Mentally ill man fighting to stay in Canada
Patient was referred to border agency after admission to P.E.I. psychiatric hospital
A man dealing with severe mental illness is facing removal from Canada in a case that advocates say sends the absolute worst message about seeking medical and mental help to those who are in this country precariously.
Mehdi Oussama Belhadj Hassine is now fighting to prevent his removal, which was ordered after the Canada Border Services Agency declared that the severity of his schizophrenia would likely put “excessive demand” on Canada’s health and social services.
The 27-year-old from Saudi Arabia has been in Canada since 2012 as an international student. He graduated last year with a business degree from the University of Prince Edward Island.
However, during the pandemic, Belhadj struggled with his mental health, friends say.
This summer, he was out with a friend when he started hallucinating about getting on a private jet to visit his family in Saudi Arabia.
Belhadj, it turned out, was experiencing an acute psychotic attack. That July episode landed him in a psychiatric hospital. He was subsequently handed over to Canada Border Services Agency and detained at a provincial jail. The border agency determined Belhadj is destitute, in poor health and should be removed from the country.
After spending a month at the Provincial Correctional Centre in Miltonvale, P.E.I., he was released this week with help from his friends and supporters.
Among several issues swirling around Belhadj’s case is what prompted the Hillsborough Hospital to contact border officials.
“Mehdi was taken to the hospital to receive mental-health care. He was admitted involuntarily. And while he was there, under the protection of the people who were supposed to treat him and care for him, they facilitated the arrival of the Canada Border Services Agency,” said Lee Cohen, a Halifax lawyer representing Belhadj. “The whole thing is wrong and has failed Mehdi. It’s a warning to other people, particularly foreign nationals in Canada with a temporary status, that if you’re in need of mental health care, you better think carefully before you access it.” Citing patient privacy, the provincial health authority that oversees the 69bed psychiatric hospital declined to comment on the specifics of Belhadj’s case, but said it would not contact the border agency in such circumstances without being requested to do so by a patient.
Governed by privacy legislation, health professionals are prohibited from revealing a patient’s medical and health information without the individual’s consent.
“Health-care facilities are safe spaces for individuals. We never want people to hesitate coming for emergency care such as urgent mental health care due to fear of immigration issues being raised,” Dr. Michael Gardam, acting CEO of Health P.E.I., wrote in a statement.
Belhadj was making his own decisions and there is no protocol requiring staff to report him to border officials, Gardam noted.
“Situations where border services are contacted are rare and done at the request of the individual.”
His lawyer maintains Belhadj has no recollection of giving his consent, nor was he in any mental capacity to do so without legal representation.
“There’s no reason to think that Canada Border Services Agency would have got involved in this guy’s life. They wouldn’t have known about him,” Cohen said.
Under Canada’s immigration law, a foreign national who has already been authorized to enter the country can be deemed inadmissible after the fact on medical grounds if their health condition might reasonably be expected to cause “excessive demand” on health or social services.
However, the rule is generally not proactively enforced unless a health condition is being identified during a medical exam of a foreign national before they come to visit, work or study in Canada or when they apply for permanent residence from within Canada.
Documents filed at Belhadj’s detention reviews show he’d had five prior admissions since mid-2020 to the hospital for acute psychotic episodes — and 14 unpaid invoices of medical bills. Born and raised in Saudi Arabia to Tunisian parents, Belhadj came to Canada in 2012 as an international student.
He began having mental health problems during the pandemic, says Sobia Ali-Faisal of a P.E.I. advocacy group, who has known him for two years.
It took him longer to finish his education because his studies had been interrupted by the loss of his family members and some financial issues, but AliFaisal said Belhadj had always maintained his legal status in Canada.
His study permit expired in March 2020 but due to his mental-health struggles, he did not immediately apply for his postgraduate work permit within the stipulated 90 days upon his graduation.
However, due to the COVID-19 pandemic, Ottawa eased the rules and gave international graduates stuck in Canada until Dec. 31 to apply for the work permit, Ali-Faisal said. Belhadj did that and is still waiting for a decision on the application.
“It was right after May of last year when his mental-health struggles began. We saw him in those states of psychosis. He was talking to himself mostly and kind of lost in his own head, hearing voices,” said Ali-Faisal of BIPOC USHR, which stands for Black, Indigenous People of Colour United for Strength, Home, Relationship.
“We really worried about his own safety because he lived on his own and we were quite concerned that he might end up hurting himself by accident. So that’s when the wellness checks started.”
Temporary residents such as international students and migrant workers don’t lose their health coverage in Canada while on “implied status” waiting for an extension of their visas or transitioning to become permanent residents.
It’s not known at which point Belhadj lost his health coverage, leading, potentially, to his unpaid hospital bills.
According to submissions to the government tribunal presiding over Belhadj’s detention reviews, a border agent met with a psychiatrist at Hillsborough Hospital as early as July 21, a week after his admission.
In a letter, Dr. Michael Eleff said the patient was diagnosed with a severe schizophrenia with paranoia and disorganized thought disorder.
“Despite the use of some street drugs in the community, that even in hospital he continues to remain floridly mentally ill and is unable to manage outside of hospital at this point,” wrote Eleff.
“He’s simply too unwell and lacking in insight, judgment and impulse control to live outside of the hospital at this point.”
On Aug. 3, the border agency issued an inadmissibility report against Belhadj concluding that his prognosis has been considered “poor,” his recurrent hospital admissions were expensive and the nature and severity of his schizophrenia would be expected to cause “excessive demand” on health and social services. The annual threshold for that determination is set at $21,798.
In a notice issued for Belhadj’s arrest and detention at the hospital on Aug. 13, a border agent said the man breached the immigration law and had allowed his status to expire for more than a year.
“Mr. Belhadj is destitute and without any place to reside. Friends are no longer able to board him because of behavioural issues,” wrote the agent, adding that the border agency was making an effort to explore alternatives to detention, including accommodation at two facilities.
“Belhadj is ... unable to afford a phone, so telephone reporting does not seem to presently be an option.”
The agency recommended that Belhadj was better to be held in isolation at the provincial jail than released into the community.
Ali-Faisal, who has called authorities to conduct wellness checks on Belhadj in the past, said she can’t fathom why her friend is being treated as a criminal rather than for his mental health.
“We do want to know why the Canada Border Services Agency would even be considered as an institution to contact for a patient who is in a psychiatric hospital involuntarily like that,” she said.
Ali-Faisal said Belhadj would be deported to Tunisia, where he only visited twice in his life, because his residence in Saudi Arabia was based on the employment of his father, who died two years ago. As an adult now, he needs an employer to sponsor him to stay in Saudi Arabia or be sent back to Tunisia, where he has one sister.
At a detention review this week, the man’s lawyer told the tribunal his client had filed a refugee claim Monday, which will essentially derail Belhadj’s admissibility hearing scheduled next Tuesday because his asylum bid must be dealt with first.
Despite concern raised over Belhadj being a flight risk, tribunal adjudicator Cristian Jadue was satisfied with the release plan put forward by his supporters to provide him fixed accommodation, 24-hour supervision and a $5,000 bond, as well as ensuring he attends to all required medical treatment.
During the detention review hearing, Belhadj’s designated representative, Julie Chamagne, who was appointed by the tribunal out of concern for his mental capability to make decisions, said she worried for the effect of continued incarceration on the man’s well-being.
“Detention in many cases exacerbates people’s mental health issues,” said Chamagne. “Keeping Mehdi detained on the pretense that it’s in his best interest is really a paradox.”
In light of this case, Health P.E.I.’s Gardam said it’s important to review what services are provided to non-Canadian residents who do not have health insurance when authorities cannot deny them emergency care or emergency admissions.
“The image of a person of colour leaving a health-care facility to go into the custody with CBSA is alarming for marginalized and racialized communities,” said Gardam, who was chief of staff at Toronto’s Humber River Hospital and an outspoken ally about issues of racism.
“Even though in this particular case Health P.E.I. did not do anything inappropriate or against the wishes of the patient, the perception that is being shared in social media deters individuals from seeking care and is detrimental to the relationship between individuals and the health-care system.”