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Help on hold: Over 1,000 P.E.I. patients unable to see a psychiatrist, despite having a referral

According to Health P.E.I., as of the end of May, there were over 770 unbooked referrals from family doctors to psychiatrists logged at the Richmond Centre mental health walk-in clinic.
According to Health P.E.I., as of the end of May, there were over 770 unbooked referrals from family doctors to psychiatrists logged at the Richmond Centre mental health walk-in clinic. - Stu Neatby

Over 1,000 Island patients seeking psychiatry services have been unable to obtain an appointment, according to a review of services initiated by Health P.E.I.

According to Health P.E.I., as of the end of May, there were over 770 unbooked referrals from family doctors to psychiatrists logged at the Richmond Centre mental health walk-in clinic. In addition, there were over 230 referrals at the Montague mental health walk-in clinic that have not been booked. 

The unbooked referrals are likely contributing to long wait times for individuals in need of psychiatric services. Health P.E.I. says it does not currently know how long the average wait time is for outpatient psychiatric care and is not aware of whether the 1,000 individuals may have seen other health professionals.

Several health professionals who spoke to The Guardian suggested the backlog is partly due to a shortage of psychiatrists working in P.E.I. The province currently has a complement of 15 psychiatrists, but several of these positions are currently unfilled. One child psychiatrist, who was working a locum contract on P.E.I., recently left the Island. 

But other factors may have played into the creation of the backlog of referrals at the Richmond Centre and in Montague. 

Health P.E.I. CEO Denise Lewis Fleming suggested individuals who have been referred to psychiatrists may not have been triaged properly.

“I think it's just a case of old processes that were never reviewed and looked at that unfortunately contributed to a situation that led to some referrals not getting from logging into booking,” Lewis Fleming told The Guardian.

"Everybody gets into a routine on how they book their work. You can get 10 years down the road and still be using the same routine. We need to look at what's our process improvement.”

Denise Lewis Fleming is CEO of Health P.E.I.
Denise Lewis Fleming is CEO of Health P.E.I.

Lewis Fleming said more people have been seeking mental health treatments in recent years. This has created new pressure-points in the health-care system.

Lewis Fleming said the finding of 1,000 unbooked referrals was the result of an examination of psychiatry programming on P.E.I. She said Health P.E.I. does not known whether the 1,000 patients may have seen another health professional, such as a psychologist or a social worker, instead of a psychiatrist. 

The Richmond Centre has been a key hub for both psychiatry services and community mental health programming since 2017.

Health Minister James Aylward said he was aware of the backlog of referrals. He said it was possible patients may have their needs met by seeing another health professional, such as a psychologist, instead of a psychiatrist.

“A lot of people seem to think that psychiatry is the end-all and be-all. Well, it's not. It's one of the many components that we have in our basket to help treat people," Aylward said.

But other health professionals who spoke to The Guardian off the record suggested rivalries between different health professionals may be contributing to the backlog.

In a letter submitted to The Guardian in April, Dr. Stirling Keizer, a family doctor, suggested the onus for the backlog was on staff at the Richmond Center.

“The allied health workers at the Richmond Centre are under-performing, as they see just one or two patients per day despite being paid a full days work,” Keizer wrote.

Keizer, who is the husband of Health P.E.I.’s chief of mental health and addictions Dr. Heather Keizer, also said in the letter that the compliment of 15 psychiatrists in P.E.I. was too low to meet the need and should be increased to 21. 

“Outpatient care is broken here and has been for so long that the government takes it for granted that it is supposed to be like it is. Patients are hurting emotionally, and some are killing themselves,” Stirling Keizer wrote.

Both Lewis Fleming and Aylward said they disagreed with Keizer’s letter.

"I would not say there is a prevalence of staff who are working at a low productivity," Lewis Fleming said.

"I honestly do not know why Dr. Stirling Keizer would have made the assertion of one or two patients a day."

The Guardian made several attempts to reach out to Stirling Keizer for comment but did not hear back.

Other health professional who spoke to The Guardian off the record have suggested shift incentives paid to psychiatrists to work inpatient shifts at hospitals are pulling these doctors away from taking on more referrals.

Health Minister James Aylward said many health professionals are eager to avoid creating "silos" in the health profession.

"It's a team effort, right from primary care to the ER to psychiatry and psychological services as well,” Aylward said. 

“We all need to roll up our sleeves and work collaboratively together to make sure Islanders are getting the help where they need it when they need it.”

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