Northern Sask. youth lose inpatient psychiatric unit for 2nd time since 2020

The child and youth inpatient mental health and psychiatric unit in Prince Albert is temporarily halting admissions for the second time since 2020 over an ongoing struggle to recruit and retain in-demand child and youth psychiatrists.

The Saskatchewan Health Authority is calling it a temporary pause while it tries to recruit more.

In a Tuesday news release, it said admissions to the unit were paused on July 18 because the resignation of the area's sole child and youth psychiatrist takes effect this Saturday.

The health authority also apologized for any stress or anxiety this may cause and said the goal is to have the unit reopened to admissions as soon as possible.

The unit previously closed admissions in June 2020 for the same reason — lack of psychiatrists.

Andrew McLetchie, the SHA's vice-president of integrated northern health, told reporters Wednesday afternoon that having one child psychiatrist is not enough to manage the demands of services that are required in Prince Albert and the northern populations it serves.

"The pressure on him as a lone provider was just not making the position attractive and one that could be sustained," McLetchie said of the outgoing psychiatrist.

"Being a lone psychiatrist is a challenging thing within a community with the demands of Prince Albert."

He said a large piece of the SHA's focus now is creating a team environment and "winning conditions" for recruitment to Prince Albert of multiple child and adolescent psychiatrists and to make that position attractive.

Currently, there are two positions in Prince Albert, but McLetchie said there is a discussion about increasing that number to three.

He said the SHA is also working on a broader supportive structure for psychiatrists that work in Prince Albert, including more dedicated support and more integrated teams on the ground that work with the psychiatrists.

Sask. now down to 20 beds

Dr. Tamara Hinz, a Saskatoon-based child and adolescent psychiatrist, said these temporary closures have really impacted Saskatchewan's overall capacity because Prince Albert once accounted for one-third of it.

She said when there were two child psychiatrists in Prince Albert, the unit there had 10 of the province's 30 beds. But with a lone psychiatrist, it had been reduced to five beds — and the province's overall capacity was down to 25 beds. Now it will be down to 20.

The outgoing child psychiatrist in Prince Albert also had to manage after hours calls and an outpatient clinic, she said.

"It's really an untenable task to shoulder all of that on one person," she said.

"Ideally, it's probably at least a three-person job to have a sustainable rotation of specialists to cover acute care — meaning inpatient work and after hours crises — and all the follow-up that's required with those patients."

"And it's really crucial to have colleagues to consult with and to be able to support each other."

'Pretty big ripple effect'

Now that the unit in Prince Albert is temporarily closed, the bulk of those patients and that work comes to Saskatoon and will impact a lot of areas, she said.

Hinz said it means that kids are waiting longer in the emergency departments, waiting for a bed.

It means that children coming to the emergency department for other reasons may have to wait longer because there's not as much space for them, she said.

She said it also affects the pediatric inpatient unit at the Jim Pattison Children's Hospital.

"There's this increased pressure to perhaps feel like we need to discharge kids earlier than we otherwise would — or not admit kids who we otherwise would — when we know that beds are scarce," she said.

"So it really has a pretty big ripple effect." 

Hinz said the Prince Albert unit serves northern Saskatchewan youth with mental health struggles that can't be managed in a community setting.

She said, similar to the two other units in the province, it would most commonly see children with very severe mood disorders, such as major depressive disorder, who are presenting with safety issues around thoughts of self-harm or dying.

Psychotic illnesses is another common presentation — which could be from an illness like schizophrenia or from drug use, noting meth use in Saskatchewan has "exploded."

Crystal meth is a very common cause of really agitated states like psychosis which require specialized, inpatient treatment, she said.

She also said, during the pandemic, she's seen a "really unfortunate explosion" of eating disorders, which can be life-threatening and can sometimes require very lengthy inpatient stays.

Outpatients will be affected

Dr. Madhav Sarda, another child and adolescent psychiatrist based in Saskatoon, also worries about the decrease of the total number of beds in the province with the temporary loss of the Prince Albert unit.

"Thirty already wasn't enough. It was already a low number. We already didn't have enough beds for the numbers we have in the province," he said.

"So the initial thing is that there's just not very many beds to go around for kids who are in crisis."

He said the result is they won't be able to provide the support for outpatients and kids who aren't in immediate acute risk, because they're spending more time with more acute children.

"We get stressed and we can't provide those services the way we would like to," he said.

"Our outpatient list gets longer."

The case for higher pay

McLetchie, Hinz and Sarda agree the high demand for child psychiatrists across the country is a significant challenge.

Sarda said he doesn't know if there is any province that has as many child psychiatrists as it would like.

When asked about the potential benefit of offering more income to help with recruitment, he said higher pay isn't going to be enough by itself, but it would help.

"If you're competing against every other place in the country, you've got to make your case," he said. "And money can be part of that case.

"You're going to have to fight to bring people here, just like everywhere else in this country is fighting."

While it searches for replacement child psychiatrists for Prince Albert, the SHA said two mental health emergency holding beds will be maintained in the city to support children and youth awaiting urgent child-youth inpatient admission in Saskatoon or Regina.

It also said adolescents 17 and 18 years of age needing inpatient care will be temporarily managed in the Prince Albert adult unit with one-on-one supports.