A new way to treat the dangerous mentally ill
PENETANGUISHENE — Twenty years ago, the province’s most secure forensic mental health facility looked like a prison.
Now it looks like the hospital it is.
Since April 2013, Waypoint has admitted 26 patients from the Kitchener and Waterloo area.
Waypoint Centre for Mental Health Care is a bright, welcoming complex on the shores of Georgian Bay. In fact, the building is designed so every in-patient has a view of the water.
That alone denotes this is a place for healing. Not punishment.
The progress our society has made in its understanding and treatment of mental illness in the last two decades is discernible here.
Waypoint is many things. It is a mental health hospital serving 1,000 outpatients. It is a low security forensic hospital that treats criminals with mental health issues, just like nine other Ontario facilities.
However, Waypoint is best known for having the only maximum security forensic psychiatric unit for the province’s most dangerous mentally ill offenders.
One of those offenders is Darryl House. He has been in Waypoint since September when his homicide trial ground to a halt due to his mental health issues.
While representing himself, House pleaded guilty to manslaughter for stabbing a man through the neck at a drug house in Hamilton.
House was mentally fit when he pleaded, the judge ruled. However, by the time his sentencing hearing rolled around, House’s mental state had deteriorated and the judge sent him to Waypoint to be assessed for his Fitness to Stand Trial. Doctors believe he has schizophrenia.
After some successful treatments and some that failed, House was deemed fit. But by then the court was questioning his mental state at the time of the homicide in January 2016.
Did he understand, in the moment, that what he was doing was wrong?
He was sent back to Waypoint for another assessment to determine if he was Not Criminally Responsible (NCR) at the time of the stabbing.
The hospital does an average of 54 Fitness to Stand Trial assessments annually and 48 NCR assessments.
Other psychiatric hospitals can also do those assessments. Offenders found to be NCR by the court will be admitted to a forensic hospital that provides the appropriate level of security.
NCR patients at Waypoint in 2017 were there for an average of 133 days.
In 2017, there were 86 findings of Unfit to Stand Trial in the Ontario Court of Justice (OCJ) and none in the Superior Court of Justice (SCJ), according to the Ministry of the Attorney General. There were 146 verdicts of NCR in the OCJ and nine in the SCJ.
In 1999, I went to Penetanguishene to tour what was then called Oak Ridge Hospital, a building modelled after a correctional facility. I went through security procedures similar to what I undergo when entering a prison: pass through an iron gate; show ID; relinquish your phone; pass through a metal detector.
An expert on psychopaths was my guide for that first visit. We walked through the maximum security wing, among patients who were allowed to wander and past those who were locked up.
“Dr. Marnie Rice strolls past small, foul-smelling rooms decorated with steel toilets and iron bars,” I wrote back then.
The baby blue cinder block hallways reeked of urine. Windows had bars. Rooms looked like cells. A recreation room in the basement had pool tables and old paperbacks.
This time, I walk through the main public entrance of fouryear-old Waypoint into a sunny, high-ceilinged atrium with a reception desk and comfortable waiting room.
Maximum security patients come in a separate entrance, a nod to safety but also privacy and dignity. Orange-jumpsuited prisoners are no longer marched in for all to see.
“This is not the big, bad scary place everyone thinks it is,” says Rob Descroches, vice-president of clinical services. “We’ve come a long way with the stigma.”
He shows me around, along with psychiatrist-in-chief Dr. Jeff Van Impe.
On this visit, I will not be allowed in the maximum security unit. Patient privacy is protected.
Instead, I am escorted into the “swing unit.”
This is identical to the 160-bed maximum unit, only completely empty.
If there is ever a catastrophe at Waypoint, patients could be evacuated into this unit. This is a necessity since there is nowhere else in Ontario to house maximum security forensic patients.
A judge, with input from psychiatrists, Waypoint staff and lawyers, determines the level of security a forensic patient needs.
The maximum security unit is for men only. There is no equivalent for women anywhere in Canada because there are not enough women that dangerous to fill a unit.
The swing unit is stark and bright, with wide halls. Lined up on the floor is “personal protective equipment” for staff. In other words, riot gear, including shields and helmets.
At first glance, rooms look like those in any new hospital room. They are 120 square feet. At Oak Ridge they were 75. Fully-accessible rooms for wheelchairs are even larger.
Each room has been designed to reduce the possibility of suicides. The safety bar near the toilet is “anti-ligature” meaning nothing can be looped through it. There is a mirror at the corner of the ceiling (made of safety glass) so staff can see every bit of the room from the hall. There is an anti-ligature alarm at the top of the door frame which sounds if anything is attached to it. Instead of taps on the sink there are sensors. Every room can be viewed by camera at the staff “care desk.” Every patient at risk of suicide can be put into a nontearable “safety gown.”
Each room has two entrances. One is a regular, swinging door. The other is a sliding door that can be locked to maintain a sixinch opening. That way, a patient is confined to their room, but there is still an opening into the hall, allowing them to see, be seen and communicate. Medication can be passed through.
Some patients are locked in their room. Others are allowed to wander the unit.
“For many patients, there’s no reason they should be locked up in individual cell-like rooms the way they used to be,” says Van Impe. “This way is a lot more conducive to the well-being of our patients.”
“We are servicing the highest risk individuals,” says Van Impe. “But I actually feel safer here than in emergency psychiatric services at a regular hospital.”