The Auditor General finds serious “shortcomings” in the services offered to the most difficult mental health cases, which include having to wait almost two years before having access to a family doctor.
“Shortcomings in the care and services offered to this clientele can […] lead to serious consequences,” warns the Auditor General of Quebec, Guylaine Leclerc, in a report released Thursday.
The category of people with “severe mental disorders” includes people diagnosed with schizophrenia, psychotic disorders and major depressive disorders. Many also deal with other problems (more than one mental disorder, substance abuse problems, physical illness, etc.). These people have “chronic needs” for care and services.
However, the auditor discovered that they waited an average of 709 days, or nearly two years, before having access to a family doctor, more than the average Quebecer. Worse still, note Mme Leclerc: These data do not even take into account the hundreds of sick people who are not even on the waiting list.
Links to the housing crisis
Based on data from the Capitale-Nationale and the Integrated University Health and Social Services Center of Est-de-l’Île-de-Montréal, she also notes that hospitals lack beds to treat them, in part because of the housing crisis.
At the Montreal Mental Health University Institute (IUSMM), the 287 beds were taken “almost 100%” at the time of the audit. However, 38% of these places were occupied by people who no longer needed care.
The “situation is particularly worrying at 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 Auditor General notes that the lack of affordable housing “limits” the exit of users who are better off. It is, she says, a real “vicious circle”. She also notes that there are not enough accommodation resources adapted “to the needs of increasingly heavy clienteles (drug addiction, judicialization…)”.
Lack of psychiatrists in the public
The audit focused particularly on heavy users of mental health emergencies (GUU), whose paths in the network are disorganized.
In 2021-2022, more than 106,000 Quebecers went through emergency due to a common to serious mental disorder. Of these, 5,223 were GUUs, according to the auditor’s assessment.
In Quebec, these people have to wait an average of 45 hours on a stretcher in ordinary emergency rooms before being transferred to the University Institute in Mental Health (IUSMQ).
Two-thirds of those who leave hospital return within six months, compared to only 28% of all patients.
From the outset, the treating staff often does not have access to the complete file of the person, the information being scattered in the establishments, sometimes in paper format.
Guylaine Leclerc is also concerned about the shortage of psychiatrists in public facilities where the majority of people with serious disorders end up.
More and more psychiatrists practice exclusively in private practice, while 11.8% of positions are vacant in the public network (an even more fragile situation in the East of Montreal with 15.2%).
However, psychiatrists in office generally treat less serious psychiatric problems (such as anxiety, minor depression, etc.) and do not practice at night, notes the auditor. In Quebec, the IUSMQ lacks psychiatrists to follow up in the community with more complex cases.