30% of Vancouver police calls involve people who have fallen through cracks of health-care system. People like Corey O'Brien
Column by Pete McMartin
Vancouver Sun
February 2, 2008
CREDIT:
Corey O'Brien as a young teenager. He suffered from a debilitating mental illness that led to his suicide in 2006 despite the efforts of the Vancouver Police Department to help him.
VANCOUVER - It's shocking and tragic and stomach-churning. It's an indictment of a mental health system unable to help those who need it most. It also may be the most powerfully written document ever to come out of the Vancouver Police Department.
A new groundbreaking report done by the VPD - released to The Sun Friday - painted a portrait of a police force overwhelmed with the needs of the mentally ill because the mental health system was failing them.
It's graphic stuff. More than a dry recounting of systemic failures, the report incorporates horrific stories of the mentally ill who have fallen through the cracks - the hardest to house, the violently schizophrenic, the addicted. The stories of people living in human filth, or of being driven to suicide, are not for the tender-hearted.
The report, the first of its kind in Canada, found that over 30 per cent of police service calls city-wide involved the mentally ill, with that number approaching 50 per cent in some neighbourhoods.
Those figures are definitely on the conservative side, VPD personnel say, since they represent only those calls that were recorded in the report's research.
The report, written and researched by Det. Fiona Wilson-Bates of the VPD's Special Investigation Section, is entitled (a little wordily) Lost In Transition: How a Lack of Capacity in the Mental Health System is Failing Vancouver's Mentally Ill and Draining Police Resources.
Six months in its research and writing, the report quantifies for the first time exactly how much of the VPD's resources are consumed by dealings with the mentally ill.
Its genesis came about after a spate of suicides and disturbances involving the mentally ill early last year. These incidents caught the attention of the VPD command.
Were these statistical anomalies, they wanted to know, or typical? What caused them? How much time and resources did police have to devote to service calls involving the mentally ill?
Wilson-Bates, a bright young officer who had served in the Downtown Eastside, was given the job of answering them.
She started trying to compile data by analyzing dispatch calls, which proved impossible. Those calls often gave no hint that a person with mental illness was involved.
So she randomly selected two officers from each of the city's 44 patrol squads, and instructed them to fill out cards for every service call they attended, and mark on those cards "when the incident involved one or more people whose mental health was a contributing factor in police attendance."
This methodology required some assumptions on the VPD's part, most especially that police, better than most, can recognize when mental illness plays a role in a service call.
"It was . . . assumed that the officers who carried out the data collection had the personal and professional experience necessary to make accurate determinations of mental health involvement in the calls they attended."
"After all," Wilson-Bates said in an interview Friday, "our officers are trained in this, and run into it daily, and under the provisions of the Mental Health Act, we are placed in the position of having to determine if people should be apprehended because their mental illness may prove a danger to themselves or others.
"And let's be clear, these cases we're talking about are - as I instructed the officers and as I say in the report - must be 'readily apparent and would likely be obvious to any lay person.'"
(An alarming figure that gives a graphic sense of the rise in mental-illness-related calls to the VPD:In 1999, there were 360 incidents when an individual was arrested under provisions of the Mental Health Act.
In 2007, there were 1,744.)
The data collection for Wilson-Bates' report took place over a 16-day period from Sept. 9, 2007 to Sept. 24.
In total, officers recorded 1,154 calls.
City-wide, data showed 31 per cent of the service calls "involved a person who the attending member believed was suffering from poor mental health to the extent that a police response was required."
District-wide, there were differences. In District 2, which includes the Downtown Eastside, 42 per cent of calls involved the mentally ill. In District 1, the downtown peninsula, it was 30 per cent. In District 3, east Vancouver, it was 20 per cent, while in District 4, the west side, it was 26 per cent.
But those percentage numbers are even higher when the VPD factored in only contact calls, those calls in which police actually made contact with an individual.
City-wide, that average came to a whopping 36 per cent, or over one-third of all police calls.
"What is clear," the report states, "is that an alarming percentage of all police calls that patrol officers currently attend in the city of Vancouver are in response to people in mental health distress. This fact is supported in current literature where it is widely accepted that 'the police are, by default, becoming the informal "first responders" of our mental health systems' (Canadian Mental Health Association BC division, 2003, p. 5)."
In effect, Wilson-Bates asserts, police have become the keepers of the asylum, and our jails the new Bedlam.
The cost of this is enormous, Wilson-Bates said, and she calculated that almost 154,000 police hours would be required to deal with such cases annually, or the equivalent of 90 front-line officers working full time. The direct wage cost for those officers would be $9 million, but that does not include ambulance, hospital or court costs, or costs related to stolen property or lost productivity.
As contributing factors to this dysfunctional state of affairs, Wilson-Bates cites what is now a litany of causes:
The historical deinstitutionalization of long-term health care; the subsequent lack of such long-term care in the Lower Mainland; an overcrowded and overburdened hospital system in which mentally ill patients are shuttled in and out of emergency care daily; a lack of supportive housing; a shocking lack of care for dual-diagnosed patients who are both addicted and mentally ill; a Mental Health Act that makes it difficult to get the mentally ill off the streets and into extended care (giving a whole new meaning to the phrase "right to die"); and an almost complete lack of information sharing on patients' medical histories between hospitals and health officials.
The result: A revolving door that spews the worst cases back out on the street - about 2,100 individuals, Vancouver Coastal Health estimates, with no permanent housing and who "exhibit behaviour outside the norm."
One of the several cases Wilson-Bates cites: "Bill Taylor" - a fictional name used to protect his identity.
"Bill lives in the Downtown Eastside. He is a crack cocaine addict and is diagnosed with both schizophrenia and bipolar disorder. In 1977 Bill was found not guilty by reason of insanity for attempting to kill someone in Victoria. He spent 10 years in a psychiatric facility as a result of this incident and was then released onto the streets of New Westminster where he wreaked havoc until 2003 when he moved to Vancouver."
Between 2003 and 2007, she reports, Bill notched up 145 documented incidents with police.
Disabled, and with a personality disorder, he often waits outside the VPD jail and assaults passersby in an effort to get arrested and get put in a cell. He's banged on cars at street lights, shouted obscenities, exposed himself and urinates regularly in the lobby of the building he's housed.
A calendar recording Bill's involvement with the law is thick with dates of those days he spent shuttling between jail and the psych ward.
"But you know what's interesting?" Wilson-Bates said.
"What's interesting is the time he's spent released out on the street, not the time he's spent in custody."
The report has gone to the provincial government. VPD deputy chief Doug Lepard, who edited the report, said the VPD has had meetings with several provincial ministers who had been shown the report.
"And to be fair to them," he said, "they really expressed a desire to fix these problems. So we're very hopeful something might be done to do that soon."
Wilson-Bates made the following recommendations in her report:
- Open a mental health facility that can accommodate moderate to long-term stays for those with chronic mental illnesses.
- Create an "urgent response" centre where patients can be assessed and triaged according to their needs.
- Increase services for those dual diagnosed with a mental illness and substance abuse problem.
- Provide additional supportive housing in Vancouver.
- Streamline the admission process at St. Paul's and Vancouver hospitals for police officers who have arrested someone under the mental health act.
- Collect more data on all police calls related to mental health issues to fuel further research on the topic and track change.
On Monday, The Sun will look more closely at the recommendations and have provincial Health Minister George Abbott's response to them.
Also on Monday, the VPD will make available on its website -
www.city.vancouver.bc.ca/police/ - a copy of the report where members of the public may read it.pmcmartin@png.canwest.com or 604-605-2905
Mental health horrors
How the system failed Corey O'Brien
Lori Culbert and Pete Mcmartin
Vancouver Sun
Saturday, February 02, 2008
Kate O'Brien remembers her son Corey as a "dream to raise," a smart, thoughtful, polite child who was a gifted athlete musician and artist.
In school in Abbotsford, he was on the honour roll, won national awards for work in animation, and created a web development business.
Upon graduation, Corey was courted by University of B.C. to play for its varsity rugby team but, instead, took a job with an animation firm, Electronic Arts.
At the age of 17, he had a dream life.
It began to unravel three years later when, in September 2001, he suddenly quit his job and moved home.
"He was such a completely normal person until he was 20, and within 11/2 to two years he was completely psychotic. He lost his work, he lost his friends," his mother said in an interview Friday.
Corey was trapped in the revolving door of B.C.'s mental health system before and after being diagnosed in 2004 with schizophrenia. In the most tragic of endings to a life that began with such promise, Corey killed himself by jumping off the Granville Street Bridge in 2006.
A new Vancouver police report, entitled Lost in Transition: How a Lack of Capacity in the Mental Health System is Failing Vancouver's Mentally Ill and Draining Police Resources, says Corey's story illustrates the problems police witness daily with the "profound lack of capacity in mental health resources."
"Corey would want his story to be told if he thought it would help other people. So I guess that's why I'm willing to talk about this," said Kate O'Brien.
"I think there were so many smart and caring people in the mental health system and the VPD who tried to help Corey, so I have nothing but respect for people who try to help the mentally ill."
However, she feels the system itself is dysfunctional, that longer-term care is needed and a rewritten Mental Health Act that doesn't make it so difficult for relatives to get help for loved ones.
The details of Corey's heart-breaking life are spelled out over six pages of the lengthy police report.
After Corey moved home, O'Brien and her partner, Craig, encouraged him to see a doctor for what they figured, at first, was depression. He refused. He ping-ponged between his own apartments and his mother's home.
In November 2002, O'Brien "walked into a nightmare" when her son's landlord in Abbotsford phoned to complain that he had trashed his apartment.
"There were disturbing drawings all over the walls, window coverings torn down, walls kicked in, mirrors smashed and food smeared on the floor," the report said.
Corey was released from police custody without the mental health assessment O'Brien had begged he receive.
Unable to live at home because of his erratic behaviour, Corey bounced from hotels in Langley to Surrey to Vancouver.
Finally, in January 2003, after Corey refused to pay for a restaurant meal, he spoke to a mental health nurse who worked with Vancouver police. However, he didn't show up the next day for an appointment at a mental health clinic -- and his file was automatically closed.
He would eventually end up on the streets of Vancouver, and although he had contact with police, he did not meet the threshold for being detained under the Mental Health Act. He would finally be admitted into a psychiatric unit in December 2003, where toxicology tests confirmed he was not a user of illicit drugs.
He was diagnosed with schizophrenia and discharged in January 2004 after some of his "psychotic symptoms" and "auditory hallucinations" had eased.
For the most part, 2004 was a time of "great hope." Corey was attending mental health programs, and took his medication.
However, by February 2005, O'Brien says she became alarmed at Corey's state, but mental health professionals thought he was fine. No one knew at the time he had stopped taking his medication.
Finally, in March 2005, Corey was involuntarily admitted under the Mental Health Act to Royal Columbian Hospital. He became "very hostile and argumentative," and was in and out of the psychiatric ward until June 21, 2005, when he was released for the final time.
He had sporadic interactions with mental health professionals that year, and O'Brien continued to raise concerns, including in December while he was home for Christmas.
"He was clearly suffering from hallucinations and paranoid thoughts, believing that military aircraft were surveilling him and that mathematical equations would help him get better," the report said.
O'Brien phoned Corey's doctor, but after an appointment the doctor noted that Corey "was neatly dressed and groomed and was wearing stylish casual clothing" and that "he denied any paranoid thoughts."
O'Brien continued to raise concerns, but was repeatedly told by professionals that her son was fine. After she complained Jan. 30, 2006, that her son had threatened her, she said a warrant was finally executed for Corey to return to St. Paul's.
However, he was released from hospital the next morning. A toxicology test revealed he had cocaine and pot in his system.
She was promised Corey's medication would be reviewed, but that did not happen.
A short time later, in November 2006, Corey stabbed himself in the stomach. Despite pleas from O'Brien to keep Corey in hospital, he was released after a four-night stay.
"Only four days after being released from hospital, at 8:26 a.m., Corey was seen jumping from the west side of the Granville Street Bridge" the report says. "He landed on the roadway below, was transported to Vancouver General Hospital and died a short time later from his injuries with his mother at his side."
O'Brien would later find a suicide note in his room.
"Kate believes that if Corey had been institutionalized for a number of months his medication could have been stabilized and he could have spent time learning how to cope with his illness," the report says.
"Further, a program of reintegration that started with housing and involved closely monitored care along with administered medication may have resulted in Corey again becoming a functioning, contributing member of society."
© The Vancouver Sun 2008
