Wait times dropping to see a child psychiatrist
Triage nurse now works with families waiting to access services
The wait time for a young person in Saskatoon to see a child and adolescent psychiatrist is the lowest it’s been in at least a decade.
Dr. Anna Felstrom, head of the University of Saskatchewan’s child and adolescent psychiatry division, has been working as a child and adolescent psychiatrist in the city for 14 years. Until the beginning of 2018, children referred to her by family physicians were waiting between 18 months and more than two years to see her or one of the seven other child and adolescent psychiatrists in the city.
Felstrom estimates that between 15 and 20 per cent of young people on the list were turning 18 and becoming ineligible to see a child and adolescent psychiatrist before they ever got an appointment.
“A couple of years ago, we phoned some families to book them into our clinic and their young person had died by suicide and so we just said, ‘Enough. We can’t do this anymore,’ ” Felstrom said.
There are 16 child and adolescent psychiatrists working in Saskatchewan: Eight in Saskatoon, six in Regina and two in Prince Albert. Felstrom estimates a province with a population of upwards of one million people needs between 35 and 40 such specialists, who are highly trained medical doctors, skilled at intervening when a mental health issue is stopping someone from participating in life in a full and active way.
But achieving that number is unlikely given the worldwide shortage of child and adolescent psychiatrists, Felstrom says. So health authorities and governments need to be smarter about how they treat mental health — and some jurisdictions do better than others.
While children in Saskatoon were waiting roughly two years to see a child and adolescent psychiatrist, children in Regina were waiting three or four months.
In Regina, families who think a young person needs help with a mental health issue or illness can go to a mental health clinic and meet an intake worker who helps set them up with appropriate care, which could include appointments with a social worker, counsellor or psychologist.
Only the most severe cases are referred to child and adolescent psychiatrists, who can take referrals from anyone.
Until the spring of 2018, child and adolescent psychiatrists in Saskatoon were only paid to see patients referred by family physicians.
So people would go to a family doctor, get a referral and wait. There was no screening and not everyone put on the list needed to see a child and adolescent psychiatrist.
“And then the list grows and grows and grows,” Felstrom said. “It would be very hard to kind of understand from two lines of a referral letter who actually needs the doctor and who doesn’t. So in order not to miss anybody, we would accept everything. So then we were seeing all of these problems that maybe could be handled by other allied mental health professionals.”
The only way people could see psychiatrists in a more timely manner was by going to the emergency room.
Sometimes, Felstrom would see patients who had been admitted to hospital and learn they had been on her wait-list for months.
“If a person had waited two years to see us, they were either super better and something else had fixed their problem or their depressive episode had resolved, or else the problem then was requiring hospitalization because we hadn’t intervened for so long and now things were really out of control,” Felstrom said.
In an attempt to solve the problem, the Saskatchewan Health Authority hired a triage nurse, who started work in April. Her job was to call the family of every person on the wait list — which was roughly 850 people long when she started — and conduct in-depth interviews to get a sense of the nature and severity of the person’s mental health concern.
She would then discuss the case with child and adolescent psychiatrists and other mental health professionals and make a decision about whether the child should remain on the wait list to see a child and adolescent psychiatrist or be connected with a different mental health professional.
Wait times have dropped to between 14 and 16 months in the last six months. And Felstrom hopes they will keep dropping. She says that if people have access to timely mental health care, it can prevent lifelong problems from occurring.
“Problems, generally, that have been going on not as long are easier to fix. The longer and more entrenched a thought becomes or a behaviour becomes, the harder it is to fix it,” she said.
The health authority is so impressed with the effect the triage nurse has had on wait times that it is hiring two additional nurses. One will start in December and another in January.
An important part of this triaging model was a change in how the health authority pays child and adolescent psychiatrists in Saskatoon.
The specialists used to be paid by a fee-for-service model, which meant they would only be compensated for treating patients referred to them by family physicians. In April, child and adolescent psychiatrists were moved to a contract payment model, which means they are paid to be part of the team triaging meetings.
The health authority says it has also hired an additional child and adolescent psychiatrist in Saskatoon who will start work in December.
“We’ve made a lot of progress in the last year,” Felstrom said.
“There will never be enough child and adolescent psychiatrists, probably, to meet the needs, we’ll never get 40 people, so we have to be really smart in how we’re using our time.”