I read an article today about advocating for a family member in the mental health system. The article talked about a family that has recently lost their son after a suicide attempt. The family went to receive healthcare from the hospital and told it was “just hormones”
This got me thinking about the mental health system in Canada. I went through nine years of hospitalization in several institutions for my mental health, therefore, I got to know the system very intimately. However, when I began as a young teenager making my way through the system – I had no idea what I was doing. My father was the person that advocated, researched, and worked countless hours to get me the help I needed. I had money, education, and insurance on my side – throughout the whole journey. What about the people who don’t have access to that luxury?
The raw truth is that the mental health system is very different from the medical physical system. A person who goes into the emergency room with a mental health crisis will have to wait an average of 8 hours (in the province of Ontario) before seen by a psychiatrist and they must be deemed suitable to be seen by the crisis team. A person with a physical symptom will wait an average of 3 hours and will be seen by an emergency room doctor within 2 hours.
But, what’s the difference really? The difference is that you can see and treat a physical disorder much faster than you can treat a mental disorder. You have x-ray’s, scans, oxygen, medicine, and pain killers which are easily prescribed because they give a definitive answer within minutes. There are sections of the emergency department in the hospital dedicated to these tests so they are finished efficiently and effectively. A mental disorder or crisis is not visible most of the time, therefore as patients – we are ignored. Our problems are much more complicated than anything physical.
The mental health section of the hospital is often one floor dedicated to mental health inpatient and outpatient treatment. In bigger cities, there are around 8 psychiatrists per region which equals out to 1 psychiatrist among hundreds of patients. I won’t even start on how there are rarely and sometimes no mental health help in the reserves, small towns, small regions, and even complete provinces or territories. Obviously, this is the reason for poor mental health emergency care. Psychiatrists are rare, psychologists usually don’t work in crisis, crisis workers do not have the training to recognize and diagnose mental illnesses and severe symptoms.
If you go into an emergency room for mental health care you will likely end up with one of two outcomes;
1. You will be seen by the crisis team and deemed “stable” and get sent home
2) You will be put on a legal Form (usually 1-42 or 3) binding you to the hospital’s inpatient care for at least 72 hours and not guaranteed to be put on the psychiatric floor. Many patients serve their time in beds at the emergency department.
Do you see where the problem is in the system? There is no middle ground! I understand that many politicians like to say that there is “nothing we can do” since mental illness usually takes years to properly diagnose and treat…but turning away people who are suicidal, psychotic, autistic, unaware of their actions, dissociating, or unstable is not the answer. Waiting lists average out to 2 years to be seen by a legitimate mental health center. When we turn these people away from emergency room care, we validate their invalidation. More times than not, that person will be back within days as a red (severe) patient after a serious incident due to impulses that could have been avoided.
Here are five ways to help improve the mental health system;
1. Creating a safety group for crisis patients to visit once a day for a determined amount of time at the hospital until out of crisis
2. Having a larger mental health unit in the hospital with trained psychologists, and nurse practitioners available 24/7
3. A safety sensory room for autistic, psychotic, and dissociative episodes
4. A follow-up call to the patient by a licensed psychiatrist or psychologist once returned home
5. A middle ground hospitalization such as day hospitalization to avoid overflowing crisis beds
As a modern society, we have no excuse for ignoring people in serious need of medical attention.
What are some ways you think we could improve the mental health system internationally?
What has your experience been like in emergency room care?