Suicidal patients in northern British Columbia are sometimes put in jail cells and are routinely sent home to care for themselves because of a shortage of acute-care psychiatric beds.
And in some small northern towns, doctors have sent patients to Alberta for psychiatric assessment because the doctors know the patients could wait months before being seen in British Columbia.
The shortage of acute-care beds for psychiatric patients is so endemic throughout the vast northern health region, said Barb Toews of the Canadian Mental Health Association (CMHA), that people who are in mental crisis are reluctant to go to a hospital emergency ward for help.
"It's not unusual for people to avoid emergency because they know they just won't get the help they need," said Ms. Toews, a community peer support counsellor with the CMHA in Prince George.
"It's a big problem. . . . I think it is far worse than they [health authorities]realize."
Ms. Toews said she's heard of cases where people "have inflicted self-harm" in the hope of being moved up on a waiting list. She said she did not know of any cases of anyone committing suicide while waiting for care.
"It is not uncommon for someone who needs to be in hospital to get put on a [waiting]list for six months to a year," she said. "You go [to hospital]because you are in crisis and need help, but you are told to go home."
The shortage of beds is "distressing," she said.
Ms. Toews said suicidal patients are sometimes locked in jail cells for their own safety if beds are not available.
One doctor said the situation, which has been described as a chronic, continuing problem, has been going on since he started working in the north 3½ years ago.
Several small-town doctors interviewed by The Globe and Mail under the condition that they or their communities not be named, said jail is a last resort. More common is simply to send suicidal patients home, and hope for the best.
One doctor told of sending a teenaged girl home this year after failing to find an acute-care psychiatric bed for her in the north. She was feeling suicidal and had rope burns on her neck.
Another doctor said he sent a suicidal patient home when Prince George Regional Hospital told him no beds were available.
"The fellow came back very intoxicated stating he loaded his gun at home and was all ready to shoot himself," the doctor wrote in an e-mail. "We put him in a [police]car and sent him to Prince George. I expect to get a call from irate [hospital]staff later tonight because we sent him without prior approval."
The doctor later learned the hospital sent the patient to detox, and four days later he was discharged without seeing a psychiatrist.
One doctor related this recent case: "A 40-year-old man presents to a rural diagnostic health centre stating he feels depressed, suicidal, has an alcohol problem, and wants psychiatric help. He would like to be admitted to a psychiatric ward and get specialty help.
"He has had three overdose attempts the past month -- alcohol, anti-depressant medications, sleeping pills, and pain pills.
"So he sounds serious. Each time he has attempted [to get admitted]to a local rural hospital but no psychiatric help was available so he was discharged home -- mainly because it was felt that on the day of discharge he was not suicidal. He was the day before, and he might be the day after, but since there is no help [today]he is OK to go home."
The frustrated doctor who sent that e-mail said when he called Bed Line, a provincial system that searches for open beds around British Columbia, he was told nothing was available and he should call 911.
The same doctor said he turned to Alberta when a man who had been hitchhiking tried to commit suicide by lying on the highway. An ambulance picked him up, but no psychiatric bed was available.
"[An]Edmonton hospital and a psychiatrist accepted him in less than five minutes . . . but the B.C. Ambulance Service would not initially transport him because of cost," the doctor said. It took five hours to work out a transportation arrangement.
Another doctor said he routinely sends mental-health patients to Jasper, Alta., for psychiatric assessment, because of a teleconferencing facility there. His hospital has teleconferencing equipment, but it is not used for psychiatric assessment and it is "almost impossible," to get an urgent appointment with a psychiatrist in northern British Columbia.
Despite these problems, officials with Northern Health, the provincial authority that delivers health care to about 300,000 people spread over almost two-thirds of the B.C. landscape, said the system is good and getting better.
"It is always a challenge to co-ordinate the care for someone who shows up in one of our facilities requiring urgent, acute mental-health care, given the distances, given the number of players involved in making an initial assessment, transferring the patient and then receiving them at the far end, providing a psychiatric opinion and finding a bed," said David Butcher, vice-president of medicine at Northern Health.
"We are certainly aware of situations in the past where the system has not worked as smoothly as it should and it has created pressure on clinicians and on facilities. . . . But we've done an awful lot of work in the background to tune up that system and make it responsive to the needs, particularly of the acute situations that you describe, of the suicidal patient."
Dr. Butcher said the number of acute psychiatric care beds in the north is increasing each year and officials are tracking the need.
Prince George Regional Hospital has 26 psychiatric care beds, Terrace 10, Dawson Creek 10, and other facilities also serve elderly people with mental-health problems.
The demand sometimes overwhelms the bed supply, but Dr. Butcher said that at other times there is a surplus. "Obviously, from a practical point of view, it's hard to make an entire system line up so there is never pressure on the beds, but we have seen a decrease in the number of times when we're aware that there's difficulty moving patients to acute-care beds."
He confirmed that patients are sometimes placed in jail cells or are transported in police cars, but said that is only when there are safety concerns.
"The system always needs work. However, I would say the system as it works now is considerably better than it was one or two years ago," Dr. Butcher said. But Ms. Toews of CMHA has a different view.
"It's pretty frustrating. The sad thing is you can see your family doctor and he might be very helpful, but should you need in-depth intervention, you're not going to get it for six months -- and there's a whole lot that can go wrong in six months."