Getting help

Mind the gaps in Canada’s mental health care system

While I’d read about the gaps in Canada’s mental health care system, I didn’t really expect to encounter them when I went looking for professional help for my daughter’s depression.

I had so many advantages compared to many in Ontario. I lived in a big city, had a family doctor and means for private therapy. Through my work, I had health insurance and, through my family, connections to people working for mental health organizations.

But still, we fell into three of the gaps in Canada’s mental health care system. For what’s it’s worth, here’s where we got caught up.

Mind the gaps in Canada's mental health care system.
Mind the gaps in Canada’s mental health care system.
Photo by Blake Cheek on Unsplash

1. Canada has a shortage of psychiatrists

I didn’t know this until two therapists suggested my daughter might need medication for her depression. They told me to call my family doctor. My family doctor referred me to a psychiatrist, but said it might take a while. There’s a shortage, she warned.

In August 2018, the Coalition of Ontario Psychiatrists released a report quantifying the problem:

  • There was an estimated 1 psychiatrist for every 7210 people in 2010.
  • This number of psychiatrists is expected to decrease by 15% by 2030.
  • There are about 500 active child psychiatrists in Canada. The coalition estimates the country needs 1500.
  • The number of children who see a psychiatrist increased 43% between 2003 and 2014.
  • The average wait time for child psychiatry was 67 days.

The shortage, according to the report, has resulted in a 53% increase in visits to the emergency department and a 56% increase in hospitalizations.

It’s not hard to see why. Our health care journey had come to a full stop, but my daughter’s depression kept moving.

What’s more, she’d now written off talk therapy. What was the point, she said, if the professionals think her problem is a chemical imbalance.

The surprising thing about this gap was that no alternatives were offered. Just call your doctor, get a referral to a psychiatrist, get medication. New to this whole parenting depression thing, I didn’t think to ask more questions.

Now, I can’t help but wonder what might have happened if I didn’t put on blinders. Or if the professionals we were dealing with did more than pass the baton from one health care provider to the next.

What might have happened if one of them sat us both down, knowing there aren’t enough psychiatrists, and said, “Here’s where you are. Here are some options.”

2. There’s a gaping hole between therapy and emergency

Every mental health organization recommends the emergency room if your child is thinking about suicide, has attempted suicide, has a plan to attempt suicide or is self-harming.

That’s helpful, but having lived through three-plus years of parenting a child with severe depression, I can tell you there’s a whole heap of stuff in between feeling depressed and feeling suicidal.

What do you do with that? Do you really hold out until suicidal ideation sets in? Or worse, an attempt? And what do you do if your kid is self-harming as a coping mechanism? Do you head to emergency for every cut, or pull out the Polysporin and patch them up at home?

The sad reality is that there are not a lot of options to quickly escalate the level of care your child is receiving beyond the emergency room. This means that you, dear parent, are first responder when things start to slip.

Here are a few tips I’ve since learned to help you navigate this gap:

  1. Learn to screen for suicide risk. I’m a big fan of the Columbia Protocol which to me is super clear.
  2. Use Crisis Services for guidance. I didn’t even think to call crisis services because my daughter was under the care of a psychiatrist. I figured the doctor would tell me when we entered dangerous territory. If things slide again, I’d now call crisis services for immediate guidance.
  3. Consider taking a Mental Health First Aid Course. The Mental Health Commission of Canada offers serveral, and there’s one specifically for adults who interact with kids. Certainly can’t hurt.

And if you do go to emergency, that’s ok, too. At the very least your child will be assessed by a professional. They’ll be kept safe if they’re deemed at risk to themselves. You may even get bumped up the list for services.

3. The post-emergency gap is by far the scariest

I thought that after a visit to the emergency room, things would change. We’d have more and better support, or my daughter’s health would be markedly improved. She’d suddenly come to realize that life was beautiful.

I’m afraid that wasn’t the case. After a short in-patient stay, my daughter was sent home with nothing more than a safety plan, and a follow-up appointment with her psychiatrist. That’s it.

I was terrified. After all, just days before she was deemed at risk to herself. What exactly had changed? I’d been so focused on the hospitalization, I hadn’t even considered the aftermath.

If your teenager experiences an inpatient stay, you need to plan for when they return home. Consider not only the safety risks in your home, but also how you’ll handle their return to school, their teenage desire for independence, your work schedule if you work out of your home, and basic day to day activities.

Child Mind Institute has a good resource for navigating this gap. Focus on setting up your own life to afford the most flexibility possible. Control the things you can control and reserve your energy for the things you can’t.

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