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Minding the gap in B.C.’s mental health system

Long wait times, lack of timely treatment, as thousands of patients fall through the cracks
Cameron Russell is one of many frustrated mental health patients who have taken to Reddit, a community-oriented news website, to discuss the gaping hole in B.C.’s mental health system where securing long-term psychiatric treatment can take several months.

Cameron Russell’s descent into depression began when he was eight. His parents would often find him sobbing hysterically, unwilling to leave his room.  

Russell was diagnosed with bipolar disorder years later, and found it wasn’t easy to find a psychiatrist in Vancouver willing to take on new patients. As his symptoms progressed, so did a series of futile attempts to secure long-term psychiatric treatment in a system, which over the years, has been forced to do less with less.

“I was bouncing around from counsellor to psychologist to psychiatrist trying to find the best mixture of therapies to work for me,” Russell said. “I tried a lot of doctors and therapists to figure out how to best manage my symptoms.”

His pursuit in vain, Russell once went six months without any treatment — a wait time that’s fairly typical when seeking psychiatric care for mild to moderate mental disorders in Vancouver.

“The thing about mental health issues is that it’s not clear what works and what doesn’t. It requires constant refinement, which obviously requires follow-up visits and those are difficult to get,” he said.

Lengthy wait times for specialist care are a distinguishing characteristic of Canada’s health care system, but the unavailability of timely psychiatric treatment in B.C. is particularly alarming.  

A 2011 study published in the Canadian Journal of Psychiatry showed only a fraction of psychiatrists in Vancouver agreed to accept new patients referred by a family physician. Led by Dr. Elliot Goldner, the study revealed of 230 Vancouver psychiatrists, only six were willing to see a new patient on short notice and scheduled an appointment.

In any given year, one in five Canadians is affected by a mental health or addiction problem, yet the system appears to cater mainly to extreme conditions — a reality many patients learn the hard way.

Two years ago, Sarah Hager started having panic attacks at work. Hager, 28, had anxiety as a child but decided to go to a doctor when the episodes began interfering with her ability to do her job.  

Hager went to a walk-in clinic in Vancouver where she was immediately prescribed antidepressants and sent on her way — without a referral to a psychiatrist or any information about how she could further access treatment, if needed.

“The doctor was super busy. He had like five minutes to see me. I told him ‘I’m having anxiety and I researched this medicine. Could you prescribe it to me?’ He said ‘yes,’ wrote me the prescription and that was pretty much it,” Hager said.

At an orientation at VGH outpatient psychiatry a year later, Hager was told it would take her anywhere between three to six months to see a psychiatrist.

“It was really difficult to cope because I wasn’t able to work very much because of the panic attacks. It was sort of like an in-between where I wasn’t suicidal so I couldn’t access emergency services but I wasn’t in mild anxiety either,” she said.

Hager and Russell are just two of many frustrated mental health patients who have taken to Reddit, a community-oriented news website, to discuss the gaping hole in B.C.’s mental health system and reveal tips on how to fast-track psychiatric care in the city.

The variety of viewpoints on the forum has one common takeaway — intake and priority are determined by the severity of the illness and the threat a patient poses to themselves or others.

Some Redditors suggest exaggerating existing symptoms in order to get an immediate referral to a psychiatrist. For instance, a person with mild depression is advised to lie about experiencing suicidal tendencies when being assessed by a nurse.

“I’ve heard people advocate for that, but I wouldn’t do it because you can get hospitalized and that’s never good,” Russell said. “There’s a possibility that you get overly medicated, which can turn you into a zombie.”

To fully grasp the breadth of this problem, it’s important to understand why so many people facing debilitating mental illnesses in the province are falling through the cracks.

A 2014 City of Vancouver report states 130,000 British Columbians and 20,400 people in Vancouver are living with serious mental health issues and addiction.  

Jonny Morris, senior director of public policy, research and planning at the Canadian Mental Health Association’s B.C. division, said cuts to B.C.’s mental health services can explain present barriers to psychiatric treatment.  

“The demand for specialist services unfortunately outstrips the supply. There aren’t enough resources to meet the complex needs of people living with mental illness or addiction here in B.C.,” Morris said.

He said long wait times for specialist services are a given in a mental health system that does not focus on early intervention.

“The system, which is quite oriented toward crisis care, arguably gets to the point where it can only serve the most ill because those folks are in the pipeline. It can never get to people further up the stream — who also need help.”

A 2009 study by Doctors of BC (formerly British Columbia Medical Association) revealed 83 per cent of patients diagnosed with a mental disorder in B.C. were only treated by their family physician.

Another survey showed the wait time from a family physician referral to psychiatric treatment exceeds five months. Such findings may explain why family doctors are less inclined to refer their patients for psychiatric treatment.

To compound matters, there is a critical shortage of family doctors in the province. According to Statistics Canada, 200,000 British Columbians who want a family doctor cannot find one — that’s up from 176,000 in 2010.  

“The government had set a target to reach but it hasn’t been able to reach it. They are, however, looking at other means to make primary care more accessible,” Morris said. “A stronger primary care system helps people before they need specialist care.”
Morris said nurses and staff in emergency departments often find themselves overwhelmed by the influx of patients seeking psychiatric help in the emergency room — a consequence of the primary care shortage in the city.  

Emergency departments at VGH and St. Paul’s Hospital together saw 16,562 mental health and substance misuse visits in 2015 — an increase of  75 per cent since 2009, according to statistics provided by Providence Health Care.

To take pressure off the emergency department, Vancouver Coastal Health opened an Access and Assessment Centre (ACC) it hopes will lead to a reduction of around 4,000 visits a year to the VGH emergency department.

George Scotton, manager of the AAC, said the centre was set up to eliminate complications that crop up when patients try to access psychiatric treatment in the emergency department.

Mental health patients waiting their turn in the ER are often bumped off the list because of life-threatening emergencies that burst in. Waiting for hours in an over-stimulating environment like the emergency room, Scotton said, can cause a patient’s symptoms to escalate.

“The way we have structured it before is we didn’t have an urgent care centre. Everyone had to come through the same door. With the Access and Assessment Centre, we’ve created that second door,” Scotton said.

Scotton explained the centre is well-equipped to care for all mental health patients, regardless of how serious their symptoms are. Clients can be referred to a psychiatrist within minutes of being assessed by a nurse or social worker who determines the need for psychiatric evaluation.

“In the short time that we’ve been open, we’ve seen a 30 per cent reduction in the number in visits to the emergency department for mental health clients,” he said.

While it’s true more psychiatrists and facilities like the AAC can address the shortfall in services and help more patients in Vancouver receive the care they need, research points out that access to treatment is greatly affected by how heath care professionals run their practice.

A 2014 study published in the journal Open Medicine found that in areas with higher supply, psychiatrists saw fewer patients while their peers in low-supply, non-urban regions had more patients.

Researchers said the study, which aimed to question the scope and patterns of psychiatrists’ practice, proved more psychiatrists won’t fix a flawed system — accountability and other models of treatment can make timely treatment more accessible to patients.

Advocates for early intervention in psychiatric treatment believe the severity of a mental illness can be significantly reduced, and perhaps even evaded, if treatment is started swiftly and suitably.

The need for early diagnosis and intervention, Morris said, is pressing.

“We need get to people before stage four. There are lots of people dealing with mental health issues and they absolutely need to be able to access the system,” Morris said.  “We should be able to get to people and provide resources at stage one.”