Anger and questions after teen in mental health crisis discharged at 3 a.m. from Abbotsford hospital

‘Had I not heard the phone ring and woken up at 3 a.m., then what?’

If you or someone you know is thinking about suicide, call 1-800-784-2433 (1-800-SUICIDE).

A young woman with a history of suicide ideation and self-harm was discharged from Abbotsford Regional Hospital at 3 a.m. in late July without ever seeing a psychiatrist, angering the person who had brought the youth to the facility just three hours earlier.

Lindsey Byrnes was at home on a Saturday evening when she received a phone call from a young woman she knew. The caller and her friend – an 18-year-old woman Byrnes also knew and whom this article will call Alice (not her real name) – had gotten drunk and begun arguing. The caller said Alice had begun acting erratically and impulsively, which isn’t uncommon when she had had too much to drink.

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 Matsqui-Abbotsford Impact Society – that the young woman wouldn’t be safe alone and was a “medium-high” risk of suicide.

The decision was made to take Alice to Abbotsford Regional Hospital. It wasn’t going to be the first time Byrnes had helped a teen in crisis get help at ARH. Those experiences haven’t always been positive, but she says there is no other options for such people experiencing a potentially dangerous mental health crisis.

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 3 a.m., Byrnes was awoken by a phone call. She listened as Alice told her she had seen a doctor, who had then discharged her.

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, Samwel Uko, a 20-year-old young man from Abbotsford, killed himself shortly after seeking help in a Saskatchewan hospital for mental health issues.

In 2018, the BC Coroners Service held an inquest after three patients who had sought help at Abbotsford Regional Hospital committed suicide in 2014 and 2015.

“Had I not heard the phone ring and woken up at 3 a.m., then what?” Byrnes asked. “Where’s the consideration for the consequences there could have been?”

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.”

Fraser Health doesn’t comment on individual medical cases, but a spokesperson wrote that “in general, a patient who presents to a hospital with mental health concerns is assessed by an emergency department physician, who determines the treatment and care they require, which may include seeing a psychiatrist, if necessary. At some sites, a patient may be assessed by a psychiatric nurse.”

Physicians may certify patients under the mental health act if they are deemed a risk to themselves or others. Such patients, Fraser Health said, are reassesed frequently, and de-certified when they are deemed to be not at a risk to themselves or at risk of deterioration.

“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.

Anna Mehler Paperny, a Canadian journalist who recently published a book called “Hello I Want to Die Please Fix Me: Depression in the First Person” about her own attempts at suicide and struggles with the mental health system, says it’s vital that mental health patients are treated seriously and compassionately when they seek help. If they don’t, patients won’t get the help when they’re most vulnerable. And the health care system will miss the best chances it has to help those entrusted with its care.

“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. Abbotsford’s emergency room now includes a specialized area for mental health and substance use patients. That area is intended to make the hospital more welcoming and comfortable for people with mental health and/or addictions.

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 Fraser Health and doctors groups has lacked urgency since she began voicing her concerns a month ago. Byrnes complained to Fraser Health, the College of Physicians and Doctors of British Columbia, and the local Division of Family Practice. But she hasn’t heard anything since the first week of August, when those groups acknowledged receipt of her complaints.

The website of Fraser Health’s Patient Care Quality Office says it can take up to 40 business days – nearly two months – before it provides any information about what it has done to respond to a complaint.

• • • • •

Four years ago, a Coroners Inquest was held into the deaths of three people who took their lives after having left Abbotsford Regional Hospital in 2014 and 2015. The jury in the inquest made 25 different recommendations for health authorities, and the provincial and federal governments.

Fraser Health says it has undertaken a range of changes since that inquest. Those include the construction of a mental health zone at ARH, a review of suicide risk management guidelines. Upon discharge from hospital, Fraser Health says admitted mental health patients are “connected to community-based supports if they need them.” Fraser Health says it also has “implemented a unifying clinical information system that enables staff to access information on patients in hospital and community settings.”

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