The Minister responsible for Social Services, Lionel Carmant, also intends to change the way patients presenting to the emergency room in a state of crisis are triaged, so that they are no longer strictly waiting to be seen by an emergency doctor . He is considering creating a trio of a specialist nurse, a social worker and a community organizer who could welcome and direct patients to the appropriate facilities.

“Emergency doctors have to accept that some patients are not seen by them. The psychological triage before the emergency doctor is a complete cultural change,” he says.

Minister Carmant believes these changes will not only ensure better mental health care but will also free up hospital beds.

“Psychiatric patients spend too much time in our emergency rooms. [C]The stays are the longest in the system. You can be hospitalized for 40 days, blocking other patients who cannot go upstairs, ”he explains to us during a tour that took him to CHUL in Quebec.

space and security issues

When we visited the CHUL Psychiatric Emergency Department with Minister Carmant, all 13 available beds were occupied. A dozen other patients with a mental health problem were waiting in the ordinary emergency room awaiting their psychiatric hospitalization. Some had been taken there by the police.

Lionel Carmant has been arrested by health workers concerned about the increase in the number of crisis patients since the pandemic. In particular, his intervention made it possible to add a security guard, but he must address the fundamental problem: the emergency room is too often the only point of access to the network for disorganized patients in need of psychiatric care. .

This is not only a safety issue, but also a space issue.

” People who have a mental health problem are classified as [des cas] not urgent, so you can wait a dozen hours in our waiting rooms. For example, if we come because of an anxiety or depression issue, we can be even more disorganized during that wait. We need to manage them faster and redirect them to other services. »

Hospitalized in his living room

In his opinion, hospitalization at home is a preferred solution.

We participated in the intervention of one of the teams, composed of a psychiatrist and a nurse, whose patient has bipolar affective disorder. Gille Bellemare has three children, has been married for forty years and owns a company.

Nothing went well last February. He hardly slept, made irrational decisions that seriously affected him and those around him. Not having a family doctor, he went to an outpatient clinic, who referred him to the emergency room at the nearest hospital when they determined he was having an acute seizure.

“They gave me the last bed I had left in a big room where people can knock on the walls. Then they explained to me that I have the choice to stay in the psychiatric emergency room or to get treatment. He chose to get treatment from the comfort of his own home.

Since then, he has been visited at least three times a week by doctor-psychiatrist Marie-Frédérique Leclerc and nurse Alexandre Boisvert, and more often depending on his condition. He can also reach them by phone whenever he needs to speak to them.

Daily monitoring

During her consultations, which we attended, Dr. Leclerc adjust the patient’s medication at home. The blue-collar duo also asks Mr. Bellemare’s spouse questions to gauge the improvement in their mental health.

“We will be there for as long as we deem necessary to stabilize the situation and ensure the patient is connected to the right service for the rest after us,” explains Alexandre Boisvert. A follow-up generally varies between six and ten weeks, but there is no limit.

” We treat patients with serious episodes, such as psychosis or major depression, that would require hospitalization. By having people in their living environment and not in the hospital, we also have access to lifestyle habits, their consumption and see if there are other issues around them. »

It has even happened that interveners accompany a patient to work, college or school for a clinical follow-up.

Call to CLSCs

For other cases that do not require psychiatric admission but require rapid treatment, Minister Carmant calls for the CLSC. “We want to use psychosocial teams in our team CLSC and work with them to do mental health walk-ins,” he explains.

Specifically, he is working to form rapid response teams in the community. This model already exists in certain regions, but he believes it should be applied everywhere.

Stakeholders could then be reached within 24 or 48 hours. They would be found in their premises CLSCbut they could also go to people’s homes after being referred by a family doctor, a community organization, or even a respondent to the info-social 811 number, where people can already call for help at any time.