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Psych problems, solutions

Barriers and solutions for urgent psychiatric care

When a person is in acute psychiatric distress — having a psychotic episode, suicidal, demented or otherwise out of control, depressed or anxious to the point that they are unable to work — urgent care is necessary to stabilize the situation and prevent harm.

Unfortunately, many people who require urgent psychiatric services have difficulty accessing them.

A variety of barriers often exist that can differ depending on the condition and are not easily recognized by those not experiencing a mental health crisis.

Here are a few of the common barriers to accessing services:

  • To see a psychiatrist, a referral is required from a general practitioner. There may be some exceptions to this for psychiatrists who are not paid on a fee for service basis, but these are in the minority. Referrals require access to a GP and can also often involve wait times for availability with both the GP and then the mental health professional.
  • Most mental health professionals require a booked appointment. Many people with even moderate degrees of mental illness have difficulty making and keeping appointments. Once a couple of appointments are missed, the patient may not be offered another.
  • If experiencing a moderately severe mental illness, the patient will likely be given a medication prescription. These can be expensive and the patient may not be able to afford it. There are some programs in place to cover medication costs, but many people don’t know what they are or how to access them.
  • Financial support for food and housing may be needed. Even if eligible for social assistance, the patient may not know how to apply for it. Some qualify for provincial or federal disability pensions, but the required process needs to be followed and can take up to six months — a completely unacceptable timeline when dealing with a mental health crisis.
  • People experiencing moderate or serious mental health symptoms can find disability applications almost impossible to complete. It can be very difficult to explain problems verbally or in writing.
  • In order to stabilize a mental health crisis, it is important to find suitable and affordable housing and be able to follow the rules. Again, daunting when in the midst of a crisis.
  • Even those being seen by salaried case managers at government-funded institutions may have difficulty keeping appointments, getting and taking medications and looking after activities of daily living.
  • Often, homeless people miss out on disability pensions because they cannot get the required information together to apply.

I believe many of these issues could be much better dealt with than they currently are. Here are a few ways we could ease the situation for vulnerable individuals:

  • Service facilities need to be easily identifiable, well known and available without an appointment.
  • A facility should have all the necessary professionals in one place i.e. social services, employment counsellors, social workers, alcohol and drug counsellors, nurses, pharmacists, psychologists, doctors and psychiatrists.
  • Patients should be able to access their medications on site free of charge without delay.
  • Help should be available to complete whatever paper work is necessary (it should be kept to a minimum). Basic information should be electronic and accessible so people don’t have to repeat the same database to several different people and institutions. Contact information and provincial health care number should be readily available to all necessary health care providers.
  • Ideally, a facility like this would be available seven days a week to reduce visits to the ER.
  • Overnight observation availability would also be helpful in many cases.
  • More affordable housing units are needed — both independent and supportive.

A clinic like this would be provincially funded and available in large and mid-sized municipalities. As it stands, all of these services are already available, but are not easily accessible or well coordinated.

Not only would it save the system money to coordinate them and make them more accessible to those in need, it would likely also go a long way toward eliminating homelessness.

I can’t tell you how amazing it would be to be able to actually discuss a patient’s needs with the other professionals involved rather than filling out a form and sending it to someone you will never meet and from whom you will never hear.

This article is written by or on behalf of an outsourced columnist and does not necessarily reflect the views of Castanet.


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About the Author

Paul Latimer has over 25 years experience in clinical practice, research, and administration.

After obtaining his medical degree from Queen's University in Kingston, Ontario, he did psychiatric training at Queen's, Oxford and Temple Universities. After his residency he did a doctorate in medical science at McMaster University where he was also a Medical Research Council of Canada Scholar.

Since 1983 he has been practicing psychiatry in Kelowna, BC, where he has held many administrative positions and conducted numerous clinical trials.

He has published many scientific papers and one book on the psychophysiology of the functional bowel disorders.

He is an avid photographer, skier and outdoorsman.

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The views expressed are strictly those of the author and not necessarily those of Castanet. Castanet does not warrant the contents.

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