Yukon’s mental health delivery needs an overhaul

Dr. Leo Elwell RE: Territory struggles with psychiatrist shortage (Dec. 9): I am a psychiatrist, fully qualified under both the American and Canadian systems with an additional subspecialty qualification in addiction medicine. I am an examiner for the Ro

COMMENTARY

by Dr. Leo Elwell

RE: Territory struggles with psychiatrist shortage (Dec. 9):

I am a psychiatrist, fully qualified under both the American and Canadian systems with an additional subspecialty qualification in addiction medicine. I am an examiner for the Royal College of Physician and Surgeons of Canada. I teach medical students and residents in psychiatry. I have been working in the Yukon initially part time and now full time. I have been helping out here now for three years, at Mental Health Services, Alcohol and Drug Services, and lately Klondyke Medical Clinic and Whitehorse General Hospital.

I would like to provide some further clarification as to your article which does raise a number of valid and important points. It should be noted that modern mental health care systems are not just measured by a psychiatrist here or a psychiatrist there. The system is best measured by providing the appropriate level of care at the right time in the right place to the right person in the right and culturally appropriate way.

Let’s start with the communities. Telepsychiatry is a very useful tool for anxiety or depressive disorders. It is not a very good technique to appropriately assess and address how a psychotic person is doing out in the community. For that I need, not just want, a trained psychiatric nurse and a supports worker in that community to help support the person and their family in the best manner.

Some of the mental health nurses are forced to drive to some very isolated places, which does not provide them with adequate hours of contact with some very seriously ill people. This job is very demanding, and in certain situations could be very dangerous for a nurse who is working alone. The commute alone could injure or kill the mental health nurse. Then they have a limited amount of time to assess the patient and support me in making the right diagnosis and change to the treatment plan, and in making sure that nobody wanders out into the bush and dies of exposure, for example.

There are some people who are labelled with a schizophrenia who are really more properly diagnosed with multi-generational complex post-traumatic stress disorder. The treatment for the two disorders is very different. For example, you don’t amputate a leg for a lung/breathing problem!

It is a team effort to make sure the community person is cared for properly. It’s not just the psychiatrist, it’s the mental health nurse, the community worker, the family doctor, the psychologist, the addictions counsellor and many different players to really care for the patient. It is also the education system providing effective in-classroom interventions as to intervene with at-risk youth to ensure they never get into the substance abuse that perpetuates the cycle that started with the residential schools or other risk factors. We need to reconcile this issue, for the betterment of all of us.

The Whitehorse General Hospital’s secure medical unit provides important support for people with acute mental health needs, but it is not the linchpin in this whole process. There are a number of other issues which are being looked at within the departments I work in.

It is also a problem that NIHB drug benefits, especially in the areas of addiction and mental health, are not equivalent to what a non First Nation person could receive as a benefit. This needs to be addressed as part of the truth and reconciliation process. I think we all inhabit this land, and we should all be treated equally. I know that given the medications I am allowed to use, Fist Nations care is below where it should be. This needs to change.

So, as you can see, mental health delivery is a complicated issue. This issue is not best addressed by passing so many dollars to one particular position in one particular location. It is my unreserved opinion that we need to look at many different choke points in the system, ascertaining what would be best standard of care, and then resourcing it properly. This should be thought out carefully.

Leo Elwell is a consultant psychiatrist who lives in Whitehorse and Edmonton.

Get local stories you won't find anywhere else right to your inbox.
Sign up here

Just Posted

Yukon Employees’ Union says a lack of staff training and high turnover at the Whitehorse Emergency Shelter is creating a dangerous situation for underpaid workers. (Crystal Schick/Yukon News file)
Yukon Employees’ Union says lack of training at emergency shelter leading to unsafe situations

Health and Social Services Minister Pauline Frost said the staffing policy “is evolving”

Justice Karen Wenckebach will begin serving as resident judge on the Yukon Supreme Court early next year. (Crystal Schick/Yukon News)
All-female justice roster ‘a good step’ for diversity in Yukon Supreme Court

Karen Wenckebach is the third woman appointed to the Yukon Supreme Court in history

The Liberal government blocked a motion by Yukon Party MLA Brad Cathers that would have asked the federal government to provide the territories with more than a per capita amount of COVID-19 vaccine doses during initial distribution. (Crystal Schick/Yukon News file)
Yukon Party says a per capita distribution of vaccines would leave Yukon short

The opposition is also asking the government to release their plan for vaccine distribution

asdf
WYATT’S WORLD

Wyatt’s World for Dec. 4, 2020

Dawson City’s BHB Storage facility experienced a break-and-enter last month, according to Yukon RCMP. (File photo)
Storage lockers damaged, items stolen in Dawson City

BHB Storage facility victim to second Dawson City break-and-enter last month

A sign outside the Yukon Inn Convention Centre indicates Yukoners can get a flu vaccine inside. As of Dec. 4, the vaccinations won’t be available at the convention centre. (Crystal Schick/Yukon News)
Whitehorse Convention Centre ends flu vaccination service early

Flu vaccinations won’t be available at the Whitehorse Convention Centre after Dec.… Continue reading

Whitehorse City Hall. (Joel Krahn/Yukon News file)
City hall, briefly

A look at decisions made by Whitehorse city council this week

Nominations continue to be open for Northern Tutchone members of the White River First Nation to run for councillors in the 2021 election. (Maura Forrest/Yukon News File)
White River First Nation to elect new chief and council

Nominations continue to be open for Northern Tutchone members of the White… Continue reading

The Town of Watson Lake has elected John Devries as a new councillor in a byelection held Dec. 3. (Wikimedia Commons)
Watson Lake elects new councillor

The Town of Watson Lake has elected John Devries as a new… Continue reading

The new Little Salmon Carmacks First Nation council elected Dec. 1. (Submitted)
Little Salmon Carmacks elects new chief, council

Nicole Tom elected chief of Little Salmon Carcmacks First Nation

Submitted/Yukon News file
Yukon RCMP’s Historical Case Unit is seeking information related to the unsolved homicide of Allan Donald Waugh, 69, who was found deceased in his house on May 30, 2014.
Yukon RCMP investigating unsolved Allan Waugh homicide

Yukon RCMP’s Historical Case Unit is seeking information related to an unsolved… Continue reading

A jogger runs along Millenium Trail as the sun rises over the trees around 11 a.m. in Whitehorse on Dec. 12, 2018. The City of Whitehorse could soon have a new trail plan in place to serve as a guide in managing the more than 233 kilometres of trails the city manages. (Crystal Schick/Yukon News file)
2020 trail plan comes forward

Policies and bylaws would look at e-mobility devices

Snow-making machines are pushed and pulled uphill at Mount Sima in 2015. The ski hill will be converting snow-making to electric power with more than $5 million in funding from the territorial and federal governments. (Joel Krahn/Yukon News file)
Mount Sima funded to cut diesel reliance

Mount Sima ski hill is converting its snowmaking to electric power with… Continue reading

Most Read