Nova Scotia·CBC Investigates

Suicidal and waiting 2 years for help. A look at N.S.'s growing mental health crisis

A CBC News investigation reveals that, while psychiatrists and inpatient services in Nova Scotia are stretched to capacity, the number of people seeking help during a mental health crisis has risen by 30 per cent since the beginning of the COVID-19 pandemic.

Janis Keirstead says her mental health deteriorated as pandemic dragged on, but she struggled to get help

Janis Keirstead, 33, waited two years to see a psychiatrist. She says people experiencing a mental health crisis deserve better care in Nova Scotia. (Robert Short/CBC)

As vibrant red and orange leaves fall to the ground, painting a picturesque backdrop in late October, Janis Keirstead admits she can't see past the darkness in her own mind.

She's consumed with thoughts of ending her own life. But even knowing she needs help, the 33-year-old Halifax woman feels helpless about where to turn. She's been waiting two years to see a psychiatrist.

"I hear about people with chest pains sitting in the ER for eight to 12 hours without being seen," said Keirstead.

"I don't want to go to the hospital and be disappointed because I feel like it's my last resort. And what am I going to do if my last resort lets me down?"

A CBC News investigation reveals the number of people seeking help during a mental health crisis has risen by 30 per cent in Nova Scotia since the beginning of the COVID-19 pandemic, at a time when psychiatrists and mental health services in the province are stretched to capacity.

Nova Scotia toll-free mental health crisis line is available 24 hours, seven days a week and can be reached at 1-888-429-8167. (Shutterstock)

In Keirstead's case, she required a medication change for multiple diagnosed illnesses, including borderline personality disorder, PTSD, anxiety and depression. She said her family doctor kept sending referrals for a psychiatrist because he didn't feel comfortable playing around with her doses.

"I'm glad that my doctor is being responsible, but there's no psychiatrist to go to," said Keirstead.

Statistics released through an access-to-information request show the number of calls to the provincial crisis line rose to 24,265 last year, up from 19,115 in 2019.

Between January and November of this year, the number of calls totalled 23,752, which is on track to exceed 2020.

In addition, mental health visits to Nova Scotia emergency departments have increased by 30 per cent.

And according to briefing notes to the health minister obtained by CBC News, caseloads with community mental health and addictions have more than doubled over the 2020-2021 fiscal year, a situation that is being "closely monitored."

When it comes to inpatient psychiatric care, beds have been at maximum capacity across the entire province since early 2020.

Keirstead required a medication change for multiple diagnosed illnesses, including borderline personality disorder, PTSD, anxiety and depression. She says her family doctor kept sending referrals for a psychiatrist, but they went nowhere. (Robert Short/CBC)

"Traditionally, inpatient care has been a little bit seasonal, so during the summer numbers tend to drop a little and during the fall and winter they go up," said Dr. Andrew Harris, senior medical director for mental health and addictions at Nova Scotia Health.

"But we've found that doesn't seem to be the case anymore. It's been 100 per cent really for the last two years, like straight on."

He adds if someone needs a bed, they will find them one somewhere in the province.

Psychiatrist shortage

Harris acknowledges that access to mental health care is particularly strained in Cape Breton, where resources are limited.

"They have gone through a very difficult time where the psychiatrists there have had to really pick up and do a lot more work because they've had to cover for the unfilled spots," he said.

Of the 14 current psychiatrist vacancies in Nova Scotia, eight of them are in the eastern health zone, which covers Cape Breton, Antigonish and Guysborough. In the northern zone, 4.3 positions are vacant. The western zone has one vacancy and the central zone has 0.8 positions available.

Nova Scotia Health said there are four offer letters signed from psychiatrists who are expected to start before the end of March.

Harris said in Cape Breton, the health authority has also developed a clinical assistant program. It gives physicians trained in other countries who operate under a different licence the opportunity to use their skills while meeting a critical need.

"They extend the reach of the psychiatrist. They can see more patients more frequently and carry heavier case loads with the support of these clinical associate positions," said Harris. 

There are also changes in the works to address problems in other parts of the province.

He said Nova Scotia Health is in the process of setting up a day hospital at the Abbie J. Lane building in Halifax.

Nova Scotia Health is in the process of setting up a day hospital at the Abbie J. Lane Memorial Building in Halifax, which is a service that was discontinued 15 years ago. (CBC)

"What that would mean, essentially, is that a person would have an intensity of care equivalent to an inpatient stay, but they wouldn't require to stay in the hospital overnight," Harris said.

"We're looking at that as a way of increasing our capacity to provide that level of care without having to have the physical space of bedrooms and inpatient nursing staff and those types of things."

It's a service that was discontinued in Halifax 15 years ago.

Earlier interventions

But the goal for mental health professionals and patients like Janis Keirstead is to avoid reaching the point of crisis in the first place.

Keirstead said during the time she waited for her doctor's referral to reach a psychiatrist, her condition worsened as the pandemic dragged on.

"It made my depression, my anxiety, I mean it went through the roof," she said.

"Maybe I waited too long, I don't know, to try and reach out for more serious help. But I didn't know that it was going to be necessary."

Following Keirstead's interview with CBC in October, she connected with staff at the provincial crisis line. They sent a crisis team to meet her, and she secured an appointment with a psychiatrist who adjusted her medication. She said she is feeling remarkably better "for the moment."

Community care

The new chief of psychiatry for the central zone, which includes Halifax, believes streamlining care at the family physician level is one way to help patients like Keirstead, rather than subjecting people to long wait-lists.

Dr. Vincent Agyapong said it was one of the first issues he heard when he moved to Nova Scotia in September.

"I've met with the chief of family medicine and also I've heard from even other psychiatrists about the difficulty with, for example, family doctors getting access to psychiatric consults for their patients," said Agyapong.

It sparked an idea that he hopes will soon become a reality across Nova Scotia.

Dr. Vincent Agyapong, chief psychiatrist of the central zone and head of psychiatry at Dalhousie University, would like to see family physicians trained to do medication changes. He says this is one way to address the backlog for psychiatrists in Nova Scotia. (Nick Pearce/Dalhousie University)

"Not everybody can be able to see a psychiatrist on demand, but people generally are very well connected to their family doctor or the nurse practitioner. So if we can be able to appropriately train them in the art and skill of providing psychiatric care, then it's going to lead to a situation where people receive the same care they would have received from a psychiatrist," said Agyapong.

He said one example would be teaching and consulting with physicians to make medication adjustments.

"We always know that if people's mental illnesses are addressed quickly, then they don't deteriorate to the extent that they need to present to the emergency department or they need to be admitted into hospital," Agyapong said.

Where to go for help

If you're experiencing a mental health crisis, Nova Scotia Health offers online mental health services.

People who are looking for support are encouraged to call their local clinic, the mental health and addictions intake line at 1-855-922-1122 from 8:30 a.m. to 4:30 p.m. AT on weekdays, or the province's toll-free mental health crisis line at 1-888-429-8167, which is available 24 hours, seven days a week.

People can also contact the Kids Help Phone at 1-800-668-6868 anytime of day.

If you're experiencing an emergency, call 911. 

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ABOUT THE AUTHOR

Angela MacIvor is CBC Nova Scotia's investigative reporter. She has been with CBC since 2006 as a reporter and producer in all three Maritime provinces. All news tips welcome. Send an email to cbcnsinvestigates@cbc.ca

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