The emergency department at Victoria General Hospital. Sarah and her daughter frequent the ER as they can’t find supports in the community. (Black Press Media file photo)

The emergency department at Victoria General Hospital. Sarah and her daughter frequent the ER as they can’t find supports in the community. (Black Press Media file photo)

Mind the Gap: Children in crisis

Navigating Greater Victoria’s mental health system

Content warning: This article contains mentions of suicide.

This is part one of a two-part series exploring mental health services for youth in Greater Victoria. Please see next week’s edition for more.

Sarah desperately types an email as she waits in Victoria General Hospital’s ER. This is her 15-year-old daughter’s third suicide attempt in a month and she’s certain the hospital will send them away again.

“I am at a loss of how to support her and keep her alive,” she types.

“I know my story is just one of thousands of parents in the same situation.”

Sarah – whose last name has been withheld to protect the identity of her underage daughter – has been fighting referrals and wait times that have left her feeling like her daughter has fallen into one of the gaping holes in Greater Victoria’s mental health services.

It is a system many experts said was cracked before the COVID-19 pandemic blew it apart.

Mental disorders in youth are ranked as the second-highest hospital care expenditure in Canada, according to the Canadian Mental Health Association, surpassed only by injuries.

In B.C., there were 21 suicide deaths involving 10- to 18-year-olds between April 2020 and February 2021, although the B.C. Coroners Service warned statistics could change as investigations are concluded. During that same time, 102 people between the ages of 19 and 29 died by suicide.

Sarah’s daughter could have been one of them.

Sarah and her daughter

After moving to Greater Victoria last fall, the teen – who we’ll call Sam – spent two weeks in hospital for a suicide attempt. That hospitalization led to a month-long stay at Ledger House – which is an Island Health facility – where she was diagnosed with borderline personality disorder and complex post-traumatic stress disorder.

Three weeks after being released, she was back in hospital after another attempt.

Every month since, Sam has been in hospital, with three attempts in March alone. A single mother on shift work, Sarah is doing what she can to keep supports in place for her daughter, but it hasn’t been enough.

Staff have been very good, but there’s a disconnect between what hospital staff think is available and what is actually available, Sarah said.

“You think you have all the options but you end up on wait lists.”

READ MORE: Mental Health – A look at a fractured system

The biggest hurdle has been trying to find the right medication balance. With no family doctor, a Victoria-based integrated health centre is filling that role, but it means there is no consistency in who is treating Sam.

Despite plans in place for when she finds herself in crisis, or lands in the ER, Sarah said they’ve been on a conveyor belt that’s been moving them through the system from emergency response back to the community with referrals to a provincially operated clinic.

“She’s chronically suicidal … every time we see them since it’s this broken record that she needs therapy.”

But they’ve been stuck waiting. Most referrals are for one-off consultations or short-term treatment plans and Sam now sees the ER as the only place to access mental health professionals.

“It seems like every resource is meant to be there for three to six months and then you’re done,” Sarah said.

She found a private psychiatrist but that came with a recommendation of specialized treatment only available in Vancouver – which also has a six-month wait list.

“We’re all just falling into (the holes) and trying to climb out.”

Navigating the gaps

While Island Health declined to provide an interview for this article, it did note its primary services for child and youth mental health are crisis response or hospital-based inpatient services. These are for youth experiencing a significant crisis or who have complex mental health needs that require long-term inpatient support.

Crisis intervention services generally can be accessed as urgently as needed, without a wait. Once a patient has been assessed and stabilized, an Island Health clinician connects them with a community-based service.

There are seven children and youth mental health (CYMH) intake clinics – which are operated through the B.C. ministry of children and family development – on the south Island, including one mobile unit, as well as offices in Duncan, Sooke, Esquimalt, Saanich, Victoria, and Colwood.

READ MORE: Fractured services leave community to fill gaps

Access to CYMH services should take place without unnecessary delays, according to the B.C. government. In the 2018-19 fiscal year (the most recent data available for performance indicators) more than 20 per cent of clients had no wait for services. On south Vancouver Island, a total of 1,308 clients received their first clinical service. Of them, 186 clients had to wait and the average wait was 70 days – higher than the provincial average of 56.

But what happens after that first referral?

That gap between referral and treatment, that’s where Maria Weaver, acting executive director of Need2 Suicide Prevention, Education and Support, said many youths are falling through the system.

“That’s who we see the most – youth not quite at the point of emergency intervention but who are in a lot of pain and don’t know where to go.”

The problem, she noted, is when too much time passes between appointments. Need2, which operates the chat/text crisis line youthspace.ca, has been helping to fill that void by conducting follow-ups when requested by other services, such as counsellors, who can’t see a patient for an extended period of time.

Resources

The B.C. ministry of children and family development said for years people who need mental health care have struggled to get help and COVID-19 has made those challenges worse. While more work needs to be done, since 2017 new services have helped reduce wait times for children and youth to see a psychiatrist or access other clinical services.

In its 2020-21 budget, the province has set aside almost $117 million for CYMH services, with $9.25 million designated for the south Island. That’s up from almost $99 million in 2018-19, which was the latest spending markers available on its website. Of that, $8.37 million went to the south Island, which received the most funding following South Fraser with $10.6 million and Vancouver/Richmond with $9.6 million.

But is more money the simple fix?

Youthspace.ca is a text/chat crisis line available to youth from 6 p.m. until midnight 365 days a year. (Katherine Engqvist/News Staff)

Dr. Pauline Lysak operates a psychiatry practice in downtown Victoria with her business partner and husband Mark Roseman.

“The mental health system was already very broken prior to COVID … since COVID it’s been in crisis,” she said.

Prior to the pandemic, there were treatment options for people in need of urgent care, but pre-pandemic those wait times were a few weeks. Now waits can range up to six months or longer.

“And that’s if they’re accepted at all … the urgent program isn’t able to handle urgent needs,” Roseman explained.

While it was an issue before, Lysak said her practice is now beyond full, and she’s still receiving a few cold calls a day from across the province. These are people in urgent need but are unable to find services in their area.

Like many resources, patients age out of the child system and are forced into the adult stream. Lysak only treats patients over the age of 18 and often receives calls from child psychiatrists who are desperately looking for someone to take on their patients as they turn 18, but they have nowhere to send them.

“It’s heartbreaking … now they have nothing.”

Despite the dark days of the past year, Lysak says there is hope. She looks to other provinces where models of primary care networks are being utilized to re-imagine how resources are used to treat patients and improve gaps in the continuation of care.

If you or someone you know is struggling, call the provincial suicide prevention hotline at 1-800-suicide (1-800-784-2433), or visit crisislines.bc.ca to find local mental health and crisis resources. Black Press Media has also prepared a mental health resource guide filled with information specific to Greater Victoria, you can find it under e-editions at vicnews.com.

READ MORE: Mental Health in Greater Victoria

katie.e@blackpress.ca


 

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