Health Sciences' integrated ER could deter people from seeking mental health care, warns advocate

When the Health Sciences Centre's new mental health and addictions facility opens, its emergency room will be integrated with the hospital's existing general emergency room. 

Eastern Health says the decision to assess mental and physical health emergencies in the same emergency room was made, in part, to reduce stigma surrounding mental health services — but an advocate says the integration might make it harder for someone experiencing a mental health crisis to seek help.

Sarah Hillier, a mental health advocate in Churchill Falls, said she doesn't think combining the emergency rooms is a good idea.

"I do understand the kind of thought of, 'mental health is health.' It absolutely is. But I just think that comes also with being sensitive to the needs of mental health and how to appropriately address emergencies." 

Hillier, who has used mental health services at the Waterford Hospital, said she might not have gone if she'd had to go to a general emergency room. 

When seeking mental health help, a person often needs to advocate for themself, she said — and even just going to an emergency room can be a hard step to take.

Being in that environment can be discouraging, she said, and the process could be a deterrent for people seeking mental health services.

Potential to backfire

Hillier said integrating the ERs to reduce stigma could backfire.

"Reducing stigma does not mean lumping everyone together," she said. "Reducing stigma means approaching it the way that it needs to be approached sensitively and and in a very timely manner." 

But having the mental health facility at the main Health Sciences Centre, said Hillier, could help reduce the stigma of going to the Waterford Hospital, a dedicated psychiatric hospital.

When asked about Hillier's concerns, Patrick Whalen, Eastern Health's regional director of mental health and addictions, said "health is health."

He said the regional health authority held significant consultations when planning the new model, including with mental health advocates, individuals and families with experience in the mental health-care system, the Eastern Health client-family advisory council and clinicians. 

"We brought that question to them: would they rather have a separate psychiatric assessment unit as part of the new build or would they prefer to have this new model, where we integrated into the Health Science emergency unit, which is being done nationally in other provinces?"

The consensus from those groups was to integrate the psychiatric assessment unit into the general emergency services, he said.

The new process

Whalen said patients will meet a triage nurse and register in a private area. They will be assessed by a mental health clinician who will determine whether the individual goes to the general waiting room or a "sub-waiting room," separate from the main waiting area.

Daniel Parsons, Eastern Health's director of engineering and planning, said anyone undergoing a mental health crisis will not have to return to the main waiting area. 

Whalen said the goal is to provide health care on an individual basis, rather than treating everybody the same, and if someone in the waiting rooms does not feel safe, the triage nurse can reassess a patient. When the new psychiatric unit will double current assessment capacity from four assessment rooms to eight, which will improve the flow of the emergency room.

Parsons said Eastern Health hired a U.S. consultant to help the health authority with the ER design.

"Their whole core business is how modern emergency functions and, you know, we have incorporated best practices and lessons learned from other emergency departments across Canada."

Parsons said the new mental health and addictions facility is on track to be completed by late 2024, with the psychiatric assessment unit scheduled for completion in early 2025.

Read more from CBC Newfoundland and Labrador