Woman’s experience highlights need for more rural supports for those in mental health crisis

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EDITOR’S NOTE: This story contains references to suicide. If you or someone you know is experiencing a crisis or thinking about suicide, there is help available. In an emergency  call 9-1-1 for paramedic services. Mnidoo Mnising Mental Wellness and Crisis Response Team offers 24/7 services for people in crisis on the Island: 705-348-1937.

MINDEMOYA—It was a call of desperation. On May 19, an Island woman, in crisis and experiencing suicidal thoughts, made that call that no one wants to make: she called 911. A paramedic attended, as did an Ontario Provincial Police (OPP) officer. The woman, who will be referred to as Ms. Smith to protect her identity, was taken to Manitoulin Health Centre (MHC)’s emergency department in Mindemoya. She was assessed and spoke with a crisis worker via video, but more than eight weeks later she is still waiting for follow up care.

“I was in crisis and truly feeling that I was capable of the worst,” Ms. Smith told The Expositor. “I needed (need) support. I needed (need) an assessment and intervention.”

She was through a similar scenario 15 years ago.

The paramedic who arrived first helped calm Ms. Smith. When OPP Sergeant Shannon McGale approached her, Ms. Smith wasn’t sure what to expect, but Sergeant McGale’s crisis intervention skills were “beyond superior,” Ms. Smith said. “She was so skilled in her words and her demeanor. This was absolutely one police officer who was exceptionally well trained in mental health crisis intervention.”

Ms. Smith believes that without the skills of Sergeant McGale, she wouldn’t be here today to share her story. “She is the reason I continue to try to fight and keep myself healthy, because the rest of the system is an utter failure,” said Ms. Smith.

When she was taken to emergency on May 19, a Thursday, it was after hours. MHC has an agreement with Health Sciences North (HSN) for after hours crisis care through OTN (Ontario Telemedicine Network), said MHC CEO and President Paula Fields. “During the day from Monday through Friday, there is a crisis worker who would come and assess the person in crisis, but we just don’t have the volume or the capacity to sustain the service 24/7.”

Pete VanVolkingburgh is a crisis worker with HSN’s Manitoulin Crisis Response Program, based at MHC, Little Current site. After hours, an assessment is done when a person in crisis attends the emergency department. If they are very agitated, the physician may determine they need a rest before they undergo the crisis assessment, he explained. Sometimes, when it’s after midnight, the doctor may decide it’s better to have them seen in person, and would like the patient to rest until a crisis worker would be able to attend to see them either at the Little Current or Mindemoya location.

Ms. Smith said she waited for hours to speak to a crisis worker over a screen. “Everyone’s crisis is significant to them, and every crisis is significant to us as well,” said Mr. VanVolkingburgh. “But there is the reality of having to prioritize and triage depending on the need. That’s a very difficult thing to do.”

He pointed out the hospital has limited physical resources as well as limited personnel resources, and there is also a legal component to holding patients. “A Form (1) (application from a physician for psychiatric assessment) cannot be issued if the medical staff don’t see if there is imminent risk of harm,” he said. “That’s not to say the issues aren’t significant. That just means that there is imminent risk of harm to themselves or others. We can’t trust them to step outside because we’re worried about what will happen. That’s the only time legally a healthcare physician is able to issue a Form 1.”

Many factors go into a crisis assessment to determine risk and they do their best to err on the side of caution, said Mr. VanVolkingburgh. “We don’t take this lightly. We’re working with people who are in difficult times, difficult moments, difficult seasons and we want to make sure that we’re providing the best support that we can.”

If the risk assessment determines there is no imminent harm, additional supports would be provided, likely on an outpatient basis. The crisis worker Ms. Smith spoke to ended the call by saying she would make a referral. Ms. Smith asked the “kind doctor” at the Mindemoya emergency department, “to please give me the full range of referrals as if I did (have an active plan),” she said. “I knew what was at stake if I acted on those thoughts I so badly wanted to act on.”

The doctor offered a helpful website, a second referral and a referral to a psychiatrist. “Why does someone who is suicidal need to act on their thoughts to get immediate help?” Ms. Smith asked. “Because I am a professional, hold a steady job, am a wife and mother and maintain a household, I felt like they look at me and mark ‘not sick enough.’ Why aren’t we doing more for suicide prevention?”

Ms. Smith did speak to a crisis worker a few days after her hospital visit, but said she was told she could call him if she was in a crisis. “I have been trying everything not to go back to that dark place,” she said.

The crisis worker’s role is often brief: they provide service at the height of when things are out of control. “Our job is to bring it from a boil to a simmer,” Mr. VanVolkingburgh said. “I can’t get you out of the hot water entirely but I can ensure that you’re connected to the people you need to be connected to once we get through the peak of this crisis moment. In that period of time, the first concern is, are you safe? Are you safe where you are at home? If you’re safe there, are there people there who can keep you safe? Can you with some level of certainty tell me that yes, I will come to hospital and that you have other people in your life that are going to be checking on you, to come up with a safety plan to make sure that if need be, you’re going to come in?”

Ms. Smith was too sick mentally to drive herself to the hospital that night in May, so despite what she calls the embarrassment of calling 911 in a small town, she did call, to save herself. Prior to making that 911 call, Ms. Smith had called the toll-free crisis number (1-877-841-1101). She asked for a referral to group therapy or DBT (dialectical behaviour therapy, a form of cognitive behaviour therapy). “These would greatly help my condition,” she said. “I was told ‘that’s for Sudbury residents.’ That further devastates me about my future living on Manitoulin Island and having no or limited mental health services.”

Ms. Smith said she has not received follow-up calls from her family doctor, the psychiatrist or the two referrals that were made. She wasn’t given an estimate of wait times.

“I can say that there is a huge human resources crisis here, as there is throughout the province,” Ms. Fields pointed out. “It’s not just in nursing, but social workers and mental health workers and healthcare workers in general. Everyone is trying to actively recruit healthcare workers, from the same pool.”

Mr. VanVolkingburgh said there’s an extensive process of reaching out to the patient, with many phone calls followed by a letter, followed by weeks of waiting. Multiple attempts would be made to contact the client. “If the person doesn’t contact us, we’ve got to move on but they can reengage if they’re ready.”

“The message we would want to share is that people should reach out if they’re concerned about themselves,” said Mr. VanVolkingburgh. “If they have concerns about their mental health or what’s been going on in their lives, we definitely don’t want to see people suffer in silence and waiting until things are at a breaking point before they reach out.”