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Alex Malamalatabua died on the grounds of the BC Children’s Hospital after his move to community care was delayed.Ben Nelms/The Globe and Mail

A suicidal youth with a long and deeply troubled mental-health history languished in hospital for 122 days while social workers argued with his medical team about the need to take the boy into government care.

The dispute over his discharge plans ended only when the youth slipped out to a remote section of the hospital grounds and killed himself. That "unacceptable" delay in finding a safe place in the community for the young man highlights the gap in resources for youngsters with complex mental-health needs, says a new report from the province's watchdog for children and youth.

The report, titled Missing Pieces: Joshua's Story, is based on a 20-month investigation into the death of the youth, 17-year-old Alex Malamalatabua, who is not directly named in the report. The pseudonym Joshua is used. However, The Globe and Mail has reported on his story and his family's struggle to obtain support since his death in 2015.

The report by Bernard Richard, B.C.'s Representative for Children and Youth, found that Mr. Malamalatabua's story is not unique, and that other families face limited and harsh choices when children's mental-health needs exceed what their parents can provide.

Mr. Malamalatabua's mother had fought to find help for her oldest son since he was two years old. He made multiple suicide attempts and, in the spring of 2015, he fled into the woods, took a potentially lethal dose of prescription pills and drank two bottles of schnapps. A search-and-rescue team found him after two days. He had hypothermia and wounds from self-harm.

At that point, he was transferred to the the adolescent psychiatric unit of BC Children's Hospital.

His mother voluntarily put him into the care of the Ministry of Children and Family Development (MCFD) to get help for him. While he was in hospital, medical staff urged social workers from the ministry to find a supervised community facility where his chronic risk of suicide could be monitored. Social workers refused and worked instead on plans to send the youth home to his mother. That delay, Mr. Richard wrote, "only served to help MCFD avoid the responsibility and costs of appropriate services for this youth and his family."Mr. Richard noted hospital staff had been through similar battles before.

"In the current environment, parents of children with needs similar to Joshua's only have one option to access these few community-based mental health placements: putting their child in the care of MCFD. This is unacceptable, and has been allowed to carry on for far too long," Mr. Richard wrote.

The report did not find that better services would have prevented Mr. Malamalatabua's death.

"What this investigation does conclude, however, is that a truly clear and comprehensive youth mental health system would have given Joshua and his family a better chance to deal with his challenging illness."

The report makes just one recommendation, that the province establish a single continuum of mental-health services for children and youth that would span social services, health and education.

Mental Health and Addictions Minister Judy Darcy told reporters she fully accepts that "huge gaps" need to be closed, and promised to work toward the representative's target of implementing the new system within two years.

"We absolutely agree we have to collaborate … across agencies to create a seamless co-ordinated system to support youth like Joshua," Ms. Darcy said. She stressed that early intervention should be available.

The report says Mr. Malamalatabua exhibited signs of serious mental-health issues at an extremely young age. His first suicide attempt was at the age of 11. His family struggled financially – at one point living out of a vehicle – but his mother repeatedly sought help for son, even as she grappled with depression herself.

Mr. Richard, at a news conference, noted that the young man faced deep mental-health problems but should also be remembered as an intelligent, caring son who had a desire to help others. The report is meant to ensure that others don't suffer as he and his family did, he said. "It requires a plan, commitment and resources."

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