Cape Breton facing 'alarming' psychiatrist shortage, Liberal health critic says

The Nova Scotia Liberals' health critic says a recent freedom of information release showed an "alarming" psychiatrist shortage in the province's eastern zone, which includes Cape Breton and parts of the mainland.

Patricia Arab, MLA for Fairview-Clayton Park, said the release shows the zone needs eight psychiatrists to fill all the vacant positions.

"It's an alarming number," she said. "When you think about the population and how many patients and individuals that those positions would be able to serve, eight is far too great of a number."

Nova Scotia Health says Cape Breton alone should have 15 full-time equivalent (FTE) positions in psychiatry and it currently has 8.5 FTEs.

The government does say it has eight vacancies in the eastern zone, despite only listing three on its physician recruitment website, but would not provide anyone for an interview.

Government promises

In 2017, while the Liberals were in power, Cape Breton doctors called for more recruitment after the complement of psychiatrists in Sydney fell to five.

Dr. Margaret Fraser, a family and emergency physician who is also head of the Cape Breton Medical Staff Association, said that number is now at six.

Arab said Premier Tim Houston promised during last year's election campaign that the PCs would fix health care.

"I definitely don't think there's a simple solution, but ... when you make a promise that big, especially after being an MLA for as many years as he has been, one would have assumed that there was a plan already in place, and I do not see evidence of that plan," Arab said.

Effects on staff and patients

Fraser said eight is a "huge" number of vacancies and that has wide-ranging effects on staff and on patients.

"Historically, we would have had anywhere from 14 to 18 psychiatrists working in the Sydney area and it's made getting a patient in for a psychiatric consult, diagnosis and treatment very challenging," she said.

There is only one child and adolescent psychiatrist in Sydney now, which means some patients have to travel to Halifax for diagnosis and treatment.

With difficulties getting an ambulance, that has left patients waiting in the emergency department for a day or two, Fraser said.

Doctor retention an issue

The government has had some success with recruiting over the years, but for a variety of reasons, people have not stayed, she said.

"If you're trying to recruit five people and you've only got two, the third person coming in is looking at it and going, 'Well, I'm doing one in three [on-call shifts] and I should be doing one in five ... and why would I go there when I can go [somewhere] that's fully staffed?'" Fraser said.

"The bottom line is we've had a lot of people come through and not stay, and that's difficult for the patients, too, because they've no sooner established a relationship with one psychiatrist and they've gone and they're having to try and re-establish that therapeutic relationship with someone else."

Brian Comer, the MLA for Sydney River-Mira-Louisbourg and minister responsible for the Office of Addictions and Mental Health, said he is concerned about the shortage.

The former mental health nurse said there have been "significant gaps" in retention, but there are plans to solve recruitment and retention issues.

"We do have a new psychiatrist coming for adult in-patient at the end of this month, in March, which is a positive step," he said.

Recent and upcoming changes

The PC government also recently announced a new day hospital for mental health and funding last week for mental health across the province, including setting up a new organization specifically for the Mi'kmaq.

There are "innovative" changes coming in virtual care that will be announced in the coming weeks, Comer said.

The premier and the minister are also planning to call psychiatrists personally and "do things differently, because clearly what's been done in the past hasn't been working," Comer said.

"There's lots of things happening right now that I think are moving the needle in the right direction," he said.

Nova Scotia Health says another two FTEs in psychiatry are expected to arrive in Cape Breton in the next few months and two more clinical assistants are being recruited to complement the three already working in local practices.