Eastern Health is facing a nearly 45 per cent vacancy rate in psychology positions after a “mass exodus” of specialists for private practice. Some psychologists say the Newfoundland and Labrador government and health authority were warned it would happen but failed to rectify long-standing issues.
CBC News spoke with several psychologists — both on the record, and on background — who have left their jobs with the health authority for the private sector.
The demand for psychologists in the eastern region has grown so much, they say, that even private practice clinics have few appointments to spare, adding it’s the patients who will bear the brunt of health officials’ inaction.
Eastern Health says that as of this month there are 25 vacant funded clinical psychology positions — nearly half the total number of positions.
The health authority says it is actively recruiting to fill those jobs.
Neuropsychologist Dr. Tanya Lentz tendered her resignation from Eastern Health in July 2021, after six years on the job. She said it became untenable to stay and work at the health authority.
“I felt as though my role was now becoming unethical because I was leaving people on wait lists for three to four years because I couldn’t physically get to them just because of the demand,” Lentz said.
“A lot of times it was, ‘Do your best,’ or, ‘You need to learn how to manage your caseload better.’ So a lot of, kind of, gaslighting essentially is what we were getting from management.”
Lentz arrived in the province from B.C. in 2014 to work as a neuropsychologist at the Janeway Children’s Hospital, providing assessments and treatment for children who have learning disabilities, brain injuries, or any sort of neurological condition.
She said she worked the equivalent of two and a half jobs, and often worked unpaid overtime.
Programs don’t treat mental health, professionals treat mental health.– Dr. Lisa Moores
A delay in assessment or treatment for someone with a brain injury could be detrimental to their health, she said. It can lead to compounding mental health problems later down the road.
Replaced by social workers
Lentz said she and her colleagues felt a loss of autonomy. She said it was apparent psychologists were seen as interchangeable with social workers — another highly skilled professional, she said, but not one that can replace years of training as a psychologist.
“A lot of psychologists who have left have talked about the heavy caseload, the lack of any sort of acknowledgement from management, the lack of appreciation from management,” she said.
“They’re not they’re not really valuing the role of psychologists. And a lot of times we’re told, oh, well, other people can do the same job. And that can be really demoralizing over time.”
Eastern Health did not respond to CBC’s questions about how often social workers are used to backfill the roles of psychologists.
Dr. Lisa Moores, a registered psychologist and associate professor at Memorial University’s residency program, co-authored a report for the Association of Psychology in Newfoundland and Labrador, and presented it to Health Minister John Haggie nearly a year ago.
Moores’ report – titled Changes to Provision of Provincial Mental Health Service – outlines concerns psychologists in the province have with the implementation of the stepped-care model. The details stemmed from a survey conducted in 2019.
Stepped-care was first introduced in the U.K. and was developed to match a person with the most appropriate care they need. It has been lauded repeatedly by the provincial health minister in the House of Assembly as a success that has improved access to services.
In 2017, the provincial government began using Stepped Care 2.0, which was developed by psychology Dr. Peter Cornish and the Mental Health Commission of Canada.
Moores said the psychologists surveyed agreed stepped-care has its advantages and that they support the model in principle.
But Moores said it should not come at the expense of longer-term mental health treatment.
“I think at this point we’d have to say it’s a mass exodus from the public system. And this is something we saw coming,” said Moores in an interview.
“We’ve seen a real emphasis — a strong emphasis — on programs or models being the thing that will fix all of these problems. Programs don’t treat mental health, professionals treat mental health.”
Psychologists indicated their clinical time was being reallocated from their more intensive work with clients to run same-day and single session programs, the report said.
Stop psychologists from leaving first: Moores
Ten recommendations were put forward from the report, including the need for increased resources and to improve the stepped-care process.
Moores cautions that before Eastern Health focuses on recruitment, it must stop the hemorrhaging of psychologists from the public sphere.
Moores said she has not heard back from the health authority or the health minister following the meeting in the summer of 2021.
Haggie declined an interview.
Asked during a recent mental health news conference about the vacancies, he pointed to the success of the stepped-care model, which he had lauded during question period in the House of Assembly on May 4.
“The stepped-care model developed and pioneered here at Memorial University and now accepted by the federal minister of mental health and addictions as a potential national standard speaks to those middle grounds of steps for those people who require more support than intermittent counselling and yet don’t require in-patient treatment,” Haggie said in the legislature.
However, in a statement, the department appeared to distance itself from the stepped-care model that was introduced in 2017 at Memorial University.
It said the province is moving forward with its own model of stepped care.
“From lessons learned during this demonstration, the province chose to develop its own model,” said a spokesperson from the department.
However, the new provincial stepped-care model has not been “fully released or implemented.”
Kaiden Dalley moved to Newfoundland and Labrador from B.C. to be closer to family in 2017. Since then, they say they have been bouncing around the mental health system.
Dalley said they had been on a waitlist for over a year before getting a call about the possibility of seeing a psychologist in the public system. By that time, Dalley had been hospitalized due to mental health issues and had been assigned a psychologist because of that.
“I was told that there had been staffing issues for the Eastern Health team that I was referred to, and so that played a big part in the wait,” Dalley said.
“There’s a need for same-day services, but there’s also a need for long-term services. I’ve heard a lot of people say the same thing, [that] short-term services are good in certain situations, but we don’t have any long-term care for people who need long-term care.”
Dalley is part of a group that has been on a campaign calling for better long-term mental health services and demonstrating weekly outside of the Confederation Building. They don’t expect to stop anytime soon.
For Lentz, the first step to improving the system is to admit there’s a problem.
“It’s something where I think until we get potentially a minister of health that actually has an understanding of mental health services or more openness to getting feedback from providers and clients, I don’t know if we’re going to get there,” she said.
Eastern Health declined an interview.
However, an internal memo released through access to information spells out what Eastern Health knew about concerns expressed by psychologists.
The document points to several issues, including a perceived lack of autonomy and respect for the psychology discipline as well as social workers doing the jobs of psychologists.
Pay was flagged as the biggest issue.
“Uncompetitive wages in a market where higher compensation can be sought elsewhere, contributes to inadequate resources, retention issues, burnout, quality of care concerns, recruitment issues, and significant wait times for services [and] psychological assessments,” the memo, dated April 2021, said.
A March 2022 briefing note prepared for the Eastern Health executive team by a psychology retention and recruitment taskforce reaffirms those concerns, and notes that pay is not competitive with rates offered in Prince Edward Island and Nova Scotia.
“The inability to recruit and retain clinical psychologists has impacted wait times for client services and significantly increased workloads for the remaining CPs, as well as other classifications trying to bridge the gap,” the memo said.
In a statement, Eastern Health said it is recruiting for these vacant positions through advertising and networking with universities as well as reviewing the compensation package and offering bursaries.
Lentz admits private practice is far more lucrative than working for a health authority, but said it was not the primary reason for her leaving.
“Honestly, money was the furthest thing from my mind when I was working in the public sector. It’s about feeling valued, feeling heard. Being able to provide ethically sound treatment for people. And that doesn’t take a lot.”
The psychology shortage extends beyond eastern Newfoundland. Western Health reported seven clinical psychology vacancies as of April. Central Health had five vacancies during that same time period.
Labrador-Grenfell Health reports that its two psychology positions in its mental health and addictions department are both vacant — one since July 2020 and the other as of last month.