Some people are not receiving timely or appropriate care for mental illness or addiction.
Emergency department mental health visits can be an indication that people did not receive timely and appropriate care for mental illness or addiction in the community. Although there has been an improvement in the last 10 years, in 2016, more than 4 in 10 (41.2%) children and youths up to 24 years old who visited the emergency department for a mental illness or addiction had not received mental health care from a family doctor, pediatrician or psychiatrist during the preceding two years. This rate varied by region from 37.7% to 55.7%.
Timely follow-up with a doctor for patients of all ages after discharge from hospital can help smooth the transition to receiving mental health care in the community and may help prevent a return to hospital. There was a nearly two-fold variation (from 26.5% to 46.1%) between the province’s regions in the percentage of people 16 years of age and older who were seen by a family doctor or psychiatrist within seven days of discharge after being hospitalized with a mental illness or addiction.
Quality standards outline for clinicians and patients what quality care looks like. Make sure to check out our Quality Standards on schizophrenia care in the community
Jeff* went to his local rural hospital’s emergency department during a mental health crisis looking for help. Little did he and his family know he would end up waiting there for four days.
Read Jeff, Calder and Kim's story
Jeff, Calder and Kim’s story
On a bitterly cold and windy Friday evening in February 2016, Jeff finished a family dinner at home and walked 15 minutes through freezing rain and snow to the emergency department of the hospital in his hometown of Espanola in northeastern Ontario. The 18-year-old had been experiencing symptoms of depression on and off for two years, but on this night, he had become overwhelmed and distraught, and had hit a crisis point. He needed to talk to someone and didn’t know where else to go.
In emergency, but without treatment
The small hospital in the town about an hour’s drive west of Sudbury did not have any mental health specialists on staff, so Jeff was assessed by a nurse and an emergency physician and spoke with a mental health crisis worker by phone through the Ontario Telemedicine Network (OTN). The emergency physician and OTN worker decided Jeff should be put on a Form 1, a legal document under the Mental Health Act that means physicians felt he was at risk of harming himself or someone else, or not able to provide care for himself. Form 1 authorizes the hospital to keep a patient in detention for up to 72 hours while admitted to a specific psychiatric bed until they receive a psychiatric assessment.
This all came as a shock to Jeff’s parents, Calder* and Kim*, who rushed to the hospital as soon as they found out what was going on, only to find their son, alone and afraid, in a room in the hospital’s emergency department.
“The nurses treated our son very well,” Calder says, “but they are not trained in how to deal with someone who is having a mental health crisis. He wasn’t able to get any mental health care. We didn’t know what to do. It was a nightmare.”
Waiting for a psychiatric assessment
Calder and Kim were told Jeff would be transferred to a psychiatric bed in Sudbury, but there was no bed available that night, so they would have to wait until Saturday morning at 9. But when the hospital called Sudbury the next morning, there was still no bed.
“They kept trying,” Calder says. “Each time they told us that there was no bed, my son was just more and more defeated. We all were. We were just spent. We came there for help. We didn’t have any doctor see him all weekend, or even have a counsellor.”
Legally, the 72-hour clock on the Form 1 wouldn’t officially begin until Jeff was admitted to the psychiatric bed, and since there was no bed available, Jeff could remain in the emergency department well beyond the 72 hours. Calder and Kim desperately tried to find a way to get their son back home before then, but the Form 1 meant the hospital would be obliged to call the police to bring Jeff back into their care if he left given their concerns for his safety. Calder made calls to several different organizations trying to find a way to get help for his son and received conflicting information. They decided to wait it out.
Transferred to hospital in Sudbury
After four days in the emergency department, still without any psychiatric care, on Tuesday a bed opened up and Jeff was in an ambulance by 11 a.m. and admitted to the hospital in Sudbury by 12:30 p.m. A psychiatrist assessed Jeff at 2 p.m. and the family were in the car heading home by 2:30.
“The psychiatrist had a smile on his face,” Calder recalls, “like, this is going to be a success story because he’s going to be just fine. It was a good eye-opener for us. It ended up being really good because it exposed a lot of stuff for us as parents.”
Calder and Kim arranged for Jeff to receive counselling for eight months, and he also went to his family doctor who prescribed him some medication. He is now doing much better, but the trauma of those four days in emergency lingers for the family. “It’s amazing the cracks that we fell through,” Calder says. “No one who wants help should end up getting trapped like that. If my son had shown up in emergency with a badly fractured leg, he would have been sent to an orthopedic surgeon immediately. Why is it different for a mental health crisis?”
Jeff’s experience led to the introduction of a Rural Health Hub project in the region, which ensures there is a consulting psychiatrist available through OTN every day to assess and speak to patients at rural hospitals.
*Names have been changed for privacy.
Patients, families and the public are central to improving health quality.
Are you passionate about quality health care for all Ontarians? Stay in-the-know about our newest programs, reports and news.