Eastern Health is facing a nearly 45% vacancy rate in psychologist positions after a “mass exodus” of specialists into private practice. Some psychologists say the government and health authorities in Newfoundland and Labrador were warned this would happen, but failed to correct long-standing issues.
CBC News spoke with several psychologists — both on the record and behind the scenes — who left their jobs with the health authority for the private sector.
Demand for psychologists in the Eastern region has increased so much, they say, that even private clinics have few appointments, adding that it is patients who will bear the brunt of inaction by health officials .
Eastern Health reports that as of this month, there are 25 clinical psychology vacancies funded, nearly half of the total number of positions.
However, the health authority says it is actively recruiting to fill these positions.
Neuropsychologist Dr. Tanya Lentz tendered her resignation from Eastern Health in July 2021, after six years on the job. She said it had become untenable to stay and work at the health authority.
“I felt like my role was now becoming unethical because I was leaving people on waiting lists for three to four years because I couldn’t physically reach them just because of the demand” , Lentz said.
“A lot of times it was ‘Do your best’ or ‘You have to learn how to manage your workload better.’ So a lot, kind of, gaslighting, that’s basically what we were getting from the direction.”
Lentz came to the province from British Columbia in 2014 to work as a neuropsychologist at Janeway Children’s Hospital, providing assessments and treatment for children with learning disabilities, brain damage or any kind of neurological disease.
She said she worked the equivalent of two and a half jobs and often worked unpaid overtime.
Programs don’t treat mental health, professionals treat mental health.– Dr. Lisa Moores
A delay in evaluating or treating someone with a brain injury could harm their health, she said. This can lead to aggravating mental health issues later on.
Replaced by social workers
Lentz said she and her co-workers felt a loss of autonomy. She said it was obvious that psychologists were seen as interchangeable with social workers – another highly skilled professional, she said, but not one that can replace years of training as a psychologist.
“A lot of the psychologists who left talked about the heavy workload, the lack of any form of recognition from management, the lack of appreciation from management,” she said. declared.
“You can’t replace a psychologist with someone who has a bachelor’s degree. It’s not the same and certainly not the same level of skill and ethically not the same level of care.”
Eastern Health did not respond to questions from CBC about how often social workers are used to fill the roles of psychologists.
Dr. Lisa Moores, a licensed psychologist and lecturer in Memorial University’s residency program, co-wrote a report for the Newfoundland and Labrador Association of Psychology and presented it to Health Minister John Haggie almost a year ago.
The Moores Report – titled Changes to Provincial Mental Health Service Delivery – describes the concerns of psychologists in the province regarding the implementation of the stepped model of care. The details come from a survey conducted in 2019.
Stepped care was first introduced in the UK and was developed to match a person with the most appropriate care they need. It has been repeatedly hailed by the provincial Minister of Health in the House of Assembly as a success that has improved access to services.
In 2017, the provincial government began using Stepped Care 2.0, which was developed by psychologist Dr. Peter Cornish and the Mental Health Commission of Canada.
Moores said the psychologists interviewed agreed that stepped care has its benefits and they support the model in principle.
But Moores said it shouldn’t come at the expense of longer-term mental health treatment.
“I think at this point we should say it’s a massive exodus from the public system. And that’s something we saw coming,” Moores said in an interview.
“We’ve seen a real focus – a strong focus – on programs or models that will address all of these issues. Programs don’t address mental health, professionals address mental health.”
Psychologists reported that their clinical time was reallocated from their more intensive work with clients to run same-day and single-session programs, according to the report.
Preventing psychologists from leaving first: Moores
Ten recommendations were put forward from the report, including the need to increase resources and improve the stepped care process.
Moores warns that before Eastern Health focuses on recruitment, it needs to stop the bleeding of psychologists from the public sphere.
Moores said she had not heard from the health authority or the health minister after the summer 2021 meeting.
Haggie declined an interview.
Asked at a recent mental health press conference about vacancies, he highlighted the success of the stepped care model, which he had praised during question period in the House of Assembly on 4 may.
“The Stepped Model of Care developed and pioneered here at Memorial University and now accepted by the federal Minister of Mental Health and Addictions as a potential national standard speaks to these intermediate steps for people who need more support than intermittent counseling and yet does not require hospital treatment,” Haggie told the legislature.
However, in a statement, the department appeared to distance itself from the stepped care model introduced in 2017 at Memorial University.
He said the province is moving forward with its own stepped care model.
“Based on the lessons learned during this demonstration, the province chose to develop its own model,” said a ministry spokesperson.
However, the new provincial model of stepped care has not been “fully released or implemented”.
Kaiden Dalley moved from British Columbia to Newfoundland and Labrador to be closer to family in 2017. Since then, they say they’ve been bouncing back in the mental health system.
Dalley said they had been on a waiting list for over a year before receiving a call about seeing a psychologist in the public system. At that time, Dalley had been hospitalized due to mental health issues and was assigned to a psychologist because of it.
“I was told there had been staffing issues for the eastern health team I was referred to, so that played a big part in the wait,” said Dalley.
“There is a need for same-day services, but there is also a need for long-term services. I’ve heard a lot of people say the same thing, [that] short-term services are good in some situations, but we don’t have long-term care for people who need long-term care. »
Dalley is part of a group that has led a campaign calling for better long-term mental health services and demonstrating weekly outside the Confederation Building. They don’t expect to stop anytime soon.
For Lentz, the first step to improving the system is to admit there is a problem.
“It’s something where I think until we potentially have a Minister of Health who actually has an understanding of mental health services or more openness to getting feedback from providers and clients, I don’t don’t know if we’ll get there,” she said.
Eastern Health declined an interview.
However, an internal memo released through Freedom of Information explains what Eastern Health knew about the concerns expressed by the psychologists.
The document highlights several issues, including a perceived lack of autonomy and respect for the discipline of psychology as well as for the social workers who do the work of psychologists.
Compensation was reported as the biggest issue.
“Uncompetitive salaries in a market where higher compensation can be sought elsewhere, contributes to inadequate resources, retention issues, burnout, quality of care issues, recruitment issues and long wait times for services [and] psychological assessments,” the memo dated April 2021 reads.
A March 2022 briefing note prepared for Eastern Health’s leadership team by a Psychologist Retention and Recruitment Task Force reaffirms these concerns and notes that the salary is not competitive with the rates offered. in Prince Edward Island and Nova Scotia.
“The inability to recruit and retain clinical psychologists has impacted wait times for client services and significantly increased the workload of remaining PCs, as well as other classifications trying to fill the gap. gap,” the memo reads.
In a statement, Eastern Health said it was recruiting for these vacancies through advertising and networking with universities, as well as reviewing the compensation package and offering scholarships.
Lentz admits that private practice is much more lucrative than working for a health authority, but said that wasn’t the main reason for leaving.
“Honestly, money was the furthest thing from my mind when I worked in the public sector. It’s about feeling valued, heard. Being able to offer people ethical treatment. And that doesn’t take a lot of time .”
The shortage of psychologists extends beyond eastern Newfoundland. Western Health reported seven clinical psychology vacancies in April. Central Health had five vacancies during the same period.
Labrador-Grenfell Health reports that its two psychologist positions in its mental health and addictions department are both vacant – one since July 2020 and the other since last month.
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