Doctor points to gaps in London-area child and youth mental health care

A doctor in Alymer, Ont., is speaking out after facing barriers to get outpatient mental health care for a 12-year-old patient identified as being at high risk for self-harm. 

Dr. Michael Fernando is a general practitioner who took over as the family doctor for the girl last summer. Her mother has given Fernando permission to speak to CBC News about her health issues. CBC has agreed not to publish the girl's name because she is a minor.

Fernando said that in assessing the patient, it was clear she needed extensive mental health supports, including outpatient care from a child psychologist.

"The mental health concerns were very severe," said Fernando.

Over the past year, the girl's parents had twice taken her to the emergency room for treatment for hallucinations and a desire for self-harm. She was provided a safety plan by doctors, but did not have a referral for outpatient care from a child psychologist.

Fernando said he and colleagues he has spoken with have found getting mental health supports for adults isn't generally too difficult. However, sometimes psychiatrists decline to care for kids, citing a lack of training or experience at what Fernando said is a sub specialty.

"It ends up falling on GPs who are not trained to look after very unwell children with mental health issues in the way a child psychiatrist would be," he said. "She did get some medication, but there was no followup booked and the prescription was very brief. The mom was really stuck."

He said it's a search that can be particularly difficult in smaller towns like Aylmer, which is 40 kilometres southwest of London. Doctors often can't find a child psychiatrist in their home town, but can't get one in a nearby city either because they don't fall into the larger centres' geographic catchment area.

"It can kind of be a catch-22," he said. "It's about the way that specialists and services draw their boundaries." 

London Health Sciences Centre (LHSC) sent a statement to CBC News in response to questions about access to child mental health care in the region. 

The hospital said the current wait time for its child and youth outpatient services is between eight and 18 months, depending on the service being requested. 

LHSC also said demand for child and youth mental health care has grown in recent years, a trend not just seen in London.

"With the ongoing rise of mental health needs across the system — something we see in our own emergency departments and patient care units — the child and youth mental health system is seeing an unprecedented demand for care," the hospital said. 

LHSC also said it's working on changes to the system to "streamline access to care." The hospital is creating a child and youth mental health care team in its emergency department with more supports for short-term mental health crisis followup.