A mental health expert leading an independent review of Manitoba's mental health and addictions services recently came under fire for recommending residential bed closures in other provinces.
That's causing concern among local advocates who want the province to increase the number of addictions beds.
"We need more long-term residential beds, not less," said Carol Ward, a Steinbach mother whose daughter fatally overdosed on opiates last summer. "Had that been available when my daughter was in the situation she was in … I strongly believe it would have made a big difference for her."
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This summer, the province recruited Dr. Brian Rush, a nationally renowned mental health and addictions consultant, and a team of experts to review the way mental health and addictions services are delivered in Manitoba.
The mental health and addictions strategy they've been asked to produce will recommend ways to to cost-effectively merge services.
Carol Ward was invited to attend one of the consultations the team hosted in the province over the summer. She told the CBC that her message was clear: the province needs more long-term residential beds for addicts seeking treatment.
"I'm a big advocate for that. I believe, and very strongly, that is our answer in Manitoba," Ward said.
In other provinces, Rush and his team recommended reducing the number of long-term beds to pave the way for more day treatment programs.
Detox, mental illness bed closures
In March 2017, the CBC obtained an internal document commissioned by the Nova Scotia Health Authority, in which Rush recommended the closure of three in-patient detox units and some beds at the Cape Breton Regional Hospital.
It also called for the closure of Beacon House, a stand-alone treatment centre for people with severe and persistent mental illness.
In some cases, the report recommended converting the addictions beds to day units.
The recommendations have not yet been implemented.
'I would suggest to Manitobans, do not accept the loss of your in-patient services' - John Lohr, Nova Scotia PC MLA
Rush made similar recommendations to the Ontario government in 2016, urging restraint when placing patients in the "more resource-intensive level of care" of residential treatment, "as outpatient/day treatment has stronger evidence of cost-effective outcomes."
In both provinces, the recommendations drew criticism from mental health advocates and politicians.
"I would suggest to Manitobans, do not accept the loss of your in-patient services," said Nova Scotia Progressive Conservative MLA John Lohr. "There's just too many places where people need to have in-patient services, where you cannot manage it at home, or you're homeless or there's conflict at home."
'Why is this an either/or?'
Mental health advocates agree that the less costly day treatment programs can be as effective as residential programs, but Lohr said one shouldn't be sacrificed for the other.
"Why is this an 'either/or' thing?" Lohr said. "It looked like it was a cost-saving measure."
The Addictions Foundation of Manitoba has some residential treatment programs with a total of 130 beds. The average wait time is 74 days. The foundation also has community outreach and day programs throughout the province.
They've stickhandled 18,000 admissions into their programs in the past year.
Ben Fry, CEO of the Addictions Foundation, told the CBC their consultations with the review team were extensive and "very, very positive."
He was surprised to learn about Rush's earlier recommendations to close residential beds in other provinces — and Fry did not make that recommendation here.
"No, AFM is not recommending reducing the number of beds," Fry said.
Tara Brousseau Snider, executive director of the Mood Disorders Association of Manitoba, agreed that community or day programs can be successful when treating mental illness — but not at the expense of residential care programs.
"The ones that tend to need beds are the very chronically ill, which Mood Disorders, that's our community as well," Brousseau Snider said. "And people with high addictions, and usually it's both mental health and addictions, so we need beds to support that."
The CBC requested an interview with Rush, but a spokesperson for the province declined on his behalf.
The spokesperson would not comment on whether the review will recommend bed closures.
"It would not be appropriate to speculate on what recommendations may or may not be included in the consultant's final report," the spokesperson said.
An interim report is expected by the end of 2017.