SOS hospitals for dozens of psychiatrists
The president of the Association des psychiatres du Québec appeals to colleagues in private practice while several departments of psychiatry, such as in Laval , face a lack of staff, beds and the slowness of the courts.
Fouad Saher, head of the psychiatry department at the CISSS de Laval
During our visit to the closed units of the psychiatry department of Laval's Cité-de-la-Santé, psychiatrist Fouad Saher warns us: “Always keep a safe distance from patients”.
You never know what can happen.
A few minutes later, two workers zoom past us, in pursuit of a young adult who is running at screaming loudly.
This is a patient who just turned 18, says Dr. Saher. He stopped his medication and returned to a state of psychotic relapse with a grandiose delirium.
A few restraint sessions were not enough to stabilize him.
A patient is escorted back to his room in a closed psychiatric unit at Cité-de-la-Santé in Laval.
I just asked for an extension of custody yesterday, because it is impossible to give him leave in the state he is in, explains the head of the psychiatry department at the CISSS de Laval.
At the other end of the corridor, a beneficiary attendant tries to calm a patient locked in an isolation room by talking to him through the window. There too, cries are heard.
As soon as we calm down, we will be able to go out. We take breaths, she tells him.
Twice during our visit, an agent came to suggest that we take another corridor due to an ongoing intervention.
There is nothing wrong with this day. ;exceptional for this team from the Cité-de-la-Santé who would not say no to an additional helping hand.
The departments of psychiatry are increasingly suffering the consequences of a backlog in the courts. And the delays for obtaining treatment orders are getting longer. Reporting by Davide Gentile.
Several patients Dr. Saher met that morning are awaiting court hearings.
One of them does not have the exact memory of an unfortunate event related to a firearm. He takes his medication, but we suggest an injectable version that eliminates the risk of forgetting to take it.
Recipient attendant Sabrina Picard calms down a patient in the isolation room.
Another patient offers no cooperation and persists in not wanting to take her medication, while a third does not wish to return home and fears using the electronic devices which cause her anxiety.
In this closed unit, all 17 beds are occupied. Another unit is just as bad.
These are patients in the acute phase of their illness, explains psychiatrist Fouad Saher, either due to a relapse or a first psychotic episode, either a deterioration following a cessation of medication or consumption problems.
The head of the psychiatry department at the CISSS de Laval, Fouad Saher, would need 13 psychiatrists and dozens of extra beds.
“We have several cases of ID-ASD* patients with autism spectrum, with significant behavioral problems and that we have to supervise more […] including some patients who have been here for a few years same. »
— Fouad Saher, head of the psychiatry department at the CISSS de Laval
In total, the hospital has 54 beds for its mental health clientele and 24 beds if necessary in Montreal at the Albert-Prévost centre.
Not to mention seven beds dedicated to the emergency (brief intervention unit), whose attendance has doubled in recent years.
The capacity of our beds is not enough for the population,” laments Dr. Saher. We should have at least 130 to 140 beds here. A number that would, however, require additional staff.
According to the head of the psychiatry department at the CISSS de Laval, if he had another wish to share, it would be that the positions in psychiatry be filled.
I admit that it is very difficult, the troops are exhausted […] We should be 31 psychiatrists, but we are currently running at 18, specifies Fouad Saher.
A few recruitments are planned for the summer of 2023, but it is still insufficient in relation to the demand, the services to be offered.
The situation can be explained, among other things, by a series of hasty retirements and various sick leaves. But to this, says Dr. Saher, is added this somewhat new phenomenon of departures from the private sector, given the pressure in the public.
His colleague from the Association of Psychiatrists of Quebec Claire Gamache abounds in the same direction.
We have reached around 250 psychiatrists who do office work, she says. So, out of 1300 psychiatrists, there are barely 1000 left who work in the hospital environment. This is an 8% decline in the public network over 10 years.
Claire Gamache, president of the Quebec Psychiatric Association
To In his view, the situation is becoming particularly difficult in secondary regions where the population has grown much faster than the services.
There, we will have to see if our colleagues in the cabinet can come and help us a little bit in regions like Laval and the Laurentians, says the president of the Association.
In the Laurentians , out of 48 posts, there are 29 psychiatrists in post who practice actively and who are distributed in four hospital centers (i.e. the Center de services de Rivière-Rouge, the Laurentien Hospital, the Regional Hospital of Saint -Jérôme and the Saint-Eustache Hospital), a CISSS spokesperson told us.
Other professionals are also in short supply.
There are on average 16% of positions to be filled within the mental health field teams, in particular the intensive follow-up in the environment (SIM) and the First Psychotic Episode Program (PPEP), according to a compilation of data obtained by Radio-Canada through requests for access to documents from health establishments.
The psychiatry department of the CISSS de Laval has made headlines in recent years and again recently, due to a triple murder committed at the beginning of August.
The author alleged, Abdulla Shaikh, had had different episodes of hospital care since 2018.
In a decision of the Administrative Tribunal of Quebec a few months earlier, in April 2022, the CISSS de Laval had also been delegated the power to tighten the deprivations of liberty of the person of the accused [ Mr. Shaikh] if the state of mental health or changes in behavior justified it.
A public inquest by coroner Géhane Kamel must shed light on the circumstances of the deaths during the next few months.
According to Eric Gauthier, director of the mental health and addiction program, CISSS de Laval, as soon as we are made aware of a risk, it is certain that we will treat it as a clinical team, in compliance with the legal orders in which we have been mis, because we work with the Administrative Tribunal of Quebec, with the Commission for the Review of Mental Disorders.
Eric Gauthier, director of the mental health and addiction program, CISSS de Laval
But the fact remains that we work with humans, we work with people who talk to us and who don't tell us everything. […] We have multidisciplinary teams that work with these populations, we have people trained to work within this approach.
A person who presents a danger to himself or others because of his mental state may be brought before a court so that he can be kept against his will and/or imposed treatment.
But for the past three or four years, due to overcrowding in the courthouses and the judiciary, the delays have increased a lot, and it is difficult to have time slots to present our [custody or treatment] orders. , deplores the president of the Association des psychiatres du Québec, Claire Gamache.
In Quebec, you can keep someone in an institution for two or three months without being able to treat them while waiting to have the court's authorization to treat him, which for us is a bit of an aberration, says the psychiatrist.
In his opinion, if someone is considered sick enough to be kept in hospital against their will, it is considered, much like in Ontario, he should be ill enough to begin treatment without necessarily waiting for the court to agree, or [otherwise] for the court to rule on both aspects at the same time.
< p class="e-p">On about fifty beds, we must have at least three or four patients all the time waiting for a treatment order, which clogs hospitals, maintains Claire Gamache who practices in Laval.
Many events related to personnel safety have also been publicized in recent years.
So much so that security upgrade work worth $8 million is planned for 2023 and the services of an external consultant were needed to find possible solutions in order to consolidate the service offer, qualify professional practices and promote a better work climate.
According to the president of the Union of Nurses, Respiratory Therapists and Auxiliary Nurses of Laval (SIIIAL-CSQ), Dereck Cyr, the planned work should solve 80% of the problem related to staff safety, but there are many internal problems to be reviewed internally, such as certain clinical aspects, human resources management, training and retention of our members in this specialized direction.
Call Info-Social 811 for help or information concerning your mental health or that of a loved one .
Call the help line and suicide prevention at 1 866 CALL (277-3553) if you are thinking of suicide or worried about a loved one.
< p class="e-p">*DI-ASD: intellectual disability – autism spectrum disorder