CAMH's Queen St. W. centreArantxa Cedillo for The Globe and Mail
An Ontario board that oversees mentally ill offenders has criticized Toronto's Centre for Addiction and Mental Health for not providing notification that it had isolated a troublesome patient in a seclusion cell for two months.
The Ontario Review Board said that CAMH failed in its duty to inform the board within seven days that the patient, Melville Ince, 49, had been isolated in a remote area.
Mr. Ince's lawyer, Anita Szigeti, said the case harks back to a bleak period several decades ago when mentally ill people were treated like pariahs who had no rights.
"If my client had died during his ordeal, there would have been an inquest," Ms. Szigeti said in an interview. "We would have seen that CAMH, the largest psychiatric hospital in the country, had done everything it could to obstruct the fact of this big, poor, mentally ill black man's seclusion from coming to light."
CAMH maintains that Mr. Ince was put in seclusion because he presented a danger to staff and other patients.
Sandy Simpson, director of CAMH's law and mental-health program, said in an interview that the hospital did not inform the review board of its action because it was unclear in law that it was required to do so.
"Sometimes we were [informing them], and sometimes we were not," Dr. Simpson said. "The board has clarified that they feel it was reportable, and that it should have been. They criticized us for that. We accept that is the case and we will do so regularly, henceforth."
Dr. Simpson said that about a half-dozen patients such as Mr. Ince are secluded for lengthy periods at CAMH each year, but this is considerably less than at many other mental hospitals.
"They need careful management and care and nursing for periods of time away from the general body of the ward," he said. "They are few in numbers, but it is crucial that we do them well because of the risks they are posing to themselves and to other people."
Mr. Ince, who has been in and out of mental hospitals regularly, was sent to CAMH after being found not criminally responsible on two charges of sexual assault and uttering death threats during incidents at Toronto's St. George subway station. In separate incidents on the same day, Mr. Ince grabbed women, got on top of them and sexually groped them while brandishing a 13-inch stick.
Ms. Szigeti said that courts have repeatedly stressed that offenders found not criminally responsible are sick people who must be treated as humanely as possible. She said that seclusion is a profoundly unsettling experience for anyone.
"There is a soiled mattress on the floor; one that other patients in seclusion before them had urinated and defecated on," Ms. Szigeti said. "There is nothing to do and nobody talks to you. You feel hopelessness and despair because you don't know when, if ever, it will end. You are utterly helpless and powerless."
At an ORB hearing into Mr. Ince's case last month, a lawyer for the Ministry of the Attorney-General, Michael Feindel, criticized CAMH for deciding "behind the scenes" that Mr. Ince could be treated in an inhumane manner without notifying the ORB.
In its report issued after the hearing, board member Janet Leiper expressed skepticism as to why Mr. Ince had been placed in seclusion in the first place.
"The evidence was short on detail about the times and rationale for Mr. Ince's days in seclusion," she wrote. "The hospital report describes periodic emotional outburst and the throwing of items from time to time in the seclusion room, but it is thin on detail of why the need for this degree of restriction was required to ensure the safety of co-patients on a secure forensic unit with a high staff-to-patient ratio."
The board ordered CAMH to inform it if Mr. Ince is placed in seclusion again.
"Psychiatric hospitals are no longer meant to have carte blanche to do as they wish with the lives and bodies of mentally ill people detained by them, without oversight and public scrutiny, yet this is exactly what happened in this case," Ms. Szigeti said.