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.