Sioux Lookout hospital getting safe rooms, with hopes of bringing better support for mental health patients

The Meno Ya Win Health Centre in Sioux Lookout in northwestern Ontario is undergoing renovations to make space for four safe rooms in its emergency department.

The rooms will be designated for patients experiencing acute mental health conditions who are considered at high risk of injuring themselves or others.

The hospital is a hub for 30 fly-in First Nations communities in the region and is one of the first points of contact for people in crisis in northern Ontario. It currently uses two small rooms in the department as mental health rooms.

But Dr. Justin Bell, the hospital's chief of mental health and addictions, said staff felt they weren't able to adequately meet people's needs in these spaces.

About 20 per cent of visits to Meno Ya Win's emergency department were related to mental health or addictions last year, Bell said. That's up from 12 per cent in 2019, and much higher than the provincial standard of around four per cent.

Drug-related deaths and "skyrocketing" suicide rates recently prompted a group called NAN Hope — consisting of First Nations crisis workers and counsellors who support the 49 First Nations that make up the Nishnawbe Aski Nation (NAN) — to call for a state of emergency to be declared.

"Some communities that I know have had over 30 deaths in the last year, and these are not huge communities that are having these kinds of deaths," said Tannis Smith, a NAN Hope co-ordinator and counsellor.

Meno Ya Win is not a Schedule 1 psychiatric facility, which means it does not have in-patient psychiatric beds or a full-time psychiatrist. It relies on the regional hospitals in Thunder Bay and Kenora for these services, which means the rooms in its emergency department serve as temporary holding spaces.

"Due to a lot of issues like weather and access to planes, access to hospital beds, individuals have had to stay in those rooms for several days at a time," Bell said.

The renovated safe rooms will be larger and purpose built, without anything present that could lend to self-injury, he said. Each will have a toilet and sink, so patients don't have to be escorted down the hall to use the washroom, and security cameras. The rooms will also have televisions behind plexiglass.

The bulk of the work should be completed by May, with the rooms operational by the summer, said Bell.

Hospitals need purpose-built safe rooms

More emergency departments in Ontario are looking at creating safe rooms for patients experiencing mental distress, but this isn't always feasible, said Dr. David Gratzner, a psychiatrist at the Centre for Addiction and Mental Health (CAMH) in Toronto.

"Because of societal stigma, because of demands on space in emergency departments, people with mental health problems were often an afterthought," he said.

He recalled working at a hospital that used two converted storage rooms in the back of the emergency department for patients experiencing mental health crises.

"Imagine you're going through some of the worst moments of your life and you're sitting on a stretcher in a room under fluorescent lights. There's no window. It's not quiet. It's just a very unpleasant environment," he said.

But dedicating the time, money and resources to constructing and maintaining safe rooms in emergency departments "can be a tall order," Gratzner admitted.

Since CAMH moved into a new emergency department with more space 2½ years ago, Gratzner said, overall incidents of violence have become lower than those in other emergency departments in the province.  

"These things matter, they make a difference. But again, the question becomes one of priorities," he said.

Imagine you're going through some of the worst moments of your life, and you're sitting on a stretcher in a room under fluorescent lights.- Dr. David Gratzner, Centre for Addiction and Mental Health

Recent data from the Canadian Institute for Health Information (CIHI) shows emergency department visits are on the rise in Canada, coming closer to pre-pandemic levels. Meanwhile, the health-care system continues to feel the pains of staffing shortages and burnout.

Gratzner reminds people that not too long ago, mental illness was often a family secret. A relative would "disappear" for a couple years — sent to a psychiatric facility — and nobody would talk about where they went or why. 

"It's great that the stigma is fading, but there's huge unmet need within our population and it's important for us to keep advocating for resources," he said.

Creating safer, more dignified spaces to meet people's mental health needs in dedicated safe rooms is an important step, said Gratzner. 

"These spaces aren't an afterthought, but they're carefully constructed."