Context: There’s been some public awareness recently of criticisms of care received at Victoria’s Psychiatric Emergency Services (PES) at the Royal Jubilee Hospital (RJH), run by the local health authority, Island Health (VIHA). All thanks to a Facebook Group spearheaded by two brave and strong young women.
As far as my involvement: my wife is a psychiatrist in Victoria, not at VIHA (she did work at other VIHA sites for a year when we first moved here six years ago and did call at PES). I help run the front office of her private practice. We know many psychiatrists and other staff at PES/RJH and work with them whenever our patients need care in the hospital. And we hear from lots of patients. And incidentally, no, my wife’s been too busy taking care of patients and didn’t help write this post.
Without commenting on the horrific stories that have been exposed, they’re indicative of a bigger problem: not a few bad apples, depraved indifference, specific policy decisions, or underfunding.
And not to minimize former patients’ experiences, but few PES staff are having an easy time of it either (predating the recent attention). It’s not a clear good-guy, bad-guy situation.
PES should be like the proverbial canary in the coal mine. It’s an early indication of breakage in the overall system, a warning to act before things get worse. But dead canaries don’t help if nobody is paying attention. And these birds have been piling up for years.
What’s the root of the problem?
PES is being pushed well beyond its mandate of providing emergency psychiatric services.
In a functioning system, people could access high-quality care early on. In many cases, early treatment would prevent most problems from spiraling into emergencies. When it’s not an emergency, people should be referred to places to access more appropriate treatment.
In Victoria, those places for non-emergency treatment are scarce and wholly inadequate. There’s nowhere to direct people for early care. So far too many people end up in PES because there’s nowhere else to go. And once they’re there, if it’s not an emergency, there’s nowhere they can be referred to get the care they need. There’s nothing right “underneath” PES that people can access quickly for urgent but not emergency care.
This isn’t unique to psychiatry. People with no access to family docs, who are turned away from walk-in clinics or urgent care clinics for physical health problems, end up at the regular ER. They’re sent home with instructions to access follow-up that often isn’t there.
Getting help before it’s an emergency
We’ve published tips for finding a psychiatrist in Victoria, but the story is pretty grim. Waits at the VIHA urgent short-term clinic (USTAT) are long. The largest VIHA outpatient clinic, VMHC, has effectively stopped taking almost all new referrals (over capacity). There are only about a dozen or so non-VIHA psychiatrists in the community. Waits are insane if you can get accepted onto a waiting list at all.
We get multiple cold calls a day from people desperate to access a psychiatrist. Many people don’t have family docs or don’t have family docs that are willing/able to address most mental health issues. Those family docs have nowhere to refer their patients. If a psychologist or counsellor won’t suffice or isn’t accessible, most people are out of luck. With nowhere to turn early on, people get worse and end up at PES… because there’s nowhere else to go.
PES has become a “choke point” for the whole system. What should be a place for emergencies gets overloaded because the entire infrastructure that should exist right below it to provide support isn’t there.
Should we be surprised when things turn out the way they have been?