Anger and questions after teen in mental health crisis discharged at 3 a.m. from Abbotsford hospital
Abbotsford NewsSep 07, 2020
A young woman with a history of suicide ideation and self-harm was discharged from
Byrnes has frequently found herself in the role of an informal "community mom" for local youth who don't have other adults they can turn to for help.
Byrnes got in her car, picked up the teens and drove them to Alice's home, where she lived alone and where the pair had planned to spend the night. But because of Alice's behaviour, her friend decided she wanted to go home. After Byrnes drove the teen home, she called Alice to make sure she would be safe to be alone for the night.
Alice is impulsive when drinking, and has self-harmed in the past, and spoken about suicide. Just weeks earlier, she had been in hospital for mental health issues. That history, and Alice's demeanor and words on the phone, convinced Byrnes – who also works as a clinical counsellor and is president of the
The decision was made to take Alice to
Byrnes spoke to an intake nurse about Alice's history and her suicidal ideation. And as the pair sat together in the hospital's ER waiting room, Alice revealed that she had self-harmed earlier that evening. After about 15 minutes, Alice was admitted into the ER and Byrnes went home. It was just after midnight.
"She went there willingly and she knew she needed to be there," Byrnes said. "There was a willingness there where previously there hadn't been."
But around
Byrnes got in her car and found the young woman sitting on the curb outside the hospital's ER. Byrnes was furious. She went inside to complain and spoke to a doctor who said that while he couldn't provide Byrnes with more information because she wasn't a relative, he was confident Alice was safe to leave the hospital.
Alice later told Byrnes that she had been given a chair to sit in after being brought into the ER. Alice wanted a bed to sleep in and had begun to walk around. Byrnes said it wouldn't have been surprising if Alice had been disruptive. But she said that shouldn't have influenced whether she got the care she needed, Byrnes said. Her mental health crisis, she said, couldn't have been resolved so quickly.
"What had changed within three hours, besides [Alice] probably having some behaviour issues?"
Byrnes said that usually when a person in crisis comes to the hospital, they end up staying the night and seeing a psychiatrist in the morning who makes treatment or medication recommendations. Indeed, Alice had gone through that exact same process previously only recently.
"Bare minimum, the fact that that had just happened and now she's in there again, yeah, maybe she should stay there a little bit longer, be re-evaluated and have some supports to follow up."
Byrnes noted that there can be – and have been in the past – deadly consequences when people in mental health crises leave hospital without getting the help they need. In May,
In 2018, the BC Coroners Service held an inquest after three patients who had sought help at
"Had I not heard the phone ring and woken up at
Byrnes remained with Alice until dawn to ensure she was safe. But Byrnes anger over the incident didn't subside. Byrnes said she has heard widespread dissatisfaction of how the hospital treats those experiencing mental health crises.
"I've experienced some pretty horrible treatment for mental health patients, but this tops it," she said. "They don't know how to deal with cases like this unfortunately."
"Some people don't even go anymore because they know they're not going to be treated with respect."
Byrnes said that patients and their mental health crises seem to be handled differently, depending on the physician working at the time.
"Every doctor handles it differently. Every doctor has a different opinion about it."
Byrnes would like to see the hospital put in place processes that better support and protect those in mental health crises.
"Some doctors are better than others, but the bottom line is there isn't a standardized treatment that's appropriate for mental health and the closest thing to that is a psychiatrist, and when they're not even accessing that at the hospital, that's a big issue for me."
She also says health officials should also consider whether the hospital is actually the best place to help those needing immediate mental health interventions.
"I'm starting to think this isn't the place for it because they treat it with such a medical/physical model, it doesn't work for mental health patients."
Physicians may certify patients under the mental health act if they are deemed a risk to themselves or others. Such patients,
"If a patient is intoxicated, after a period of time to allow them to sober up, the physician will perform another mental health evaluation," the spokesperson wrote.
"It takes a lot of bravery to approach a stranger and say I need help with what's going on in my head," she said. "We need to understand, as a starting point, the amount of courage you need to take that first step."
"Even if you have relatively good outcomes – like a person goes to emerg and gets dealt with and gets discharged and doesn't god forbid kill themselves or harm themselves or deteriorate further … if you poison a person against seeking care, if you convince them that seeking care in this manner is wrong or just going to put them in confrontations with people who make them feel unsafe or not understood, then they're not going to seek help the next time they're in crisis. And that can result in deterioration, it can result in self-harm, it can be devastating."
Health organizations and hospitals have improved how they deal with patients with mental illness in the last 10 years.
But Paperny says that while significant advances have been made and that progress is important, much more needs to be done.
"We have come a long way and we're talking about this in ways we weren't only a few years ago. But I don't think we can use that as an excuse … I think we need to say these are urgent health issues that need to be done now and we can't pretend we don't know enough to make changes, we can't pretend people's lives aren't at stake.
"We need to get much better at obviously addressing the acute mental health issue but also addressing whatever is chronically going on."
The cost to improve mental health care also isn't an excuse, Paperny said.
"Even if this were just about money, you end up saving a lot of money when somebody doesn't return to hospital every week or every couple weeks because they're having the same problem you've continually failed to address."
Byrnes said she hopes the incident can help spur change. But she says the reaction from
The website of
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Four years ago, a Coroners Inquest was held into the deaths of three people who took their lives after having left