With more people than ever seeking help for mental health issues and new client appointments for her private practice now being booked into March, 2022, a Dartmouth psychologist is calling the situation in Nova Scotia a crisis.
Registered psychologist Dr. Kiran Pure expressed her concern in a July 8 tweet, noting that patients and families are struggling and waiting months for both public and private services.
Pure was prompted to share her concern on social media on a day when she had 28 new referrals and more people desperately needing help but struggling to find it in a timely fashion.
I need to say that we have a mental health crisis in our province. I’m not sure how to address it? We have kids and families struggling. waiting for months for public/private services. 28 referrals a day in our practice. We can’t deal with this alone.
— Dr. Kiran Pure (@DrKiranPure) July 9, 2021
“On that particular day, there was a referral for a 16-year-old female who has anxiety, depression, and suicidal ideation, and we booked her in for March 2022 because that’s the first opening to see a psychologist here,” Pure said in an interview last week.
“And so her mom emailed and said, ‘I will take these appointments and I told my daughter. She said, ‘Mom, I think I’ll try to wait until then.’”
Pure’s private practice provides a range of psychological services to children, adolescents and families. Although the numbers fluctuate, she arrives at work each day to find multiple referrals have landed in her inbox overnight.
“The severity of the reason for referral has also gone up, the seriousness of the cases. They’re not kids who can just wait. There’s increased anxiety, depression coupled with suicidal ideation, that’s a very common everyday referral,” Pure said.
“Substance use, family discord, a large increase in eating disordered behaviour…It’s referrals like that. You can’t just say they can wait for six months or eight months or 10 months.”
Before the pandemic, Pure would receive between 1,200 to 1,400 referrals a year. From June 2020 to last month, that number had jumped to 3,200 referrals.
“We’re working around the clock trying to triage referrals and send them to other practices and redirect them to IWK when it’s an emergency,” Pure said.
“It’s a significant increase (in referrals) along with an increase in acuity of the type of cases. I can tell you, I’ve been working in some capacity in a psychology position since 1992 and I have never had 11 child sexual abuse cases of girls under 10 on my caseload in total. And I have that now.”
‘We are going to see a long term impact’
Overwhelmed with “way more referrals” than her practice could handle, Pure reached out to four psychologist colleagues in other local practices.
Although she often redirected referrals prior to COVID-19, the dramatic increase in people seeking help led her and a handful of clinicians to create their own “hub” over the last year. Pure does the “triage,” reading the intake referral forms from families before determining which psychologist is the best fit.
“I just honestly want kids to get help when they can in a timely fashion,” she said.
“If my hole in the wall practice — I literally am a very little practice in downtown Dartmouth — is getting 3,200 referrals in a year and (pre-COVID) was getting 1,200 referrals, it’s an issue.”
About 72% of the 3,200 referrals she received over the last year went to other practices. Pure’s own practice has taken on 820 new clients since last June.
“That’s about 70 new children per month added on to our already very busy practice, and the rest of them all went out by me to other psychologists,” she said.
“Now all of those psychologists — as well as us — have no openings and we’re still getting all these referrals daily.”
Last month, the IWK Health Centre’s chief of psychiatry told the Halifax Examiner that while distress calls and the number of patients presenting with eating disorders was up, there were no overall changes in admission rates. Dr. Alexa Bagnell said they’ve so far seen no increase in the number of patients coming into the IWK who’ve attempted suicide or who are struggling with suicidal ideation.
Pure said while that may be true, the challenges faced by private practice psychologists have largely gone unnoticed. She said even if the public system is doing well, it’s not servicing their growing client lists.
“Regardless of whether you have money or insurance and can access a service or you have to go to public health, the wait times are long in either case,” Pure said.
“It’s not like a division or private versus public services anymore.”
Pure was recently asked if “crisis” was too strong a word to describe the situation, and doesn’t believe it is. She said many studies over the last year point to similar challenges elsewhere in the country.
“Children and adolescents have really suffered more mental health issues, as have their families (during the pandemic),” Pure said.
“If you don’t intervene early, the stuff that you experience when you’re little carries on, and so we are going to see a long term impact of this for sure.”
‘It’s gotten extremely bad’
Pure’s experience isn’t unique among private practice psychologists in the province.
Susan Marsh, executive director of the Association of Psychologists of Nova Scotia (APNS) said even before COVID-19, psychologists were “very, very busy” and it wasn’t unusual to have three to four month-long waiting lists. For some specialized services, that wait could be up to six months.
But Marsh described the current situation as “tough,” echoing Pure’s description of it as a crisis.
“I get calls from the public saying ‘I can’t get in through the hospital system where it would be free services because they have wait lists and always did, so I thought I’d try private practice and now I’m hearing that some aren’t thinking about taking new clients until spring,’” Marsh said in an interview last week.
“So they say to me, ‘What can we do? What can we do?’”
The association offers a referral service for private practice psychologists, and Marsh recently sent a message to members asking them to let her know if they’re not taking on new clients.
She has received many replies since from psychologists advising her they’re not taking new clients until at least January, and others are waiting until November to determine if and when they can.
“These are people who are also usually doing a mix of seeing people in person and also a lot of tele-psychology, video and a few phone calls, so yes, it’s gotten extremely bad,” Marsh said.
“Certainly in Halifax I have seen people have long waitlists, but I’ve never had them say ‘I have stopped taking new clients,’ that’s the difference that I see. It’s not the wait lists. The wait lists happen because there are lots of people out there that need help.”
Outside the Halifax area, Marsh said that before the pandemic she could usually find someone in the Annapolis Valley, Truro, the south shore, or northern Nova Scotia who would be able to help someone calling APNS looking for a psychologist.
That has also become increasingly difficult.
“There’s still a few people out there who are (taking new clients), but yes, it has become more widespread and we are now actually going from long wait lists to many of them saying I cannot take any more clients for X amount of time,” Marsh said.
Marsh said in conversations with executive directors of psychology associations across the country, everyone is concerned about the need for more psychologists in schools, hospitals, institutions and in private practices. Marsh points to private practice job opportunities listed on the APNS website, many of which have been up for long periods of time.
“It’s not as if you can attract people from other places because they’re just as short as we are,” Marsh said.
“It’s going to be an ongoing problem and it will get worse. What COVID has done is shine a light on things that are a problem in a lot of different areas, and this is just another.”
‘Need exceeds the capacity’
Erica Baker runs a large practice with 20 part-time and full-time psychologists in Halifax. Her practice is devoted primarily to conducting assessments. They work with children, youth, and adults who have questions about learning and behavioural challenges.
Baker thanked Pure for her July 8 tweet and responded with her own.
Thanks for speaking up Kiran. I think all mental health clinicians are feeling this right now. We are doing what we can, but it simply isn’t enough. @nsgov @nshealth https://t.co/XceIz8RDCB
— Erica Baker, PhD (@EricaABaker) July 9, 2021
In a recent interview, Baker said her practice is experiencing challenges similar to Pure’s. While her practice had a waitlist before the pandemic, Baker said it has grown “substantially” since.
“We’re now booking into the new year, and that’s with a very large practice of individuals,” Baker said. “We’ve always had a one-month, two-month waitlist but now we’re at a six month — and in some cases more than six month — wait for people to get in.”
Baker believes there are several reasons for the larger backlog at her practice.
COVID-19 public health restrictions meant assessments were shut down for several months because they must be completed in-person and couldn’t happen virtually. She said as a result, school psychologists and hospital clinicians weren’t able to do these evaluations either.
“So in addition to the kids who are already waiting, you’ve put a lot more kids on that waitlist,” Baker explained.
“And there’ve been a lot more parents who’ve been increasingly concerned about their kids’ learning and behaviour during the pandemic, and there just aren’t enough psychologists or other mental health clinicians in Nova Scotia so the need exceeds the capacity.”
‘People just aren’t thriving’
While she doesn’t believe there’s been an overall increase in actual diagnoses of learning disabilities, autism, ADHD or even major depressive disorder or generalized anxiety disorders among children, Baker said parents and children had “far more struggles” over the last year and a half.
In a frequently cited article published in the New York Times in April, organizational psychologist Adam Grant referred to the pandemic ‘blah’ many were feeling as “languishing.”
Baker embraces that term, describing it as a sense of joylessness or aimlessness and a loss of normalcy that has affected our overall sense of well-being.
“Although there may not be this clinical depression, people just aren’t thriving. Parents are seeing their kids as not being as engaged, not being as energetic, not being as happy as they have been pre-pandemic and that’s why they’re reaching out for help,” Baker said.
“They’re saying ‘This isn’t my kid. Something’s different here.’ Also, the parents have been feeling that same way…and if we don’t recognize that word ‘languishing,’ then that can eventually turn into a major depressive disorder, a generalized anxiety disorder, or a more significant mental health problem.”
Baker said the upcoming election is an ideal time to shine a spotlight on the issue. She believes politicians and policy makers need to create a task force or find some other way to bring together clinicians working in hospitals, schools and private practices to brainstorm effective solutions.
Although she agrees Nova Scotia needs to recruit more psychologists, psychiatrists, and mental health clinicians, Baker said we should also be making more effective use of the mental health clinicians who are here.
“For example, I don’t think that we’re making really optimal use of all psychologists in the delivery of primary mental health care,” Baker said.
Baker said school psychologists working in the public school system could play an important role in helping identify children who are struggling or languishing to deliver “some of that basic mental health care” before it becomes a more serious problem.
Although school psychologists conduct testing, she thinks their role could be expanded to include recognizing and providing referrals for complex mental health disorders, offering professional development, consulting with teachers, and doing basic mental health intervention with children and youth both individually or in groups.
“From an equity perspective, it makes a lot of sense to be offering these basic mental health services in the schools because all kids are going to school and that allows them to provide services within their own community,” Baker said.
“It can be accessible to everybody, that’s what I’m really emphasizing there, the importance of effectively using all of the mental health clinicians in the province in a more thoughtful way.”
‘We want to address this early on’
Baker is hopeful that by September, people will no longer be primarily focused on getting through the pandemic day-to-day, allowing for a greater recognition of COVID-19’s mental health toll.
“These conversations aren’t going to go away, and I think that as we’re heading out of the pandemic this is the time to be really rethinking how to address and understand the mental health and wellbeing needs, especially in our kids,” Baker said.
“We want to address this early on so that the issues that we are seeing, the challenges that we’re seeing, don’t become really clinically significant.”
When September rolls around and schools reopen, Baker said conducting assessments to determine where children are in terms of learning gaps and their overall mental health is critical.
“Once we identify those kids, how are we going to address that? I think that now, right now, in these next couple of months before September, is the time for us to be thinking about that,” she said.
‘Don’t know what else to do’
Pure said while she didn’t expect the overwhelming reaction to her tweet, she’s grateful it has sparked some thoughtful conversations.
Looking for alternative methods to tele-health appointments — a method she said didn’t work for many children and teens — Pure started walk-and-talk sessions.
So far, she’s worn through three pairs of sneakers. She walks an average of 5km per session, and sometimes does several sessions per day. Pure chuckled when she explained that there are weeks when she clocks between 100 and 110 km.
While she doesn’t have comparable creative solutions to the current crisis, Pure does believe we need to do things differently and there needs to be a solid plan.
That starts, she said, by having conversations with front line educators, those in private practice, and people working within public health.
“We do our best and we try to be creative…The tweet was really about I just don’t know what else to do,” Pure said. “I do think there needs to be a real plan and a real conversation of what is happening and how services are being delivered.”
Resources for Nova Scotians seeking help:
The province’s mental health and addictions team takes calls from people struggling with mental health or addiction concerns Monday to Friday from 8:30am to 4:30pm at 1-855-922-1122.
The provincial mental health and addictions crisis line is available 24/7 at 1-888-429-8167.
Kids Help Phone offers help for children and youth seeking mental health support. They can get more information about texting, calling or online chats by visiting kidshelphone.ca.
Resources provided by Eating Disorders Nova Scotia (EDNS) are available online here. They can also be contacted at 902-229-8436 or via email, info@eatingdisordersns.ca.
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