‘It’s simply not acceptable’
Psychiatrist shortage could mean Cape Breton children in crisis sent to IWK: document
An internal document states that mental health services in Cape Breton are at a “tipping point” and proposes that anyone under age 19 in crisis requiring psychiatric help would not be seen in the Cape Breton Regional Hospital’s emergency department or admitted locally.
If the recommendation outlined in the document is accepted, when the needs of a child or adolescent cannot be met on an outpatient basis, they would have to be cared for
at the IWK in Halifax.
That is the plan set out in an internal memo from Scott Milligan, site lead with the department of psychiatry, distributed to local emergency department doctors, which was obtained by the Cape Breton Post. He proposed that the recommendation be put into effect Friday, Dec. 1.
“I think it’s appalling,” said Dr. Margaret Fraser, a doctor in family practice in Sydney who also works at the regional hospital’s emergency department.
Fraser said it was her understanding the change was to go into effect next Friday, Dec. 1.
“The state of mental health services in Cape Breton is in crisis anyway, we currently have seven adult psychiatrists and one part-time child and adolescent psychiatrist ... To have one part-time child psychiatrist when we’ve had three child suicides in the last year is insane. “It’s simply not acceptable.”
Greg Boone, a spokesperson for the Nova Scotia Health Authority, said Friday afternoon the recommendation has not been accepted at this point.
“That’s part of the discussion underway, now, around options,” Boone said in an interview.
“So while no decision has been made, our focus at this time is on options, not a specific date.”
In the memo, dated Nov. 19, Milligan notes they currently have only seven psychiatrists on the call schedule — soon to be six as the College of Physicians and Surgeons has given notice that it will not renew the defined licence of one psychiatrist. Three candidates had agreed to take positions, only to renege over the summer.
“One of these candidates was a muchanticipated child psychiatrist,” Milligan wrote. “We have no candidates in the offing and our current numbers are insufficient to continue working as we have been.”
He noted that, usually, the department had 12-14 psychiatrists and historically the full complement may have been about 16 although they have never had that in the past 15 years. It has lost seven psychiatrists since December 2014.
Halifax, by contrast, has more than 120 psychiatrists, as well as 39 residents and two fellows.
“It does not take a statistician to conclude our numbers are woefully inadequate,” Milligan wrote.
Unlike adult psychiatrists in the capital zone, Milligan said those at the regional hospital are regularly asked to see youth under age 19 in the emergency department and are forced to admit youths to adult psychiatric inpatient units.
“This can no longer continue,” Milligan wrote. “We have always done our utmost to treat these patients locally but we simply do not have the resources to provide the safe, timely and appropriate care that these young people deserve. Youth in Cape Breton, just as youth in Halifax, deserve specialized care when required. Having fourteen or sixteen year olds on an adult psychiatric unit in Sydney is not acceptable.”
Milligan said the current staffing levels don’t allow the department to meet all of its requirements while giving patients the care they need. As well, continuing on under the current model will drive psychiatrists who are still here away, he said.
“This is a gap,” Milligan wrote. “Further, working in such a system puts each of our professional licences in jeopardy.”
The Nova Scotia Health Authority website currently lists the wait time for adolescent and child outpatient or community-based mental health services at the Cape Breton Regional Hospital at 163 days.
It notes that wait times are measured from the time the referral is received by the clinical service to the date the patient has their first choice appointment with a clinician. The shortest wait time in Nova Scotia for the service is in Truro at 44 days.
Boone said recruitment efforts are ongoing. He said, however, that the NSHA knows that it will have to adjust some services “based on the clinical resources we currently have available, and that includes psychiatrists.”
Options the NSHA are considering may include help from other areas of the province, but that discussion is ongoing, Boone said.
The document that Milligan wrote was intended to serve as a catalyst for discussion and a possible plan to move forward, he added.
“We hope that any change that may take place in relation to emergency services for child and adolescent visiting emergency wouldn’t be a barrier for someone deciding whether they should look for emergency help or not,” Boone said, adding they encourage anyone with an emergency mental health concern to present at an emergency department or call the mental health crisis line.
Fraser said during every shift at the emergency department she sees at least one patient with suicidal thoughts, and almost every shift she sees a child who has had suicidal thoughts. She noted Cape Breton in general has high rates of mental health disorders and depression.
“We have children presenting in crisis all the time,” Fraser said. “We have children presenting with suicidal thoughts as young as eight and nine years old, thinking of harming themselves, and now we’re going to have to tell those families, ‘we’re going to have to send you to the IWK.’”
That could open up many other potential problems for families, she added, from potential lost school time, the need to find child care for other siblings, not to mention the expenses associated with having to travel to Halifax and parents potentially trying to rely on family doctors to provide necessary care. It would also be taking place among a population where many are without family doctors and where almost one-third of children are living below the poverty line.
“It’s a huge financial burden,” Fraser said.
She is calling on the province to look at the resources being put into mental health, noting the zone has had great difficulty recruiting, in part because psychiatrists are worked hard and paid less than in other provinces.