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Some referrals for psychiatric help being rejected, Saskatoon doctor says

·5 min read
Once you get on a waiting list, Dr. Misfeldt says it can take nine months to a year to see a psychiatrist. (igorstevanovic/Shutterstock - image credit)
Once you get on a waiting list, Dr. Misfeldt says it can take nine months to a year to see a psychiatrist. (igorstevanovic/Shutterstock - image credit)

Saskatoon family doctor Marlys Misfeldt says wait-lists for psychiatric help have been an issue for a long time but recently, several of her referrals have been rejected outright.

Dr. Misfeldt told CBC's Saskatoon Morning that she has been working with a patient who has depression and is not improving.

"He's not doing well, so I requested a referral from the pooled psychiatry referral system and about three or four weeks later, I got a letter back saying, 'Specialist has decided this referral is not needed and has been cancelled,'" she said.

"No discussion with my patient, no discussion with me, just a letter back saying … it is cancelled."

She said she has received two or three other letters like this in the past year, where prior to that, she would receive a letter saying her patients were on a wait-list.

Misfeldt was trying to access the pooled referral program, which is operated and directed by psychiatrists. The voluntary program includes 22 psychiatrists and the Saskatchewan Health Authority provides one staff member for the program, a triage nurse.

Misfeldt said a psychiatrist she spoke to who deals with the pool system told her there are 300 people on that waiting list.

Once you get on the waiting list, Misfeldt said it can take nine months to a year to see a psychiatrist.

There are eight other psychiatrists who are not part of the program and who can, in theory, accept referrals, but Misfeldt said when she has tried reaching out to them, they've said they're not taking new patients.

Global shortage of psychiatrists

Psychiatrist Sara Dungavell, who works in Saskatoon and northern Saskatchewan communities, said what happened to Dr. Misfeldt is "not appropriate."

"What Dr. Misfeldt got as a response is, frankly, wrong," Dr. Dungavell said.

"If you aren't accepting patients or if the wait-list is going to be too long for you to see this person with an adequate amount of urgency, then at least you told the family doctor why you said no. You can't leave this blank."

While the number of psychiatrists per capita in Saskatchewan compared to other provinces is low, Dungavell said there's actually a global shortage of psychiatrists.

"We can't see people quickly because brains don't heal quickly, so it requires a lot of psychiatrists to provide adequate levels of care for folks, and we're not accepting people just staying in misery and untreated mental illness anymore."

Dungavell said efforts have been made to provide more access to psychiatry in Saskatchewan, particularly for those who go to the emergency room. Even that, however, adds to the backlog, because there's no one to take those patients on once they leave the ER.

"It's leaving family doctors in the situation of Dr. Misfeldt, where they are doing their absolute best to try and treat their patients but don't have access to the specialists who should be supporting them," she said.

Saskatchewan needs to be a place psychiatrists want to work, which means creating a good continuum of care for patients, Dungavell said.

"What most of us physicians want is to be able to provide good, quality, efficient care where we're doing what we do best," she said.

"We count on community mental health nurses, social workers, on licensed psychiatric nurses and occupational therapists, rec therapists, to help our patients with those other very important areas of life that contribute to their mental health."

Dr. Sara Dungavell splits her time between her Saskatoon clinic, where she provides support for members of the LGBT community, and northern Saskatchewan communities, including La Ronge, La Loche and Stony Rapids.
Dr. Sara Dungavell splits her time between her Saskatoon clinic, where she provides support for members of the LGBT community, and northern Saskatchewan communities, including La Ronge, La Loche and Stony Rapids. (CBC)

The north is particularly lacking the kinds of support people need to care for their mental health, Dungavell said.

"The more the government actually pays for and supports this full team of people to work with each psychiatrist, the more efficient and effective we can be, the more psychiatrists will want to work here and the more we can stretch the limited resources that is psychiatry."

Cancelled referrals uncommon: government, SHA

The Saskatchewan Health Authority, the Psychiatry Referral Pool and the Ministry of Health sent a joint statement in response to questions about psychiatric referrals.

"The capacity of pooled referral psychiatrists is significantly below the rate of incoming referrals," the statement said, but it's uncommon for psychiatrists to cancel referrals.

While the statement said the departments can't comment on specific cases, they will "continue to look into the individual reasons why [cancellations] may occur in certain instances."

Alternatives for family physicians include contacting the psychiatrist on call, contacting LINK — a provincial program that connects family physicians with psychiatrists — or contacting a psychiatrist who is not part of the referral pool.

The statement said that in situations where a patient has been triaged and recommended for treatment other than psychiatry, "a letter always accompanies the return with information about the review and includes clear guidance on mental health access points as well as the phone number for the intake triage."

'Heartache and grief for the people of our province'

Dr. Misfeldt said if this problem doesn't get solved, it will cause "more suicides, more marital breakup, more relationship deterioration, more heartache and grief for the people of our province."

She's continuing to work with her patient who was denied access to the pooled referral program but she said it makes her feel "anxious and depressed" to hear about the long waits for psychiatric help.

"These people are valuable people to our province and they are not functioning to their best ability and not participating in life."

If you're experiencing suicidal thoughts or having a mental health crisis, help is available.

For an emergency or crisis situation, call 911.

You can also contact the Saskatchewan suicide prevention line toll-free, 24/7 by calling 1-833-456-4566, texting 45645, or chatting online.

You can contact the Regina mobile crisis services suicide line at 306-525-5333 or Saskatoon mobile crisis line at 306-933-6200.