East Region Mental Health Services closure panics family

The staff and programs at East Region Mental Health Services (ERMHS) are what keeps Smith safe, stable and healthy, says his family. It’s as comfortable to him as his own home at the clinic located in the King Campus of St. Joseph’s Healthcare at 2757 King St. E., between Nash Road South and Centennial Parkway.

The 58-year-old Hamilton man, who has bipolar disorder and cerebral palsy, can’t understand how St. Joseph’s could shutter a clinic that has been helping people like him since it opened in January 1983.

“I can’t believe it,” said Smith. “I thought, ‘Why?’ There are so many people in need.”

Some health-care workers have also been voicing their concern in an open letter that started circulating on Thursday, urgently calling for a halt to the closure and, instead, increasing staffing and services at the clinic.

The letter states the shutdown “threatens to exacerbate health inequities and increase the burden on Hamilton’s already strained mental-health system. ERMHS serves as a lifeline to residents in the east end of Hamilton, providing accessible, trauma-informed, and community-based mental-health care. Its closure is not merely the loss of a building; it is the erasure of essential services that reduce stigma, prevent crises and foster wellness.”

The founding psychiatrist of the clinic has also weighed in, urging St. Joseph’s to re-examine the decision to stop taking new referrals this month and completely shut down around the end of March.

Dr. Nick Kates started ERMHS nearly 42 years ago at a time when east-end residents had nowhere else to go for outpatient mental-health care, and he continues to work at the clinic today.

“I think there still is a large need for mental-health and addiction care for people living in the east end of the city,” Kates said. “I think closing a service that has filled that need for many years is going to leave a gap and presents some challenges for people to reach the services they need.”

St. Joseph’s says the clinic is closing to consolidate outpatient services at the West 5th Campus and best use limited resources at a time of high demand. The hospital network says cutting the clinic is not related to its projected deficit of $24.3 million for the fiscal year that started April 1.

“It’s not about a budget cut, it’s about optimizing our resources to provide the most care,” said Dr. Randi McCabe, interim vice-president of mental health and addictions at St. Joseph’s. “We’re in a crisis of mental health and addictions in Hamilton, so how do we optimize our resources to provide the best care that we can, meeting those needs.”

McCabe says a big influence on the decision to close ERMHS was that visits have dropped by more than 20 per cent compared to the last fiscal year that ended March 31, 2024. Just two-thirds of the budgeted 12,000 visits for this fiscal year were forecast to take place.

“We’re always continually evaluating our programs, looking at how they’re meeting the needs and looking at the data in terms of referral volumes, visits and changing patterns,” McCabe said. “As we went through that process, we saw that the volumes to East Region had really reduced year over year.”

However, Matteucci says, the value of ERMHS can’t be measured in numbers alone.

“Mental health is different — people often don’t have the money, the support systems and they need a place that they can get to quickly and that they’re comfortable at,” Matteucci said. “Brian can be very vulnerable and when he goes downhill, it’s fast.”

The ERMHS staff are the “lifeline” that keeps Smith stable, says Matteucci. She particularly gives credit to his main therapist who has been treating him for decades, building trust and respect.

“He hasn’t had an easy life, but having the support and care from ERMHS has made his life better,” Matteucci said. “His therapist is absolutely the most caring, supportive, vital link to helping keep Brian stable and healthy.”

In addition to in-person appointments, Smith can contact his therapist any time by email and she will respond to help him. She alerts his psychiatrist if he’s starting to go off course and, with Smith’s permission, she communicates with his family so they can work together to keep him well.

“By having the ongoing support and contact with his therapist, when his mental health declines, Brian has been able to avoid long hospital stays,” Matteucci said. “She averts problems that could potentially happen if nobody’s watching him … She’s been in his life for so long, I just can’t imagine how he would deal with it.”

Smith also has built strong connections with other ERMHS patients and staff while attending programs.

The clinic is such a safe haven that he kept his care there when he moved to the west Mountain in 2020.

“You meet people who have more problems than you or less problems than you,” Smith said. “But you sort of come together as one.”

Smith will lose his therapist and other ERMHS staff when the clinic closes, and their jobs are eliminated. Kates said that, unlike other consolidations, the ERMHS staff are not going with the patients to the community psychiatry clinic at West 5th. Only the psychiatrists will make the move.

McCabe said St. Joseph’s is “working on a case-by-case basis to find opportunities for any affected staff members to work elsewhere in the hospital.”

But mental health is based around relationships, said Kates, and those “absolutely critical” ties will be lost when the clinic closes.

“We can never underestimate the importance that these relationships can play,” said Kates. “It’s just knowing that there’s someone there with whom you have a continuing relationship. If you do have a problem, there’s someone to call and there’s someone who is going to be checking and seeing how you’re doing.”

McCabe said existing patients will continue to receive the care they need and efforts will be made to minimize any disruption.

But both Matteucci and Kates question how West 5th will take on more than 350 extra patients with no additional staff.

“That’s a service that is already busy,” said Kates. “There is an enormous amount of unmet need … As we reduce the staffing for general outpatient psychiatry, I think we do run the risk of people in the east end finding it harder and harder to reach the services they need.”

While Smith can get to the West 5th Campus, Kates worries that many other ERMHS patients will not go there.

“We know that the closer you are to a service, the more likely you are to use it,” Kates said. “I think it becomes an equity issue as well. We know within the East Region catchment area … there are people who face multiple disadvantages, not only social or economic, but also in accessing services.”

A Hamilton public health report in November strongly tied health outcomes to social determinants of health, such as income, education, housing status and race.

The Community Health Status report found the gap between Hamilton neighbourhoods is widening. For instance, those living in parts of the city with the lowest household incomes were nearly five times more likely to self-harm than residents in the most wealthy areas.

“Closing ERMHS will worsen these inequities, further marginalizing vulnerable populations and increasing reliance on emergency services that are ill-equipped to provide ongoing mental-health care,” stated the open letter.

Kates asks why St. Joseph’s isn’t looking to improve the service — instead of closing it — if its referrals are declining at a time when mental-health care is in high demand.

“I would hope that this decision could be re-examined and we can understand why numbers have been dropping off and looking at whether there are any barriers or obstacles to people reaching the services as they’re currently configured,” Kates said. 

One key reason for the drop in numbers at ERMHS is dwindling resources over the last five years, said Kates. The program is down to five psychiatrists working the equivalent of less than one full-time job and two of the doctors are retiring.

“One of the things we’ve noticed is psychiatrists leaving and we haven’t, for a variety of reasons, been able to replace them,” Kates said. “The efforts have been there, but, they haven’t been successful … Generally, it’s hard to recruit psychiatrists and community mental health isn’t necessarily everybody’s ideal job.”

The open letter also puts the blame on “persistent staffing shortages, particularly in psychiatry” that have resulted in increased wait times.

“The needs assessment must account for actual demand for ERMHS programs and explore the reasons for reduced referrals, which are more likely linked to longer wait times, staffing shortages and barriers to accessing care — not a diminished need,” stated the letter. “Closing ERMHS risks pushing residents to pay out-of-pocket for private care or forgo care entirely, worsening inequities.”

This is not the first time that ERMHS has been targeted for closure. St. Joseph’s considered shutting it down in 2016 as well. Matteucci is hoping the clinic can be saved a second time, so her family doesn’t have to go back to constantly worrying about Smith’s mental health.

“Before he had this facility, we were always on guard watching to see when the shoe would fall next,” said Matteucci. “This is not a good thing for him or anyone.”