“My suggestion to my friends, family, and people on the street, is to drive carefully. Look both ways before you cross the street. Eat your Wheaties and take your vitamins.”
I’m speaking with Dr. Kerry Mothersill in September 2021. Alberta is still in the middle of their fourth wave of COVID, the Delta wave. Omicron has not yet been discovered by scientists in South Africa, and Alberta ICUs are already at their limit. Dr. Mothersill is issuing this warning because he doesn’t want anyone to get into a car accident, show up at the Emergency door of the nearest hospital, and be turned away because they are at capacity.
“ICUs and other hospital-based services are under a significant crunch, and though I tend to be optimistic I’m not so optimistic to think that within 18 months we’ll be out of a pandemic situation. The difficulties we’re experiencing at the moment tend to get lost down the line. It’s important to be informed and to base our decisions on the best evidence we have. It’s important that we all be mindful right now of the challenges in the healthcare system.”
It is now February 2022, and Dr. Mothersill’s comments seem particularly prescient. Alberta is now putting together field hospitals in Calgary and Edmonton in preparation for an expected surge. Although this will mean additional beds, health-care workers are unsure they will have enough staff to manage them. Dr. Mothersill is mainly in private practice now, but is still heavily involved with the public health system, training residents within Alberta Health Services.
The pandemic has been stressful on everyone, but no one has been affected more than health care workers in hospitals. Many psychologists who work in hospitals have been working overtime trying to help their colleagues cope with the overwhelming and unending toll the pandemic has taken on them. But not all hospitals are the kind that are being overwhelmed with COVID patients.
Dr. Kelsey Collimore is a psychologist working in the Mood and Anxiety Disorders Program at the Royal Ottawa Mental Health Centre and a Clinical Investigator with The Royal’s Institute of Mental Health Research. The Royal is a specialized mental health centre that provides tertiary care to individuals with complex and treatment resistant mental illness and/or substance use issues. Dr. Collimore says the pandemic has affected her program much differently than many other general hospitals – mostly in the shift to virtual services.
“Virtual care was something that was in place at The Royal prior to the pandemic. Of course it has really been propelled forward across all of health care as a result of COVID. I think the shift toward telemedicine has been somewhat helpful, in that now we have a better understanding of where we might want to continue with some of those services. I think there’s a real place for them going forward. As of now, we have returned to some in-person services, but most are still primarily virtual.”
Dr. Stephanie Greenham, the Chair of the CPA’s Psychologists in Hospitals and Health Centres, is a clinical psychologist working at CHEO – a pediatric health and research centre in Ottawa, where she is the professional practice leader and coordinator for psychology. She is also a psychologist and clinical lead with the inpatient mental health unit. With so many children experiencing the pandemic in ways that affect their mental health, CHEO has certainly been busier over the past two years. So what kind of services does CHEO provide, and how do psychologists factor in? Dr. Greenham gives an example.
“We have a specialty service that provides outpatient care for children and youth with complex chronic pain that integrates care from the physical, psychological, and pharmacological perspectives. Psychologists play a key role in program development and evaluation. The multidisciplinary team involves physicians, nurse practitioners, psychiatrists, psychologists, social workers, physiotherapists, occupational therapists, and pharmacists. They work collaboratively with children, youth, and families to provide a multidisciplinary assessment and interventions. That could be individual or group interventions run by psychologists or other members of the team, family therapy, follow-ups with physicians, and medication management. It’s very much a team offering!”
The Royal provides a much different type of care, primarily geared toward adults. They work with a particular client population or a particular group of clinical disorders, for assessment and treatment. They also place a large focus on evaluation and an increasing focus on clinical research integration. The people Dr. Collimore sees are often those for whom traditional treatments haven’t worked.
“I work with adults with a range of depressive disorders, bipolar and related disorders, traumatic stress or anxiety and related disorders. Most often I work with individuals who historically haven’t responded to various treatments and have had their symptoms for quite some time. Often I work with clients who have a more complex clinical presentation – meaning that they have more than one difficulty with a lot of stressors to consider within the context of service delivery.”
Psychologists who work in hospitals have a certain kinship with one another, which is why the CPA created the Hospitals and Health Centres Section. Dr. Mothersill, who practiced in hospitals for about 40 years in Ottawa and Calgary, is one of the founding members of the section.
“There were a number of us who felt there were particular challenges and opportunities for psychologists who were working within the publicly funded health care system. People working outside of industry, outside of private practice, outside of government. We created the section to discuss issues that were pertaining specifically to practice within hospitals and various health care clinics.”
Today’s Chair, Dr. Greenham, explains that while initially the section was made up predominantly of psychologists working out of hospitals, that makeup has changed over the years.
“Members of this section include psychologists working in rehab centres or other types of treatment centres affiliated with public health. They’re clinical psychologists, health psychologists, neuropsychologists – who happen to be working in the public health system.”
Dr. Mothersill says there are a few reasons this shift has happened.
“Things have evolved in publicly-funded healthcare over the last several decades, so as much healthcare as possible is being delivered outside hospitals – in urgent care centres, clinics and the like. There is a continuum of care that’s provided from very intensive in hospitals to less intensive outside with which psychologists are involved.
Up until maybe ten years ago, most emerging psychologists coming out of grad school, especially those who specialized in clinical psychology, neuropsychology, or health psychology, had a desire to work in a hospital setting or a publicly funded health system of some sort. I think in the last decade, and increasingly so, this is no longer the case. A growing percentage want to enter directly into the private practice field. There has been a growing number of large private practices, where many psychologists can work and consult with one another. I think this poses some challenges for publicly funded systems to attract and hold onto psychologists within that system.”
Dr. Greenham points to another place that is attracting psychology grads – primary care.
“I think there are increasing opportunities for psychologists in communities to get involved at the primary care level, where they’re becoming embedded within primary care practices with primary care physicians and interdisciplinary practices within the community.”
The more psychologists are involved with primary care, and with clinics and therapy centres and multidisciplinary teams across Canada, the more involved they are in every facet of public health. And the stronger their voice will be when they give advice like;
“Drive carefully. Look both ways before you cross the street. Eat your Wheaties and take your vitamins.”