'Desperate need for improvements' to mental health services in northern Sask.: auditor

Saskatchewan's provincial auditor is calling on the province to improve how it handles the treatment of at-risk people in the province's north, after finding that suicide rates in the northwest region exceed the provincial average by nearly 50 per cent.

Judy Ferguson identified several gaps in the Saskatchewan Health Authority's services in the second volume of her 2019 provincial report, delivered Thursday. 

"The reality is there's a lot of room for growth and there's a desperate need for improvements," she said. 

Her report says the suicide rate in northwestern Saskatchewan — an area that includes communities like La Loche, Meadow Lake, Lloydminster and North Battleford — is 27.9 per 100,000 people. That compares to a provincial average of 18.7.

Ferguson identified several key areas for improvement for the health authority, including ongoing training of staff in assessing and managing suicide risk, and consistently following up with patients at risk of suicide after they have been discharged from an emergency department.

Saskatchewan Rural and Remote Health Minister Warren Kaeding told reporters Wednesday he had only briefly looked at the 25-page report, but said he accepted the recommendations. 

"We're looking right now at doing a inter-jurisdictional scan — and that's scanning all the other provinces and territories to look at what they have incorporated into their initiatives policies."

Kaeding said the province is working with northern communities "to make sure that they've got the resources that they need." 

The chief of Makwa Sahgaiehcan First Nation in northern Saskatchewan has previously his community is in the midst of a suicide crisis, and he's been disappointed by the response from government.

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Kaeding was asked where the needs of northwestern Saskatchewan fit in comparison to other regions, and how those needs might be addressed next year's budget. 

"I won't preclude one over the other. I think it's necessary that we make sure we have the services for all people and in rural and remote Saskatchewan," he said. "The north is certainly a priority in this budget, as well as all rural and remote communities." 

NDP Opposition leader Ryan Meili called for action and criticized the government's response. 

"Obviously, you triage the communities that need that help the most and we have not seen this government take interest in northern Saskatchewan, in particular the northwest, where things have been even more difficult," Meili said. 

He repeated his party's previous call for a provincial suicide strategy. 

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Ferguson said frameworks and strategies are positive — but "sometimes you need to get beyond just the planning stages and do stuff." 

"They need to do data analysis and to sit back and look at it holistically to figure out what is going on. Not just provincially, but frankly try to drill down by community … that hasn't been done yet."

Staff receive insufficient training

Ferguson found it troubling that high-risk suicide patients were discharged by emergency department staff without psychiatric consultation — which goes against protocol. 

"Research shows about one-third of people that have accessed emergency departments — that re-attempt — die within one month of visiting [the ER]," she said.

She also said the provincial health authority is not giving staff at facilities in northwest Saskatchewan — working with patients at risk of  suicide — sufficient training. Some staff members at emergency departments did not receive any training related to mental health and suicide screening. 

She said high staff turnover, vacancies and limited training opportunities contribute to the problem, noting turnover of mental health professionals could be higher in small communities. 

As well, there are challenges in treating mental health in small and isolated communities, where everyone knows everybody. 

"I think that makes it even harder — it makes it more personal," Ferguson said.

She found that as of August 2019, four of seven mental health-related positions remained vacant in La Loche. 

Telehealth attendance at 50%

Those staffing challenges are why the health authority relies on teleconferencing to connect psychiatrists with people in remote areas. 

However, Ferguson found that the service wasn't being used, and that the SHA didn't know why.

"That analysis hasn't happened." 

In 2017 and 2019, only 50 per cent of patients attended their teleconferencing appointments with a psychiatrist. The program didn't run in 2018 because of a shortage of psychiatrists in North Battleford.

Ferguson said the authority didn't formally track or assess why so many patients were missing appointments and called on the SHA to find out about the barriers to using videoconferencing.

No single record system for patients 

Ferguson said the health authority has not implemented an accessible and online IT system to track patient files in all facilities. That means some facilities are keeping manual records, which makes data sharing, collection and analysis challenging.

"Not having a single file that includes all mental health services provided to a patient can impede diagnosis and provision of care for those at risk of suicide," Ferguson said. 

Kaeding said there's no timeline on when the online system will be implemented province-wide. 

As of August 2019, only one emergency department in the northwest had access to the mental health and addiction information system, in North Battleford. That emergency department was given access after an investigation into a "critical incident" in April 2019.  

"They're working on it, but it's not there yet," Ferguson said.

"They need it. They absolutely need that." 

If you're experiencing suicidal thoughts or having a mental health crisis, help is available. For an emergency or crisis situation, call 911. You can also contact the Saskatchewan suicide prevention line toll-free, 24/7 at 1-833-456-4566, the Regina mobile crisis services suicide line at 306-525-5333 or Saskatoon mobile crisis line at 306-933-6200. You can also text CONNECT to 686868 and get immediate support from a crisis responder through the Crisis Text Line, powered by Kids Help Phone.