Rural Mental Health Care in Ontario: How to Get Help

A new investigation from the Investigative Journalism Bureau shows just how differently mental health emergencies are handled depending on where in Ontario you live — and the numbers are stark.

At Muskoka Algonquin Healthcare's two hospitals, 291 of 295 psychiatric admissions in 2024-25 — 99% — were involuntary. In Parry Sound, 158 of 161 (98%). In Espanola, Petrolia, Timmins, and Hearst, involuntary admission rates ranged from 94–98%. Compare that to Ontario's overall average of 68.5%, or the rates at specialized centres like Toronto's Centre for Addiction and Mental Health (29%) and the Royal Ottawa Health Care Group (about 15%).

The gap isn't about how sick patients are. It's about what the hospital they walk into is equipped to do.

Why Small and Rural ERs Struggle With Mental Health Crises

Most small and rural hospitals in Ontario weren't built to deliver psychiatric care, but their emergency departments are often the only door open at 3 a.m. As Dr. Kirsten Jewell, head of emergency medicine for Muskoka Algonquin, put it: patients can end up waiting days in an ER room "just for admission to see a psychiatrist."

Without a psychiatrist or psychiatric nurse on call, an emergency physician juggling a chest-pain case and a mental health crisis at the same time often has one safe option left: hold the patient — sometimes in a locked room — until a bed opens at a better-equipped facility, or arrange a transfer. In many of these communities there's no urgent voluntary admission pathway, so if a patient can't safely be discharged, involuntary hospitalization becomes the default.

Dr. Alan Drummond, who practises emergency medicine in Perth, says the nearest psychiatric referral centre is 64 km away in Brockville. If patients can't get there in time, "they're stuck overnight against their will in ill-suited spaces."

The Real Cost of Involuntary Care

Being held against your will for a mental health crisis isn't a neutral outcome. Dr. David Gratzer, psychiatrist-in-chief at Sinai Health, notes the double standard: a patient with chest pain at 3 a.m. gets fast, high-quality care — but a patient in psychiatric crisis at the same hour, in some parts of the province, does not.

Ottawa lawyer Melissa Lukings, who works with patients who've been involuntarily admitted, says the experience can cost people their job, their home, or custody of their kids — and it changes how they seek help afterward. "Once they get out, they're like, 'Yeah, if ever I feel like this again I'm not going to the hospital.'"

That's the paradox: a system meant to protect people in crisis can end up making them avoid care the next time they need it.

How to Get the Right Care Before It Becomes an Emergency

The biggest lever patients and families have is getting connected to care before a crisis forces an ER visit. A few practical steps:

• Find outpatient mental health support now, not during a crisis. Ontario's mental health clinics can connect you with counselling, psychiatry, or ongoing treatment without a wait-and-see trip to the ER.
• Know your symptoms and options. Our mental health support guide walks through what different levels of care actually look like, from talk therapy to crisis stabilization.
• If it's not an emergency, a walk-in or family doctor visit can help. Search all clinics near you, including walk-in options that can start a referral without an ER visit.
• Check wait times before you go, when safety allows. Ontario's live ER wait times can help you choose the closest, fastest option if a hospital visit is needed.
• Rural or smaller community? Look at what's actually nearby. Browse clinics by city to see what's realistically available in your area versus a larger regional centre.

None of this replaces emergency care when someone is in real danger — it's about not waiting until the only option left is a locked room in an ER that wasn't built for this.

When to Call 911 or Go to the ER Anyway

Rural gaps in psychiatric care don't change the basic safety rule: if someone is at immediate risk, get emergency help right away.

Call 911 or go to the nearest emergency department if:

• Someone has expressed a plan or intent to end their life, or has attempted to harm themselves.
• Someone is experiencing psychosis (hearing voices, severe paranoia, loss of touch with reality) and cannot be kept safe at home.
• A mental health crisis is combined with a medical emergency (overdose, injury, chest pain).
• You genuinely cannot keep yourself or someone else safe in the moment.

In a crisis, safety always comes first — even if the nearest hospital isn't a specialized psychiatric facility, the ER can stabilize the situation and start the process of transferring to appropriate care.

FAQ

What if my local hospital doesn't have a psychiatrist on staff? Many small and rural Ontario hospitals don't. Emergency physicians can still assess and stabilize you, and will arrange transfer to a hospital with psychiatric beds if inpatient care is needed.

Can I refuse mental health treatment at the ER? In most cases, yes — unless a physician determines, under Ontario's Mental Health Act, that you pose a serious risk to yourself or others, in which case involuntary assessment or admission can apply.

How do I find mental health support before things become urgent? Start with a mental health clinic search or talk to a family doctor or walk-in clinic about a referral — getting connected to outpatient care early reduces the odds of an ER-only crisis response later.

Are involuntary admission rates the same across Ontario? No. According to Canadian Institute for Health Information data cited in the investigation, rates range from around 15% at specialized centres to over 95% at some small and rural hospitals — largely reflecting available resources, not patient need.

Find the Right Care, Before You Need the ER

If you or someone you know is dealing with a mental health concern that hasn't reached crisis point, don't wait for an ER visit to be the first step. Search CanClinics to find walk-in clinics, family doctors, and mental health providers near you.

This article is for general information only and is not a substitute for professional medical or psychiatric advice. If you or someone else is in immediate danger, call 911 or go to the nearest emergency department.

— CanClinics Team