TORONTO Mental health workers should avoid using physical restraints to control combative patients and adhere to far stricter standards when there is no other option but to use them, a coroner's jury recommended yesterday.
Restrained patients also need faster assessment and closer medical monitoring than that afforded Jeffrey James, a 34-year-old schizophrenic who died at Toronto's Centre for Addiction and Mental Health in 2005, after five days strapped to a bed.
The recommendations, among 65 presented in a Toronto coroner's court, are aimed at preventing the kind of fate that befell Mr. James moments after CAMH workers freed him. He collapsed and died of a pulmonary thromboembolism, a particularly deadly type of blood clot produced by the constricting effects of the restraints, the four-week inquest heard.
The five jurors also heard that Mr. James rarely got to see his doctor during his 58 days at the CAMH, and waited an “extreme” amount of time – a full month – for his first one-on-one psychiatric consultation upon arrival from a maximum-security facility in Penetanguishene.
They called for patients to be “provided a full psychiatric assessment … within 24 hours of admission or transfer,” and said “this should never extend beyond 72 hours” if an assessment must be put off due to a weekend or holiday.
Ontario should also expand and strengthen the role of patient advocates, the jury said. The Psychiatric Patient Advocate Office, an arm's-length agency of the Ministry of Health, should be overhauled to give it stronger governance and greater independence from the government, and should be available to patients 24 hours a day, seven days a week, rather than the current Monday to Friday from 9 to 5.
“It was a very satisfying verdict,” Jennifer Chambers, co-ordinator of the Empowerment Council, an advocacy group for CAMH patients, said outside Coroner's Court on Grosvenor Street. “I think that the coroner and the jury made recommendations that are going to save lives.”
By calling for mandatory inquests when a patient under restraint dies, the jury has likely ensured that their recommendations will be implemented not just at the CAMH, but across the province, said Anita Szigeti, lawyer for the Empowerment Council.
“All the other psychiatric hospitals will know that the coroner's office intends to call an inquest into every physical restraint death,” Ms. Szigeti said. “So, if I were one of the other psychiatric facilities, I would hate to prepare and participate in an inquest where these recommendations had come out prior to that death, and not have implemented those recommendations.”
At the CAMH, Canada's largest mental hospital, internal discussion and changes undertaken after Mr. James's death and another restraint-related fatality have already led to a drastic drop in their use, said Gail Czukar, an executive vice-president and general counsel.
“We came here to learn, to find out what we could do better, and we have started to do that,” Ms. Czukar said. “We've reduced our use of restraints from the last three years by 67 per cent, so we're not restraint-free yet, but we've certainly made significant progress towards that.”
Vahe Kehyayan, director of the Psychiatric Patient Advocacy Office, said he welcomed the jury's call on the Health Ministry to beef up his agency's role in looking out for people like Mr. James.
“We're hopeful that the ministry will consider a more independent PPAO and one that has also a broader mandate,” Mr. Kehyayan said.
During the inquest, the jury heard that Mr. James had a mental illness that made him believe he would be harmed unless he sought sexual favours. He was restrained at the CAMH after refusing to stop masturbating near a nurses' station.
He had a criminal record for violence and was transferred to the CAMH after a stint at Penetanguishene, where he had been sent after he was found not criminally responsible for sexual assault.
Members of his family did not attend the inquest, nor was any photograph of him shown at the inquest, despite Ms. Szigeti's wish that one could have been introduced.
“It's easy to assume that [psychiatric patients] are all ‘others,' or raving maniacs that you can't relate to who deserve to be tied to a bed,” Ms. Chambers said.
“I think if [the public] see people who have actually been in the system, and understand that one out of five people in Canada actually gets a mental health diagnosis in their lifetime, they realize it could be them, it could be anyone they love.”