Psychiatric urgent care clinic in Charlottetown won't be reopening

A special facility to treat those in psychiatric emergencies in Charlottetown won't be reopening, despite earlier assurances from the health minister that the closure was temporary.

The psychiatric urgent care clinic — or PUCC as it's called — operated from April to the end of October at the Hillsborough Hospital, just around the corner from the Queen Elizabeth Hospital.

It was set up to handle those in mental health crisis — a place for them to go for specialized support, and also divert them away from the QEH's emergency department to reduce visitors there during the early days of the pandemic. The clinic was staffed with a team, including a psychiatric nurse, who triaged patients and arranged virtual psychiatric appointments.

It closed at the end of October due to a nursing shortage, and patients were directed to the ER instead.

At the time, Health Minister James Aylward said the PUCC would reopen in a few days.

"I stand here today, promising Islanders the PUCCs will not wind down. They're not closing permanently. We have just a short glitch here with resources, human resources," Aylward said on Nov. 6.

Friday, however, health officials told CBC News after a review of the situation, they decided to keep the urgent care service at the ER of the QEH, and the PUCC in Charlottetown will remain closed. The PUCC at the Prince County Hospital in Summerside however will stay open.

"As things changed with COVID, the reality came to light very quickly that the service would be best served back in the emerg department," said Carol Chipman-Francis, acting nurse manager, Unit 9, mental health crisis response. 

The province said all the mental health services offered at PUCC will be offered in the ER, and that it's a better location for staffing and safety reasons. 

When you're sitting in emergency too, it's not usually very nice how you feel when you're in there.— Ellen Taylor, mental health advocate

Not everyone agrees, however, that closing the PUCC is a good idea.

Ellen Taylor, an advocate for those with mental health and addictions issues, said the PUCC offered specialized services, a safe place for those in crisis, and shorter wait times to see a specialist.

"When you're sitting in emergency too, it's not usually very nice how you feel when you're in there," she said. "You're maybe going through withdrawal, or wanting medication or needing a referral.  And in there you might feel judged. That's kind of been people's experience."

She said the province needs to make mental health services a priority.

"I'm just really disappointed that's the decision they made because I feel like again, the mental illness/addictions piece just goes to the bottom," said Taylor.

She said she knows it's not an easy fix, but she's frustrated that a service that was helping people will no longer be there.

"These are the people who are going to keep presenting themselves in the hospitals and at the jails," said Taylor. "It kind of needs to be a well-oiled machine, and I feel like this is a step back from what we were doing well on."

Political opposition

"An ER is simply not conducive to supporting people in a mental health crisis," said Trish Altass, Green MLA and Opposition health critic. "Having those services at Hillsborough Hospital where people could seek immediate support and care was incredibly valuable, and would continue to still be valuable if it were available.

"We need to recognize when things are working, when they're going well, and we need to put the resources there to make sure they continue to work for Islanders," she said.

"At a time when demand for addiction and mental health services is increasing, government must expand access not reduce it," said Liberal health critic Heath MacDonald.

"Government is expanding online gambling services and at the same time reducing access to addiction and mental health services. I am left questioning this government's priorities."

Similar services, says province

Health officials, however, said services in the ER will mirror what was offered at the PUCC.

In an email to CBC, they said the triage process has been improved at the ER so mental health patients aren't kept waiting too long, generally.

A crisis nurse is working in the ER daily from 8 a.m. to 8 p.m. to provide services to mental health and addictions clients, and a nurse liaison and a social worker will be added to improve treatment.

In addition, appointments with a psychiatrist can be arranged, in-person or virtually, through the ER during those same hours, in the same way they were available at the PUCC.

However officials said waits of several hours might happen depending on the seriousness of a patient's condition and how many others were waiting for help.

Officials said they are working to hire more specialized staff to improve wait times.

Unit 9 beds still limited

Moving urgent care needs back to the ER has not lead to more available inpatient beds for mental health patients, however.

Back in April, when urgent care needs were moved to the PUCC away from the ER, the Unit 9 psychiatric ward at the QEH was emptied of psychiatric patients to make way for potential COVID-19 patients. However, no COVID patients needed to be hospitalized.

Instead of reopening Unit 9 to mental health patients, though, special needs patients, mainly those with dementia, were moved into the ward.

In early November 2020, six of the 20 beds in Unit 9 were made available to mental health patients.

That number has not changed.

Health officials said they hope to reopen another six beds to mental health patients within a few weeks.

They said they've hired a clinical lead, a nurse and an LPN, and they plan to post positions soon for three other nurses and one LPN, as well as several personal care workers.

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