Short­age of psy­chi­a­trists strains Ot­tawa re­sources

Re­port finds both com­mu­ni­ties and hos­pi­tals af­fected as sit­u­a­tion wors­ens

Ottawa Citizen - - FRONT PAGE - KIERAN DELAMONT kde­la­m­ont@postmedia.com

The wide and wors­en­ing short­age of psy­chi­a­trists in On­tario is af­fect­ing the Ot­tawa area, and the city needs around 25 more psy­chi­a­trists to make up the dif­fer­ence, says the pres­i­dent of the On­tario Psy­chi­atric As­so­ci­a­tion.

Dr. Mathieu Du­four, as­so­ciate chief at The Royal, is one of the co-chairs with the Coali­tion of On­tario Psy­chi­a­trists, who re­leased a re­port last week that said On­tario is fac­ing a short­age of psy­chi­a­trists that is ex­pected to worsen by 2030.

The re­port, plainly ti­tled “On­tario needs psy­chi­a­trists,” found that On­tario has a short­age of about 200 psy­chi­a­trists. By 2030, that num­ber is fore­cast to rise to 350.

That pro­vin­cial short­age ex­ists on a lo­cal level as well, said Du­four. “Just re­cently, we know that there’s be­tween 20 and 25 psy­chi­a­trists miss­ing in the whole re­gion,” he said. That short­age is sim­i­lar in scale to what other ur­ban cen­tres in the prov­ince are fac­ing, but since Ot­tawa en­com­passes so many ru­ral ar­eas, other chal­lenges arep­re­sent.

“There might be a big­ger short­age of psy­chi­a­trists in ru­ral ar­eas,” Du­four said. “That’s for sure. There’s more dif­fi­culty ac­cess­ing psy­chi­atric care in the re­gion of Ot­tawa if you’re out­side of Ot­tawa.”

The short­age in Ot­tawa and across the prov­ince touches dif­fer­ent ar­eas of psy­chi­a­try, but the re­port points out that there is an “acute short­age” of com­mu­ni­ty­based psy­chi­a­trists, which in turn adds to the work­load of psy­chi­a­trists who work in hos­pi­tals and emer­gency de­part­ments.

“We cer­tainly need more com­mu­nity-based psy­chi­a­trists in the re­gion of Ot­tawa,” Du­four said. It is not, how­ever, the case that we need com­mu­nity-based psy­chi­a­trists ex­clu­sively. “But we also need, I would say most hos­pi­tals — acute care hos­pi­tals and The Royal — we also suf­fer from that short­age.”

The re­port also sin­gles out child and youth psy­chi­atric ser­vices as an area in which this pinch in psy­chi­a­trists is par­tic­u­larly wor­ri­some. The re­port found that Canada needs about 1,500 child and youth psy­chi­a­trists but that there are only about 500 ac­tive; in On­tario, there are fewer than 100 child psy­chi­a­trists, mostly in ur­ban ar­eas, leav­ing parts of the prov­ince “en­tirely un­served.”

Joanne Lowe, ex­ec­u­tive direc­tor of Ot­tawa’s Youth Ser­vices Bu­reau (YSB), sits at the in­ter­sec­tion of those two con­cerns. She sees day in and day out how that short­age im­pacts young peo­ple. “We cer­tainly see that for young peo­ple, the whole lack of men­tal health ser­vices in gen­eral plays it­self out through the ab­sence of child and youth psy­chi­a­trists, for sure,” Lowe said. “If there is a need for a psy­chi­a­trist, that’s when it be­comes more chal­leng­ing when you’re try­ing to find some­one.”

A psy­chi­a­trist short­age is a prob­lem that will con­tinue to grow as psy­chi­a­trists age out of the sys­tem with lit­tle in the way of young re­place­ments. Fifty-six per cent of the psy­chi­a­trists in On­tario are above the age of 55, the re­port notes; only 4.3 per cent of psy­chi­a­trists sur­veyed were be­low the age of 35. The re­port does not mince words on this point, say­ing that “the ef­forts made to re­cruit stu­dents to psy­chi­a­try are abysmal.”

Part of the prob­lem, notes the re­port, is that ev­ery year psy­chia- try res­i­den­cies — the spe­cial­ized train­ing po­si­tions in med­i­cal school that qual­ify one to prac­tise psy­chi­a­try and other spe­cial­ties — go un­filled de­spite ex­cess de­mand for them. In 2018, for in­stance, 190 med­i­cal stu­dents ranked psy­chi­a­try as their pre­ferred dis­ci­pline, but of 184 res­i­den­cies avail­able, only 175 were filled.

“We need to en­sure all psy­chi­a­try res­i­dency spots are filled,” reads the re­port. “The need for psy­chi­atric ser­vices is too great, and the effects of psy­chi­atric short­age are too se­vere, to fail here year af­ter year.”

Though the re­port points out that in 2017 that the Univer­sity of Ot­tawa left two res­i­den­cies un­filled, Véronique Val­lée, a spokes­woman for the univer­sity, con­firmed that all res­i­dency spots were filled for the past five years.

Du­four said that mak­ing sure the lo­cal med­i­cal school fills all its va­can­cies is a start to­ward at­tract­ing more psy­chi­a­trists to Ot­tawa in the first place. “We try to re­tain them as much as we could,” he said. “We’ve also been try­ing to re­cruit out of the prov­ince, out of the coun­try as well, to get some good candidates to pro­vide men­tal health ser­vices.”

The sup­ply of psy­chi­a­trists and the num­ber be­ing trained an­nu­ally give shape to the re­source man­age­ment chal­lenges that front-line ser­vices face. Lowe said she was hes­i­tant to put a num­ber on the short­age of psy­chi­a­trists that her or­ga­ni­za­tion, and the field of child and youth psy­chi­a­try in Ot­tawa sees; she jokes that if she could, she would hire 100 new staff and start there.

“I mean, let’s be re­ally clear. Do we need more child and youth psy­chi­a­trists? Ab­so­lutely,” she said. “It’s an im­per­fect sys­tem. I’ll be the first per­son to say that.”

Ef­forts to in­crease the num­ber of psy­chi­a­trists work­ing in the prov­ince by in­cen­tiviz­ing psy­chi­a­try in med­i­cal school have a built-in lag time for train­ing, which means that in the short-term the field will con­tinue to feel the pinch in Ot­tawa.

“As psy­chi­a­trists we have seen the in­creased de­mands,” Du­four says. “Psy­chi­a­trists have re­sponded by ac­tu­ally in­creas­ing their hours and the num­ber of pa­tients they see. Over 10 years, psy­chi­a­trists have in­creased by 20 per cent (in terms of ) their hours and the num­ber of pa­tients they see.”

Lowe ad­mits that more fund­ing would be nice, but in the in­terim they will con­tinue to work with part­ners to try to mar­shal what re­sources they do have to the right places. “The gap’s not just in the what we have, but how we use our ex­ist­ing re­sources,” she said, and then jokes: “If you could write me a blank cheque I’d be good with that.”

If you are ex­pe­ri­enc­ing a men­tal health cri­sis, you can call the 24/7 Men­tal Health Cri­sis Line at 613722-6914. If you’re a young per­son ex­pe­ri­enc­ing dif­fi­cul­ties, you can call the Youth Ser­vices Bu­reau at 613-260-2360 or talk to some­one on­line, be­tween 4 p.m. and 10 p.m., at www.chat.ysb.ca.

The need for psy­chi­atric ser­vices is too great, and the effects of psy­chi­atric short­age are too se­vere, to fail here year af­ter year.

DAVID KAWAI

On­tario has a short­age of about 200 psy­chi­a­trists and that num­ber is fore­cast to rise to 350 by 2030, ac­cord­ing to a new re­port.

JAMES PARK

Joanne Lowe, ex­ec­u­tive direc­tor of Ot­tawa’s Youth Ser­vices Bu­reau, says there is a des­per­ate need for more psy­chi­a­trists — and fund­ing — to serve strug­gling chil­dren and youth.

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