The way psychiatrist Dr. Yvonne Libbus sees it, mental health is a cornerstone of well-being. “Your emotional state is your fifth vital sign – it’s that important,” she said. “When we don’t attend to someone’s emotional health, their physical health can suffer.” 

Dr. Libbus is part of a small, dedicated team of psychiatrists and allied practitioners providing mental-health care for people in Cape Breton. “There are a lot of mental-health difficulties in our community because of socio-economic challenges,” she said. “We have an older population and many people have family members who work away. There is a lot of stress and substance use disorder. Our child and youth poverty rates are also very high compared to the rest of the province.”

Born and raised in Sydney, Dr. Libbus initially studied family medicine; she worked for six years as a family doctor in Dartmouth before heading back to Dalhousie to study psychiatry.

She returned home to Sydney in 2006 and has been working in the Adult Mental Health Clinic at the Cape Breton Regional Hospital ever since. She is a past chief of psychiatry and a former clinical director of the hospital’s mental health program.

“I have no regrets about coming back to Cape Breton,” she said. “It’s special to be able to give back to the place that gave to you.”

Dr. Libbus provides out-patient care at the hospital and is the psychiatrist overseeing the seniors’ mental health team that cares for seniors at 14 nursing homes in the region. Using Telehealth, she visits patients remotely and consults with other health-care providers, including family doctors, social workers and pharmacists.

She also works on-call for the Emergency Department and cares for patients admitted to the hospital. “That means covering 46 inpatient beds when the inpatient psychiatrist leaves for the day,” she said. “It’s a lot of responsibility.”

Challenges with recruiting and retaining physicians mean there are just six psychiatrists, and one part-time child and adolescent psychiatrist, for mental health and addictions programs in Cape Breton, which is located within the Nova Scotia Health Authority’s eastern zone. “The resources we have now aren’t matching our needs,” Dr. Libbus said. “We should have 16 psychiatrists.” 

Dr. Libbus and her colleagues are working hard to provide care with limited resources. During the month of January 2018, for example, the psychiatrists and clinicians – including social workers, psychologists and community mental-health nurses – handled over 1,800 visits for mental health services, including crisis services. Addiction services saw 297 visits, not counting patient visits to the Opioid Recovery Program and the Addictions Day Program.

“I’m proud of the work we’ve continued to do despite the challenges,” said Dr. Libbus. “We’re working so efficiently and at capacity.”

Providing good care means listening more and triaging patients carefully. “It’s important to take the time to listen to people and hear their stories,” Dr. Libbus said. “Our communities also need more education about mental health, including coping strategies, self-management and other community resources.”

It also means speaking up for people whose mental illness can overshadow other health concerns. “They don’t ask for enough and neglect can happen, especially for people with severe and persistent mental illness,” she said. “They are dying earlier and that’s the stigma of mental illness.”

Dr. Libbus loves helping people find their way through desperate circumstances. “Sometimes, just showing someone that you care about them makes a difference,” she said.

Patient Donnie Wambolt bears that out. About 10 years ago, he arrived in the ED, suffering from depression and anxiety. “I was at the end of my rope,” Mr. Wambolt recalled. “I knew I had to do something or I was going to die. It’s a hard thing to accept, but acceptance is the first step to recovery.”

He stayed in the hospital for one month. “For two weeks, I was on suicide watch,” he said. “I was quite ill.” Once released from hospital, he came back for weekly counselling and group sessions. He learned how to manage his symptoms and find ways to cope. “Dr. Libbus picks me up when I’m down,” Mr. Wambolt said. “She’s taken me through an awful lot over the years.”

Getting more psychiatrists working in Cape Breton is a priority for Dr. Libbus and her colleagues. “In the last few years, we’ve lost half of our department and those are challenges that we can’t fix easily,” said Dr. Libbus. “Having a good base of support is really important to build more programs and service care delivery.”

In the meantime, she’s focused on providing the best care possible for her patients. “I’m proud of the work we do and how well we are working together,” said Dr. Libbus. “We’re really here for our patients and they are so thankful.”