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Mental health care straining under pressure of pandemic at Southlake

The Newmarket hospital is now seeing as many as 17 people per day coming to the emergency in a mental health crisis
2021-04-01 mental health pandel ASH-1
A panel discussion about the state of mental health services at Southlake Regional Health Centre with Lesley Ring (upper left), Dr. Mark Katz (upper right), Arden Krystal (lower left) and MP Tony Van Bynen.

The intensive care unit is not the only department at Southlake Regional Health Centre that has been hit hard by the pandemic — the mental health unit has been overwhelmed with as many as 17 people every day coming to the emergency in crisis. 

Southlake's overcrowding problems have extended to mental health care, with patients waiting in overcrowded hospital rooms for days for a vacancy in the mental health care centre.

"The pandemic has shined a light on a global mental health epidemic. As people's ability to cope has been compromised, mental health needs continue to grow. With my own loved one's life-long mental health journey, I have seen this unbearable burden first hand," said Jennifer Klotz-Ritter, president and CEO of Southlake Regional Health Centre Foundation during an online panel discussion. 

"I wished my loved one was not out in the hallway under harsh lights in the midst of a chaotic emergency department, where they spent days, before being admitted to a crowded room they shared with others trying to cope with their own excruciating pain; knowing the whole time that what they needed was space, calm and safety so they could receive the treatment and care to begin to heal."

On Wednesday evening, Newmarket-Aurora MP Tony Van Bynen hosted the hour-long community conversation on the situation and the ways Southlake is trying to address it, such as through the Better Begins Today campaign launched last year. 

Fundraising executive Lesley Ring noted that the hospital's 30-year-old design and lack of modern treatment spaces is a big part of the problem. This is why the campaign is looking to raise $7.5 million to build a better space. 

"We need the community's support to make this happen," said Ring. 

Hospital CEO Arden Krystal said that the hospital is seeing more mental health crisis cases coming in because of the pressures of the pandemic, particularly among youth and adolescents. 

The one silver lining, she said, is that the pandemic has forced more people to realize how "tenuous" most people's mental health is, and how important it is to have the services and supports in place.

"Before the pandemic, a lot of people believed it was 'them' and 'us', there are people with mental health issues and the rest of us who are all fine. Going into COVID-19 and putting this level of stress on people where they have no access to their regular stress-relieving activities, such as being with family and loved ones, exercising, shopping, whatever. It has really exposed a number of mental health issues for people, and we have seen increased levels of stress and anxiety."

Southlake psychiatrist Dr. Mark Katz said that roughly 17 patients in crisis come to the hospital's emergency room every day, two-thirds of whom are referred to a psychiatrist, and one-third end up being admitted to hospitals. Many of these patients are intoxicated in some way, and the cases that Southlake sees are often more severe than other hospitals, with a higher number having to be placed under a safety watch because they are suicidal or a danger to others.

When the pandemic began, said Katz, there was increased fear and increasing rates of depression, and it was feared this would lead to a rash of suicides. 

"What's interesting is that we didn't see that. Studies have now come out and shown a worldwide phenomenon of suicides not increasing during the first phase of COVID-19 because of the sense of solidarity that we were all in this together. There was an effort by most governments to support people financially, such as the CERB payments, so we didn't see an initial rise in suicide rates."

But more recent studies show suicides have begun rising, said Katz. At the same time, overdose deaths have been increasing across Canada, all of which is part of what he calls the "mental health pandemic."

People's fear of going to the hospital for treatment because of COVID-19 and the shift away from in-person mental health services has also not helped matters, said Katz. 

"These telephone, video and virtual services are not as powerfully helpful for many of our patients," said Katz. "Many of our patients don't have access to the necessary technology or don't know how to use it, and there are limitations on what can be provided by phone. We have also had programs and clinics shut down."

When someone comes to Southlake during a mental health crisis, said Katz, they won't be left to sit in the waiting room, but are triaged and quickly taken to another part of the department depending on the available space.

"Sometimes space is at a tremendous premium in the emergency department," said Katz.

The patient is then seen by a crisis worker and, if necessary, by a psychiatrist as soon as one is available, which could be many hours.

If beds are available at the emergent mental health assessment unit, the patient may be sent up there to be seen by a psychiatrist. Once they are seen, they will either sent home or admitted to the hospital —  some voluntarily, some not. 

"They then wait to be admitted to our inpatient unit, which can take days sometimes. They could be in the emergent mental health unit for days before a spot opens up in the regular unit," said Katz.

"Even when they get into the unit, they often have to deal with a very full environment and, in some cases, a room meant for two people — that meets the needs of one person —  with three people in it, because we had to put someone in there on a stretcher."