905 regions failing the mentally ill
Psychiatrist shortage leaves too many patients in
Peel and York without the treatment they need
2007 04:30 AM
Kerri Alderman desperately needs a
But even after plunging into
depression eight years ago, even after her two young
daughters were taken away because of her four
hospitalizations, the 30-year-old can't find one to
"It's all I asked for in the
beginning," she says. "It's not my fault nobody
Alderman, who lives in Milton and
sees a Mississauga-based family physician, is not
alone. Thousands of people, with varying degrees of
mental illness, aren't getting proper treatment
because there is an acute shortage of psychiatrists
in 905 communities.
Experts blame the dearth of doctors
on a litany of problems. Too many psychiatrists are
retiring. There are not enough residencies in
medical schools. It's hard to recruit bright young
doctors to community hospitals and clinics. And the
influx of people, especially in York Region and the
Region of Peel, fast outpace the number of doctors.
For Alderman, it doesn't matter why
she slipped through the cracks. In many ways, she
says, it's already too late for her.
"If I had a psychiatrist, I wouldn't
have lost my kids," she says, her bottom lip
trembling. "But I didn't. So now I blame the
Dr. John Esmond, Alderman's family
doctor of eight years, tries to counsel as many of
his patients as possible in lieu of sending them to
a psychiatrist, where wait lists can be one year or
longer – if he can get them in. He estimates one in
five of the 2,200 patients he shares with partner
Dr. Chien Pham at Grand Park Medical Clinic in
Mississauga require regular counselling for a
variety of mental illnesses, including anxiety,
depression and bipolar affective disorder. That, he
says, is a fourfold increase in the last four years.
"There are a lot of Kerris in my
practice," he says. "Every day I see someone like
this. Just the other day I had someone come in who
was hearing voices. He came in with his sister and
she asked me when he could see a psychiatrist. I
told her there was no one. She said, `What do you
mean there's no psychiatrist?'"
The Canadian Psychiatric Association
recommends one psychiatrist for every 8,400
citizens. That means Peel, with a population of more
than 1.5 million, should have at least 130. In 2005,
there were only 54.
Dr. Marino Battigelli, chief of
psychiatry at Credit Valley Hospital in Mississauga,
says there has been a shortage of psychiatrists in
the region for years, but no one has taken any
action beyond forming committees. He estimates there
should be 30 child psychiatrists for Peel's 300,000
"We have less than 10," he says.
"These figures are astronomical."
Peel is at the bottom of the heap
when it comes to provincial funding for mental
health. Ontario spends $22.92 per year per person on
mental health in the Central West Local Health
Integration Network, according to CEO Mimi Lowi-Young.
Other health networks receive between $15.50 and
$134.86 per person per year, but a spokesperson at
the Ministry of Health could not explain the reason
for the discrepancy, saying only that they try to be
fair when doling out dollars.
Not only does the lack of funding
hurt patients, it also makes it difficult to recruit
new psychiatrists, Battigelli says. Recent graduates
prefer to stay at downtown university hospitals,
where they can get research money and where there is
more community support. Right now, Toronto has 500
more psychiatrists than the ratio recommended by the
Canadian Psychiatric Association.
Battigelli has only been able to
recruit three psychiatrists to Credit Valley in the
last 10 years even as the population has
boomed.York's population, for example, ballooned by
more than 160,000 between 2001 and 2006, an increase
of 22 per cent, compared with a 17 per cent increase
Alderman can't understand why there
were no psychiatrists to treat her when she was
first diagnosed with postpartum depression after the
birth of her second daughter in 1999.
When Esmond couldn't find her a
psychiatrist – except for one month in 2001 – he
prescribed antidepressants and counselled her up to
three times a week, often for only 10 minutes before
regular office hours.
But it wasn't enough for Alderman,
who describes her depression as having "a hole in my
heart that won't go away."
In January, the Children's Aid
Society recommended her two daughters be permanently
removed from her care because frequent
hospitalizations kept her away from home too much.
Dr. Rayudu Koka, chair of the
psychiatry section at the Ontario Medical
Association, says the earlier a patient gets
treatment, the better the outcome. Too many people
are not getting help in Ontario, especially when one
in four people are estimated to have a mental health
"It's a major problem, but we're not
paying attention," he says. "It's a hardship to
family and friends and it has an incredible cost to
the system." In the last year, Koka has only been
able to lure three psychiatrists to Sudbury, where
he practises, to bring the total number to 11 – nine
fewer than there should be.
"I work 60 to 80 hours a week and
it's still not enough," he says. "We do Saturday and
Sunday clinics because the community needs it. But
we just don't have enough days in the week. And it's
a similar story all across Ontario."
Even though the Ontario Ministry of
Health has recently increased residency spaces for
psychiatrists, Koka says the province has to do more
to attract people to the profession.