

There was a great deal of public interest and fanfare at the time the mental consultation report was produced. In a letter dated September 29, 1987, to those who had participated in the consultation, the minister said, among other things: "The recommendations in the report are a distillation of the hundreds of submissions received by the mental health services division...." It goes on to say: "The report addresses planning on three fronts: effective replacement of the outdated facilities at Riverview Hospital; long-range planning for development of appropriate community living and support services; and development of regional program capacity to ensure a managed and integrated system of care."

When we look at what has happened since then, I think we would have to say that the judgment of at least those members of the public who are active in this field is that it's come to a grinding halt. I don't think the number of increased boarding-home beds that the minister referred to a few moments ago really — given that that's between 1985 and 1988, if I heard correctly — in any way begins to address the serious problem. The minister has acknowledged this, but what concerns me is that apparently the government has not seen fit to allocate the kind of priority to this issue that it deserves in this province at this time. I know the minister can't talk about this, but I would expect that he is himself experiencing a certain amount of private frustration over the fact that the allocation of financial resources is not being made available to him so that this part of the issue could be dealt with.

Clearly, when we look at the recommendations that came from 300 groups and individuals, when we look at the process that went into developing that report, some really important initiatives were called for. What has actually happened is that we haven't heard from cabinet with regard to what is going to happen with that new mental health plan, We keep hearing that there is going to be an announcement made at any time, but as far as I can see, it keeps being put off. I don't know what the cabinet is waiting for; I don't know why this has to be put off again and again.

People who are deeply distressed about the situation of mental patients in this province and who are deeply distressed when they realize the number of homeless out there on the streets — some of them sleeping in alleys, and lacking the kind of out-patient services needed — are asking some very legitimate, serious and urgent questions about this.

As I said before, I can only sense the minister's frustration in not being able to say that an appropriate infrastructure has been put in place with regard to the available beds for these people. We have to ask: when will this government give priority to this kind of planning and action?

The minister said it in the House today and has been quoted previously as saying.... I have an article from the Vancouver Sun dated May 12, 1988, where the minister said that there will be no further reductions in the number of beds at Riverview Hospital. But as the second member for Vancouver-Point Grey has pointed out, at the time those statements were being made, the number of beds at Riverview Hospital was 1,220, and the fact is that at the present time it is somewhere around 1,000. We can't say that the plan is not taking place, at least the part of the plan to deinstitutionalize, when in actual fact there has been a significant reduction in the number of beds at that hospital.

The other thing, to the minister, is that anybody who works in the field of mental health, whether it's from a volunteer or professional point of view, working in various hospitals throughout the lower mainland, will tell you that it's very difficult to get a seriously ill mental patient admitted to Riverview Hospital. There is a limit to the available number of beds, and that limit has seen a significant reduction since previous statements were made that this was not going to be the case.

We have a situation of diminishing resources, where there is a requirement for institutional care. The minister has said: "Look, I want to set your minds at ease. The concerns that have been expressed about deinstitutionalization are not true." Yet it's statistically obvious that the process has been continuing apace.

You cannot do it this way without doing the other things on the other side of the equation that were promised. For instance, a lot of us expressed concern

[ Page 6402 ]

about the fast track to shut down Riverview Hospital. I think the minister listened to that, and therefore the fast track was put more onto a side track. But the train still moved along, and deinstitutionalization continued.

The draft mental health plan calls for new facilities, containing 550 acute-care beds. I believe that one of those facilities would be in the lower mainland, containing 300 beds; another in the north, containing 50 beds; another on Vancouver Island, with 100 beds; and one in the Okanagan-Kootenay, with 100 beds.

I am not aware of any movement toward producing that kind of infrastructure, and yet we still hear about the deteriorating buildings out at Riverview Hospital. Someone told me the other day that they had heard that the Langley hospital had been promised a psychiatric ward, and that what has been established there, while providing some psychiatric services, is anything but something that could properly be called a psychiatric ward.

As has been pointed out by my colleague the second member for Vancouver-Point Grey, there simply are not the acute-care beds in existence that are required to deal with the need of some very desperate people at this time. Therefore the people who work within Riverview Hospital and other psychiatric units are left in a kind of pressure-cooker situation where, because of shortages of staff and beds, they cannot accommodate the people who desperately need this acute-care service. Therefore these people, as has been pointed out, are diverted.

The statistic I've heard is that the diversion rate is between 50 and 60 percent. People who are desperately ill are being placed in an ambulance, and 50 to 60 percent of them are being diverted from the hospital to which they are taken when they are in need of care. That is appalling, Mr. Chairman, and I sense the frustration of the Minister of Health in that this government has not seen fit to provide him with the resources to fulfill this desperate human need. It's more than obvious that that is the case.

All my friend has to do is visit some of the facilities in the province that are operated by very effective volunteer groups like the Mental Patients' Association and Coast Foundation who are trying very hard to provide humane non-professional services to ex-mental patients and are doing a wonderful job Those people will tell you, if you're not already aware, that the supply of acute-care beds is grossly inadequate in this province, and that this diversion situation is very serious indeed.

The situation has become so serious that the Vancouver city council has called mental health officials on the carpet to talk about the acute situation they have to deal with in that city. I understand that the Greater Vancouver Mental Health Service could place 250 people immediately in boarding homes if those homes were available. I understand that the nursing shortage is acute with regard to psychiatric nursing The recommended workload for a psychiatric nurse is a ratio of one to 30 patients, and in the Burnaby mental health facility it would be closer to one to 80 Again, this is putting unfair pressure on people who are trying to provide a service from within that system.

We have to ask the minister what is going to be done in the very near future to address this serious situation with regard to the lack of boarding home beds. I would also like to ask him what has been done — which is part of the plan outlined in this report — to educate the communities that would be receiving boarding homes into their neighbourhoods, so that we don't have neighbourhoods up in arms and raising fearful images of ex-mental patients, and where a boarding home is being set up in such a way that the community is properly prepared and assisted in receiving these people and ensuring that the standards of care in those boarding homes are maintained at a level that is as high as that found within an acute care hospital.

We only have to go back a few years to realize that there were changes through order-in-council in the Community Care Facility Act and in the Employment Standards Act to make it easier to set up boarding homes for ex-mental patients. But sometimes making it easier means there's a loss of standards, the quality of care is lost and these people are out in the community — which at the very basis is a good concept. But it's easier for them to become invisible — out of sight and out of mind — and therefore society and the body politic is less aware of the plight of these people in that situation. As has often happened in the American examples that are so tragic, people have gone from acute-care hospitals into boarding home situations that were not properly administered and then on to the street, only to be lost.

MR. CHAIRMAN: I'm sorry, the member's time has expired.

MR. PERRY: I think the member for Maillardville-Coquitlam is making some extremely interesting comments. He knows what he's talking about, and I'd like to hear the rest of them, please.

[11:15]

MR. CASHORE: Part of the infrastructure in society that helps us to be a more humane society with regard to people with mental illness is the volunteer organizations that operate on a club-house model to provide a drop-in space for people who are out on the streets. It's my understanding from discussions I've had with people in the Mental Patients' Association that about 50 percent of the clients who come into their facilities are receiving help at that time from the continuing-care team, and the other 50 percent are multi-system users. Some of them, in actual fact, have never been in a mental hospital, but they just keep rotating from one facility to another.

I've discussed this with the minister in previous years, and I know that he's well aware of the value of this resource in the community. Again, I would plead for the recognition of the importance of providing adequate funding assistance to the organizations who provide the service. I believe it's very cost-effective in the long run. I believe that these clubhouse models and the drop-in centres operated by self-help organi-

[ Page 6403 ]

zations mean that some of the most effective people are helping with mental illness. Formerly mentally ill people, ex-mental patients, are in a position to help their peers. They are often the people who can do that, because they've been inside the system and they understand it.

[Mr. Rabbitt in the chair.]

The scenario I've had described to me is that an individual goes to that drop-in because it is a friendly and more appropriate environment, perhaps, than a beer parlour in the downtown east side. Going into a place like the Carnegie Community Centre or a Mental Patients' Association locale is much more worthwhile for that individual, if he or she chooses to go there. The openness, the friendliness and the fact that resources exist there make it more likely that those people will make use of those facilities. They do need support to be able to continue to provide that service.

Quite often, if somebody's medication, for instance, is getting out of whack and a psychotic episode is coming on, a friend will come along and say: "I think you should come with me. We'll go down to the continuing-care team and have a look at how your medication is working." That will then result in a consultation with the people on that team, who will help get that individual back on track before there is another demand for acute care, which we all agree is very costly.

I'll just refer to one other thing at this time. About a year ago there was an announcement that Health and Welfare Canada provided $186,000 for a two-year project that would track a group of Riverview Hospital patients who were discharged into the community. I wanted to ask the minister if that project is being conducted by Dr. John Higenbottam. He said at the time that at Riverview, 40 percent of patients discharged are re-hospitalized. He went on to say: "That's very tragic. It carries high economic and social costs."

I would like to ask the minister to just give us an update, if he can, on that program. I realize it's a two-year program, but I'd also be interested in knowing if the ministry is providing any research funding of a similar nature to enable us to come to a better understanding of how to help with the issue of patients returning to hospital with high frequency, and that sort of thing. Is there money going into research and development that helps us understand better how to deal with mental health issues?

HON. MR. DUECK: There is enough in that material that I could go on for three days. We are touching on a very important issue, and a very involved and very complex area. The member for Maillardville-Coquitlam, of course, is familiar with this area of mental health. I appreciate some of the comments he is making.

I made some notes, and I should go back to when you started so that I can address some of the issues we are speaking about this morning. There was a mention made that this government is not committed to mental health. I think I should dispel that statement, because that is not true. We are committed. I personally am very committed. I also have to consider the resources that I have available, although this year I did receive more than $1 million a day increase in my budget and I feel there will be some movement in the area of mental health as well.

Talking about the mental health consultation plan or the process that we went through, it was a quite an interesting process. We had many submissions, reports, individual people making presentations to us on this particular plan and what they would like to see done in the areas we should address. It has been a rewarding exercise. It hasn't stopped in its tracks, as was mentioned. It has not come to a halt. It is very much alive. We are now in the planning process.

It is not simple, as you well know. We've got a Riverview Hospital that has been there for years and years, with anywhere from 1,000 to 1,200 patients; at one time it was 4,000. But I did make a commitment that it would not be downsized until we had resources in the community to take up that slack. That is not simple. I am taking this plan forward. We are still working on this plan with many people involved to see what resources we need, where they should be located and how many dollars we need. That will be going forward to cabinet.

Cabinet has not yet addressed the issue of this plan or this consultation process plan; that will be going forward to cabinet in the very near future with a recommendation from us and an outline of a plan we want to put in place to downsize Riverview. We know that we will always have a Riverview of some kind. It will be smaller and located in various areas. The areas have not yet been identified. There could well be one in the Fraser Valley; there could well be one in Vancouver, maybe at the present site or somewhere else; there could be one or two up north. They will be smaller and more manageable, because we know we will always have some people who require that type of attention and must have a secure place for the protection of themselves and for the protection of others. That will be done.

It's taken longer than I had expected and longer than I like to see. I'm always very impatient and like to do things quickly, but this is government. When you're talking about this process it cannot be fast tracked, because we are going to make errors. I think you are well aware that some provinces have made some very severe errors with just downsizing and moving them out, period. We've been in touch with other provinces; we don't want to make that mistake. When we downsize, we move people out, and we want to be sure they are looked after properly and that the infrastructure is in place. There will always be some people moving in and out of Riverview, and you well know that. There have been people moving into the constituency from various places throughout the province for some time.

I just got some notes here on the decrease in Riverview. There has been a decrease of 53 beds in the Riverview Hospital over the last 15 months. This was attributable to a number of operational factors and is not related in any way to the downsizing of

[ Page 6404 ]

Riverview. There were some staffing problems, and some problems we encountered with early retirement. We therefore decreased that slightly but very little. I've made a commitment that it will not be downsized until we have those resources in place.

We've talked about education and what we're doing to keep the public informed. We're working very closely with the Canadian Mental Health Association. Last year we gave them $300,000 for public education, and it will be extended this year. They are a very good body of people, as you well know. They've come up with the "Community Alternatives in Mental Health." There are three big binders here, If the member would like to take a look. There's a lot of material there, so when I say it's complex, and it takes a while, rest assured it is not something you can do overnight. It just isn't possible.

MR. CASHORE: When did that come out?

HON. MR. DUECK: I understand it just came out We're just going through it now. This is other agencies working with us.

I could go on and on. Maybe I should read something into the record from some of the areas we're funding this year. I should mention that we're working very closely with the B.C. mental health association developing a comprehensive public education program. That is our plan. I think it was a point well taken. We will continue to work with them, using the research information to educate the public out there.

It's not easy. You probably read in the paper just the other day that we're trying to get some homes established for people who are on the outside and are not commitable. What do we run into? Even mayors in communities say: "No way. Not in my back yard." Even with proper education.... We've worked with , the Union of B.C. Municipalities, and they've asked us to downsize from ten to six beds per home. This Is going to increase the cost dramatically. We've had some communities that don't even want the six. As soon as they hear that you're going to establish a home in the community... It's well within our rights and within the rights of the society establishing the home. It meets all regulations; it's a residence. Yet the community will go up in arms and say: "Not in my back yard."

We have found that where we've established these homes, again and again, once the homes are there, they are good neighbours. We haven't encountered any problems. The odd one, but that's expected When I look at the paper in the morning, I find out that the so-called normal people are doing all the shooting, killing and marauding. We cannot point a finger and tell people in the community: "Let us put this home into this particular community because they are really very nice people and you will like them." We have evidence that they are good neighbours, but we find it difficult to persuade them. Yet these people have the same rights as you and I in that community to live in a residence, to be free to enjoy the things we do. That's one of the problems we have encountered. I am working with it, and we try to educate people. It's very difficult.

I'd like to read into the record some of the things we are doing this year to at least give you an idea that we are not at a halt and that this government, as the statement has been made, is not doing nothing. It is doing something, but maybe not as much as we should or could do.

Vancouver: ten staff, including seven community mental health workers and two community nurses to work in the Broadway and Strathcona areas to provide a rapid response team, $350,000. Six community mental health staff to work In the Fraser Valley providing intensive case management services supported by psychiatric consultation, $250,000. Forty residential beds at the intermediate-care level 3, $500,000. Greater numbers are potentially possible, depending on the types of housing developed. These beds are targeted primarily for Vancouver and, secondarily, for the Fraser Valley.

[11:30]

1 mentioned the northern one. For Houston, two staff to provide general mental health counselling through Houston Health Care Services Society, $75,000. Williams Lake, $53,000 to develop a clubhouse. I think you mentioned that the clubhouse and drop-in centres are very valuable. This is for that purpose. At 100 Mile House, a funded activities centre through the local branch of the Canadian Mental Health Association, $19,780. Dawson Creek, $10,000, and another $1,500 for part-time mental health counselling through the South Peace Community Resources Society and to provide additional therapeutic volunteer program spaces.

Fort St. James: provide one mental health worker through the Fort Alcohol and Drug Society, $30,000. Burns Lake: provide one indigenous mental health worker through the community services society, $30,000. Chetwynd: provide one indigenous mental health worker, $30,620. Prince George: funding to operate the teen crisis line, which was mentioned earlier, $18,000. Mackenzie: I just mentioned, $48,000. McBride, Valemount and Tumbler Ridge: three counsellors to provide family mental health counselling services for these areas, $128,000. Okanagan Kootenays: one community nurse, one social worker, an office assistant and a part-time medical consultant to pilot a community geriatric mental health outreach service based in the south Okanagan, providing travelling services to the Kootenays in conjunction with Cranbrook Mental Health Centre, $150,000. Vancouver Island: 12 community beds at the intermediate care level, three targeted to provide community placement for patients waiting in the Eric Martin Pavilion, an additional $150,000. The list goes on and on.

I am just pointing out that it perhaps is not as much as we should have, but it certainly is a good start. You mentioned, Mr. Member, clubhouses and that type of activity, rehabilitation programs to societies and third parties — this year in the budget there is $5,025,000 for 95 contracts.

[ Page 6405 ]

Again you might say it is not enough, and I probably would agree with you. But we are improving. When I look back through the records of three, four, five and ten years ago, it is a tremendous improvement. We are not where I want to be, but we are improving. We are going ahead, and we want to continue to help these people. Especially since we are on this particular subject, I am very much concerned and I know they need help.

I hear all the critical comments that you do and probably many more. I am well aware of what's out there, of the shortages and some of the crises that develop in individual homes and with individual people. I can't give an anecdote for each case, although when a case comes to my attention, I do follow it through individually. In the House I couldn't comment on individual cases, as you can understand.

MR. LOENEN: This morning we're discussing mental health. I think all of us are agreed that this is one area where we have to do the best. We have to create a very humane society and reach out to those who have special needs in special ways. I wish to commend the ministry for the initiatives they have taken. This government's program of deinstitutionalization has had so many positive results. It is one area where we can hold up our heads and be really proud of what has been accomplished. Yes, more remains to be done. But I've seen the examples of it. Families and parents and grandmothers and grandfathers and those in the community have seen the very positive examples of what happens in people's lives when they're taken out of institutions and put into the community, where they can lead more meaningful lives and participate in simple ordinary experiences like shopping or going on the bus or taking in a movie or simply going out to the swimming pool. All of these are very positive things that we ought to acknowledge and be grateful for.

That is not to say, Mr. Chairman, that more cannot be done; of course more can be done. But I've seen some of these group homes. Some of these are purpose-built. I wish more residents could have a look at these places, because the facilities are absolutely first-class. For instance, you walk into a bathroom, and it's a huge room with a great big bathtub in the middle and a hoist to lift people in wheelchairs directly into the bathtub for bathing purposes. You look at the kitchen, the special equipment that has been supplied. In many of these group homes they have a van to take the residents into the community. All of that has meant that people's horizons have widened and their experiences have broadened and deepened. It's wonderful to see that.

I was particularly struck, on one recent visit I made — well, it was last fall — to one of our schools, Samuel Brighouse Elementary School, which has a very innovative program of integrating mentally handicapped, mentally ill, people with multiple handicaps, into the normal classroom situation, and they will take a child with multiple handicaps and put him in with 24 or 25 so-called normal youngsters.

The amazing thing is that this is a wonderfully positive experience, not only for the special-needs child, but also for all the other students in that classroom. Obviously it is true that many of these special needs students cannot keep up with the class in terms of academic achievement. But they grow in so many other ways. In particular, they learn social skills simply from observing what is allowed and not allowed in the activity that goes on, because suddenly they have 24 or 25 role models around them from which they learn how to interact with other people. Their experiences as a result of that are immensely enriched.

I want to congratulate that particular school and those teachers. In fact, I was so enthusiastic I encouraged the Premier to visit that school — which he did — and he came away with the same enthusiasm for those programs.

So when we talk about providing the support services within the communities that enable us to deinstitutionalize, we should look at all these facilities and the various programs the Ministry of Health provides. But we should not forget that there are other ministries such as the Ministry of Social Services and Housing and the Ministry of Education.

In fact, I have a letter here directed to the Minister of Education (Hon. Mr. Brummet) by the Richmond Society for Special People. I'd like to read that into the record because it acknowledges some of the very positive things that are happening in our community.

"The Richmond Society for Special People is a non-profit society which provides services and programs to individuals who have mental handicaps and to their families. During the past five years we have been privileged to participate with the Richmond school district in developing an integration program for students with special needs. The consultative, participative process followed by the school trustees and the school administration has been commendable. Their measured approach is appropriate, and the end result to date most encouraging.

"On behalf of our board of directors and membership, I would like to express our appreciation to the Ministry of Education.... Your ongoing interest and financial assistance has been important in ensuring that an effective and successful program was developed.

"By continuing to work together, the Richmond School District, the ministry and our society can develop an integration model that is a leader in the province.

"Thank you again for your continued support.

Yours truly,
         Robert Robertson,
         President"

That kind of an example is multiplied not only in my community time and again but throughout this province. There are many ways in which we do supply the kind of support services that are needed by the people that come out of the institutions, and we were grateful for the work of the Greater Vancouver Mental Health Service. It provides many of these services to our community as well as to Vancouver. They established, for example, a community out-patient service which services between 450 and 500 patients at any one time.

[ Page 6406 ]

I also think of the Richmond General Hospital, which provides care through its psychiatric unit. In that connection, Mr. Minister, I would just like to remind you how much our community is looking forward to having that new addition to the Richmond General Hospital which will house the psychiatric unit. I know that you have supported this, and we look forward to the finalization of that and to receiving some planning funding this year out of this year's budget in order to proceed with that. It will be a tremendous boost of encouragement to those people and it would help the administration and the board to provide the support services that our community needs.

I think of the Richmond crisis centre. It's a very important service which depends on the work of volunteers. They're out there counselling and helping people 24 hours a day. The Canadian Mental Health Association in Richmond do a wonderful job. They have a number of sheltered workshops, including Pathways Clubhouse. The member for Maillardville-Coquitlam (Mr. Cashore) talked about the importance of clubhouses, drop-in centres. I had occasion to visit there, I think it was about five weeks ago. It's an ordinary home with an ordinary living room. There were about 25 to 30 people jammed in and they wanted to make the point to me that they are desperately in need of another clubhouse. We cannot overestimate the service of the people who run that. They do provide the comfortable environment that the people who have come from the institutions need. I felt very good about the service they are providing there. In fact, I would want to encourage and recommend the services of that particular organization to the Minister of Health.

I was very much involved with the same organization when I was an alderman. During those years they started, and they continue to this day, to provide through the seniors' centre a training program to allow people with mental illness or mental handicap an opportunity to acquire self-confidence and some basic skills. For instance, they contract with the seniors' centre to provide janitorial services and to provide cafeteria services for the restaurant there They put their clients through that program. It provides them with an opportunity to acquire skills and confidence which will allow them to move on and sell in the private sector the abilities they have acquired It's a wonderful program. It's one more area where we, as a community, do provide the services that these people who come out of the institutions need.

I was very much pleased to notice that Kwantlen College, under the direction of Mr. Derek Nanson, is looking at developing a specialized program for the mentally ill as well as the mentally handicapped which would emphasize the upgrading of their employment skills. Again, our community has so many of these groups and organizations that provide the needs of people with mental illness and handicap problems and support those families.

[11:45]

We can always make a case for saying that there's not enough. I've gone out of my way. When people phone me or talk to me and say, "You ought to do more; you're emptying the Institutions and not providing the service," I've gone out of my way to say to these people: "If you know of one particular individual who does not have a home, a bed or the support services that he's entitled to, I want to know the name of that person. Phone my office. You can phone me 24 hours a day." It has not happened, and I want the minister to know that.

Nobody in my community has come to my office or phoned and said, "Here's a person or there's a family in desperate need." It has not happened. I am pleased about that. That does not mean that we cannot make improvements. Yes, we can, and we continue to do that. In fact, on Monday morning next, the Premier and I will be meeting a delegation in our constituency office that will be representing the Richmond mental health service. They are an umbrella group, and they will make representation about some of the ongoing needs as they see them.

To say that there is a crisis situation, to say that somehow we are emptying the institutions and that those people have nowhere to go, is not true from my experience. I just want the minister to know and the people of this province to know that, in summary, I am proud of the program that this government has instituted, because I know, as I've said earlier, that it enriches the lives of individuals and of families. It's great to see that happen, and I hope that we will continue to do it in a responsible, measured sort of a way, as we have in the past. It's a program that we can all be proud of, and I commend the minister for initiating it and for continuing it.

MR. PERRY: I listened with interest to the foregoing remarks. I am not a psychiatrist professionally, but I could have given the member for Richmond examples of patients from his constituency who have not been able to receive adequate services, had he asked me.

MR. LOENEN: Give me names.

MR. PERRY: I don't think it's appropriate to breach patient confidentiality by raising names in the House; I agree entirely with the Minister of Health on that. I would be surprised if the member doesn't learn differently on Monday morning from some of the comments he has just made.

Since the time is running low, I want to apologize to the minister for the fragmentation of my part in this debate. We expected the debate to be concluded on a different day, and unfortunately I have to leave for a meeting this afternoon. We had hoped it could be more continuous.

In the short remaining time, I want to get down to some brass tacks. I think that I want to finish one last, illustrative point of the problems in the system, which is the issue of caseloads, something which is not inherently obvious. I refer to a summary of a report of the Vancouver city manager for the neighbourhood cultural and community services committee dated May 4, 1988, from the social plan-

[ Page 6407 ]

ning department of the city of Vancouver; a very interesting, carefully put together longer report. This is a summary pointing out an example of problems in the greater Vancouver area.

The community mental health team caseloads have gone from 30 patients per staff member in 1973 to between 38 and 60 clients per staff member in 1987. In some cases those numbers are larger now. What does that mean? It means that it's the primary mental health worker, usually a nurse or a social worker, who is dealing with those patients. The responsibility of the mental health worker, among other things, is to make sure that patients are getting their medications. These patients include people with chronic paranoid schizophrenia who could be violent, who could be dangerous to society if they are not receiving their drugs. Even with drug therapy, the treatment is often not very successful. One of the important ways of ensuring they are treated is for the nurse or the social worker to visit them in their house or their boarding home, wherever they live — even on the street if necessary — to make sure they get their medication.

As the caseload increases, in order to attempt to service the increasing number of patients or clients, the workers are kept increasingly in their office. They can't afford the time to go out into the street. Simply to attempt to deal with an increasing number, the only possible way is to stay in their office. This means that the most important work they do, which is to go out after the patients wherever they are to be found, can't be done. It's something that doesn't meet the eye when you look at the bald figures. It's one of the components of the real crisis.

I want to quote again from a letter from one of the senior officials involved in Vancouver: "Four years is a very long time to wait for action that is critically needed on a report" — namely, the mental health consultation report — "and a report which has the support of virtually every sector of the community." Those are the facts. The community supports it. The Vancouver city council, on March 21, 1989, approved recommendations from the city of Vancouver standing committee on neighbourhood issues and services, including a request to meet with the Minister of Health as soon as possible to urge the province to provide sufficient funds to improve mental health services in Vancouver. And remember that Vancouver serves the whole province in this respect, it's not a parochial issue.

The city council of Vancouver also voted to: "...inform the Minister of Health of the need to provide in the upcoming budget" — that's this government's budget of last month — "$20 million for the implementation of the plan."

Let me just remind the House what the $20 million is for. The Vancouver Sun in a very excellent series of articles by Kim Pemberton and other reporters treated the problem of services for the mentally ill during the month of March. One of the unsigned articles dated March 11 deals with the feelings of Dr. John Blatherwick, the health officer for Vancouver. He pointed out that for mental health services in the lower mainland $15 million is needed immediately.

Mr. Chairman, that's not to improve services; it's just to bring them back up to the standard of 1977, which is 12 years ago. Elsewhere in the world services have been improving steadily. We're lagging behind the rest of the world. What was the $15 million for? For the Greater Vancouver Mental Health Service, $2 million per year just for staffing; $7 million to replace substandard residential beds. Substandard means places that are condemned, filthy or are inadequate for human habitation. I wish that more of us could see some of the places where patients are living. If we pay attention to the letters we're receiving, we know these are substandard. There is $6 million to increase psychiatric hospital beds throughout the province, so that not so many patients will end up gravitating to the streets of Vancouver. That adds up to $15 million.

The remainder of the $5 million referred to in the $20 million includes $2 million for rural and northern British Columbia and $3 million for the Fraser Valley, the east coast of Vancouver Island and the Okanagan. These are places where....

For example, the communities on the east coast of Vancouver Island have recruited elderly people for retirement without planning for what's going to happen when some of them develop serious psychiatric illnesses, Alzheimer's disease or chronic mental health problems. What is going to happen to these people? They're not looked after already. The question I'd like to ask the minister which, in view of the time, perhaps he can deal with this afternoon.... His deputy minister agreed last August in a meeting with the B.C. Hospitals Association, the College of Physicians, the B.C. Medical Association, the Canadian Mental Health Association, the B.C. Long Term Care Association, the RNABC, the Alzheimer Society, the Friends of Schizophrenics, the Greater Vancouver Mental Health Service and others that $20 million per year was needed just to bring the mental health system up to running order. Not to improve it; just to bring it up to running order. I've read statements in the newspaper in which he has agreed but says: "I'm sorry. You haven't a hope in" — an unquotable word here — "of getting that money from the provincial cabinet now."

I'd like to ask the minister to respond this afternoon. When are we going to see this money, which all people in the field, including the conservative, rightwing city council of Vancouver, agree is urgently needed? Everyone in the field agrees with it. The deputy minister agrees with it; I think the minister agrees with it. When are we going to see this go to cabinet? I remember Sen. Heath Macquarrie dealing with the Skagit Valley case many years ago, saying in the Senate: "How long, O Lord? How long are we to wait?"

HON. MR. DUECK: I have to go back a bit, because some of this information was not available when the question was asked. The member for Maillardville-Coquitlam (Mr. Cashore) asked a question in regard to Higenbottam's study. It is proceeding. It will examine the effectiveness of intensive

[ Page 6408 ]

community treatment. There are roughly seven and a half staff members on this committee. They're looking at 30 patients. It's not yet complete. It's also moved from the Vancouver area to the Fraser Valley. That's where they are operating out of. It is continuing, and I'm looking forward to the report.

Also, the member mentioned the shortage of nurses per psychiatric patient. He mentioned there being one nurse per 80. It's true if you're talking about out-patients. We do have one nurse for every six in-patients during the day and one for every eight in-patients at night. One can take these figures and say there's one nurse for 80, and throw it into the record, and everybody says: "My gosh, how can they look after 80 patients?" While we're talking about out-patients, there's a big difference between out-patients and in-patients, and I think there was a bit of a grey area, where it may have appeared as though we had one person for 80 people in beds, and that's not so. I just wanted to put that in the record.

I should also mention that we are constantly in communication with the city of Vancouver and Dr. Blatherwick, whom you mentioned a number of times. He is certainly an authority of what goes on in the city of Vancouver.

I just announced this morning — you weren't in the House; the member had to leave for a moment, which was perfectly in order — that $350,000 additional funds have been allocated for the city for ten staff members to reduce the caseloads that you referred to.

I have to agree with all the critics who criticize me personally, as a ministry and as a government, that there is probably never enough, and when you mention $20 million.... My deputy just whispered in my ear: "Yes, that is what the industry says would probably be required to cure all the problems this year." You can go and on in hospitals. I could have another billion dollars and would still have people like you.... You mentioned right-wing government; left-wing people come up and say it isn't enough. Let's not use the label "right-wing" or "left-wing" when we are talking about people who need hospitalization and care. Let's leave — I won't use the word "politics" — out of it at this time, because I don't think it's proper.

I'm being told that I am too long-winded. I move that the committee rise, report progress and ask leave to sit again.

The House resumed; Mr. Speaker in the chair.

The committee, having reported progress, was granted leave to sit again.

Hon. Mr. Richmond moved adjournment of the House.

Motion approved.

The House adjourned at 12 noon.