When the “Salt Spring Island Health Review” came out in June 2010, the top two priorities identified were more services and facilities for seniors and for mental health patients on Salt Spring Island. The report was undertaken by V.I.H.A. (now known as Island Health) and explored Salt Spring’s entire continuum of health care services. It was not surprising that health services for seniors was identified as a priority since we have the highest population of residents over the age of 65 in the province, but mental health, often the silent illness in a community, was surprising to some. Here is what the data told us:
“Over the past few years, residents of the Gulf Islands Local Health Area have used acute care psychiatry at a higher rate than almost every other local health area in VIHA, regardless of the hospital where they are admitted. The utilization rate for these services is almost twice that of BC and of VIHA as a whole. The only VIHA Local Health Area with a comparably high rate is Vancouver Island North (Mt. Waddington).”
The report further describes the demographic and shared some of the feedback provided by stakeholders.
“Residents know that there are many people on Salt Spring Island who are coping with mental health issues. Because the island has a reputation as a peaceful, tolerant and supportive community, mentally ill people may come to Salt Spring looking for refuge, a slower pace of life, and a “healing” atmosphere. The rural nature of the island also means that there is plenty of open space where people who are mentally ill and homeless can camp out. Whatever the factors involved, it is clear that Salt Spring Island has a relatively large population of people with serious and persistent mental illness.”
Since that report was published, some important changes have taken place to address the gaps and provide better care for mental health patients on the island.
ANASTASIA WILLIAMS, MENTAL HEALTH NURSE
In September 2010, Anastasia Williams. B.Sc.N. was hired full time as the Mental Health Nurse for Lady Minto and provides coverage from Sunday to Thursday, 8:00 am to 4:00 pm. Working in conjunction with our psychiatrist, Dr. Montalbetti, Anastasia sees emergency mental health patients who present at the hospital in crisis and provides discharge planning and follow up for up to six weeks after patients leave hospital. She also runs “The Core Program: Practical Strategies for Personal Change” which is a Cognitive Behaviour Therapy program to help people living with depression to create positive change in their lives. The program runs for eight weeks, with 2 hour sessions scheduled weekly, and is offered several times a year. An emergency mental health worker is available after hours between 4 p.m. and midnight through the Salt Spring Community Services Society.
“I love my job. I love helping people to help themselves. I feel very lucky to work in this field.”
The workload certainly goes in cycles, Anastasia says, but it is true that one of the most common diagnoses for admission to Lady Minto is mental illness. “Sometimes it feels like we are putting out fires when it gets really busy. Right now we have a client that requires transfer to Victoria and a new admission that came in earlier this morning. We also have two inpatients under treatment.”
Anastasia describes some of the challenges. “There is only one of me and I have to juggle priorities when it gets really hectic.” “Mental health patients often come to Salt Spring to get off the streets. We don’t have a fraction of the services available in the city such as occupational therapy for people with mental illness, adequate housing and day programs. In Victoria, there is a variety of supported housing facilities and day programs where activities such as yoga and art are offered. Here on Salt Spring, we have no real mental health housing, but we do have the Yellow Submarine which offers valuable but limited services for those with mental illness. In the winter months only there is a shelter “In from the Cold” program which is run by the Community Centre. The shelter provides overnight accommodation and a hot meal during the very inclement weather.”
When asked why the needs are so great here on Salt Spring, Anastasia believes that, “People are disenfranchised. Everybody is stretched. Kids are stretched. We have vulnerable seniors. Some clients with addictions have untreated mental health issues. The foundations for good health are shelter, food, clothing and security. People slip through the cracks, especially when poverty is a factor.”
“The nurses at Lady Minto are great and handle many emergencies at night,” she adds. “The doctor on call also handles mental health emergencies between midnight and 8 a.m. The nurses are really good and well versed in helping people through crisis.”
It takes special skills to work in mental health: excellent communication skills, healthy boundaries, lots of patience and good self-care. Anastasia works closely with our psychiatrist, Dr. David Montalbetti, and together with our new psychiatrist, Dr. Sally Garbett, they form the mental health team here at the hospital.
PSYCHIATRIC SERVICES AT LADY MINTO AND IN THE COMMUNITY
Dr. David Montalbetti has practiced on Salt Spring since 1993. When I asked him what was on the top of his wish list at Lady Minto, he agreed that there isn’t any sexy equipment needs in psychiatry but having adequate and appropriate space in the facility has been a challenge. Coping with tight quarters in the emergency room has already been identified as a priority for change and the present location of the quiet room poses some challenges as well. Anastasia fills in a large gap as the psychiatrists can’t be at the hospital for all shifts. “We do the best we can with what we have,” Dr. Montalbetti says. “It would be great to have ‘more boots on the ground’ to handle the workload.” The need for a social worker trained in mental health and more psychiatric nurses was identified. Having two consultations rooms would be ideal.
The good news is that a new psychiatrist, Dr. Sally Garbett, joined the team in September and works full time at the hospital and at Community Services. With the help of a grant from the Foundation, Dr. Garbett was able to set up the community office and has already addressed the challenge of improved communications between community mental health and the health authority’s medical records system. The project will see all outpatients registered within Power Chart, an electronic charting system used for all clients within the health authority. Patients can then be tracked and care can be consistent. Having access to current data through the Power Chart will help to identify needs and assist with funding requests.
Trained in the U.K., Dr. Garbett came to Canada in 1995 and worked in northern B.C. for the Peace River Regional District. She helped to set up a dedicated centre for mental health in Dawson Creek. For rural psychiatry, the model of care is based on a team approach. “Modern psychiatry is family centred and it is important to keep patients close to families. Mental health patients do much better when the family is involved. The mandate includes care of the whole family.”
“I would like to leave a legacy,” Dr. Garbett tells me, so that it can be better for psychiatry in the future. “I wanted a new challenge and applied for the position here on Salt Spring. I had served in the process for growth and change in the Peace River District and worked within a challenging environment up north.” Dr. Garbett’s legacy was certainly a big part of the success at Dawson Creek where services were vastly improved during her nearly twenty years of service. To achieve this here, she tells me that we need more funding. We need to advocate for better services in the community, nearer to home.
We are also lucky to have access to psycho-geriatric services through Dr. David Leishman (Psychiatrist in the Department of Geriatrics, Royal Jubilee Hospital) who visits the island every two weeks. He is available to discuss difficult cases with the medical staff and is very approachable for consultations. Dr. Peggy Fishbrook, a Child Psychiatrist, also provides weekly visits to the island through the Community Services Centre.
Soul Matters Counselling, a professional counselling service founded by Elsje Hannah, for low-income individuals, children and families, receives some referrals through Community Services. For more information about this service, visit : www.soulmatters.ca