Cape Breton doctors worried over state of psychiatric care
'We need to solve these problems locally as help is not forthcoming from Halifax,' says health authority memo
A shortage of psychiatrists in Cape Breton has doctors alarmed that only about half the number needed are practising on the island, according to a Nova Scotia Health Authority memo released Wednesday by the provincial NDP.
There are supposed to be 16 psychiatrists working in Cape Breton, but only seven full-time and one part-time psychiatrist are currently operating there.
"We need to solve these problems locally as help is not forthcoming from Halifax," says a memo sent to doctors and nurse practitioners last month. The memo is signed by Dr. Scott Milligan, psychiatry department lead for Cape Breton, and Dr. Faisal Rahman, chief of the eastern zone's psychiatry department, which includes the island.
The memo says the area has lost seven psychiatrists since December 2014 and four in the last year alone. There were also three psychiatrists who made commitments to come to Cape Breton and then backed out.
The memo also outlines barriers to obtaining temporary relief because the department has more than four members, making it ineligible for the provincial locum program.
The memo also calls for family doctors and nurse practitioners in Cape Breton to help treat more stable patients, as the first priority needs to be caring for patients with severe and persistent mental illness.
While the idea of having a family physician take on as much primary care as possible — with patients accessing psychiatric services as needed — makes sense and has been tested in places like British Columbia, a Doctors Nova Scotia official said there are some problems with that model for Nova Scotia.
'A Ping-Pong match' between resources
"We don't have enough family physicians and we don't have enough psychiatrists, so it's a bit of a Ping-Pong match in that neither side is resourced enough to do what needs to be done," said Kevin Chapman, the director of finance and partnerships.
This can lead to other problems.
"Ultimately, the providers get burnt out and then what is a bad situation becomes almost an interminably bad situation," said Chapman.
"It's almost like a treadmill that you can't get off of."
Prioritizing sickest patients
Warren Wilkes, medical executive director for the eastern zone of the Nova Scotia Health Authority, said the strain on resources means prioritizing the sickest patients.
"In all specialities, a lot of patients that have been stabilized are often sent back to the primary-care physicians to be followed up, so I think in psychiatry that's no different," Wilkes said.
"The risks of a delay in receiving care typically is primarily that somebody will end up in the hospital instead of having their care as an outpatient, which typically would be more ideal. But overall, most patients do get the acute care they need in some fashion."
He said one of the plans locally is to develop a crisis team with psychologists, social workers and physicians to help manage some of these patients in the short term.
Chapman hopes to see psychiatry residents rotate through Cape Breton, which he said would introduce them to the life of rural psychiatry, as well as hopefully find people who want to stay there.
'Traumatic inequity in health care'
NDP Leader Gary Burrill said this is just the latest example of differing levels of health-care services across the province.
"This kind of terrible, traumatic inequity in health care between particularly industrial Cape Breton and the HRM is entirely unconscionable," he told CBC News.
The memo notes that 122 psychiatrists are working in Halifax.
Burrill said the province needs to make providing health care to people everywhere in Nova Scotia a priority and make the investments for that to happen.
"You have to listen to people who are providing health-care service on the ground," he said. "The government needs to understand and acknowledge that there is in fact a [health care] crisis."