The Parkland Institute

Parkland Institute Research: Fact Sheets

published April 08, 2010

The need to redevelop Alberta Hospital:

Psychiatric beds are at the centre of psychiatric care

by Diana Gibson

download the summary
read the media release 

"Psychiatric beds are at the centre of psychiatric care, and Alberta Hospital Edmonton is essential to the Regional Mental Health Program." - Capital Health¹

Ed Stelmach's Government wants to shut down the Alberta Hospital. In the summer of 2009, they reversed a long-standing plan to redevelop that leading mental health institution, and announced that they were going to close the majority of beds at the facility – 246 of 410 beds – and move the patients to different locations.

A major public outcry resulted, and the Government struck an advisory committee in order to deflect the heat and allow for a face-saving tactical retreat. The advisory committee dutifully recommended a middle ground – leaving 146 of those beds open, but closing the geriatric ward and moving just over 100 patients to another facility.²

The government is proceeding with that plan and has made no commitment to redevelop the hospital.³

alberta needs more psychiatric beds – not fewer

The last thing Alberta needs to do is shut down psychiatric beds. Currently, Alberta has approximately 1,440 mental acute care beds.⁴ This amounts to just under 0.39 beds per 1,000 population.⁵ The Canadian Psychiatric Association (CPA) Position Statement on Psychiatric Bed Levels notes the well-established standard of 0.5 beds per 1,000 population⁶ – 28% more than Alberta has. The CPA position paper states that attempts to use fewer than 0.5 beds per 1,000 population, or to function without adequate community resources, leads to "the substitution of more expensive general medical beds."7 Bringing Alberta up to the CPA standard would require another 412 beds – an extra Alberta Hospital.

However, it is important to bear in mind that Alberta's needs may well be higher than those of the rest of Canada.8 Alberta has a 50% higher proportion of Aboriginal people than the rest of Canada, and northern Alberta has an even higher proportion. Because of their history (colonialization, residential schools abuse, cultural and language suppression, racism, etc.), Aboriginal people have been caused to suffer mental illness at higher rates.⁹

Research does seem to suggest that mental illness rates are higher in Alberta than in Canada as a whole, which clearly has "implications for the planning and funding of services."10 This implies that Alberta may well need even more than 412 new beds.

The problem is acute in the northern half of Alberta – the half served by Alberta Hospital. Alberta's Auditor General noted that the Edmonton regional health authority experiences higher demand for services that they can meet with their existing systems.11 Capital Health identified a "shortage of psychiatric acute care beds" as a challenge facing the regional mental health program.

"Throughout the region, psychiatric acute care beds are in short supply."¹²

Delayed discharges account for 20% of psychiatric acute-care beds, primarily because of inadequate long-term care beds and community care options.¹³ Clearly, closing down beds isn't going to solve that problem; the long-term and community care beds need to be established first.

Alberta Hospital should be redeveloped, not shut down

The concentration of expertise and mental health professionals at Alberta Hospital results in excellent treatment and creates economies of scale that boost cost-effectiveness. Indeed, Alberta Health Services notes that Alberta Hospital is "well recognized for several treatment programs" and is a "national and international leader in the field of research."¹⁴

Capital Health noted that Alberta Hospital "provides a wide range of specialized psychiatric services to residents of Alberta, particularly to those in the north. This provincial resource should be sustained through the provincewide services envelope."¹⁵

However, the facility is stretched and the occupancy rate exceeds capacity.16 In addition the buildings are old, and in need of redevelopment. Several studies have pointed out the need for redevelopment. For instance, Capital Health stated:

"Although the Hospital's services are among the best available anywhere, the site needs redevelopment... Some buildings... would benefit from replacement or major repairs... Many buildings were constructed in the 1920s..."¹⁷

Capital Health identified redevelopment as "a priority to continue to provide complex services to adults and seniors." plan was to implement re-building and repairs (45), and add new forensic beds by 10% (68) by 2007-2008.¹⁸

The plan for Alberta Hospital was that existing aged buildings would be "replaced with a new inpatient campus that will meet the recommendations of the Provincial Mental Health bed review for northern Alberta."¹⁹ The redevelopment apparently was "underway" and the vision was:

"a mental health campus of excellence for client-centered treatment that fits with the beauty of its natural environment. With a growing population, our new, contemporary approach at Alberta Hospital Edmonton will provide specialized mental health treatment in a home-like, non-institutional environment with a central area for common services available to all patients. Our new approach will allow us to respond to future changes to best practices in psychiatric care and will incorporate a focus on community living."²⁰

Why are beds important?

"[Psychiatric acute-care] beds are the first line of service for acutely ill patients who need stabilization. A stabilized patient can then return to the community, access community services and lead an independent life. When psychiatric acute care beds are not available, patient care cannot begin. These individuals may never regain the mental health needed to manage their illness and live independently." - Capital Health, Roadmap for the Future, p.24

In its recent announcements about closing down Alberta Hospital beds, the Government didn't even mention these earlier plans.

Conclusions

The Government of Alberta is heading in the wrong direction with its plans to shut down beds at Alberta Hospital. According to regional studies, and Canadian Psychiatric Association standards, Alberta already has a shortage of acute-care mental health beds.

To bring Alberta up to the standards, we should open 412 more beds – another Alberta Hospital. And because of the higher prevalence of mental illness in Alberta, we could well need more.

Alberta Hospital is a well-recognized, leading treatment and research hospital. However, the facility is over-stretched and in need of repairs and re-building. Several studies have pointed out that it needs redevelopment. It is time for the Alberta Government to take another look at the redevelopment plans that it abandoned in the summer of 2009, and to expand those plans. Alberta Hospital should be redeveloped, and the Government should consider a major expansion.

Full citations are available in the PDF of this datasheet.

download the summary
read the media release 

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