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Quebec vs mental health care: ‘A band-aid on a leaking dam’

We spoke with MUHC psychiatric nurses about why they launched a fundraiser for their unit, and what the province needs to do to improve mental health services and reduce the need for acute care.

Accessing mental health care has long been arduous in Quebec, and the pandemic only further exposed those difficulties. While a predicted post-COVID spike in anxiety and mental health issues among the province’s general population never really materialized, a lack of funding and a shortage of specialized healthcare staff, psychologists and social workers have made the struggle to access care for those struggling a significant one. 

In 2021, a study by a McGill University professor revealed Quebec’s program for mental health services “showed an average delay of three months to get a follow-up and five more to receive any kind of service, meaning it takes an average of eight months for most to get care.” That’s a very long time for someone experiencing distress, severe depression and other serious mental health issues.

Some of Quebec’s public health workers and nurses working in the mental health field are currently undertaking major strikes and organized pressure tactics as they try to negotiate better pay and working conditions.

Naveed Hussain, who worked in internal medicine for 18 years and made the jump to McGill University Health Centre’s psychiatric unit three years ago, is one of them. As a mental health nurse, Hussain treats patients who are in acute psychosis or have issues with drugs. 

“We detox patients before they go to rehab,” he says. “You end up meeting people from across Quebec, all walks of life, all age ranges and all languages.”

The psychiatric unit he works in treats 40 to 42 patients with various psychiatric diseases, weaning them off alcohol, heroin or amphetamines. 

Fundraising for the psychiatry unit 

Quebec nurses mental health services
Naveed Hussain on mental health care in Quebec

Even in the middle of contract negotiations, healthcare workers don’t forget what motivates them and who they often prioritize: their patients. Hussain is currently trying to raise money for better patient activities on the unit. 

“My goal is to be able to have items the patients can use and can distract them from what’s happening to them,” he says. “Books, games, things to keep them entertained. We have stuff from the 1980s here because we don’t have enough money to replace them — broken vital signs machines and things just falling apart.”

Chronic underfunding of the healthcare system and budgetary cuts have taken their toll. In 2021, Quebec’s Treasury Board ordered health authorities and hospitals across the province to chop a total of about $150-million from their budgets, as the government scrambled to find ways to recoup heavy COVID-related spending. A lack of adequate patient activities is just the tip of the iceberg of a healthcare system buckling under immense pressure. 

“The pandemic exacerbated patients’ mental-health problems,” says Beverly Brown, also a psychiatric nurse in the same MUHC unit, “because they didn’t have access to as many resources and day programs. We have a certain number of beds on our floor and they’re pretty much full all the time. There’s always a need.”

The MUHC’s Mental Health Mission offers both in-patient and out-patient services, treating people in the most acute phase of their illness, but also those transitioning back into the community. 

“I really love my work,” Hussain tells me, “because you get a chance to listen to their stories and understand where they come from. Sometimes people just want someone to listen.” 

Hussain says the patients might be confused or disorganized but they’re still human beings in need of connection. “They remember your name,” he says, “they smile and are willing to open up. That’s huge for people who suffer from mental heath illness. And that’s essentially our mission: creating spaces where people feel safe, where they can get treatment and go back to live their lives as normally as possible.”

Brown says that once people find themselves on their unit, they can be there for quite a while. “For those who are starting to do better, it helps to have more activities, more structure, more things to do. Being occupied in a calm manner, like bingo night, things like that can prevent a crisis. These activities are so helpful for the patients.”

Lack of mental-health community resources 

Brown acknowledges the bigger issue is lack of resources within the community, which in turn affects the number of people they treat. “People end up on our unit because there aren’t adequate resources, places for them to live, like low-income or specialized housing,” she says. “People might come to the hospital because they might be on a wait list for a service they need, like psychological help for borderline personality disorder. If you don’t have private insurance, you might be on a waitlist for six months, or a year. Within that time, how many crises could occur? Are you ending up in a hospital because you don’t have access to resources because there are X amount of people ahead of you?”

Chronic schizophrenics and the unhoused are people who often slip through the cracks. “The police pick them up and bring them to the hospital,” Hussain says. “They receive treatment, and we discharge them, but you often see them again.”

The mental health nurse, whose father was an immigrant from Pakistan who worked as a psychiatric aide for 36 years, also teaches for the Riverside School Board, training licensed practical nurses and orderlies. Hussain warns people not to assume that mental health only affects a certain demographic. He stresses the majority of people at the mental health unit are functional human beings who have jobs, who have lives, who have family and who are just going through a rough time.

“Some people have this idea that a psychiatric unit is like a scene from One Flew Over the Cuckoo’s Nest,” he says, “that someone who’s ill is in a gown, strapped in, getting held down and popped with pills and needles. And 99% of the time, that’s not the case at all. It’s just people who work as accountants, dentists or baristas at Starbuck’s and they’ve just had a bad period.”

A recent study by the Canadian Institute for Health Information found that “about 1 in 5 Canadians experience mental illness each year. Many must wait to get the care they need, while others don’t get any care or don’t get enough — with young people particularly hard hit by lack of services.”

“It’s people who maybe had a bad loss or breakup and now they can’t cope and they’re struggling,” Hussain says. “Or they’re battling alcoholism and need to detox so they can go to rehab. And we help them. And it’s not just medication, it’s listening, being present for someone.” 

Mental-health stigma a continued issue

Brown says stigma surrounding mental health remains an obstacle, both for people seeking treatment and for better government funding. “We’re not as individualistic as many other places in the world,” she says, “but we’re still very much, ‘Take care of yourself and your problem.’ And if people can’t do that, it’s their own fault that they’re not dealing with it properly.” Some people, she says, just need more help. The same way some people need a walker or adapted transport to get around, some people with mental health issues need more support. “We’re not really willing to deal with that at all,” she adds. “If it’s not a visible, physical issue we can identify, fix and address, then it’s their issue and they should take care of it.”

Hussain says it’s encouraging that politicians are starting to talk more about mental health, but he’d like to see more done. Bureaucracy and red tape continue to be barriers to better service. “We try our best to follow up on patients,” he says, “but it’s impossible, because the way the healthcare system is set up now, it’s basically short-term fixes and no long-term plan.”

Brown says that easy access to mental healthcare is simply not there. “There are definitely more resources and more training for someone who’s had a stroke,” she says. “Mental health is largely pushed to the side, not as adequately funded, not as adequately researched. It lacks all the things that we could do to prevent people from needing acute care.” 

She’d like to see more community mental health services and more preventative care, as well as easier access to regular healthcare, since the strain of not having healthcare in itself also leads to anxiety and stress disorders. “We shouldn’t wait until the problem is major,” she says. “It should be easy to see a psychologist before it becomes a crisis.”

‘A band-aid on a leaking dam’

Hussain, who says his work at the psychiatric unit has taught him empathy, patience and amplified his ability to listen, says it often feels like healthcare workers are trying to put band-aids on a dam that’s leaking more and more every day. “It feels like the government doesn’t get what’s happening on the ground,” he says. “We’re not getting enough supplies, enough help to treat patients. We need to come together and find solutions.”

He says he’s seen a greater increase in intolerance and an inability to listen to one another since the pandemic. “Human interaction decreased substantially (during COVID) and we were all living in bubbles,” he says. “We’re not meant to live in isolation. We’re human beings — touch matters, being able to see one another matters, and that was taken away from us.”

He worries that people unable to take care of their mental health risk spiralling and seeing everything around them in bleak terms. “Lots of young people are being affected by all this and sometimes that unleashes things underneath.”

If you’d like to donate to the fundraiser, you can do so here. ■

Read more weekly editorial columns by Toula Drimonis.