After a CTV report last week outlining how many adolescents in Ontario have to get care from Emergency Rooms, I decided to evaluate how care is in one outpatient program, the one where I work.
My goal was to try and get an impression of what it was like to be a patient in the Youth Outpatient Program at The Royal, the psychiatric hospital in Ottawa. I am the physician Director of that program. I started at the Admitting Department, proceeded up to the Outpatient waiting room, and then imagined I participated in both the psychological testing and the clinical interview that comprise a first assessment in the program the Outpatient Team has developed. This is the kind of exercise that is recommended as part of a Quality Audit.
It took two and one half hours to complete the exercise. The process was complicated by the fact that I had decided not to tell anyone what I was doing – I felt that this would make the experience more authentic. At the end of the experience, I can say that I am surrounded by helpful and curious people – especially curious. Also, a lot of people know me…a lot.
Here are some of the questions people ask:
In Admitting, “Can we help you, Dr. Beck?”
To find the Youth Program, you follow red butterflies to the third floor. I have to ask, “Which butterfly do you think is red and which maroon?”
When I don’t take my usual route to my office (because I’m following red butterflies), one helpful person says, ”You’re going the wrong way, Dr. Beck.”
While sitting in the waiting room, “Did you forget your keys? Shall I call Security?”
It occurs to me that, if I had to sit in that waiting room for any length of time, I’d be pretty bored. Should we suggest that parents waiting for their adolescent bring a book? Should we see whether it might be possible to get a TV for the waiting room – one that showed educational tapes on mental health or information about services locally. I ask others waiting with me. They like that idea and speak with me about the services they’d like. When I tell them who I am and what I’m doing, the suggestions are even more useful. There is a lot of curiosity about why I’d do this: ”Can’t someone less important do this?” (MY favourite question!) “Do you think You’ll be able to change anything you don’t like?”
At the end of this exercise, my impressions are of a large, complex building with lots of light – The Royal’s new building is a beautiful, light-filled building. It is, however, somewhat difficult to find your way around it. The offices are numbered but it seems as if they are oddly arranged at times – I can never remember if I am in Room 3311 or 3312. I also recall trying to find a colleague in the Geriatric Psychiatry Program and realizing that finding their office would conclusively establish that my executive functioning was still intact.
People are friendly. I started working at The Royal in 2002 after a long period in private practice and I remember how impressed I was by how much many people enjoyed their work and how many of them were kind and devoted. It’s one of the best things about the hospital and it’s still true today despite all the cutbacks we’ve had to work around.
It’s also evident that many patients who’ve been coming to the hospital for a while feel very comfortable there. A young man that I saw five years ago as a teenager is attending St. Nicholas Adult High School close by and picks up his morning coffee at The Royal. He always tells me how his courses are going. Another young woman greets me every morning as she arrives for the Day Hospital. This is very important, that people feel comfortable there. To me, this would help others feel comfortable.
There is a lot more that is good about the youth program than comfort. The team I work with has gotten the wait list down to three months, less than two weeks for urgent patients. Last week’s news report suggests that there are not enough mental health services in the community for youth and that access to physicians in the system is not adequate.
Having said this, if you have ever known an adolescent experiencing a mental health crisis, you will likely recall that these seldom occur at 9 a.m. They occur in the evening, when you can’t figure out your homework, or your girlfriend dumps you, or your parents are fighting. When we’re worried about a youth, my team and I develop a safety plan with them and their family. During the day and early evening, there are places to go and people to see. These safety plans often include a family doctor and the family doctors are not the inaccessible ones mentioned in the CTV report.
But even family doctors’ offices and psychiatry departments close and, in the wee hours, when things get scary, there is only one place left. “Where will you go?” I ask youth, “Where will you go if you can’t find anyone else?”
“I’ll go to Emergency, Dr. Beck. They know me there.”
That, to me, is the point. The Emergency Room may not seem like the best place if you’re stressed out, but it’s better than the alternative. I wish that the CTV report had ended by reminding youth and their families that Psychiatric Services in Emergency Rooms are still the right choice in a crisis. I wish they’d said, “We wish there were more psychiatric services for youth, but please use the Emergency Services if you have to.”
Sometimes it’s the best choice.