Sask. people unable to access timely mental health treatment due to lack of psychiatric staff

Saskatchewan people grappling with serious mental illness can't access timely help. 

Dozens of beds at the province's main inpatient mental health facility in North Battleford, Sask., aren't open.

The facility is supposed to have 188 psychiatric rehabilitation beds open, and 96 beds available in a separate, secure wing for people accused of crime living with mental health issues. Government data from April 1 shows 48 of the 96 corrections beds and 166 of the 188 non-corrections rehabilitation beds were operational.

One Saskatchewan couple said their son who burned down their house and was charged with arson requires an assessment in the secure facility, but were told he cannot get in for one because of the shortages. They say their son who needs immediate mental care is stuck in a jail waiting.

The Registered Psychiatric Nurses Association of Saskatchewan said beds are closed at the psychiatric hospital because the province can't staff them. A spokesperson for the Saskatchewan Health Authority said it is "working with many partners to recruit staff to help open additional beds" and that the numbers fluctuate day-to-day. 

Long wait-lists for outpatient care

Adult and youth patients are also waiting months or years in Saskatchewan for outpatient psychiatric help. These wait times can create bigger problems down the line.  

"Delayed care means progression of illness to a more severe level that may have been preventable," said Dr. Doug Urness, president of the Canadian Psychiatric Association. 

They also have a wider impact on the patients' support networks and the health system, he said.

There were 120 licensed psychiatrists in Saskatchewan as of March 2021. The government funds 64.7 full time equivalent contract positions, and the rest are "fee for service physicians."

Urness said there's not a clear answer on the optimal psychiatrist-to-population ratio, but some estimates pinned it as one psychiatrist for every 6,500 to 10,000 people. 

He said that even if an area achieves that ratio, it still won't be enough to meet demand, because many psychiatrists spend their time occupied with administration, education or research on top of seeing patients. 

Delays trickle down 

The long wait list for adults referred to psychiatrists is also creating backlogs in the child psychiatric realm. 

"I will continue to treat patients who are 18, sometimes 19 or 20," Dr. Tamara Hinz, a child and youth psychiatrist, said. "Given the crisis in adult psychiatry, sometimes there just isn't an accepting adult psychiatrist to transition some of these patients out of my practice, which then of course affects our capacity to bring in new children." 

Hinz said this further complicates the child psychiatric system, which has long faced its own lengthy wait-lists and inability to meet demand. 

"It's hugely frustrating," Hinz said. "To know that as a system, we are failing so many kids. It's hard to think about — it's hard to know about —  how a child who is suffering now will have to wait 18 months before they can see someone like me."

Hinz said children facing mental health challenges who are left untreated may develop more complex, harder to treat mental health issues in adulthood.

Urness said psychiatric shortages are prevalent across Canada, and said one key way to tackle that is to also expand education programs, increasing training spots in psychiatric programs. 

The Saskatchewan Health Authority (SHA) would not co-ordinate an interview with the provincial head of the department of psychiatry or another member to talk about the pressures, but wrote that the SHA "recognizes the challenges in recruiting and retaining psychiatrists in the province. The demand for psychiatrists in Canada and abroad is great."

The SHA said there were 38 residents in the psychiatry residency program at the University of Saskatchewan's college of medicine in residency years one to five as of Jan. 1, 2022.

It added that the Ministry of Health also provides funding to the college of medicine for subspecialty training in child and adolescent psychiatry.  There are currently two residents obtaining this sub-specialty.

Psychiatric nurse shortage also a 'crisis'

Beverly Balaski, executive director of The Registered Psychiatric Nurses Association of Saskatchewan, said the facility in North Battleford isn't the only one affected by a lack of psychiatric nursing staff. 

She said there are at least 165 unfilled registered psychiatric nurse positions in the province. These are nurses who undergo specialized training related to mental illness, psychiatric emergencies, overdoses, suicide crises and psychoses.

Balaski said these professionals can ease the load on the mental health system. However, psychiatric nurses are retiring far faster than new people are being trained. 

​"The impact is a reduction or closure of services," she said, noting long wait-lists, the situation at North Battleford hospital, along with reduced services in smaller cities like Yorkton and Prince Albert. "If nothing is done and those people are allowed to retire without replenishing, we simply cannot sustain the profession in the province at a time when we're at multiple mental health crises." 

She said the shortage is expected to increase dramatically during the next decade, because half of the current membership is expected to retire. 

The province recently announced the construction of a new urgent care centre in Regina meant to relieve some pressures in the city's emergency rooms, including issues related to mental illness and addictions. The government said psychiatric nurses will provide care at the centre. 

Balaski questioned where these psychiatric nurses would come from, because the government has been unable to staff existing facilities. She said the recent government budget increased the number of training seats to 80 up from 56, but that's not enough.

"We need 120 immediately, for at least three years, to get out of this crisis."