Teens cut off from longtime therapists amid changes at Hamilton mental health clinic: ex-staff

This is Part 1 of an in-depth look at changes to a leading child and youth mental health clinic in Hamilton, and the impact they've had on families and mental health practitioners. Read Part 2 here. 

Warning: This story mentions suicidal ideation.

A Hamilton woman says her daughter's therapist at a free mental health clinic run by the city suddenly "fell off the face of the Earth" after helping pull the teen from the brink of crisis. 

Lesley had worried for years about her daughter, who was diagnosed with post-traumatic stress disorder (PTSD) and general anxiety and was having suicidal thoughts. She began receiving therapy at Child and Adolescent Services, which serves people under 18 in Hamilton. 

CBC Hamilton has agreed to withhold Lesley's full name to protect the privacy of her daughter, who fears stigma may impact employment opportunities.

Lesley said her daughter, now 19, built a "really unique and close connection" with her therapist over several years attending the clinic, run by Hamilton Public Health, and her mental health improved significantly. 

Without warning, the therapist was suddenly inaccessible, Lesley said. The family said they kept calling and emailing the clinic to try to get contact information for their former therapist, but were told only that "she was no longer there. We weren't given any reason," Lesley said.

As part of a CBC Hamilton investigation, Lesley, along with a former patient of the clinic and nine former Child and Adolescent Services staffers shared concerns over changes to care offered by the clinic that they say impacted patients. 

Their concerns come at a time when young people across Canada are struggling with their mental health. 

Lesley said her daughter opted to stop therapy rather than rehash her traumatic memories — including those from a sexual assault, bullying and witnessing a murder of another teen — with a new person. Her mental health deteriorated significantly as a result of the lack of care, her mother said.

Clinic pushed for shorter treatment, says therapist 

Former staff members at the clinic said changes came after a management reorganization in 2018. Several of them told CBC Hamilton they felt management's focus shifted from patient outcomes to the number of patients seen, and they felt pressured to offer care in the least number of sessions possible — an approach that was often not in clients' best interests.

"It would be viewed [by management] as a great thing if you had a single session," said Louise Oke, a registered psychotherapist who worked there from 2001 to 2020. 

Former staffers told CBC they're speaking out now because they're worried about the state of care the clinic is offering and they want to share the toll the changes took on them personally.  

One former staffer said she believes the clinic had been serving "the bulk of kids" in Hamilton experiencing mental health crises, so losing so many specialized therapists is bound to have affected the quality of care available for free in the city.

"We were a big player," said Joanne Robinson, who worked at the clinic for 10 years.

In response to the concerns, the city told CBC Hamilton in an emailed statement that the clinic went through a review process to align with the province's Moving on Mental Health initiative and to help reach the greatest number of patients. Those changes resulted in "concrete and positive outcomes," the city said.

11 therapists left or laid off: former staff

The former staff CBC spoke to shared similar experiences that followed new clinic management in 2018. 

Many former therapists said management stopped relying on their expertise to guide programming, stopped allowing flexible work hours to accommodate patients' schedules and began to "punish" employees who voiced concerns about how the clinic was operating. 

Staffers said they were told to stop consulting each other on cases, which they said is an accepted practice in therapy that had allowed them to draw on each other's specialized knowledge. 

Nearly all believe the changes had a negative impact on patients. Staffers also said resulting stress made it hard for them to provide their best care to one of the city's most vulnerable populations.

"It's hard to be a really good mental health clinician when you're struggling," said Robinson, who holds a master's degree in social work. 

The changes were followed by an exodus of staff, former staffers said. At least 11 of 14 clinical therapists left or were laid off by Child and Adolescent Services between the fall of 2019 and June 2022, they said. The vast majority left voluntarily, while at least one was laid off.

Of those who spoke with CBC, almost all said they left "because of the work environment" and several said they felt "forced out" despite leaving voluntarily. Some said they were denied the opportunity for final sessions with their clients.

Clinic changes in line with Ontario priorities: city

CBC Hamilton sent a detailed list of the former's staffers' allegations to clinic manager Lynn Foye and City of Hamilton media relations. We requested interviews with Foye and public health, but they were declined.

Antonella Giancarlo, senior communications officer in the city manager's office, responded by email, saying the clinic went through a review process in 2018 that was "aimed at improving service delivery and changing the in-clinic approach to align with the provincial transformation initiative Moving on Mental Health." 

The Wynne government initiative aimed to streamline access to mental health care and standardize levels of care across the province, according to the Canadian Mental Health Association. 

The city said the clinic saw improvements as a result, including "the review and reinforcement of practice standards, validated assessment and treatment protocols, and an increase in evidence-based interventions, including cognitive behavioural therapy and trauma-focused treatment," said Giancarlo.  

"The changes resulted in more standard hours of work and operating hours of the clinic (including more evening appointments) and the introduction of community-based service delivery, which has enabled the program to maximize reach and the number of children, youth and families served without barriers. 

"Concrete and positive outcomes from 2019 to 2022 include a significant increase in clients served, decreased wait times and a 12 per cent increase in clients who reported a positive experience."

The Ontario Ministry of Health told CBC Hamilton in an emailed statement that local agencies are responsible for the delivery of care in their respective regions and required to submit delivery plans each year to the ministry. It acknowledged the City of Hamilton conducted a program review in 2019 "as part of a continuous effort to improve quality in the organization.

"The ministry did not receive any complaints from the staff or clients with regards to the staffing changes made, nor any impacts to the quality of the service provided by the organization as a result of these changes," the province said.

Social worker says clinic was 'a developing therapist's utopia'

Tim Gordon, a Hamilton social worker in private practice, completed two practicums at Child and Adolescent Services starting in 2012. 

He described it at that time as "a developing therapist's utopia…. The clinic was an incredible place to be a part of. The staff, an eclectic mix of experienced therapists with sometimes complicated caseloads, were willing to share their work and train students."

Gordon specializes in treating attachment- and trauma-related disorders in young people, and has seen an increasing number of complex trauma cases seeking care in recent years. 

He said the ballooning need makes him wonder if Child and Adolescent Services is not offering the same level of intensive trauma therapy that it did previously.

"To help fill the gap, I've increased my supervision support and am taking on as many clients as possible, but I am a solo practitioner, and often, people can't afford to pay for this work out of pocket."  

Gordon added he supervises two student therapists who offer pay-what-you-can services through his clinic, but when they graduate, it can leave a gap. 

New therapist had 'no clue' about his case, says patient

One former Child and Adolescent Services patient who was being treated for complex trauma related to childhood sexual assault said that sometime in 2020, his therapist of about three years was replaced without warning.

"One day I show up for my scheduled appointment and there was a completely different therapist, one I had never met," said the client, now 21. He said the replacement "was all, 'Do breathing exercises. Make some tea if you are feeling sad' ... She had no clue about the details of my case."

CBC has agreed to withhold his name to allow him to speak freely about his health history without fear of stigma around mental illness. 

"If I were to continue with a different therapist, it would be starting back from zero," he said.

He said that after being cut off from his therapist, he struggled in his first year at university and eventually dropped out. 

"I kind of had a nervous breakdown." 

For Lesley, her hope is that quality, long-term trauma therapy remains available to the next family whose child is in crisis.

"It scares me to death to think there's some other kid [who] might not get the care she got," she said. "I can't even imagine being a parent now that doesn't have that option."

If you're experiencing suicidal thoughts or having a mental health crisis, help is available. For an emergency or crisis situation, call 911.

Here are some other resources:

988: Canada's new 988 hotline gives people access to suicide prevention services via call or text. It went live on Nov. 30.

Talk Suicide Canada: 1-833-456-4566 (Phone) | 45645 (text, 4 p.m. to midnight ET only) talksuicide.ca/parlonssuicide.ca.

In Quebec (French): Association québécoise de prévention du suicide: 1-866-APPELLE (1-866-277-3553).

Kids Help Phone: 1-800-668-6868 (Phone), Live Chat counselling at www.kidshelpphone.ca.

Canadian Association for Suicide Prevention: Find a 24-hour crisis centre.