Nova Scotia

C.B. psychiatrist shortage could force youth in crises to Halifax for care

In a recent memo to emergency department staff, Dr. Scott Milligan recommended that anyone under the age of 19 who comes to the emergency department needing urgent psychiatric care be referred to the IWK as of Dec. 1.

'I can see children not receiving care because of this,' says ER doctor

Dr. Scott Milligan, psychiatry department lead for Cape Breton, says there aren't enough psychiatrists in the region to provide adequate care to youth experiencing mental health crises. (iStock)

A shortage of psychiatrists in Cape Breton could force youth in crises to travel more than four hours to the IWK in Halifax to get help.

In a recent memo to hospital staff, the head of Cape Breton's psychiatry department said it's no longer possible for the psychiatrists to adequately treat youth and children in the ER and adult psychiatric inpatient units. 

Dr. Scott Milligan said as of Dec 1., anyone under the age of 19 requiring psychiatric care beyond what's available at outpatient clinics should be sent to the IWK for assessment.

That recommendation hasn't been accepted yet, said the Nova Scotia Health Authority.

The memo noted that there's only one part-time child and adolescent psychiatrist and seven adult psychiatrists at the Cape Breton Regional Hospital when the region should have closer to 16.

It's the second such memo this month to draw attention to the shortage of psychiatrists in Cape Breton.

"We have always done our utmost to treat these patients locally but we simply do not have the resources to provide the safe, timely and appropriate care that these young people deserve," wrote Milligan in the internal memo dated Nov. 19.

"Youth in Cape Breton, just as youth in Halifax, deserve specialized care when required. Having fourteen or sixteen year olds on an adult psychiatric unit in Sydney is not acceptable."

Youth will slip through cracks

Dr. Margaret Fraser, who works part-time in the Cape Breton ER, said she's worried families won't make the trek to Halifax because they can't afford it.

"I can see a lot of patients declining and saying, 'No, I'm sorry. We simply can't do that.' … So I can see children slipping through the cracks. I can see children not receiving care because of this," said Fraser. 

Dr. Margaret Fraser typically sees about four youth who are experiencing mental health crises every month. (Norma Jean MacPhee/CBC)

She typically sees about four youth who are experiencing a mental health crises every month, she said.

Given the three teen suicides that happened in the community in the past year, Fraser wonders where the province's promise of help is.

"This is a pretty basic service — child psychiatry. This is something that we absolutely should have," said Fraser.

Health authority 'still recruiting'

Nova Scotia Health Authority spokesperson Greg Boone said tapping into resources from other psychiatric units in the province is a possiblity.

"We know that we will have to adjust how we deliver some services based on the resources we currently have available, and that's not been a secret in the sense of the fact that we have vacancies and we're still recruiting," he said. 

If Cape Breton youth were sent to Halifax, it would be those in emergency situations. But how long they wait will be up to the IWK team that does the assessment, said Boone.

111-day wait in Halifax

According to the province's website, the average wait time for child and adolescent mental health services at the IWK is almost four months. The only region with higher wait times is Cape Breton, where patients can be expected to wait about 5½ months. 

Todd Leader, an author and mental health and addictions consultant, said fixing the chronic wait-time problem requires a system-wide overhaul.

People should not have to wait until they're in crises to get help, he said.

Todd Leader, who has studied mental health wait times in Nova Scotia, says fixing the problem requires a major overhaul of how we view mental health. (Emma Smith/CBC)

"We draw a line and we say, 'Sorry you don't qualify,' but the result of that is we end up with — like in Cape Breton now — too many youth who are at a point where they potentially need that higher level of care," he said.

Leader said many problems that youth experience in mental health and addictions are preventable if caught early.

If you are in distress or considering suicide, there are places to turn for support. Nova Scotia's Mental Health Mobile Crisis Team can be reached at 902-429-8167 or Kids Help Phone at 1-800-668-6868. The Canadian Association for Suicide Prevention also has information about where to find help.


Emma Smith


Emma Smith is a journalist from B.C. who has covered rural issues and Indigenous communities. Before joining CBC Nova Scotia in 2017, she worked as the editor of a community newspaper. Have a story idea to send her way? Email