Before the crisis point
There is a tragic order of things that can happen when someone experiences a mental health crisis. A call is made to 911; the police show up; something goes wrong.
On Jan. 16, Charlottetown's Tyler Knockwood was displaying such severe signs of paranoia, his family called 911 three times throughout the day and asked the police to take him to the hospital.
Laura Knockwood says police told her that her husband was “just a little under the criteria” for hospital admission and instead dropped him downtown.
“They just kept telling me he’s a grown man. He will figure it out himself. But I knew he was going to die,” Laura told SaltWire Network.
The next morning, security found Tyler Knockwood dead inside Province House – a place where he had worked and so valued he donated an eagle feather to be encased in its wall.
Laura believes her husband might still be alive if he had been admitted to hospital, seen by mental health professionals and given a support plan before being released.
Another family member of a man in crisis says she is lobbying Atlantic Canadian governments to add “deteriorating health” as a condition for involuntary hospital admission.
Marlene Bryenton wrote in a guest opinion for SaltWire, “Our son has been deteriorating for five years.
He had a normal life. He is now sleep deprived, malnourished, homeless and deteriorating daily. It seems to me that if you used an ounce of common sense, you would determine that he requires a medical assessment.”
While it is heartbreaking to read about family members who are powerless to get help for their loved ones, forcing medical care on unwilling adults may not be the answer.
In November, New York City issued a directive that people with severe mental illness should be hospitalized and kept there even if they did not pose a threat to themselves or others.
The order drew immediate backlash from mental health workers, homeless advocates and emergency room staff, citing concerns like privacy breaches, police overreach, shortage of hospital beds and the failure of involuntary admissions to effectively help patients.
Time spent in emergency departments, wrote a group of doctors in an opinion in Doximity, “does not provide a therapeutic environment for a mental health crisis” and sometimes leads to “dangerous and violent behavior directed at staff or other patients.”
A study published in 2018 in the British Journal of Psychiatry Open that looked at psychiatric patients in Ontario from 2009-13 also found negative outcomes for those who didn’t admit themselves.
That study found involuntary psychiatric admissions “can be disruptive to the patientprovider relationship and negatively impact the patient’s perception of his or her care at the time of the admission and afterward.”
The New York doctors and the authors of the Ontario study both concluded that avoiding violent outcomes for people struggling with mental health issues means establishing appropriate supports in the community before the patient hits a crisis point.
The New York doctors wrote, “Focusing on upstream causes, such as affordable housing and access to addiction resources, could heal communities ...”
That is a treatment plan all Atlantic Canadian governments could get behind.