The Auditor General notes serious “deficiencies” in the services provided for the most difficult cases of mental illness, including the need to wait nearly two years before access to a GP.
“There may be deficiencies in the care and support of this clientele.” […] lead to serious consequences,” warns Guylaine Leclerc, Comptroller of Quebec, in a report published on Thursday.
The category of people with “severe mental disorders” includes people who have been diagnosed with schizophrenia, psychotic disorders, and major depressive disorders. Many also struggle with other issues (more than one mental disorder, drug problems, physical illnesses, etc.). These people have “chronic needs” for care and services.
But the investigator found they waited an average of 709 days, or almost two years, before they had access to a family doctor, more than the average Quebecer. Worse, notes Ms. Leclerc, this data doesn’t even account for the hundreds of sufferers who aren’t even on the waiting list.
Connections to the real estate crisis
She also notes, based on data from the Capitale-Nationale and the Integrated University Center for Health and Social Services of Est-de-l’Île-de-Montréal, that hospitals lack beds for treatment, partly due to the housing crisis.
At the Montreal Mental Health University Institute (IUSMM), the 287 beds were “nearly 100% occupied” at the time of the audit. However, 38% of these places were occupied by people who no longer required care.
Of particular concern is the “situation on the CIUSSS de l’Est de l’Île”, where the average waiting times for the different types of accommodation vary between 173 and 337 days.
The Comptroller notes that the lack of affordable housing “constrains” the deduction of better-off users. It is a real vicious circle. She also notes that there are not enough shelters “adapted to the needs of an ever-increasing clientele (drug addiction, legalization…)”.
Lack of psychiatrists in the public
The audit specifically focused on heavy users of mental health emergencies (GUU) whose paths on the network are disordered.
During 2021-2022, more than 106,000 Quebecers experienced an emergency due to a common to severe mental disorder. According to the examiner’s assessment, 5,223 of these were GUUs.
In Quebec, these people have to wait an average of 45 hours on a stretcher in standard emergency departments before being transferred to the University Institute of Mental Health (IUSMQ).
Two-thirds of those who leave the hospital return within six months, compared to just 28% of all patients.
The treating staff often does not have access to the complete patient file right from the start, since the information is scattered throughout the facilities, sometimes in paper form.
Guylaine Leclerc is also concerned about the lack of psychiatrists in public institutions, where the majority of people with serious disorders end up.
An increasing number of psychiatrists practice exclusively in private practice, while 11.8% of positions in the public network are vacant (an even more fragile situation in East Montreal at 15.2%).
However, resident psychiatrists generally treat less serious psychiatric problems (such as anxiety, mild depression, etc.) and do not practice at night, the investigator notes. In Quebec, the IUSMQ lacks psychiatrists who could follow up more complex cases in the community.