Three patients treated at St. Paul's Hospital (Vancouver) stabbed elderly people following discharge

July 28, 2014

VANCOUVER -- St. Paul’s Hospital in Vancouver is defending its record for treating psychiatric cases, even though three recently discharged patients have been arrested for violent crimes in the last year.

The downtown hospital released recommendations Thursday from an internal review that was launched after 35-year-old Nicholas Osuteye of Alberta was charged with three counts of attempted murder for his alleged attacks on women aged 63, 79 and 87 last December. He had seen emergency room doctors at St. Paul’s two days earlier after asking police for help.

The latest review follows a more sweeping, independent report prompted by attempted-murder charges against Mohamed Amer, who allegedly stabbed a 71-year-old man in a café on Feb. 21, 2012. The homeless man, 30 at the time, had been taken to St. Paul’s by police for assessment under the Mental Health Act twice that day, but was released both times.

Then in January of this year, a stabbing spree in a West End apartment building resulted in French national Jerome Bonneric, 33, being charged with 12 counts of assault. Bonneric’s lawyer has said his client suffers from mental health problems and had been to St. Paul’s shortly before the attack.

But Dr. Maria Corral, head of psychiatry at St. Paul’s, said the hospital has far more success stories than tragic ones.

“There are many ways to treat psychiatric illness and mental illness problems,” she said in an interview. “By far the most common and effective is to treat them in the community by outpatient means. We had 4,500 psychiatric patients (through the emergency department last year) ... the majority of those patients are managing very well in the community as our neighbours, our friends, our brothers, our mothers.”

She emphasized that hospital staff will hold anyone — even against their will — if they are considered a threat to themselves or others. St. Paul’s has 60 beds in its psychiatric ward and a four-bed secure observation unit in the emergency department.

The hospital serves Vancouver’s Downtown Eastside and a larger than average number of people who have mental health problems, drug addiction, low incomes and inadequate housing.

“I want to assure the public that I’m very confident in our treatment team and in the processes we have in place to deliver safe psychiatric care to all the patients who visit St. Paul’s,” Corral insisted.

But Darrell Burnham, executive director of Coast Mental Health, says that St. Paul’s has been trying to cope with a flood of psychiatric patients for years and there aren’t enough places for discharged patients to go.

“I think it’s safe to say their emergency ward is overwhelmed with the number of mental health crises it sees on a daily basis and this has been going on for many years, at least 12. They’re in the unenviable position of deciding who is the most in need today ... Every once in a while, despite their best efforts, they’re going to make that call wrong.”

Coast Mental Health is a not-for-profit charity that runs group homes and supported living apartments for about 800 people in Vancouver. While more spaces are being created for mentally ill people to get help from health and support workers outside of hospitals, there still aren’t enough, said Burnham.

“It’s because Vancouver is the end of the road and it’s also because people’s living situations are less supported. There are a lot of folks coming out of SROs (single-room occupancy hotels) and shelters and literally off the street … If you’re discharging someone to a loving family to care for them that’s far better from a hospital point of view rather than discharging them to a shelter or literally to nowhere.”

All of the accused are in custody awaiting trial and no one was killed in any of the incidents.

At least one of the women beaten in December is still in hospital, as is one of the victims from the Jan. 31 stabbings, according to Vancouver police department spokesman, Const. Brian Montague.

Source: Erin Ellis, "St. Paul’s Hospital defends record after three discharged psychiatric patients arrested for violence," Vancouver Sun, March 1, 2013.

Comments
Willy Doetschmann
2014-07-28 11:28:54
What catches my attention most in this article is

1) "hospital staff will hold anyone %u2014 even against their will %u2014 if they are considered a threat to themselves or others," and they sure do, and with little to no consideration whether the drugs they give those patients (or let's call them rather prisoners)could be harmful. It was almost deadly twice for a patient I know personally.
"Considering" someone is subjective; the person's behavior or appearance could be from drug residues, side effects from drugs they gave them already - nothing objectively, scientifically stated, yet acted upon very strongly.

2) I had no idea that low incomes and inadequate housing trigger hospital interference. Is that a disorder, too, or just a reason to catch those people and "consider" them?
There isn't basically anything wrong with helping the struggling; help is so much needed, but please not with methods that I compare with having a butcher do a heart surgery that the patient's condition may not even require or allow. I wonder how they get medical clearance for certain cases.

3) Wonder how "those patients who are managing very well in the community as our neighbours, our friends, our brothers, our mothers" will be doing in 4, 8, 10 years from now.

Already in the 70s was known what's called in psychiatry the "revolving door" effect, meaning those large turning doors at some hotel entrances. In psychiatry it describes patients coming in, going out "healed", coming back in, getting out "healed", then coming back in, and so on and so forth, more and more until, like Dr. Kielholz, a psychiatry professor in Basel, my hometown, described it, "until they kill themselves at some point; nothing we can do about it." Medications in those times were laid out rather towards suicide than homicide. I lost a dear, very close family member exactly like this. "It's the illness," is a very famous phrase you hear in psychiatry to justify whatever they do. Interestingly enough, many if not most of those end-phase outburst people weren't just on psych medication or coming off it; they were also doing rather well in life until they got "considered"; which brings us to the question, "What was first, the chicken or the egg?"

A saying was also very common in my younger years, "In 19th century's psychiatry, the straight jacket was visible outside, and one could hear the patient scream and go wild; nowadays, with all the medication, the straight jacket is inside, invisible to others, and the patient's wild screams cannot be noticed anymore."

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