Independent review panel examining KHSC’s Mental Health and Addictions Care program

Kingston General Hospital (KGH) is home to both the adult and adolescent inpatient mental health and addictions care programs available through Kingston Health Sciences Centre (KHSC). Those programs and the impacts of the short staffing of nurses are currently being investigated by an independent review panel, according to both KHSC and the Ontario Nurses Association (ONA). Photo by Michael Amesse.

Content warning: this article contains reference to self-harm and other items of a sensitive nature with regard to mental health and addictions issues. Reader discretion is advised.

“Imagine a 280-pound mental health patient coming at you, fists a-blazing… imagine, when you don’t have enough nurses on the unit, having someone trying to hang themselves, and trying to cut them down and save their life on your own… things like that.”

This is how Cathryn Hoy, RN and President of the Ontario Nurses Association (ONA) described work conditions for nurses who work with the most vulnerable populations in Kingston and the area – those with mental health and/or addictions issues seeking inpatient treatment through Kingston Health Sciences Centre (KHSC) at Kingston General Hospital (KGH).

And while those dealing with mental health and/or addictions issues are, undoubtedly, one of the most vulnerable populations, they are also one of the most volatile populations, lending itself to the violence experienced by the registered nurses (RNs) trained to care for them – or worse, Hoy said, RNs, registered practical nurses (RPNs), and/or personal support workers (PSWs) brought in from units outside the mental health and addictions unit who have little to no training in how to handle and help the mental health patients they’re being told to care for.

These issues may seem like the result of the oft-discussed shortage of health care workers as a result of the COVID-19 pandemic, but the issues with staffing and the safety of the staff and KHSC’s Mental Health and Addictions Care Program were first noted in 2017, Hoy said. And the progression since in the wrong direction is what’s led to a number of RNs and ONA calling for an independent review of the program, a process which was announced to KHSC in November 2021, KHSC said, and began yesterday.

On Tuesday, Oct. 18, 2022, ONA announced that an Independent Assessment Committee (IAC), made up of three nursing experts, would begin hearing evidence from RNs on the Mental Health and Addiction Care unit “regarding the negative impact that inadequate RN staffing levels are having on their ability to safely care for this complex and very vulnerable patient population.” Those hearings began the same date and will continue through Friday, Oct. 21, 2022, ONA said in a press release.

“The panel will then consider the evidence – regarding whether RNs have been assigned more work than is consistent with the provision of proper patient care – and make recommendations,” the release reads.

Hoy, who commented in the release about how Kingston RNs have “consistently provided written documentation to their employer, clearly outlining their inability to properly and safely care for their seriously and acutely ill mental health patients,” also said that “the hospital continues to fail to adequately address the concerns and our dedicated members remain deeply worried – about the health of their patients, and about their ability to meet their professional nursing standards due to the nursing shortage.”

In an interview with Kingstonist, Hoy further commented on the lack of necessary mental health training KHSC provides to nurses – including those nurses that are moved to the Mental Health and Addictions Care unit from other units without specialized training.

“Oh, yes, they are! Oh, yes, they are!” Hoy responded emphatically when asked if KHSC is moving untrained nurses onto the unit to cover staff shortages.

“If they don’t have enough of their own nurses, which they don’t, they just say ‘Hey, Suzy, you need to go to Mental Health.’ So, they’ve got no experience, no education, no training, nothing,” she continued.

“The employer needs to do a better job of educating and training all new staff that come in, because mental health nursing is very different than other nursing. You need to know how to de-escalate people, among many other things.”

Hoy then outlined how the nursing shortages have impacted the unit in question. According to Hoy, while those shortages began pre-pandemic, they’ve been exacerbated since, leading to situations where one nurse is assigned to oversee 15 patients in the adult mental health and addictions unit. And in the children’s unit, it is “often one RN for nine patients,” along with a PSW or RPN.

“That’s not enough for nine children,” she said. “And remember, a child can be up to 18 years of age.”

Furthermore, Hoy said, in the Intensive Observation Mental Health Unit – which she described as being similar to an intensive care unit (ICU) for mental health – there should be three RNs on the clock at all times.

“But they often only have two,” she said, her tone flat and expressing a sad disappointment.

“Now, because of the shortage in the hospital as a whole, the skill-mix is being diluted, and there’s less RNs, even less RPNs, they’re sending PSWs to help, but that’s not what is needed in a mental health unit.”

While noting that the incident was not the catalyst of the review initiative, Hoy said she was aware of an attempted suicide on the Mental Health and Addiction Care Unit on Friday, Sept. 30, 2022. She wondered aloud why more media attention had not been directed at the incident, and then stated that suicide attempts are nothing new for those working with the patients on the unit.

“More people need to realize you can’t turn a blind eye to this, because it’s getting worse every single day,” said Hoy.

“The nurses are up and quitting… I’m really fearful for that department, to be honest.”

Both KHSC and Kingston Police confirmed that an incident occurred on September 30, but would not share further details due to the sensitive nature of the incident and confidentiality. However, KHSC did state “Counselling resources have been provided to support those individuals who have been directly impacted, and we will be conducting an incident review following our standard process. We will not be providing any further comment.” The status of that patient remains unclear.

On the inquiry called for by ONA, KHSC offered the following statement:

“This week, Kingston Health Sciences Centre (KHSC) and the Ontario Nurses’ Association (ONA) are meeting virtually with an Independent Assessment Committee (IAC) to review workload and nursing practice issues in the inpatient mental health and addictions unit at KHSC’s Kingston General Hospital site.

An IAC is an option available to the union through the collective bargaining agreement and allows for a third-party review of unresolved key issues between the hospital and union. The IAC panel will be comprised of three Registered Nurses (RNs): one chosen by KHSC, one chosen by ONA and a Chairperson who is mutually agreed to by both parties. The panel will hear presentations from both parties and will issue a final non-binding report with its findings and recommendations. 

KHSC welcomes the third-party perspective provided by this process, and we look forward to continuing to work collaboratively with front-line staff to find mutually agreeable resolutions to the issues.”

According to Hoy, ONA will make their findings public once they have had opportunity to review the findings of the hearings and working group, which will include recommendations for remedying a situation that is nothing short of dire, she expressed.

“This is really important,” Hoy said.

“These patients need our support and guidance and, when you don’t have nurses there to do that, they’re not getting it, and that’s not helpful to them, the nurses, or the community.”

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