Inside Hillsborough: A look at P.E.I.'s psychiatric hospital

P.E.I.'s psychiatric hospital, Hillsborough Hospital, is a maze of hallways, connecting sections built in different decades. It treats many of the province's psychiatric patients in its four units and 69 beds.

While it is a public building, news media has rarely been allowed inside.

CBC News secured a tour of the facility with Dr. Heather Keizer, the medical director of the hospital and P.E.I.'s chief of mental health and addictions, as part of our ongoing project on mental health services in P.E.I. — Peace of Mind.

• Peace of Mind | CBC P.E.I.'s ongoing coverage of mental health services in the province
• What has your experience been with mental health services in P.E.I.? Contact us here.

New security

When you enter the building, the first thing you see is now a security desk. The dedicated security force is new to the hospital — within the last two months — and was added following a security review of the facility from 2016.

"We know who's in the building and who is out of the building. That sounds very basic but it's actually very important and it's something that has never been the case here before," said Keizer.

"It's the first time Hillsborough Hospital has actually been secure in this way."

Keizer added that there is now key access required to get into the different units and different parts of the building.

Forensic unit required to meet demand

Beyond the security doors, the newly added forensic unit, Unit 3B, is directly to your left.

This is a place with extra security to keep patients in — often for people who have been found not criminally responsible in court.

Previously, these patients would have been sent to East Coast Forensic Hospital in Dartmouth, N.S. — and some still are, but Keizer said there's also a need to be able to treat people at home.

"There's been an increase in our forensic numbers over the last few years, so that now Prince Edward Island's going to have to build our capacity to cope with that," said Keizer.

Keizer added that P.E.I. doesn't have any dedicated forensic psychiatrists, so will often still send patients to East Coast Forensic Hospital for a consultation.

Acute care akin to QEH

If you follow the hallway to the left, you'll end up in Unit 3, the acute care unit.

Keizer said this unit is "essentially the same" as Unit 9 at the Queen Elizabeth Hospital.

"Essentially it's the same treatment, same psychiatric care, same nursing kind of care, different location, but essentially that's the only real difference," she said.

"Patients who come in acutely, distressed with say severe depression and suicidal thoughts. It's a place for them to come and be safe while they're being treated. Patients who come in with say, psychosis secondary to using marijuana or primary psychosis — again, it's a place to be safe while we start them on medication to help them with those symptoms," said Keizer.

Keizer said a psychiatrist will make a decision about where to admit a patient — Hillsborough or the QEH — based on where a bed is available.

Unit 3 at Hillsborough has 17 beds, while Unit 9 at QEH has 20. Both units have two psychiatrists.

Design of geriatric unit has 'certain limitations'

Further down the hallway through what Keizer refers to in passing as the "rabbit warren" is the the geriatric psychiatry unit — Unit 5.

There are no units 1, 2, 4 or 6 at the hospital. Keizer admits that the units are "strangely named" — leftover from when the hospital was a 300-bed facility.  A number of units closed in the 1990s, Keizer said, and she hopes to rename the units in a more logical way soon.

Unit 5 is for patients over the age of 55 who have psychiatric issues, and often medical issues as well, said Keizer.

"So problems with their kidneys, let's say, or cardiac problems or diabetes along with often dementia or other psychiatric illnesses," she said.

Keizer said Unit 5 was built about 20 years ago, but said the planning wasn't as well thought out as it could have been.

"I think there was a real belief that there was a need, and it was built kind of quickly on a dormitory model. After the fact it was discovered that the doors weren't wide enough to take hospital beds, that there are certain limitations — significant limitations — on the unit," she said.

One of those limitations is that the nurses' station doesn't have a clear view of the corridors.

One of the design features of the existing geriatric unit that Keizer lauds is the circular hallway.

"So patients who have dementia can walk in a circle and it helps them deal with pacing and frustration," she said. "We do have a capacity for patients within the unit wander and be safe."

Patients with 'dual diagnosis'

Up a flight of stairs are doors for units 7 and 8.

In Unit 7 are patients with what Keizer calls a "dual diagnosis" — an intellectual disability as well as a psychiatric illness.

"These patients need a secure environment and need ongoing sort of daily programming with the nursing staff," said Keizer.

She said each of the patients on Unit 7 has a personalized therapeutic behavioural program as part of their treatment.

"Each patient has had their program specifically developed for them to maximize their well-being and maximize their care," said Keizer.

Both Unit 5 and Unit 7 will have patients that are at the hospital long term, and Keizer said many patients from Unit 7 will go to a camp in the summer.

Transition from the acute unit

Unit 8 is the "transition and recovery unit," said Keizer.

"It's a unit where we actually provide services to patients who, for instance, would have been on acute care unit and struggled to get, say housing, set up for them, so they might come up here for a little longer stay," she said.

"We also have patients on this unit who have essentially been in an institutional setting for a very long time and need to be in an institutional setting — so it's kind of a mixed unit."

Keizer said social workers and occupational therapists are key to the patients in Unit 8.

After the hospital

She said the hospital is connected with community services, which allows staff to follow patients after they are released from the hospital. It also has an outreach team that is able to follow up with patients at home.

"For instance if a patient has transitioned into the community and isn't really used to the medications yet, our outreach team will go and visit the patient in their home, will go and deliver their medications on a daily basis often initially, then will drop in on the patient and see how they're doing on a very regular basis," she said.

Keizer said a challenge is the lack of a day program for adults in P.E.I. — one that would provide a space for patients to transition from life in the hospital back to life at home.

Community spaces

Some of the spaces at Hillsborough — including the cafeteria, chapel and gym — aren't attached to any of the units.

Keizer said both patients and staff eat together in the cafeteria — although some patients may have their meals delivered to them depending on what level of care they need.

"We've had parties here for patients. We host a Christmas dinner here for patients," Keizer said.

Keizer said it's a social space as well, where people can sit and chat over coffee. She would like to see more done with it, such as bringing in speakers who might be of interest to patients.

There is also a chapel where regular services are held, which Keizer said are relatively well attended.

"Chapels have always had an important role in hospitals, even though we would say now that we're a diverse population," said Keizer.

"Spiritual well-being of patients is always a factor in medical care and psychiatry care is no exception."

There is also a gym available to patients and staff in the hospital.

"It's so important. Physical exercise is so pivotal to mental health," said Keizer.

Staff offices on site

The hospital has 137.16 full-time equivalent staff positions at Hillsborough Hospital. Staff typically work eight-hour shifts, according to Health PEI.

On the second level, there are now a number of offices for mental health staff, including nurses, social workers and Keizer herself.

"It allows us to actually work together, which is really exciting," Keizer said.

Keizer shares an office space with Verna Ryan, P.E.I.'s chief administrative officer for mental health and addictions, which she said allows the two to connect every day.

She said she decorated her office out of her own pocket, because that she believes an office should be "a sanctuary," in order to maintain the person who works there's well-being.

The floor where the offices are — used to be hospital rooms, and Keizer said the layout still reflects that to a degree.

Looking to the future

Eventually, Hillsborough Hospital will be replaced. The province has begun the process of planning for a Mental Health and Addictions Campus, but it won't be fully operational for at least a few years.

"We're in the very baby stages," said Keizer of the planning process. Currently a team is meeting regularly to figure out that process.

While that process is underway, Keizer said part of her job is still improving Hillsborough for its remaining years.

"When we talk about master planning for Hillsborough Hospital in the future, is we have to realize that while we're planning and while we're developing our new plan for mental health care in P.E.I., we still have to do it," she said. "We're still here."

This story is part of an ongoing project CBC P.E.I. is doing on mental health services in the province. You can share your experiences with us here.

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