With wait lists for his services stretching into the hundreds, and wait times that can last month upon month, a Prince Albert-based child and youth psychiatrist says Saskatchewan kids’ life outcomes are being put at risk by an under-resourced health-care system.
Children are waiting too long for services, being discharged at less than ideal times and finding the time to follow up with all patients has become a challenge, according to Dr. Randall Zbuk. He said this can have negative and potentially even deadly consequences.
“If you don’t intervene early it leads to big problems,” Zbuk told Global News, saying the waitlist in Prince Albert has been hovering at around 400 and isn’t decreasing.
“Let’s say you have a kid with severe ADHD. They might think they’re not bright so they give up on high school when in fact they’re quite smart they’re just not being treated effectively. These things impact the trajectory of kids’ lives so severely. It’s a big deal.”
Zbuk began working at the centre, which is one of just three offering specialized youth mental intake services in Saskatchewan, about 15 months ago. The unit had been closed for more than half a year after one of its two former psychiatrists passed away and another retired.
“I’d be lying if I said things are going smoothly,” he remarked.
“My job basically is dealing with crisis admissions on the unit. Following up with those individuals after they’re medically stabilized and trying to maintain follow-up. Then, covering the emergency calls, which is pretty standard for any psychiatrist.
“It feels like putting out fires instead of being proactive.”
Since he started, the facility has been running at half capacity as the Saskatchewan Health Authority struggles to recruit a second doctor.
That means the 10-bed centre has only been able to treat five patients at a time.
Zbuk says that in addition to keeping the waitlist stagnant, that limitation can also result in patients being discharged at a less than ideal time.
“They’re triaged, and triaged very well by our team, but still, there’s a lot of kids with things like severe anxiety, depression and trauma who aren’t being treated,” Zbuk said.
“And a lot of the kids who I discharge, I’m not discharging them with zero risk. They often have issues with trauma, substance use, ongoing psychosocial stressors. They’re leaving still at chronic risk and it’s frightening to know we’re not able to effectively track them down.”
Compounding the problem, Zbuk says, is that nurses are in short supply as well.
“Recruitment is especially hard in Prince Albert,” he said.
“We’ve had a children’s response team we’ve been trying to develop for about a year now but it’s been difficult to keep people on staff, to keep people hired long enough to even form that team.”
He said that, while the Prince Albert centre has been steadily staffed with at least a few dedicated nurses during his experience, hiring more could mean the centre could run at its full ten-bed capacity.
“If we had an abundance of nurses we’d be at 10, no problem,” he said.
Zbuk says that due to his pressing workload at the centre he’s been struggling to follow up with all of his discharged patients, some of whom he says he’ll lose contact with completely.
“We need to be able to track these high-risk kids down to help out,” he explained, saying that if he misses a child or youth on the first attempt it’s sometimes weeks later by the time he’s able to reach out again.
By that time the contact information he has may no longer be current.
“So we need a lot more people and more organized systems in place.”
The problem isn’t unique to Prince Albert.
According to the Saskatchewan Health Authority, from March there were 391 people awaiting the services of a child and youth psychiatrist in Saskatoon.
The average wait time to access those services, according to the SHA, is 278 days.
Province-wide there are just 19 child and youth psychiatrists practicing, the Authority says — one in Prince Albert, seven in Regina and 11 in Saskatoon.
In total, between the Prince Albert, Regina and Saskatoon youth mental health intake facilities, there are currently 25 beds in operation.
With regards to recruiting a second psychiatrist to Prince Albert, an SHA spokesperson said “the SHA is working with many partners to recruit to our vacant children-youth psychiatry position and, yes, further inpatient bed resumption is contingent on additional hiring.”
Speaking Wednesday, Mental Health Minister Everett Hindley acknowledged that recruitment has been a challenge in Prince Albert and suggested the province needs to identify advantages as it endeavours to attract more health-care workers to Saskatchewan.
“We’re trying to get that other psychiatrist position filled and looking at what other supports might be necessary in Prince Albert,” Hindley said.
“We’re working pretty hard to make sure we’re capitalizing on the positives that we have in Saskatchewan, the things we have here that perhaps make us more competitive or advantageous. We know we’re in competition with every province and territory in this country and beyond those borders as well.”
The executive director of the Registered Psychiatric Nurses Association of Saskatchewan (RPNAS), meanwhile, says her profession can help.
But, despite the province dedicating budget funding this year to expanding the number of RPN training seats in Saskatchewan, she says more RPNs will still be retiring than are becoming newly trained.
“Fifty per cent of our membership are 50 years of age or older and are poised to retire at any moment. Currently, we have more people exiting the profession than graduates who are coming in,” Beverly Balaski told Global News.
“Saskatchewan was the first province to license psychiatric nurses back in the mid-1940s. So right now at a time when mental health support is so highly in demand, it would be really detrimental to mental health goals to see that vital profession disappear from our province.”
Right now there are only 56 RPN training seats.
Balaski said a 2021 study concluded that 120 RPN-specific training seats are needed right now to meet demand and ensure the number of practicing nurses doesn’t decline over time.
The Saskatchewan government announced at budget time that nursing training seats would expand by 150.
Saskatchewan Polytechnic will add 16 new registered psychiatric nursing seats as part of this expansion. That’s in addition to a previously planned expansion of eight new registered psychiatric nursing seats brokered by North West College in North Battleford, according to the Ministry of Advanced Education.
This will expand the number of training seats in the 96-week advanced diploma program to 80 this fall.
Dr. Zbuk acknowledged that recruiting child and youth psychiatrists in particular will come with its challenges.
“There’s an inherent shortage anyways of child psychiatrists,” he explained. “You have a pick of going wherever you want to go in the country. We’re fighting the Pentictons and the Kelownas and all those other places.”
His advice for attracting people to a place like Prince Albert, in part at least, is to bring them by to see what it’s all about.
“There’s beautiful lakes that no one knows about, and it’s an hour from Saskatoon which is a beautiful city that people often don’t know is as beautiful as it is,” he said.
“I think a lot of insight visits would be really helpful so they can see what Prince Albert is like, especially in the summer. That should be a recruitment time.”