The Rouge Valley Health System is faced with long-term debt and capital deficiencies that total $78 million, and moving mental health beds and cutting jobs are part of a plan to improve efficiency and ease financial pressures.

"We've got to learn how to spend our money more effectively," said RVHS president and CEO Rik Ganderton. "We have to fix this situation."

In late March, the Central East Local Health Integration Network board of directors approved a plan by RVHS to cut costs, including the elimination of up to 220 jobs and the consolidation of the mental health in-patient unit at Centenary hospital. The board also asked RVHS to consult the public, since it's a LHIN requirement.

The jam-packed meeting that held nearly 1,000 residents went about 40 minutes over its allotted time with lineups of people still waiting at the microphone to give their opinion. Twelve-year-old Emily Sams was in tears at the end of the meeting. She didn't get the chance to speak, shouting "Let us speak" when the microphones were turned off. Although the meeting ended, some members of the CELHIN and RVHS stayed to continue conversations.

Whitby resident Cadence Grace stepped up to the microphone and described herself, a college graduate and musician, as the face of mental health.

"We have discovered once again that you're using the people with the most to lose to shield yourselves from your own mistakes," she said to the cheering crowd.

Ms. Grace has spent six weeks in the unit during the past nine months and says it's always close to full.

"It's Centenary that has difficulty filling in-patient beds, not Ajax," she said. She added if the LHIN and RVHS staff took a pay cut, they could save millions of dollars a year, which brought the crowd to its feet.

The RVHS has stated only 77 per cent of mental health beds are utilized. In a breakdown at the stakeholder meeting Wednesday, RVHS director of mental health Cheryl Williams said RVAP has an occupancy rate of 80-to-82 per cent, whereas Centenary patients fill 72-to-74 per cent of the beds.

"But, still there are more patient days at Centenary than Ajax," she said, adding stays are usually around 10 days at RVAP and 12 days at Centenary.

Ms. Williams's justifications for the changes were met with boos from the crowd.

"All in-patient beds will be available, just at a different location," she said.

Ms. Williams said consolidation allows the creation of a critical mass of care. She said mental health services can still be accessed through RVAP, and that current mental health care is focusing on community programs, and out-patient services.

"Hospitals should only be used when all other less-restrictive approaches have not been beneficial," she said. She added crisis hours are increasing to 16 hours a day and follow-up care will take place in the community, whether through the hospital or other mental health programs in the area.

Bill Parish, co-chairman of the Friends of Ajax Pickering Hospital, also stirred the crowd up by grilling the panel with a number of questions and comments. He noted the public should have been consulted before the decision to move the beds was approved.

"They've abused the process and they've abused power and they shouldn't get away with that," he said.

Ajax resident Chris Andersen, who has suffered from depression, asked if a decision has been made, and if it had, "what the hell are we doing here?"

Deborah Hammons, CEO of the CELHIN, explained the plan was approved, and James Meloche, senior director of planning, integration and community engagement, later added the reason for the meeting was to determine the community's needs, how to improve services and ease issues such as transportation concerns.

Wendy Lawson, who's been a mental health in-patient at the hospital, said she's seen someone snap and tear the wiring off the ceiling in the ward and said she couldn't imagine if that person had to be transported to Centenary.

"When you snap, you snap, and there is no time," she said.

Dr. Steve Fishman, chief of psychiatry, explained in an interview after the meeting that senior management, more specifically, Mr. Ganderton, are "picking up the pieces in a very difficult situation.

"You can't have growth on a rotten foundation," Dr. Fishman said. "If you can fix the foundation then you can grow."

Ashley Swalm said she's waited 10 hours in crisis to be seen in the past and mentioned "then to be transferred to Centenary is really unbelievable."

Dr. Fishman said later that 10-hour waits are "unacceptable" and said a mental health area is planned to go in the RVAP to help improve and co-ordinate service.

Ms. Swalm, along with a number of others, asked what happened to the nine beds intended for the mental health unit that were announced with the redevelopment.

Mr. Ganderton said RVHS has not been given additional funding for them as of yet, but did say the beds will go toward the expansion at RVAP.

"We're in discussions with the LHIN as to the best use for those beds," he said.