905 regions failing the mentally ill

Psychiatrist shortage leaves too many patients in Peel and York without the treatment they need

Jun 09, 2007 04:30 AM

Health Reporter

Kerri Alderman desperately needs a psychiatrist.

Kerri Alderman, 30, was first diagnosed with depression after the birth of her second child in 1999, but was never adequately treated. Depression, she says, is like having "a hole in my heart that won't go away."


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 treat her.

"It's all I asked for in the beginning," she says. "It's not my fault nobody could help."

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 system."

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 children.

"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 in Peel.

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 problem.

"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.