The head of the University Hospital of Northern British Columbia’s psychiatric ward, backed by 23 community agencies, says it’s time the province addressed the lack of mental health and addictions care for patients, and has organized a petition to bring a psychiatric hospital to northern B.C.
Dr. Barb Kane, a practicing psychiatrist in Prince George for 34 years, says the needs of northern B.C. patients go far beyond the capacity of existing hospital facilities and mental health agencies.
She says that stems from the closure of Riverview Hospital in Coquitlam in 2012, a decision that was made in the late 1980s, which left B.C. as the only province in Canada without a psychiatric hospital.
The petition is calling for the provincial government to create a mental hospital to serve the northern half of the province and its population of 309,000, which represents about six per cent of the population of B.C.
Posted online Friday the petition explains: “There is a complete lack of access for people in northern communities to the highest level of psychiatric care. Without this level of service, the people who need the care, their friends and families, and northern communities including police services and hospitals among others, are left to deal with problems they don’t have the resources to manage.
“Your petitioners respectfully request that the (provincial government) work with Northern Health to develop long-term secure psychiatric services, such as a psychiatric hospital or equivalent, for people in our communities who need this level of care.”
In a letter to Prince George city council included in Monday’s public meeting agenda, Kane is asking council to endorse the petition.
Kane said the writing was on the wall: the closure of the province’s only psychiatric hospital would leave a serious void in the medical system that would result in violent patients being released prematurely from care, additional stress put on hospital staff having to deal with complex care patients, and more addictions and homelessness.
“There were clear indications even before Riverview closed that the community services could not manage the people who needed long-term secure psychiatric care,” wrote Kane.
“Homelessness and street crime were starting to escalate even before Riverview closed, as outlined in the Vancouver Police Department report ‘Lost in Transition’. That 2008 report recommended that there be a mental health facility that could care for people with chronic and persistent mental illness, four years before Riverview closed.
“Since then, governments have added community supports but they are not able to compensate for the services of a psychiatric hospital. As a result, communities have been left ‘holding the bag for services’ they cannot provide such as long-term secure psychiatric care.”
Some stakeholders have suggested the Prince George Youth Custody Centre west of the airport, which closed permanently last spring, could be easily converted into a mental health facility.
The cost of operating a psychiatric hospital in Prince George is unknown. The 61-bed PGYCC, at the time it closed, was costing the province $5 million annually.
It’s estimated that in the north, 50 people need long-term psychiatric care. Of that number some will require that care for the rest of their lives due to brain injuries and severe mental illness, while some need temporary treatment for months or years.
The nearly 9,000 acute and tertiary beds in B.C. hospitals are intended to be short-term facilities for mental health patients.
In Prince George, UHNBC has a 20-bed locked unit with four seclusion rooms and a six-bed adolescent unit. Terrace’s Mills Hospital has a 10-bed locked unit with two seclusion rooms, while Dawson Creek District Hospital has a 15-bed locked unit with two seclusion rooms.
If any patient requires a higher level of care there are just three beds available at Hillside Hospital in Kamloops.
Provincially, the 90-bed Red Fish Healing Centre in Coquitlam is the only alcohol and drug treatment centre for people with concurrent mental health problems. Red Fish also offers a 15-bed enhanced care unit for severe mental health problems.
The Forensic Psychiatric Hospital in Port Coquitlam is only accessible to the criminal justice system after a crime is committed and a judge orders the person to be sent there. That facility is regularly at or over capacity and patients sent there are routinely sent to UHNBC, which lacks the resources of high-security units, leaving staff and other patients vulnerable to violent offenders.
Kane said psychiatric wards in northern B.C. hospitals are not equipped for violence or patients who go absent without leave.
Before it closed, Riverview accepted patients from any hospital in B.C. and was open to civilly committed patients (on the advice of two doctors) not ordered by the criminal justice system.
Forensic patients who finished their review board orders but were still considered dangerous were routinely sent to Riverview, where some of them lived out their remaining years. Now, they stay at the Forensic Hospital as civilly committed patients.
“Forensic Psychiatric Hospital tries to send them to the psychiatric wards in the north (and) we take a lot of heat for refusing them,” said Kane.
“We are releasing dangerous patients from the hospital, before they are ready to go, because we have to. There is nowhere else to send them. There is nowhere to send patients who need extended stays in secure units. B.C. has no access to long-term secure psychiatric care.”
The Riverview facility, before it closed, had the capacity for between 800 and 1,000 mental health patients.
According to Kane, past practice in the 1900s and early-2000s for dealing with a severely violent and dangerous patient admitted to hospital in Prince George was to transfer that patient to Riverview within days. Other hospitals in the province would have done the same and that patient would have remained at Riverview for months or years.
If they did come back to Prince George they were never discharged from the hospital to the street or to a shelter, as they are now. They would instead be sent to a group home and released on an extended leave and if things did not go well they were sent back to Riverview.
“All of the people I have spoken about would not have been in our hospital on a long-term basis, probably not even a week,” said Kane.
In the decade before Riverview closed, no new patents were admitted to the facility and the province set up several 20-bed unlocked residential regional mental health units, two of which are in the north – Iris House in Prince George and Seven Sisters in Terrace.
“There was no provision for the next generation of people who needed long-term secure psychiatric care,” said Kane, who says the lack of care is one of the causes of the province’s increased homelessness problem.
She says mental health teams were originally developed to treat people on the street and help them live in the community in market housing. While that continues to work for some, many of their clients are considered unhouseable because they are so mentally ill and addicted to substances.
“(It’s a) self-perpetuating cycle where untreated mental illness leads to more drug use, which leads to worse mental health,” said Kane.
Jennifer Whiteside, B.C.’s minister of health and addictions, in a March 23, 2023 Vancouver Sun opinion piece written by Douglas Todd, acknowledged that since the closure of the Riverview the level of psychiatric care in the province has suffered and has not recovered.
“When Riverview was closed, the government at the time failed to make sure proper community-based care and supports were in place for those leaving institutional care,” Whiteside said.
“When we became government in 2017, a mental health and addiction system of care did not exist. And we’ve been working hard to build one for people. We know there is more to do.”
That Sun article, referred to a February 2023 quote from BC United leader Kevin Falcon in which he pledged $1.5 billion over three years to rebuild mental health and addictions services, echoing NDP promises of funding for regional centres to serve patients with complex care needs.
Falcon admitted that “over 40 years, successive governments closed down a rightly criticized institutional approach to mental health, without ensuring an adequate system of supports was available.”
In 2016 the auditor general report, Access to Adult Tertiary Mental Health and Substance Use Services found there was no provincial strategy to ensure patients with brain injuries, developmental disabilities or with a history of extreme violence exhibiting highly aggressive behaviour, as well as people with serious mental illness and/or substance use, will be able to receive the services they need.
The report also highlighted that no single program is responsible for developing resources to meet the province’s needs and there was no data to determine the number of patients who need that help.
That lack of a provincial strategy is putting too much pressure on hospitals, resulting in worsening patient care and more difficult working conditions for hospital staff, says Kane.
“When our hospital has to keep violent, high-risk patients on our psychiatric wards, patients who otherwise would have come to our ward either stay in emergency or go to other wards,” Kane said.
“That leads to emergency department overcrowding, long emergency waits, violence in the ER and staff attrition.”
She said not having a place to send psychiatric patients is delaying surgeries, if a surgical bed is filled over the course of year by a patient requiring mental health treatment.
“If the average length of stay of a surgery patient is three days, then roughly 100 surgeries don’t get done that year,” said Kane. “If there are 10 beds used by psychiatry patients, 1,000 surgeries aren’t getting done.”
