2000

...and 29 hits!

Good News!

The Ministry of Health and Long-Term Care no longer funds Fulshear Ranch Academy.
I seriously think it is a huge shortfall that reported physical abuse takes a year to be heard but I'm glad it has now!
:) 

1000 Hits!

As of today, sometime, I have reached 1000 hits!

TTH: Making up for Deficits in the Canadian Healthcare System

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Making up for Deficits in the Canadian Healthcare System

When the Government of Ontario cannot provide adequate healthcare to its residents, they offer  Prior Approved Out-of-Country Health Services in four key areas: Bariatric Services, Cancer Care, Diagnostic Imaging, and Residential Treatment Facilities (Ministry of Health and Long-Term Care, 2002). 

One year ago, I arrived back home in Canada after having attended a United States Residential Treatment Facility that had been Prior Approved by the Ontario Health Insurance Plan (OHIP) for an initial three month period. Gaining approval from OHIP was a very arduous and frustrating task. It involved getting a referral from my attending psychiatrist, and although it was recommended my family pay a lawyer to process the claim, I produced a 35 page document myself, proving that there were no adequate facilities in Ontario that could accommodate my situation. To my relief, OHIP accepted my application for this three month period. In October 2011, I discussed treatment options for my diagnosed illness, Borderline Personality Disorder (BPD), with my psychiatrist. We had previously been exploring healthcare options in Ontario- many of which were self-referral (which has since been changed to physician-referral), Day Treatment (partial hospitalization) programs that were not widely available. There are, however, three facilities in Ontario that offer an unrestricted service area based on residency: Ontario Shores Centre for Mental Health Sciences; Providence Care Centre: Mental Health Services Site; and the Centre for Addiction and Mental Health (CAMH) (Centre for Addiction and Mental Health, 2012a; Ontario Shores Centre for Mental Health Sciences, n.d.; Providence Care, 2013). At the time in which I was seeking treatment at these facilities, each had at least a three year waitlist; CAMH was not accepting any referrals and it was suggested to me that at the beginning of each month, I telephone the referral line to determine whether a spot on the waitlist had opened up (CAMH, 2012a).

With 1% of the population suffering from Borderline Personality Disorder, and a population in Ontario of 13.5 million, it means that  about 135 thousand individuals in this province, alone, suffer with this illness (Paris, 2005; Statistics Canada, 2012). About 10% of those with the disorder take their own lives (CAMH, 2012b). A diagnostic feature of particular concern with persons experiencing BPD is “recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior” (4th ed., text rev.; DSM–IV–TR; American Psychiatric Association, 2000). In patients that display these behaviours, the efficacy of full hospitalization in general psychiatric wards is unsubstantiated and can often have a negative outcome (Paris, 2004). Psychotherapy, notably, Dialectical Behavioural Therapy (DBT), which has been the most widely studied, is the most effective treatment for BPD (Biskin & Paris, 2012).

Dialectical Behavioural Therapy (DBT) is a large component of the three Borderline Clinics (and of many that have restricted service areas) in Ontario (CAMH, 2012a; Ontario Shores Centre for Mental Health Sciences, n.d.; Providence Care, 2013). With waitlists in Ontario of over three years, and the concerning pattern of behaviour displayed by individuals with the illness, most can simply not wait for the publically funded treatment. DBT is also offered in a private setting for a cost, which is often only partially covered by private health insurance and is commonly only offered in urban areas.

When I discussed the possibility of going out of country for treatment with my psychiatrist, we knew that treatment would not be immediate, but that I would receive it before I came to the top of the waitlist in Ontario. With concerning symptoms requiring frequent emergency room visits, my family and I were desperate to find an appropriate treatment.

In February of 2012, I was approved by OHIP to travel to Texas, which is one of two U.S Preferred Providers (Prior Approved), Residential Treatment Facilities offering therapy for Borderline Personality Disorder (Ministry of Health and Long-Term Care, 2012). At the beginning of March 2012, I entered Fulshear Ranch Academy to begin treatment. I quickly found that the treatment facility was not equipped to deal with my illness and the therapy that had been recommended (DBT) was not offered, despite their claim to the contrary.

The Fulshear Tuition Financial Agreement states that there is a one-time enrollment fee of $1600 and a program fee of $369 USD per day (Fulshear Ranch Academy, 2012). OHIP has a preferred rate of pay for this treatment facility of $202 USD per day. The Ministry of Health and Long-Term Care (2012) states on their website that they:

[Do] not endorse, warrant, guarantee or otherwise certify the quality or standards of residential treatment or other services provided by preferred providers. These considerations should be reviewed by the patient in consultation with his or her attending physician(s). Hospital scorecards are one tool that may be of assistance to patients and physicians seeking further information about appropriateness, quality and safety.

As there is no information on the Ministry’s website pertaining to how any of the treatment centres came to be “preferred providers”, I question whether the decision to sponsor a facility as a “preferred provider” has anything to do with a reduced cost of service. I can say with certainty that it is not due to the quality of service or level of professionalism of the staff. Many of the practices were not to the same, or similar, to standards one would expect in Ontario hospitals. For instance, the staff on hand throughout the day, who were not directly providing structured individual psychotherapy, had no clinical background and were ill-equipped to provide treatment to the patient population. Those who were providing psychotherapy were not licensed with the American Psychological Association (APA). In spite of informing the Ministry of Health and Long-Term Care about the negative experiences that I had, they continue to list Fulshear Ranch Academy and two other Residential Treatment Facilities operated by the same Company, InnerChange, on their website.

Individuals who face similar circumstances to myself are often desperate to try anything and receiving treatment in a more timely manner to what is typical in Ontario is enticing to anyone. Regardless of the MOHLTC’s disclaimer stating that they do “not endorse, warrant, guarantee or otherwise certify the quality or standards”, I argue that publishing a list of Preferred Providers is a form of endorsement, if not the definition of the word itself and I feel that they should do more to ensure the quality of care to such a vulnerable population. The Ontario Government should license these facilities prior to allowing their name to be associated with a given institution.  

Reference List

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.

Biskin, R., Paris, J. (November 20, 2012). Management of Borderline Personality Disorder. Canadian Medical Association Journal (184.17). Retrieved from http://search.proquest.com.proxy.queensu.ca/docview/1314695485

Centre for Addiction and Mental Health. (2012a). Borderline Personality Disorder (DPB) Clinic. Retrieved from http://www.camh.ca/en/hospital/care_program_a nd_services/CATS_centralized_assessment_triage_and_support/Pages/guide_cats_bpd.aspx

Centre for Addiction and Mental Health. (2012b). Borderline Personality Disorder. Retrieved from http://www.camh.ca/en/hospital/health_information/a_z_ mental_health_and_addiction_information/borderline_personality_disorder_an_information_guide_for_families/Pages/Borderline-Personality-Disorder.aspx

Fulshear Ranch Academy. (2012). Enrollment agreement. Retrieved from http://ww w.fulshearranchacademy.com/attachments/fraEnrollmentAgreement.pdf

Ministry of Health and Long-Term Care. (2002). OHIP Out of Country Services. Retrieved from http://www.health.gov.on.ca/english/providers/progr am/ohip/o utofcountry/us_preferred_providers.html

Ministry of Health and Long-Term Care. (2012). U.S. Preferred Providers: Residential Treatment. Retrieved from  http://www.health.gov.on.ca/english/providers/pr ogram/ohip/outofcountry/us_preferred_providers/restreatment_facilities.html

 Ontario Shores Centre for Mental Health Sciences. (n.d.). Borderline Personality Self- Regulation Clinic. Retrieved from http://www.ontarioshores.ca/cms/One.aspx?p ortalId=169&pageId=5902

Paris, J. (June, 2004). Is Hospitalization Useful for Suicidal Patients with Borderline Personality Disorder? [Abstract]. Journal of Personality Disorders (18.3). Retrieved from http://search.proquest.com.proxy.queensu.ca/docview/195242380

Paris, J. (June 7, 2005). Paris, J. (2004). Borderline Personality Disorder. Canadian Medical Association Journal, vol. 172. doi: 10.1503/cmaj.045281

Providence Care. (2013). Personality Disorders Service. Retrieved from http://www.providencecare.ca/cms/sitem.cfm/clinical_services/adult_treatment_&_rehabilitation_services/personality_disorders_service/

Statistics Canada. (2012). Population by Year, by Province, and Territory. Retrieved from http://www.statcan.gc.ca/tables-tableaux/sum-som/l01/cst01/demo02a-eng.htm

More Updates!

Last night I was happy to learn that the submission I made for the Jack Project's Unleash The Noise Youth Mental Health Summit, made a positive impression and I was chosen to be a student delegate at the conference!

Stay tuned to how it goes (more than likely I will update this post with a new blog address so I can write about the progress we're making on this wonderful fight to reduce stigma and reduce the occurrence of mental illness in our youth population)!

http://www.thejackproject.org/
http://letstalk.bell.ca/en/  (Happy Bell Let's Talk Day- If you have a bell phone, text me, although I won't be here to text you back- but I will when I am on February 13th!)

6 months later...

Lots of other things that happened, I did not mention. Like the physical abuse I suffered.

To update y'all (no, I didn't really coin terrible "English" from this sorry excuse for a treatment centre...), I am now attending more than full-time studies at a very prestigious Canadian academic institution (Harvard of the North*). I have decided to complete a 4 year degree in 2 years. I am studying a Bachelor of Science in Life Sciences with a Subject Specialization in Neurology and a Minor in Psychology. In the future, I hope to attend an internationally leading school in the UK for joint studies at the Ph.D/M.D level and I hope to continue to pursue neurology as a life long career.

If I had stayed in this program, I would have experienced more abuse, more neglect, and ultimately probably have died from my illness. Now I know that I am an intelligent human being, and I can fight the system. My life will be filled with wonderful, joyous achievements and I am so glad I was able to escape from such an awful situation. I hope that you, who is reading this, makes a good choice for you, for your daughter, for your family member. This is probably not worth it, but that's just my opinion.

Attending "treatment" at Fulshear Ranch Academy was quite honestly one of the worst experiences of my life. I am a 20 year old from Ontario, Canada. I started my process of seeking treatment in the United States in October of 2011. I was directed to the Government of Ontario's prior-funding approval website. Due to the nature of my disorder (BPD), I had no other choices in terms of treatment in another country other than Fulshear Ranch Academy. My family was urged to hire a lawyer for the process of attaining full-funding from OHIP. We declined to go this route and in February of 2012, we were approved. I would just like to note what OHIP says on their website regarding prior-approval...

The MOHLTC does not endorse, warrant, guarantee or otherwise certify the quality or standards of residential treatment or other services provided by preferred providers. These considerations should be reviewed by the patient in consultation with his or her attending physician(s). Hospital scorecards are one tool that may be of assistance to patients and physicians seeking further information about appropriateness, quality and safety.

This is the absolute truth! Two-weeks into my stay at Fulshear Ranch Academy, we were visited by InnerChange's CEO, Dustin Tibbitts. He explained to me that he went to all of the governments in Canada, asking for them to fund treatment at this facility. Ontario, stupidly, was, to my knowlege, the only province to accept. I feel like you don't just start funding three residential treatment facilities for no reason (the Ontario government funds all three of InnerChange's residential treatment facilities for young women). I cannot confirm that money was exchanged, but I don't believe that Ontario started to fund this facility solely based on the stellar record that I'm sure Mr. Tibbitts presented.

In March of 2012, I traveled to Texas to start treatment at Fulshear Ranch Academy. The first thing I noticed was the facility was not as it was presented to be on their website. The bathroom that was assigned to be mine did not look like it had been cleaned in recent memory, despite the fact the girls were said to have cleaned it every week. There was mold growing all over the shower curtain and it was all just completely unsanitary. Another thing that I found to be appalling was the quality of the food. I am a vegetarian and most nights, meat was on the menu. We were told we were only allowed to eat what was on the menu. Fortunately, we could also make salads for ourselves. However, having a salad is not a balanced meal. I would consistently bring up the fact that for vegetarians, the meal choices were nutritionally lacking and I was met with, "well, you can have a salad". My stomach started to hurt constantly from being deprived of protein, despite my best efforts to include it in my diet while adhering to my beliefs.

Fulshear Ranch Academy claims on their website that, "[their] professionals are selected for their clinical sophistication and talent with this population; they undergo continuous training in the most effective educational, therapeutic, and transitional approaches available for young women". This couldn't be further from the truth. Most of the daily staff likely had no post-secondary education and at the most had an undergraduate degree. One staff member, specifically, told me she was studying for a Master's degree in psychology and was using the same texts as Queen's University uses for second year, undergraduate courses. Some staff were employees at juvenile detention centres and would use tactics taught for that setting with the population at Fulshear, which was usually inappropriate. The clinical staff were no better. I found the therapists (mostly male, strangely), who are licensed (supposedly), would make sexual comments towards the young women in treatment and stare at our breasts. The recreational therapist loved to have us swim in the little pool during his time with us. He loved to see 20 girls all in their bikinis. I didn't find it the most appropriate, but it didn't seem to bother anyone else.

The daily programming is not how it is portrayed on Fulshear Ranch Academy's website. Having Borderline Personality Disorder, I expected the treatment, dialectical behavioural therapy (DBT), to be twice a week (as per the sample schedule on their website). DBT was once a week, but most weeks it was cancelled due to the therapist who was supposed to be running it not showing up (which was another commonality). I am an avid swimmer and was happy to learn that swimming at the YMCA was every morning and some evenings. I was told I was not allowed to swim during the mornings because it was not designated as a Christian swim time and it was inappropriate for me to be swimming during mainstream swim time. I don't happen to be Christian, so I found it strange, and a little offensive for me to be using their swim time for myself. Needless to say, I never went swimming my entire stay. Another aspect of the schedule that I was looking forward to was the academic time. This, quite simply, never happened. I started to take a course prior to going to Texas under the impression I could continue with it while I was down there. One day was allotted to me to work on my course but I wasn't able to access people with any knowledge of my course material for help, making it difficult. Although, I will admit, some of the girls who had not completed their high school diplomas were taken off of the treatment facility's campus to attend GED courses and some people in the other phases of the program were urged to attend classes at Wharton County Junior College. I have a high school diploma and I wouldn't have wanted to take classes at a college (especially not in the USA, especially not in Texas) but I was not offered such an opportunity.

Medication was an issue all on its own... There were three times dedicated to medication- Morning, afternoon, and evening. I usually would not wake up on time for the morning medication time and was not given an opportunity to take my medication until the afternoon. As many people know, psychotropic medication is not something to be messed with. Taking it at the wrong times, even though it was my fault, did not prove to be a good thing. Medication was usually doled out by the supervisor on the shift (yes, the same ones with little to no education, yes, those ones). You had to be very careful that you were, in fact, receiving your medication at the right dose because they would constantly give you someone elses or an incorrect dose, neither of which I found to be very professional. They claimed to have had some training on the subject but it was certainly not enough. In Ontario, the handling of medication in a health care environment is not done by anyone without sufficient training, so something like this would never fly here.
Because I am from Ontario, I got three months worth of my medication from the pharmacy here, prior to going to Texas. Some medication is marketed under different names in the US to Canada and the staff were very confused on this issue. It was left up to me to know both the Canadian name (which was the name on the bottles of pills I was taking), and the American name (which was on the list of medications I was taking and therefore what the staff referred to it by). This is where some of the confusion and misuse of medication came from.
When I left Fulshear Ranch Academy, they neglected to give me all of my medications that I had brought with me. I have a feeling they were giving it to other girls in the program, despite the bottle clearly having my first and last name on and is illegal. We contacted them after realizing their mistake and they never returned the unused medication or replied to our emails on the subject.

Fulshear Ranch Academy has some strange practices, albeit likely common in the world residential treatment facilities. A practice that they uphold is that no client shall call their family until two weeks into treatment and only for a half-an-hour on Sundays after that time. I don't know about you, but when I'm going through stuff, I kinda want to talk to my family. When you are allowed to talk to them, your phone calls are monitored (not super closely, though) and you always feel like you could lose your privileges if you say the wrong things. I honestly feel like not allowing clients to talk on the phone is due to the slew of malpractices. Most parents, if you are lucky enough to tell them how bad it really is, will bring it up in a phone family session. If your therapist gets word you have been saying bad things about the program, they will do their best to assure your family it is due to your child's manipulative nature and to absolutely not give into it. My parents, like many, did believe my therapist. Which was fine with me, I was 20, I checked in voluntarily, I would check out. Or, so I thought... Trying to get out without my parents approval was hell. Another one of Fulshear's strange practices is they take all of your money, most of your possessions, and your passport/other identification and lock it up. I thought that because I was an adult and in the program voluntarily, getting my things and leaving would be no problem. Boy was I wrong! At first they refused to entertain the idea of me leaving and told me I could not book a plane ticket, because I would be using their computers. I had my own, but it was locked up and according to them, it was my parents possession and that was their reasoning for not allowing me to have it. Fine, that was fine. I can live without a computer, but what I can't live without, and what there is no disputing was mine, was my passport and other forms of identification. Well, I was pretty much SOL when it came to obtaining those things, too. So I asked to seek legal council. The director of the program, Gayle Jensen-Savoie (awful, awful woman, by the way), sought legal council for herself and told me that according to her lawyer, it was within her right to keep me there because I was "unsafe". Well that was the biggest load of bullshit I had ever heard... So I thought I was going to have to call the Canadian Consulate, but not before I got my hands on a telephone and called the police. I called them, they came, and told me if I wanted my things back, I would have to take Fulshear Ranch Academy to civil court. So, in short, they were not very helpful. I was adamant I was going to leave, so eventually, they did entertain the idea. I looked up flight information on their computers and proceeded to call my family to let them know what time to expect me home. They were not thrilled with this idea, so they decided they would give into me, and drive down from Ontario to Texas. On the day that they arrived, I was so excited to show them all of the shit I had to put up with that month. We met with my therapist as he made one last ditch effort to keep me there. Fortunately my parents sided with me and told me that they had known me for twenty years and this man had known me for two minutes. What he was doing was manipulating them into keeping me there, not the other way around and thankfully they saw that. And thankfully I was not persuaded into staying with the promise of them getting me a dog (yeah, I'm serious...). 

As something I have not yet mentioned, some of the other girls at the treatment facility were not the best company. While I was there, one girl freaked out and was sent to jail because she injured two others. One girl was exposing herself to the other girls in treatment. Some girls would go off campus for meetings and in spite of the fact it was a smoke-free facility, cigarettes routinely made it onto campus and drugs were also common. 

I would think twice about sending my child to any of InnerChange's programs, but especially Fulshear Ranch Academy. I wanted to put this information where it could be accessible because I don't want anyone to have to go through what I had to. When I searched for reviews of Fulshear Ranch Academy, I didn't get very far when it came to negatives, but I assure you, this is the popular opinion even on the campus of FRA. If you are considering it, go to visit it first and talk to the girls, they will give you an accurate picture of what this place is really like, and I think you'll find it's not how Fulshear Ranch Academy portrays themselves.


*Also, just to note, the other two treatment facilities operated by InnerChange are located in Utah, which, for a reason I have not been able to answer, is filled with corrupt treatment facilities. If you would like more information on residential treatment facilities, particularly for adolescents, I recommend you read Teens In Crisis: How the Industry Serving Struggling Teens Helps and Hurts Our Kids.