Last month, Sean Eckford wrote an article about psychiatric care at Sechelt Hospital that ought to concern everyone in our community.
His piece detailed the decision by a senior and highly respected psychiatrist on the Coast to withhold his consultation services to the ER because of safety concerns. Dr. Anthony Barale – who I know personally as a serious, skilled and dedicated practitioner – was making a point: Both in the ER and in the in-patient psych unit, staff and patients are at risk because these facilities are simply not designed or equipped to handle the nature and number of potentially violent situations.
I won’t recap Sean’s story here. If you are interested, you can see the article here.
I’ve interviewed over the years scores of administrators, clinicians, patients, and police – both here on the Coast and in the Metro Vancouver area. Here’s what I’ve learned.
On the Coast, as elsewhere, the ER handles a huge number of patients presenting on admission psychiatric issues. A great many of these patients come in with acute substance-abuse/withdrawal symptoms, which are frequently attended by suicidal thoughts, anxiety, depression and, not uncommonly, violent behaviour.
This sets in motion a cascade of challenges to ER staff in particular, and hospital staff – clinical and otherwise – in general.
First is safety. Medical staff in ER deal daily with distraught, unpredictable and sometimes violent patients. On a bad night, work in the ER can be scary and dangerous. Though that is not their core training, they deal with it bravely. The nurses’ and docs’ and orderlies’ security and ability to do what they do best are stressed. Their personal safety is too often at risk.
Second. While a potentially violent patient is occupying the time and attention of clinical staff, other patients – with broken bones or heart illness – wait for treatment. Don’t think for an instant that I am picking on substance abusers or suggesting a triage protocol. I’m not. But there it is.
Third. Where, after ER, are these patients to go?
Well, upstairs, to the psych unit. Problem is, there are only six beds there (plus one in isolation) – far too few to handle the need. Plus, the unit is unsafe. Security doors on an otherwise regular hospital ward don’t make the unit secure for staff and patients.
I might add that the ER is not the only alternate “safety net” for individuals presenting unpredictable and possibly violent behaviour. Too many wash up onto the shores of the RCMP, whose members here on the Coast are, in my opinion and experience, about as good as they get. But, the Horsemen are about the law and keeping the peace, not housing medical cases.
Solutions.
Vancouver Coastal Health (VCH) needs to provide resources for more in-patient beds on the psychiatric unit. More staff and more training. That is just a given.
We need a detox facility on the Coast. Far too many ER admissions to Sechelt Hospital are the result of alcohol and drug abuse. We have a very serious substance abuse issue here. More about that in my next column.
VCH and Sechelt Hospital administration must address the broad sense of distrust and disrespect our local physicians feel. This is only my opinion, but I will say without reserve that I am on the side of our caregivers.
Get with it, VCH. Do your job.
