Three psychiatrists resigned from St. Joseph’s Healthcare this week because they believe working conditions in the psychiatric emergency room are unsafe.

The doctors quit at the same time that McMaster’s Faculty of Health Sciences is pulling its psychiatric residents from St. Joe’s psychiatric ER for the same reason.

The drastic measures come years after the safety problems were first flagged by the Royal College of Physicians and Surgeons. The college has repeatedly said St. Joe’s must make a number of changes to the psych ER at the site on Charlton Ave. E. (Charlton Campus) for it to be safe for residents to work there.

This raises serious concerns about the impact these departures will have on the level of care available to mentally ill patients in our community, which is frequently talked about as being underserviced.

However, Peter Bieling, head of mental health and addiction services at St. Joe’s, says patient care will be “unaffected” by the loss of residents and doctors.

The psychiatric ER sees some of the most volatile mental health patients in the city. This is where police bring people when they have been involuntarily “formed” and are at risk of doing harm to themselves or others.

Dr. Nick Kates, chair of the department of psychiatry at McMaster University, has told the Spectator that one of the many issues impacting safety is the spike of crystal meth patients, who are often violent. Those patients need to be kept in the ER longer while they come down from their high and can be properly assessed — which can cause a backlog.

He added that many of the problems experienced at St. Joe’s are reflected in psychiatric ERs across the country.

On April 1, Mac’s postgraduate education committee informed St. Joe’s it unanimously agreed to withdraw its residents as of Friday at 5 p.m.

On April 7, Kates sent an email to all physicians in his department.

He wrote that the withdrawal of the residents “has created a challenge unlike any other that I can remember in my time at McMaster.”

He wrote that the primary safety issue identified by his department is that the psych ER is far too small, creating an unsafe work environment for staff.

He wrote that in recent weeks psychiatrists have voiced their “frustrations, anger and disappointment at the lack of progress over many years” to the leadership at St. Joe’s and that “the withdrawal of residents presents an opportunity to rectify long-standing problems once and for all and build an outstanding academic psychiatric emergency service, but these changes need to happen now.”

In a Spec interview, Kates said the Royal College of Physicians and Surgeons has flagged a variety of problems at the psych ER over two evaluations — which were done seven years apart.

When asked about this, the college said: “It is not our practice to comment on any issues that may have been raised during a residency program accreditation visit.”

Dr. Maxine Lewis, chief of mental health at St. Joe’s, says the hospital has been working on fixing the problems for some time and many have been rectified. She is hopeful the residents will return to the hospital in the near future.

Asked about the doctors who have resigned, she says some psychiatrists have found it “difficult to accept” that they will have to work nights and weekends to bridge gaps left by the residents.

However, one doctor who works in the psych ER, says scheduling isn’t the problem.

The problem is a “toxic” work environment where overworked staff may be crammed into a small space with “a floridly psychotic guy coming off meth.”

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“We have violent, agitated people in a small, locked area all together,” says the doctor, who does not want to be identified out of fear of reprisal.

The potential for harm to staff, the psychotic patient and other patients who happen to be in the regular St. Joe’s ER at the same time is real, according to the doctor. It is not unheard of for fights to break out between patients and for patients to bring weapons into the hospital.

The doctor says when staff do report safety problems to supervisors, incident reports are rarely done. Which means that on paper, the psych ER appears to be an incident-free department.

(Bieling told The Spec there has not been a rise in unsafe incidents reported from the psych ER.)

The doctor identifies many problems with the physical layout and operation of the psych ER:

Only in recent weeks has St. Joe’s assigned security staff to stay in the psych ER. Before that, security would have to be summoned from other parts of the hospital.

The psych ER is so small “they’ve been doubling up psychotic patients in the same room.”

The psych ER is often full and causing a backup of possibly dangerous patients in the general ER waiting room.

St. Joe’s has cut clinicians in the psych ER, including social workers and addiction counsellors.

Some nurses in the psych ER have no specialized psychiatric training.

Some psychiatrists now expected to work nights and weekends have no training to deal with violent patients, don't know what resources are available for patients in the community and don't know how to use St. Joe's computer system.

In the past, involuntary patients brought into the psych ER were required to change into hospital gowns, the reason for which — in part — was to reveal weapons or drugs they may have on them. That requirement no longer exists.