Crisis at the Crisis Response Centre Burned-out employees sound alarm on ‘short-staffed’ mental health centre where patients often go AWOL By: Chris Kitching Posted: 6:35 PM CDT Friday, May. 17, 2024

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This article was published 17/05/2024 (892 days ago), so information in it may no longer be current.

Employees at a Winnipeg mental health centre are pleading for more resources and security, while overwhelmed by chronic understaffing and high numbers of patients in severe crisis, sources told the Free Press.

Staff for years have been concerned about the safety of themselves and patients at Health Sciences Centre’s 24-hour crisis response centre, but Shared Health hasn’t taken enough action, the sources said.

“We want to help the patients, but we don’t even think it’s safe for patients to be there,” one of the health-care sources said. “It is short-staffed almost every day, and the acuity (of patients in crisis) has never been higher.”

“We want to help the patients, but we don’t even think it’s safe for patients to be there”–Staff, Shared Health

Staff and security guards are attacked or threatened by some patients.

The source said a lot of clients “go AWOL” amid long waits at the inner-city facility, which is not a secure site and doesn’t have enough locked, or isolation, rooms for patients waiting for an involuntary psychiatric assessment.

When an involuntary patient walks away, staff are instructed to call 911 and not to physically stop them.

Trevor Farley, then 37, killed his parents and stabbed nursing supervisor Candyce Szkwarek at Seven Oaks General Hospital in 2021, after walking away from the crisis response centre, despite being on an involuntary hold, a court heard.

After Farley was found not criminally responsible in October, Szkwarek said more must be done to prevent people from leaving the centre, if they’ve been deemed a danger to themselves or others.

Other concerns were raised after a young man in crisis self-harmed inside the facility May 11. He died the next day, after self-harming on a hospital unit while recovering from surgery, sources told the Free Press.

The man’s death, deemed a critical incident, is subject to an internal investigation.

The source said concerns about resources and safety have been raised multiple times with Shared Health. They believe bureaucracy and budgets stand in the way of changes.

Staff are burned out and frustrated, and morale is low, the person said.

The facility on HSC’s campus opened in 2013 as a central access point for adults in crisis. Patients are not admitted, but they may be held while awaiting transfer to a psychiatric facility.

The source said the facility does not meet today’s needs due, in part, to an increase in people seeking help, the higher level of acuity, a lack of staff and it having only one locked room, which must be monitored when occupied.

“(Some patients) wait for days to be transferred to a hospital,” the person said. “The centre has turned into almost an urgent care centre, without the resources to run it.”

“(Some patients) wait for days to be transferred to a hospital. The centre has turned into almost an urgent care centre, without the resources to run it”–Source

People seeking help cannot be turned away, they added.

Standard operating procedure states the centre should have a maximum of two clients on a “form 4” — an application for an involuntary psychiatric assessment — at one time, but it’s common to have three or more, the source said.

The source said the centre lacks staff overnight, and does not have 24-7 psychiatrist coverage. It usually has one security guard present at any time, despite requests for at least two, they added.

“When clients come in, part of the screening questions is if they have thoughts to kill people, and many say yes,” the person said. “It’s very scary.”

Mandated overtime is another concern.

“When clients come in, part of the screening questions is if they have thoughts to kill people, and many say yes. It’s very scary”–Source

“It’s hard to stay vigilant on the 15th or 16th hour,” the source said.

Shared Health is working with staff to “develop processes to safely provide crisis services,” said Dr. James Bolton, medical director of crisis response services and HSC’s emergency psychiatry.

“We are also reviewing staffing levels for each shift,” he said in a statement.

Bolton said other steps include “refinements” to criteria and protocols for when EMS staff are deciding the most appropriate site for care, and attempts to “streamline” the notification process when an involuntary patient leaves without authorization.

In 2019, a nursing student was sexually assaulted by a patient. A review led to changes to the building’s layout, including a new security desk in the waiting room, and new windows and security cameras in patient rooms, said Bolton.

The centre has eight assessment rooms overall, he said.

Health Minister Uzoma Asagwara said front-line staff want to do the best they can for patients.

“Listening to folks, and the critical incident reports, will be key to learning how we can enhance safety and improve care at the CRC,” the minister said in a statement.

In the 2022-23 fiscal year, the crisis response centre and crisis stabilization unit cared for about 13,800 people.

Manitoba Association of Health Care Professionals president Jason Linklater said clinician staffing levels have been stagnant since the centre opened.

“Shared Health has not provided any additional resources despite the volume of people seeking help, and despite the growing severity and acuity of mental health issues, part of which is certainly driven by the methamphetamine crisis, but it’s been a growing trend for years,” he said in a statement.

Sometimes, a full slate of 15 patients is receiving care and up to 10 more are waiting to be assessed, said Linklater.

Marion Cooper, CEO of the Canadian Mental Health Association in Manitoba, said the centre was designed to be community-based.

“It’s really evolved into more of a mental health ER setting. It was not designed to be the only resource, and it has turned into that,” she said.

Existing services are limited, so people are often told to go to the crisis centre, said Cooper, who noted Manitoba also lacks psychiatric beds.

“All of these situations are really speaking to a need for a complete review of the system of crisis care,” she said.

Cooper said the creation of community-based and mobile services could help to provide earlier intervention and take pressure off the crisis centre, which has struggled to recruit and retain staff.

CUPE Local 204, which represents health-care support workers, has raised concerns about staffing levels and safety at the HSC campus, said president Margaret Schroeder.

The Manitoba Nurses Union has also pressed for improvements.

“We know from the many reports from nurses that mental health and addictions issues contribute to an onerous demand on our strained health-care system,” president Darlene Jackson said in a statement. “We also know that the current safety and security issues for all health facilities is a significant issue for patients and staff.

“Whenever and wherever resourcing is inadequate, patients, staff and the public face greater risks, and poorer overall health outcomes.”

chris.kitching@freepress.mb.ca