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Earlier discussion

Dr. Donald Milliken and hospitals

Psychiatrist talks about mental health and the hospital system

Globe and Mail Update

When it comes to care, mental health has always been the poor cousin of physical health, Globe reporter Andre Picard writes. This is partly due to a legislative anomaly: Half a century ago, when medicare was created and Ottawa started funding hospitals, asylums for psychiatric patients were excluded.

Those suffering from severe, persistent mental illness were warehoused in institutions paid for solely by the province. Then came the civil-rights movement, coupled with the advent of effective drug treatments, which led to policies of massive deinstitutionalization.

In the article Dr. Donald Milliken, president of the Canadian Psychiatric Association and a practitioner with nearly 40 years of experience, recalls his experience as a medical resident in 1970: "They gave me the keys to a ward and said, 'There are 100 patients in there. Discharge 50.' "

The number of long-term psychiatric beds in Canada plummeted from a high of close to 60,000 in the 1950s to just over 6,000 today. That, in itself, was not a problem. But mental illness did not miraculously disappear and governments did not invest in community supports for sufferers.

"The system is in chaos," says Dr. Milliken. He says patients might be getting good care but not appropriate care. The fundamental trouble is not necessarily a lack of money or a shortage of beds but a lack of organization.

"If you take the same amount we spend on ad hoc care and spend it on organized care," he says, "the care and the outcomes would be better."

What do you think? Do you have questions about the hospital systems? Have you or someone in your family had a brush with hospitals and the mental health system?

We're pleased to have Dr. Milliken join us online for a live discussion now, until 1 p.m. ET. Ask a question now and join us then to read Dr. Milliken's answers, which will appear below.

Dr. Donald Milliken has practiced both clinical and administrative psychiatry for almost 40 years. He trained in psychiatry at the University of Alberta and has an additional degree in health administration from the University of Colorado. He was the Chief of Psychiatry for the Misericordia Hospital, Edmonton, then the Clinical Director of Forensic Services, Alberta Hospital, Edmonton and taught at the University of Alberta with the rank of Clinical Professor.

In 1993, Dr. Milliken relocated to Victoria, British Columbia, where he was the Chief of Psychiatry for seven years. During this time, he developed a catchment-area model of services, integrating in-patient and out-patient systems with the belief that care must go to those most in need; that the system must provide continuity of care and support in a simple yet seamless manner, and that the organization of care must be seen as being clinically sensible by practitioners and recipients alike.

A past-president of the Canadian Psychiatric Association (CPA), Dr. Milliken advocates about the need of getting levels of care for patients with psychiatric illnesses that are equal to those provided to patients with other illnesses of equivalent disability.

Editor's Note: globeandmail.com editors will read and allow or reject each question/comment. Comments/questions may be edited for length or clarity. HTML is not allowed. We will not publish questions/comments that include personal attacks on participants in these discussions, that make false or unsubstantiated allegations, that purport to quote people or reports where the purported quote or fact cannot be easily verified, or questions/comments that include vulgar language or libellous statements. Preference will be given to readers who submit questions/comments using their full name and home town, rather than a pseudonym.

Christine Diemert, globeandmail.com writes: Thanks for joining us today Dr. Milliken. In Andre Picard's story Tuesday about hospitals you were quoted saying the system is in chaos. I'm curious about how we can begin to fix a system that varies according to each province, but needs national attention.

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