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Mental illness <span></span><br>

Family members of adult patients have expressed frustration at being excluded from the treatment process. But care providers have insisted they are bound by privacy laws. Andrea Woo reports on the divide – and possible solutions

Eddie Young.

Eddie Young.

Courtesy of Kim Young

All was normal when Eddie Young stopped by his mother's home two Fridays ago: He took the dog for a walk, had some food, caught up on Game of Thrones. He helped himself to a bowl of ice cream to satiate the sweet tooth he'd had since childhood.

The 38-year-old had fallen upon hard times recently, in part due to mental-health issues exacerbated by his father's death seven years ago, said his mother, Kim Young. He used drugs, lived on limited means from disability cheques and alternated between sleeping at his mother's home and at those of friends. But Ms. Young had just secured an apartment for him; its refrigerator was already stocked. On that day, everything seemed good.

But three days later, Mr. Young appeared at his mother's door again, beaten and dazed. Two days after that, he was dead.

The Fraser Health Authority is now reviewing the death of Mr. Young, who was admitted to Burnaby General Hospital for mental health reasons early this month and who died by suicide upon discharge two days later. Ms. Young says she told hospital staff her son was suicidal and had repeatedly requested they contact her before he was discharged, to no avail.

Kim Young attends a vigil for her son, Eddie.

Kim Young attends a vigil for her son, Eddie.

John Lehmann/The Globe and Mail

The death shines a light on the intersection of safety, privacy and personal freedoms in the treatment of people with mental illness. Family members of adult patients have expressed frustration at being excluded from the treatment process and other relevant communications. Care providers have insisted they are bound by privacy laws.

But mental health experts say those laws can be revised to allow more clarity and better care without privacy violations.

It is a complex issue that comes up with some regularity. An inquest into the deaths of three people who had recently left Abbotsford Regional Hospital, where they had been admitted for mental health issues, was scheduled to start next week, but has been postponed.

When Mr. Young showed up at his mother's house the second time, he told her he had been drugged and robbed on Vancouver's Downtown Eastside, Ms. Young said. He was largely incoherent, and his arms were covered in bruises.

"I took one look at him and I knew that to be true," she said. "I said, 'Come on, we're going to the hospital right now.'"

Ms. Young says her son was admitted to Burnaby General on a Monday morning. When she phoned the hospital the next day, hospital staff told her he had been assessed by a physician and she could pick him up. When she told them he had mental-health issues and had threatened to harm himself, hospital staff told her he would be kept under the Mental Health Act and assessed by a psychiatrist.

When she called back on Wednesday, Ms. Young said, staff told her he was being assessed and to phone back. Throughout, Ms. Young insists she made repeated requests for the hospital staff not to discharge her son without notifying her.

"I phoned back at 1 o'clock: 'How's my son?'" Ms. Young said. "[They said:] 'Oh, the psychiatrist just looked at him. We gave him a bus ticket and he just left.' That was 1 o'clock; he was dead at 2. He took the bus from Burnaby hospital and went straight to the bridge and killed himself.'"

These events could not be independently verified. The Fraser Health Authority, which operates Burnaby General, declined to comment on specifics of Mr. Young's case, saying only that a review is under way. However, chief medical health officer Victoria Lee has been quoted in news reports as saying the health authority's policy is to ask patients if they would like staff to notify their loved ones and that staff followed Mr. Young's wishes.

Kim Young during a vigil for her son outside the Burnaby General Hospital on May 9, 2016.

Kim Young during a vigil for her son outside the Burnaby General Hospital on May 9, 2016.

John Lehmann/The Globe and Mail

Ms. Young says it was clear her son was not of sound mind, so she should have been involved in his treatment and discharge.

Nigel Fisher, program medical director and regional department head of mental health and substance use at Fraser Health, said patients' outcomes tend to be better when family is involved, and that most patients consent to their involvement. However, when they do not, staff will disclose patient information to family only when there is an "immediate and significant risk" to the patient's health.

"But if we thought that was the case," Dr. Fisher said, "we wouldn't be discharging someone."

In other words: A person deemed fit for discharge is no longer considered an immediate or significant risk, which means family members are not typically notified if the patient does not want them to know.

Caution is important. For patients with an abusive home situation, for example, upholding such privacy is key. But the same rules create obstacles in other circumstances.

Dr. Fisher pointed to B.C.'s Freedom of Information and Protection of Privacy Act (FIPPA), noting that while significant efforts are made to engage the patients and involve family when possible, "the rules for confidentiality are quite high."

However, Gerrit Clements, a long-time health lawyer and teacher who has advised B.C. health authorities on the Mental Health Act, believes the handling of patient information under FIPPA is not overly restrictive, just unclear.

Because it is open to interpretation, there will be inconsistencies across hospitals, Mr. Clements said.

The section that states that a public body may disclose personal information "so that the next of kin of an injured, ill or deceased individual may be contacted," for example, is currently interpreted as permission to notify family that a person is in hospital, Mr. Clements said. He said the law should be amended to clarify that the body can disclose detailed information if it will help family care for the patient.

"Also," Mr. Clements said, "I am sure that if the patient says no, disclosure does not happen."

Elizabeth Denham, B.C.'s information and privacy commissioner, confirmed that there is discretion in privacy law and said that common sense and good faith should guide the disclosure of personal information to family or other loved ones in compelling circumstances that affect a person's health and safety.

The call for improved family involvement in mental health cases is not new. After the 2008 suicide death of a Mission man diagnosed with schizophrenia at what was then Matsqui-Sumas-Abbotsford General Hospital, a coroner's inquest recommended legislative changes that would, at a psychiatrist's discretion, allow family members access to information, diagnosis and inclusion in the treatment plan.

Ana Novakovic, a program and development co-ordinator at the B.C. Schizophrenia Society, has said that while it is encouraging that such inquests are being held, "it does bring into question the usefulness of the inquest and recommendations if you can see the same ones over and over again without concrete changes being made."

No one from B.C.'s Ministry of Health or Ministry of Finance, which is responsible for FIPPA, was available to comment on past recommendations or potential changes to the legislation. However, the government does acknowledge that clarity is needed.

A statement provided by the Health Ministry's manager of media relations, Kristy Anderson, said the ministry is looking into streamlining B.C.'s health information policies.

"B.C. has about nine separate pieces of legislation and many regulations dealing with the protection and storage of health information. That makes for a confusing and complex system, more prone to misunderstandings and mistakes," the statement read. "In her report of April 2014, [Ms. Denham] also called for comprehensive information standards, with consistent rules for public bodies, such as hospitals, and private ones, such as doctor's offices. We're in the process of creating this framework."

At least one health authority has taken steps to clarify privacy rules regarding mental health patients in its own guidelines. According to Vancouver Coastal Health's family involvement policy for mental health clients, care providers can share some information even if the client asks them not to. This includes information "on a need-to-know basis to prevent harm to a client's health or safety, or the health or safety of others."

If a clinical team cannot reach a decision, it can consult a risk-management department or an ethics committee, said Monica McAlduff, VCH's operations director of mental health and addictions for Vancouver Community.

As well, Ms. McAlduff said a working group of family and consumer representatives, mental-health teams, police and others developed a new mental-health and addiction "communication protocol" last fall.

This protocol includes check lists for a client's arrival, admission and discharge; the discharge check list includes providing emergency contact information and referrals for follow-up services to the client and the family, often an appointment date for a follow-up visit, and prescriptions to cover oral medications until then. There are quarterly audits to ensure this happens with every mental health discharge, Ms. McAlduff said.

Ms. Young, who is planning for her son's funeral next week , said she hopes his death draws attention to what she feels is a broken system. "They dropped the ball. They most definitely dropped the ball," she said. "My one wish is that awareness gets out so that not one more person commits suicide."

Parents share the stories of three adult children who died by suicide shortly after leaving hospital:

Stephen Kennedy-Pannett.

Stephen Kennedy-Pannett.

Courtesy of Jackie Kennedy-Pannett

Stephen Kennedy-Pannett, 20, was admitted to the University Hospital of Northern B.C. as an involuntary patient in August, 2010, during a struggle with severe depression and psychosis, said his mother, Jackie Kennedy-Pannett. Alarmed that their son spoke of harming himself, the Kennedy-Pannetts say they requested pre-discharge meetings with a psychiatrist and social worker.

About a week after admission, Mr. Kennedy-Pannett phoned home and asked to be picked up. His mother initially thought he had a day pass; she soon realized he had, in fact, been discharged. The requested meetings had been "completely denied," Ms. Kennedy-Pannett said. Her son had no keys, phone, money or medication with him when he left the hospital. The Kennedy-Pannetts say they received no discharge notes or care instructions.

"It was a ridiculous situation," Ms. Kennedy-Pannett said. "In the morning, he was so ill that he had to be confined against his will … and looked over by professionals. In the afternoon, we were supposed to provide the same level of care. We have no medical training, no information, no guidance, no advance notice and no access to a psychiatrist."

In the next 24 hours, the Kennedy-Pannetts made eight telephone calls – to the hospital, to a psychosis unit, to a psychiatrist – two trips to a pharmacy and one to their family doctor trying to get help for their son.

"Some people helped as much as they could, some wanted to help but didn't have the information … some just didn't phone back," Ms. Kennedy-Pannett said. "The [Northern Health Authority] Community Response Unit said they couldn't help unless we actually caught Stephen in a suicide attempt. Others refused to help, citing privacy laws."

Mr. Kennedy-Pannett killed himself two days after being discharged. "It failed at every level," his mother said.

Sarah Louise Charles

Sarah Louise Charles

courtesy of Deborah Nolet

Sarah Louise Charles, a bubbly 41-year-old mother and office worker, struggled with severe depression and alcohol dependency after several traumatic life events. In a 14-month span, she was admitted to hospital 13 times.

After harming herself in April, 2015, Ms. Charles was admitted to Abbotsford Regional Hospital under the Mental Health Act; two days after admission, a doctor noted that she should be kept for further stabilization, said her mother, Deborah Nolet. The next day, a different psychiatrist assessed her and deemed her fit to be discharged.

"That was a loophole for her to get out of there herself, when everyone there knew she was completely out of her mind," Ms. Nolet said.

The grieving mother, who tried unsuccessfully to keep her daughter at the hospital, says she should have been involved in the assessment as her daughter was not of sound mind. Instead, she says she was excluded from the process and received only an impersonal print-out of low-cost counselling options from the hospital.

Ms. Charles died by suicide at her mother's Abbotsford apartment the day after her discharge.

Brian David Geisheimer.

Brian David Geisheimer.

Courtesy of Daryl Geisheimer

Brian David Geisheimer was admitted to Abbotsford Regional Hospital as an involuntary patient in mid-December, 2014, the day before his 30th birthday. The heavy-duty mechanic suffered from severe depression and had attempted to harm himself. Nurses told his parents he was deemed high-risk and would be watched closely, his parents said.

Mr. Geisheimer, a smoker, was permitted unaccompanied 30-minute cigarette breaks and, within days, unaccompanied eight-hour day passes.

About two weeks into his stay, Mr. Geisheimer became agitated: He was verbally abusive to hospital staff and threatened to hurt himself. Despite this, his parents say, he was permitted to leave the facility for a cigarette break, during which he took his own life.

"I don't get it," his mother,

Lorraine Ross, said. "You say someone is committed, because they're in danger, and then you let them out there on their own."

Mr. Geisheimer's parents expressed frustration at being excluded from the treatment process. His father, Daryl, said he repeatedly asked for meetings with doctors. As well, they question why he was allowed to leave the premises, given his state, and wish they had been educated on how best to help their son.

The deaths of Brian David Geisheimer and Sarah Louise Charles will be the subject of a public inquest by the B.C. Coroners Service, grouped with that of Sebastien Pavit Abdi due to similar circumstances.