ERs can’t keep up with kids’ needs
Mentally ill ‘desperately underserved’
A desperate shortage of child mental health services across Ontario is making it more difficult for hospitals to cope with mentally ill children who come to their emergency rooms, let alone those with complex mental and cultural needs, says the division chief of community-based mental health services at the Children’s Hospital of Eastern Ontario.
Dr. Hazen Gandy’s comments come as Peterborough Regional Health Centre investigates the treatment of a First Nations youth the hospital wanted to discharge last week even though his psychiatrist says he was suicidal and unstable. He is now being treated at CHEO.
Gandy did not comment specifically on the case, but he said the lack of child mental health services across the province and the lack of co-ordination among various services is a cause for concern.
“There is a fundamental issue of access to services in that child psychiatry and mental health services for children and youth in general are desperately underserved. Smaller communities have very little if any access to child psychiatry whatsoever.”
This comes at a time when there are suicide crises involving children and youth in Ontario’s remote northern communities and the demand for child mental health services is skyrocketing in southern Ontario. Gandy said that demand has increased by between 70 and 75 per cent at CHEO in the past four years.
It also comes as Ontario announced funding for mental health, addictions treatment and healing centres this week as part of an apology from Premier Kathleen Wynne to indigenous people for abuses of the past. A spokesperson for Ontario Child and Youth Minister Tracy MacCharles said the government is committed to “providing culturally-appropriate mental health services to indigenous children and youth, as close to home as possible.”
Gandy, meanwhile, said many community hospitals are lucky if they have a psychiatrist. While they might have access to child psychiatry, it would not likely be available on-call at the emergency room.
CHEO, he said, has launched a tele-mental health program with Cornwall Hospital, “to see if we can essentially develop a virtual emergency room.” Using telemedicine technology, a psychiatrist from CHEO sees children who come to the Cornwall emergency room with mental health needs to determine whether they can be treated there or should be transferred.
“We are trying to take the limited expertise that is available and use technology to make that expertise more easily accessible to local clinicians who may be struggling with cases that they see in the emergency department.”
Gandy said there also “other dynamics and pressures” on patients to get through the system as quickly as possible.
“For challenging and complex cases, there is pressure to move kids or adults through emergency departments where that may not always be in the best interest of kids and their families.”
Dr. Elena Shurshilova, the Ottawa psychiatrist who told Postmedia about her client’s situation this week, believes racism played a role in his poor treatment in Peterborough. She said his case fits a pattern of treatments she has seen repeatedly for First Nations youth needing mental health treatment.
“This is very typical of an ongoing problem with mental health, and especially with aboriginal youth because they have extremely complex behaviour.”
At CHEO, which serves patients in Nunavut, Gandy said that there has been an effort to offer cultural accommodation and understanding of patients and for staff to better understand cultural practices. He said the hospital has contacted the Wabano Centre for Aboriginal Health about cultural sensitivity when First Nations patients are involved.
A spokesperson for MacCharles noted the province has just announced $6 million in new funding to hire 80 mental health workers.
“As part of Ontario’s Mental Health and Addictions Strategy, we have funded the hiring of more than 80 new Aboriginal mental health and addiction workers to support high-needs communities. These workers provide culturally-appropriate services to 4,000 indigenous children and youth each year. We also fund the development and implementation of training supports for Aboriginal mental health and addictions workers.”
Indigenous children and youth also benefit from an investment in tele-mental health services to remote and underserved communities.
“We have made significant improvements for all children and youth facing mental health issues, but we know there is always more than can be done. We’ll continue to work with our community partners, indigenous communities, service providers and advocacy groups to make sure that every child in crisis knows that help is available and how they, their friends or family, can access those vital services and supports.”