Improvements to mental health and addictions services in the Prince Albert region and to the healthcare provincial inmates receive while behind bars are overdue, according to the provincial auditor.
In the first volume of her 2018 report, released Thursday, Provincial Auditor Judy Ferguson said the former Prince Albert Parkland Health Region, now part of the unified Saskatchewan Health Authority, did not meet its wait time targets for mental health and addictions services in the 2016/17 year. While the health region spent $13.2 million on mental health services, the second-highest per-capita rate among the health regions, Ferguson said about 80 per cent of child and youth clients with mild or moderate illness severity did not have an appointment with a psychiatrist within 20 days.
“Long waits for clients with mental health issues can lead to worsening conditions and, at times, significant adverse effects,” Ferguson said in a statement accompanying her report.
According to Ferguson’s audit, nearly 40 per cent of all mental health and addictions clients failed to show up to appointments in the region, and the health region “could not demonstrate it followed up with clients who missed scheduled appointments.” According to the audit, follow-ups help prevent future hospital visits and reduce costs to both clients and the healthcare system.
Health authority responds
Brett Enns, executive director of primary care for the northeast area of the Saskatchewan Health Authority, acknowledged the challenges the health authority faces when it comes to reducing wait times and following up with clients.
While wait times for youth mental health clients were often lengthy, Enns told paNOW those particular clients were assessed as a lower risk, and were not in immediate danger. Those assessed as a high risk often have appointments immediately, he said, which can sometimes result in longer waits for lower-risk patients.
“The situation is assessed at the time to determine if their level of need is more urgent,” Enns said. “Those lower levels of need do often tend to take more time to be seen.”
While the audit noted the lack of effective follow-ups when mental health and addictions appointments were missed, Enns noted the difficulty of following up with clients who may not have a current address or phone number. Staff typically make three attempts to contact a client who failed to arrive for an appointment, he said, by both phone and mail, but in some cases clients simply cannot be reached.
Correctional centres not meeting legal healthcare requirements
Ferguson’s audit of healthcare inside Saskatchewan’s four secure adult correctional centres, which house roughly 1,800 offenders at any given time, found significant shortcomings.
The rates of infectious diseases inside correctional centres were “significantly higher” than the rates among the general public, the audit found, and only 65 per cent of staff members at one institution held current first aid certifications. All staff members are required to hold a first aid certificate, Ferguson’s report noted, because medical staff do not work overnight and nurses are only available during certain hours.
Ferguson’s audit also found training was lacking for nurse managers at correctional centres, as the managers received only a brief orientation or, in some cases, no orientation at all.
“Having thorough orientations and the proper and up-to-date training helps to ensure staff can quickly respond to medical emergencies and provide the necessary medical care,” Ferguson said.
The auditor also found long delays between inmates making health-related complaints and receiving any response, in violation of legal requirements.
“Almost 30 per cent of the time, the Ministry [of Justice] responded to adult inmate complaints about medical care later than the law requires (i.e., within five business days of receiving the complaint),” Ferguson wrote. “Responding promptly to inmate complaints avoids jeopardizing inmate health.”
While correctional centres in Saskatchewan maintain medical files for each inmate, Ferguson’s audit found the entire file was not transferred when inmates were moved to a different institution, or when former inmates returned to correctional centres. This practice, Ferguson noted, made it more difficult to determine whether inmates are receiving appropriate medical care.
Responding to the audit, Ministry of Justice Executive Director Drew Wilby told reporters the ministry has accepted all of the auditor’s recommendations around medical care within correctional centres.
“We’ve also indicated timelines and a work plan moving forward to address all of those recommendations,” Wilby said. “There’s no doubt there’s gaps, and we’ll work to try to close those as best we can.”
Wilby said first aid training for all employees is necessary as providing fist aid is a “core responsibility” of healthcare within correctional centres in Saskatchewan. Each of the province’s correctional centres now has mechanisms in place to ensure all employees have up-to-date certifications.
The ministry is always open to suggestions for improvement, Wilby noted, and recently began a broad review of the care in Saskatchewan jails.
“We’ve launched a fairly significant review of healthcare within our correctional facilities,” he said. “We’re looking to see what we can potentially do better.”
On Twitter: @TaylorMacP
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