Wait-lists for psychiatric assessments on P.E.I. cut dramatically during COVID

The list of 500 children waiting for a psychiatric assessment on P.E.I. has been eliminated during the COVID-19 pandemic and the wait-list of 1,200 adults has been cut in half, according to Dr. Heather Keizer, chief of mental health and addictions on P.E.I.

"That's never been a possibility before," she said.

Reducing those lists has helped toward clearing a consistent backlog over the past three years, said Keizer.

In addition, newly referred adults are now being seen within two weeks, compared to an average of 350-plus days before the pandemic.

Children and adolescents were waiting 150 days or more prior to the pandemic. That wait was reduced to one to two weeks in July, but is now at under four weeks, as physicians have begun to refer more patients now that the backlog has been eliminated, she said.

Keizer said this is all due to a number of factors.

First, she said, the demand on psychiatric services dropped during the early days of the COVID-19 pandemic.

That allowed Keizer's psychiatric team to start working through the backlog.

In addition, patients who showed up at the Queen Elizabeth Hospital emergency room were diverted to the Psychiatric Urgent Care Clinic (PUCC) at the Hillsborough Hospital, and a psychiatric nurse was moved from the QEH to act as a triage nurse at the PUCC.

Keizer credits the staff at the PUCC with helping to work through the backlog to schedule assessments.

She cites "their real agility and innovation in terms of figuring out how to book people and to do it in a very quick and efficient way." 

Video assessments

But a significant factor was the move to virtual assessments.

Since April, more than 400 Islanders have been assessed by telehealth.

"It's a huge win for us … one big, big step forward," said Keizer.

Conducting assessments via Zoom allows patients to have that conversation from their own home, and for a psychiatrist to provide a full psychiatric assessment and a treatment plan sooner.

"It's been a boon because it's meant that we've been able to deliver service to patients — not only patients in their own homes [but] patients in the nursing homes, patients in the community care — without having them have to come to hospital, without having them have to come to the clinics," said Keizer.

Telehealth is relatively easy and convenient for both the doctor and the patient, she said, eliminating transportation costs for the patient.

Virtual calls are not for everyone, however. Keizer said when her office gets a referral, staff will ask them to try a virtual psychiatric call, and if that doesn't work for them, a meeting will be scheduled in person.

Long-distance psychiatrists

Another big part of reducing the backlog has been the use of psychiatrists in other provinces. 

They're licensed on P.E.I. but most are working part-time: on weekends, evenings, or even just a few hours during the week. One is on-call 24/7 for the emergency rooms on P.E.I. And, Keizer said, a second off-Island psychiatrist will be joining the on-call schedule in January.

There are 13 psychiatrists working on P.E.I. and another seven with a P.E.I. licence, but working virtually from other provinces — since most are working part-time, together it's the equivalent of 13.6 positions.

Before COVID-19 hit, Keizer had one full-time child and adolescent psychiatrist. Now she has two additional part-time positions, which is why there is no longer any wait for children to be assessed, she said.

"The level of satisfaction is pretty high," Keizer said, adding feedback from those who have used the service has been positive. 

Another new initiative during the pandemic: All new patients get a followup call within 24 hours.

Help offered — 2 years later

Another reason why the backlogs were reduced is that some patients on the wait-list managed to find help elsewhere. Or they stopped asking.

Two years ago, Chelsea Perry was looking for help after moving to Charlottetown from western P.E.I.  She didn't know who to turn to, and didn't want to face hours waiting in an emergency room, so she went to a walk-in clinic. 

"God help the doctor, but there wasn't a lot that he could do, other than, you know, attempt to adjust medications," said Perry.

He offered to put her name on the provincial wait-list to see a psychiatrist, she said, but warned her it would be a wait. 

While she was waiting, she saw a counsellor at UPEI, where she was a student at the time, and was put on a wait-list with the P.E.I. Rape and Sexual Assault Crisis Centre. 

About four months later, she was matched with a counsellor there.

Where were you two years ago?— Chelsea Perry

Then just recently, she got a call saying a spot had opened up on the provincial wait-list, if she was still interested in being assessed.

"It was really disheartening to hear that after two years," she said.

"I laughed when she called me ... not at her, at the situation in general, " said Perry. "It felt so pointless at that point.

"I came to the walk-in clinic in a crisis and just kind of at the end of my rope. And when you hear two years later, like, 'Oh there's something for you now,' I'm like, 'OK, well, where were you two years ago?'"

Perry said she knows there are likely thousands of Islanders looking for help and she's glad the backlog has been reduced.

"But it just kind of made my heart sink a little bit."

She considers herself one of the lucky ones because she found a counsellor while she was waiting.

She hopes the province in the future can do more publicity and education on what mental health services are available and how to access them.

Followup care

Advocates for those struggling with mental health issues said it's great to hear the backlog has been reduced, but they're also concerned about what happens after people get their assessment. 

Sarah Stewart-Clark said there needs to be more focus on helping Islanders before their struggle turns into a crisis.

"We need to start treating the root. We need to start making sure that there's trauma counsellors available to help people through life events," she said.

When COVID-19 hit, for example, trauma that had been bubbling below the surface ended up overflowing for some people, she said.

"We're not helping the province or the situation by not treating people for trauma. We're just making sure that each year as things happen, it gets worse and worse and worse for them," said Stewart-Clark.

P.E.I. aims to hire more psychiatrists

Keizer is trying to hire more psychiatrists.

The province approved an increase to the provincial complement earlier this year, giving Keizer clearance to hire more psychiatrists, increasing the number of positions from 15 to 20.8.

That's a challenge though, as P.E.I. — like provinces across the country — hasn't been able to fill all of its vacancies for years.

Hiring during a pandemic has added an extra layer of complications.

"With COVID it has been very difficult to get psychiatrists from out of province."

That's why she's employing psychiatrists in other provinces who only want to work part-time — an arrangement she thinks will continue post-COVID-19 because it provides quick followup for counselling and outpatient services.

And while virtual meetings are part of the solution, she hopes some new hires will agree to move to P.E.I., given that in-person contact is important for some patients to make a connection.

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