An internal report commissioned by the Nova Scotia Health Authority and completed last October recommends the closure of inpatient detox units in Pictou, Springhill, the Strait-Richmond area and some beds at the Cape Breton Regional Hospital.
The report, which CBC News obtained from a confidential source, also calls for the closure of Beacon House — a stand-alone treatment centre in Kentville that treats people with severe and persistent mental illness.
A shift to day treatment
Authored by Ontario consultant Dr. Brian Rush, the report recommends the conversion of addictions units in Middleton and Yarmouth to day units from inpatient facilities.
It also suggests 16 beds at Simpson Landing at the Nova Scotia Hospital be converted for use by addictions services in the Halifax region. That facility was originally designed to allow people diagnosed with serious mental illnesses to learn the basic living skills needed to reintegrate into the community.
The report, Advancing Clinical Services and Supports — Mental Health and Addictions in Nova Scotia, says authorities should model the new day treatment programs after ones already in place at the Cape Breton Regional Hospital in Sydney or at the Fishermen's Memorial Hospital in Lunenburg.
An 'over-reliance on hospital beds'
According to the report, occupancy rates for inpatient mental health beds range from 37 per cent at the Valley Regional Hospital in Kentville to 109 per cent at the Cape Breton Health Care Complex.
The report cites a "very low occupancy rate of the vast majority of the province's withdrawal management services" as a problem given "a significant wait to get into service."
Overall, the report says more than 42,000 Nova Scotians sought help for an addictions problem in 2014-15. For urgent cases, they waited, on average, between four to 34 days to be seen. For "general priority" cases, people waited between four and 41 days for a first appointment.
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The report blames the low occupancy rate on two factors: the unavailability of doctors to do the intake and the number of health-care workers offering addictions services.
"The low occupancy rates may also be a reflection of other options being more available," says the report.
Despite low occupancy rates, Rush says there is an "over-reliance on hospital beds" when it comes to addiction treatment.
"While hospital-based services are important for high-complexity clients and the mix of interdisciplinary professionals seems to be in place to deal with these challenges, there is no evidence that the complexity profile of the majority of cases require this level of hospital-based support."
A call to consolidate beds
The report goes on to say that "intensive but less expensive community-based day treatment services are missing in the province."
It also takes issue with the fact inpatient facilities help patients control their opioid addictions but those patients "are being discharged with no subsequent professional supports in place."
"This is clearly against accepted best practice guidelines," it says.
In the health authority's northern zone, which serves communities from Truro to the New Brunswick border and into Pictou county, the report recommends consolidating all inpatient mental health and addiction beds at the Colchester East Hants Health Centre in Truro.
The report also suggests the authority cut beds by 30 per cent in the western zone, which includes the Annapolis Valley, Digby and Yarmouth regions, as well as most South Shore communities.
Health authority responds
Maureen Wheller, senior communications adviser for the Nova Scotia Health Authority, told the CBC the report was only a single source of information being used to redesign Nova Scotia's health-care system.
"The report constitutes one piece of information that is being used to inform our population-health and needs-based planning approach to improve access, treatment and recovery outcomes in mental health and addictions service delivery," she wrote in an email.
According to Wheller, the total cost of the project will be $183,000, of which $115,000 was provided by Health Canada.