Fulshear Ranch Academy: Worst Experience of My Life. But it's Getting Better Everyday: 2013

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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

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