Two of the longest-working professionals inside the Waterford Hospital say Newfoundland and Labrador needs to replace the 161-year-old institution, which was founded the very year Newfoundland gained responsible government in 1855.
Isobel Keefe, the regional director of mental health and addiction services with Eastern Health, and Dr. Nizar Ladha, a prominent psychiatrist, told CBC in a wide-ranging interview that the hospital has become very crowded.
"The place is too large, it is not conducive to really getting well properly," said Ladha.
"However, I hasten to add that we have excellent staff [who] are able to provide services within this very old building that is older than Canada."
Ladha and Keefe have been working with one another for nearly 30 years at the province's only psychiatric hospital.
Earlier this month, Keefe and Ladha gave CBC Newfoundland and Labrador an exclusive tour of the hospital that's often discussed but rarely seen.
"It is a very old building. If you could have seen the wards, and you can't see the wards for privacy reasons, you would see that the bedrooms house four to six people with one bathroom," Ladha said.
"There is no privacy, there's only curtains between them. So when the behavior of one person changes, because a person is very acutely ill, it affects 20 other people within the same corridor."
Hospital could be more private, positive and safer
Keefe agrees, noting she would like to see "a lot more private rooms, and probably all private rooms" for the good of patients' treatment.
"I think privacy, and quiet, and time to just be on your own and rest, is a really important part of recovering," said Keefe, when asked what a new facility should look like.
While on the walk-through of the Waterford, many of the hospital's doors are locked. They need to be unlocked and locked again when entering or exiting rooms, halls or stairwells.
"I think there are things that we have to do in this building because of the way that it is laid out ... that in a new building you would be able to build safety features within the design of the [new] building," Keefe said.
"It would take care of a lot of things that we now need to check and observe, and those kinds of things."
Keefe said if the Waterford Hospital is ever replaced, she'd like to see the new facility "offer a much more positive environment."
She added that recently, about a thousand different people have each year sought medical help at the hospital for mental illness.
Keefe said there are currently 137 beds, though more beds can be made available should patient numbers increase.
Three-quarters of patients check themselves in
The Newfoundland and Labrador Centre for Health Information (NLCHI) says that in 2012-2013, 964 people were admitted to the Waterford Hospital.
Their average length of stay was 22.7 days.
Of those 964 people, 22.8 per cent of admissions at the Waterford Hospital were involuntary.
Ladha said the vast majority of the people who need mental health help are actually taken care of by general physicians and other health workers, those acting as the points of first contact for people in communities across Newfoundland and Labrador.
Provincially, 30.7 per cent of all mental health and addictions hospitalizations in 2012-13 were at the Waterford Hospital.
Ladha said he sees anywhere between 40 to 60 patients each week, treating and helping them with anxiety, bipolar disorder, schizophrenia, psychosis, eating disorders, depression, as well as other mental and nervous disorders.
He said other psychiatrists across the province are seeing more than a hundred patients a week.
NLCHI says in 2012-2013 there were 14 psychiatrists per 100,000 people in the province.
Ladha said more than 550 people are currently on a waiting list for mental health services through a central intake system.
"Statistics would tell you that 100,000 Newfoundlanders right now suffer from a mental disorder, so you are not only thinking about the families impacted, [but also] the caregiver is impacted — so it is a huge problem," Ladha said.
"We are stretched to the limit in terms of providing resources."
When the Waterford Hospital opened in 1855, there could have been as many as a thousand different patients staying there at any given time. Part of the idea was to keep patients isolated and secluded, in what was then the outskirts of St. John's, away from residents.
Today, a tenth of that number of patients stay at the Waterford Hospital. Treatment now is focused on a regimen of medicine, mental health intervention, and community and peer supports.
"Mental illness is an illness," Ladha said.
"Like any other illness it is not a weakness. It is not a moral weakness. It is not a character defect. It is an illness like diabetes is, or, like hypertension is — and it is an illness that stays with you [...] that needs to be treated and managed, and it is an illness that you can recover from to attain function to go back to your life."
How to replace the Waterford?
The previous Progressive Conservative government had suggested that a new Waterford Hospital could be constructed on the same site as the existing facility.
Just last week, Health and Community Minister John Haggie said building a new mental health facility to replace the aging Waterford Hospital is a top priority for the new Liberal government.
"Replac[ing] the Waterford Hospital remains a priority and will proceed without delay," said Haggie.
The Liberals had made an election promise to replace the building estimating the job could cost some $325-million and that construction could start in 2017.
The government also said that unless it cuts expenses or finds new revenues, the provincial deficit for 2016-17 will be $2.4-billion.
Whether or not any money will be allotted towards the construction of a new facility may be seen when the province's next provincial budget is brought down.
"Yes, the Waterford needs to be replaced. But you know, as Isobel would say and I would say, we are very much the realists," said Ladha.
"Whether it will be replaced now, or sooner, or later, is really somebody else's decision — but the place needs to be replaced very badly."