Doctors have fuelled delays at London’s busiest ER by refusing to discharge homeless and mentally ill patients to one of the city’s shelters, a Toronto psychiatrist claimed.

Dr. Ian Dawe, asked in 2014 by London Health Sciences Centre to investigate a bottleneck that left some patients with mental illness waiting more than a week in the ER, lays some blame on doctors who resist discharging patients from the psychiatric ward until proper housing is found.

“While notable and laudable, this practice needs to be reassessed in the face of the crisis in the ED,” Dawe wrote in a report not made public until The Free Press learned of it and asked for it. “Local culture seems to dictate against discharging a stable ward patient to the community before the establishment of stable housing.”

But two years after his recommendation, the hospital seemingly hasn’t budged, at least not much.

“We didn’t really agree (with the report),” said Dr. Paul Links, the chief of psychiatry at London hospitals.

The hospital may have been more cautious a few years ago about discharging those with mental illness to a shelter, but it still weighs that concern before a patient is approved to leave, he said. To do otherwise, said Links, creates a risk the patient deteriorates quickly and returns to the hospital.

Asked if the average length of stay for homeless patients has changed since the report, Laurie Gould, the hospital’s chief clinical officer, said that hasn’t been tracked.

Dawe was blunt in his assessment, writing that, however well intended, psychiatrists on the ward were forcing the most acutely ill to suffer extended stays in the ER.

“Current ward culture and practices must shift to embrace a ‘good enough care’ model as stable patients are discharged into less than ideal, but adequate and appropriate conditions to ensure that the sickest patients are assured access to available hospital beds as they require them,” Dawe wrote.

But experts and advocates for the homeless say that Dawe’s advice would backfire and that psychiatrists here were smart to stick to their guns. The experts include a nurse who pioneered research and efforts to find stable housing for the mentally ill, Cheryl Forchuk, associate director of nursing research at the Arthur Labatt Family School of Nursing at Western University and an assistant director at Lawson Health Research Institute.

Early on in her research, her team compared two groups of patients at risk of becoming homeless for the first time after being at the psychiatric ward of Victoria Hospital. Housing was arranged for the first group of seven patients, but not the second.

Six months after discharge, the first group were living in homes, but in the second group, six people were still homeless while a seventh had become a prostitute.

Forchuk later obtained pilot funding to match patients to housing before they left the psychiatric ward, and though that program later was replaced by another, the intent is the same: Don’t discharge patients to the streets where there will be flares of mental illness and the addictions that often come along, too.

“We should not be discharging people into homelessness,” Forchuk said.

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Still waiting

Ontario’s Health Ministry has still not delivered on a promise to fund a low-cost program that helps psychiatric patients who leave hospitals.

The cash dried up Dec. 31 for those who oversaw efforts to match patients with peers at a cost of $106,000 a year.