Psychiatric Care
Mental Health Services
Emergency & Inpatient Guidelines for Mental Health Patients at QGH
Social Context
The cultural and historical context of many of our patients is complex. The continuous adaptation to rapid social, economic, and cultural changes over the last century, stemming from the colonization of the Arctic by the Government of Canada, has resulted in a deep sense of strength and resiliency amongst Inuit in Nunavut. Most of these changes were forceful and traumatic and have resulted in some of the social challenges that continue today. While some are only a generation removed from the direct impacts of events like community relocations and residential schools; the community and culture continue to suffer from inter-generational trauma with elevated suicide rates, disenfranchisement and increasing cultural isolation. You can find more information about this through testimony gathered as part of the Qikiqtani Truth Commission. Below.
Nunavut has one of the fastest growing and youngest populations in Canada, with more than 30 percent of the population being below the age of 15. Nunavut has a suicide rate that is 10 times higher than the national average. Substance abuse, particularly cannabis and alcohol, can be a contributing factor and a possible comorbidity in this patient population. It is important to provide culturally informed and trauma-informed care to patients that balance respect for their autonomy and resiliency with patient safety
These guidelines will outline the various ways in which patients may present to the QGH and the process in which care is provided, particularly when the Mental Health Act is being used to help ensure a patient’s safety.
Trauma Informed Care
We support the use of trauma-informed care. Trauma-informed care assumes that any of us may have experienced traumatic incidents in the past. Seeking healthcare can create a sense of vulnerability and fear in all of us. Trauma-informed care seeks to ensure that receiving healthcare does not worsen trauma.
More information can be found below:
Structure of Mental Health Services
Iqaluit
The Mental Health team in Iqaluit consists of inpatient and outpatient care providers which includes:
Inpatient mental health nurse (MHN): based at the QGH and is in-house during daytime hours and available for inpatient and emergency assessments. A MHN is available on call after-hours for emergencies. They can assist with disposition and management, including behavioral management. The QGH MHN can also provide a brief period of follow up for recently discharged patients.
Outpatient mental health services: Mental health referrals are triaged through a central intake process that assigns patients to one of the Mental Health Counselors and Addiction Counselors who can see patients on an outpatient basis. This process also triages patients for the visiting Psychiatry clinics which are held monthly.
Akausisarvik (AKA): a mental health facility in Iqaluit intended to provide a short-term residence for people with mental health problems that need an additional level of supervision and care, such as administration of medications and meals. There is a mental health nurse (MHN) at AKA during business hours Monday to Friday. AKA also provides care to ‘day programmers’ who live in the community but come for medication administration as well as day programs and meals.
Mental Health Physicians: Family physicians who see patients at Akausisarvik. Their role is to provide a medical and mental health care to patients living at Akausisarvik and see patients with mental health problems that the mental health counselors have referred. Their role is act as a physician resource to the mental health team in addition to the psychiatry visits. All physicians who provide family medicine care in clinics can and do see patients for mental health concerns as well.
All the above use electronic notes which can be found on Meditech under notes or patient care, as a risk assessment. Psychiatric assessments are found under reports. These can provide important clinical information.
Qikiqtaaluk Region
There are Community Mental Health Nurses (CMHN), registered psychiatric nurses who provide care to patients with mental health concerns in the communities outside of Iqaluit. Ideally, there is a CMHN in every community, but this is not always the case. If there is no CMHN in the community a community health nurse (CHN, registered nurse) will assess patients with mental health concerns.