Spike in mental-health patients going AWOL raises questions of police involvement and community care

A significant increase in a little-known statistic Vancouver police keep on mental-health calls might suggest the province’s embrace of community care is not be working as well as everybody hoped it would

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      In the days preceding Spencer Walden’s death, he was in and out of hospitals, experiencing increasingly severe symptoms of schizophrenia.

      On January 24, he was admitted to Peace Arch Hospital in White Rock, Walden’s sister Tara recounted in a telephone interview. She said her family told the hospital he was very sick and asked them to keep him there, against his will if necessary. But on February 13, the hospital granted Walden, 32, a pass for a short walk outside, which he used as an opportunity to flee.

      Eventually, Walden’s mother connected with him on the phone and convinced him to return to Peace Arch, Tara continued. But the next morning, Walden was granted another pass and went missing a second time. Again, he returned later that day of his own volition.

      “By this time, we’d already told the staff, ‘Please don’t let him out, because he’s really sick,’ ” Tara said.

      A few hours later, Walden’s wife and their daughter visited the hospital with a Valentine’s Day present. For the third time in two days, they found the hospital had issued Walden a pass and that he had used it to vanish.

      This time, Walden didn’t return to Peace Arch. He found his way to Vancouver, somehow, and was apprehended by police and admitted to St. Paul’s Hospital. On February 18, he broke a seventh-storey window and fell to his death. A coroner’s investigation is ongoing.

      “He ended up AWOLing and being out in the community and then ended up downtown and, subsequently, didn’t get proper care,” Tara said. “If he had been treated properly at Peace Arch Hospital, he probably never would have died.”

      When an involuntary mental-health patient is issued a pass and then fails to return by its deadline, a care facility can issue what’s called a Form 21 director’s warrant. Though no crime has been committed, police will attempt to find missing patients and return them to hospital.

      According to Surrey RCMP, Walden was one of 52 Form 21s that officers responded to during the first six months of 2016.

      Apprehensions the Vancouver Police Department classifies as a Form 21 director's warrant (purple) have increased dramatically in recent years.

      A lack of detail in past B.C. RCMP record-keeping makes it impossible to track how this statistic has changed over time. But in the City of Vancouver, the VPD has recorded a sharp rise in Form 21 apprehensions.

      In 2012, VPD officers were involved in 385 such calls. The next year, they responded to 727 Form 21s. Then 996 in 2014 and 1,189 in 2015. This year, the VPD is on track for a projected 1,284 Form 21 apprehensions, a more than threefold increase in just four years.

      Hospitals issue passes to involuntary mental-health patients for a variety of reasons and as a matter of routine. Patients might receive passes for 15 minutes so they can smoke, or they might be trusted with six-month passes so they can stay with family members and receive treatment in the community.

      The idea is to extend as much trust to patients as possible; when longer passes are issued, it is with an understanding that a person’s mental health has a better chance of improving in the community, with friends and family, as opposed to alone in a hospital.

      A lack of holistic support

      Speaking generally in a telephone interview, Jonny Morris, B.C. director for the Canadian Mental Health Association, said those two different sets of circumstances in which Form 21s are issued mean there are possibly two issues at play. In cases of short-term leave, Morris said it’s likely simply a matter of care professionals granting passes when they shouldn’t.

      On long-term passes, Morris expressed more serious concerns about the Form 21 numbers obtained by the Straight. He explained that since long-term institutionalized care has essentially been phased out of the Canadian mental-health-care system, it is crucial that care in the community work as an effective and safe alternative. But what the Form 21 statistics could suggest, Morris said, is that the province’s embrace of the community-care model for people with a severe mental-health issue might not be working as well as everybody hoped it would.

      “Is it doing what it was originally intended to do?” Morris asked. “Because people on extended leave don’t have the same rights that you and I have. They don’t. They are subject to conditions. So what’s going on there?”

      He suggested the larger issue is a lack of holistic support.

      “Access to sustainable housing, access to food security, access to employment support—all of those are big ingredients with being able to stay in community,” Morris said. “Not just pharmaceutical treatment or psychotherapy. Are the resources there needed to help people maintain their well-being?”

      On October 11, the CMHA's B.C. chapter published a "manifesto" that calls for this province to do a major rethink of how it cares for people with a mental illness or addiction issue. That document lays out a concise plan that emphasizes a need for prevention as well as greater support in the community.

      The family of Spencer Walden (above) has raised questions about mental-health and consent for care after the 32-year-old man died while experiencing an episode of psychosis related to schizophrenia at St. Paul's Hospital last February.

      The B.C. Schizophrenia Society’s executive director, Deborah Conner, told the Straight she isn’t surprised by the increase in Form 21s because she knows hospitals have seen significant increases in emergency mental-health visits across the board.

      As previously reported by the Straight, the number of emergency mental-health visits recorded annually by Vancouver General Hospital and St. Paul’s Hospital was projected to surpass 10,000 before the end of 2015. That’s up from 6,520 in 2009. (In 2016, monitoring changed from a calendar year to a fiscal year, making comparisons difficult.)

      Conner said she met with representatives of the B.C. Ministry of Health and local authorities such as Vancouver Coastal Health as recently as last month. She’s recommended that in granting leave, care providers adhere to guidelines developed by Accreditation Canada, a nonprofit that monitors standards in health-care facilities across the country.

      “The guidelines specifically for mental health clearly state that family or a caregiver with capacity must be identified as a personal advocate for the person who is in care, and that family should be attending all discharge planning,” Conner said.

      Form 21 statistics obtained from the VPD don’t even reveal the whole picture. They only count instances of a Form 21 issued where police are involved. And, often, a Form 21 can resolve itself without police, for example if a patient is returned to hospital by a family member.

      Vancouver Coastal Health and the Ministry of Health both claimed that they do not keep statistics for Form 21s. Both organizations also declined to grant an interview on the subject, as did the Fraser Health Authority, the operator of Peace Arch Hospital, where Walden was granted passes.

      Previous investigations bring little change

      The Waldens were motivated to share their story with media after attending a coroner’s inquest that began on September 7. There, they met families who had lost loved ones in circumstances that shared similarities with those of Spencer.

      That inquest was convened to investigate the deaths of Brian Geisheimer, Sebastien Abdi, and Sarah Charles. All three committed suicide shortly after leaving Abbotsford Regional Hospital during a four-month period beginning in December 2014.

      At the inquest's conclusion, jurors made recommendations related to procedures around the release of a mental-health patient who are admitted to hospital involuntarily, and on steps that should be taken to ensure patients who are released have the support they need. But ahead of that inquest, the Straight reported that advocates for mental-health were skeptical of the prospect for meaningful reforms, given similar reviews in the past have resulted in few tangible changes.

      Geisheimer, Abdi, and Charles died under the jurisdiction of Fraser Health Authority. But hospitals operated by Vancouver Coastal Health and Providence Health Care—Vancouver General Hospital and St. Paul's Hospital, respectively—have also dealt with high-profile incidents that followed patients leaving a facility after they were admitted for a mental-health issue.

      In December 2012, for example, Nicholas Osuteye attacked three women two days after he was discharged from St. Paul’s Hospital. In February 2012, Mohamed Amer stabbed an elderly man the same day he was released from St. Paul’s. And in January 2012, Jerome Bonneric was charged with assault shortly after St. Paul’s let him go. (An external review of the Amer case resulted in 22 recommendations for service improvements.)

      Still the best option

      Blaine Bray is director of inpatient mental-health programs at St. Paul’s Hospital. He acknowledged the rise in Form 21s but maintained that care in the community remains the best environment for the vast majority of patients he sees.

      “You’re trying to build a therapeutic relationship,” he said. “There is a lot of payoff to doing that.”

      Bray placed the increase in Form 21s in the context of what Vancouver mayor Gregor Robertson has described as a “mental-health crisis”. “The numbers of mental-health and addictions presentations in emergency have gone up a tremendous amount in the last five years,” Bray said.

      In a telephone interview, VPD spokesperson Sgt. Randy Fincham said it was difficult for him to guess why the numbers are going up, given they are initiated by hospitals as opposed to by police.

      “But it’s a good thing,” he added. “These are not people in crisis, they are people who are on some sort of a treatment plan.”

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