THREE years ago, a mentally ill man died in custody 30 hours after being Tasered at an HRM police station. Howard Hyde’s heart stopped and he [pictured] had to be revived. The subsequent inquiry determined that it was a restraint hold — properly applied a day later by correctional officers — which caused his heart to stop forever.
Mr. Hyde’s death could have been avoided if he had been handled differently at every turn. Many Nova Scotians still suspect the Tasering was a contributing factor.
Ironically, they might be surprised to hear that many Quebecers were left wondering last week why Montreal police didn’t Taser a mentally ill man who allegedly charged them with a knife. Tragically, the suspect was shot dead instead, and an innocent bystander was killed in the crossfire.
We do not yet know the answers to these questions. If the officers believed they were in immediate, mortal danger, they would not have reached for a (generally) non-lethal weapon. Most likely, they were not armed with Tasers anyway — the Montreal force only has 42 stun guns on hand, compared to Toronto’s 700.
The use of Tasers, especially on emotionally disturbed people, is an emotional issue. But last week, Nova Scotia contributed something useful to the debate: the voice of reason.
In becoming the first province to clarify the rules of engagement in such circumstances, Justice Minister Ross Landry has found the right balance and created a model for other jurisdictions to follow.
We agree with Nova Scotia’s new guidelines that law enforcement officers should consider whether an agitated person is mentally ill and do everything in their power to de-escalate a confrontation, before deploying a stun gun.
We further agree with the precaution — although it’s not always practical — of calling paramedics to the scene before making the call to Taser a medically precarious or disturbed individual.
Most important, police as well as correctional and sheriff’s officers in Nova Scotia will be better trained to recognize signs of a mental illness.
The Hyde inquiry made the salient point that the jail guards didn’t know how to de-escalate confrontations. Better training is certainly the key to enforcing this province’s policy of minimizing harm to the mentally ill.
(edits@herald.ca)
Anne Derrick, In the Matter of a Fatality Inquiry Regarding the Death of Howard Hyde, Report pursuant to the Fatality Investigations Act (2010).
By Kim Brooks (pictured)
Long overdue, in 2010 Canada ratified the United Nations Convention on the Rights of Persons with Disabilities. (The United States has yet to ratify the Convention.) While countries can ratify conventions at the international level, it is often the case that only in translation to our domestic, sometimes even local, contexts do we see the real effects of our commitments.
Judge Anne Derrick’s piece, a report on the death of Howard Hyde ordered by Nova Scotia’s Minister of Justice, pushes at the boundaries of what most of us would consider scholarship; yet, it is the most interesting piece of scholarly work motivated by equality considerations that has crossed my desk in the last several months. It provides a marvellous illustration of the values reflected in the Convention played out against one very specific set of facts.
Howard Hyde, who was experiencing a recurrence of his chronic schizophrenia, was arrested by the Halifax Regional Police on November 21, 2007, after assaulting his common law partner. Mr. Hyde tried to escape from the police when he was being booked. A conducted energy weapon was twice used to shock Mr. Hyde. After additional struggles, Mr. Hyde collapsed and stopped breathing. He was revived and taken to the hospital. After recovering at the hospital, Mr. Hyde was discharged once again to the police. Later in the day, he appeared in court and was remanded to a correctional facility for the evening. Mr. Hyde did not sleep that night.
On November 22, while being transported to court, Mr. Hyde attempted to escape from correctional officers. He was restrained in a cell by correctional officers and stopped breathing. He was pronounced dead at 8:43 a.m.
This is the story that gave rise to the inquiry and the subsequent inquiry report. Even in its simple telling, drawn from the Preface of the report, the terror that a man living with a mental illness must have felt through the whole ordeal, and the inadequacy of the institutional response to his needs, is apparent.
The report deserves to be read in its entirety – all 7 parts, 57 chapters, 462 pages. Rooted in the experience of one man, in one small corner of the world, the inquiry report demands broad readership.
Following a moving introduction and preface, the report reviews the factual narrative (Part II), outlines the cause and manner of death (Part III), addresses a range of issues that arise from the inquiry (Part IV), delineates the major findings (Part V), reviews changes since the time that Mr. Hyde died (Part VI), and provides for recommendations (Part VII) and a conclusion (Part VIII).
Let me highlight two aspects of the report, simply as a teaser. First, the report’s 80 recommendations are essential ground for equality scholars with an interest in policy-relevant scholarship. It might be noted that the recommendations appropriately do not focus on the assault of Mr. Hyde’s common law partner (although the need for appropriate accommodation for accused persons living with mental illnesses is underscored); rather, they are focused on the interaction between mental health and the criminal justice system. The recommendations cover everything from the importance of developing a provincial mental health strategy that ensures coordination of care, integration of services and supports, and monitors quality and outcomes (Recommendation 1) to implementing a diversion program, including pre-charge diversion, for accused persons with mental illness (Recommendation 10) to training police with an eye to the overarching purpose of the development of a culture of respect and empathy for persons with mental illness in the justice system (Recommendation 49).
Second, the report is beautifully written. Let me draw from the conclusion, which demonstrates more than ably the skill of the author and her ability to cut to the core of the issues before her:
"At an immediate, fundamental level, what Mr. Hyde needed was human contact, reassurance and kindness. The evidence discloses how well he responded, even when somewhat agitated, to simple but effective interactions that incorporated these elements. Certain police officers, sheriffs and correctional officers were all successful in their interactions with Mr. Hyde utilizing approaches that were empathetic, respectful and caring. Even though he was acutely ill, Mr. Hyde was reassured and comforted “by talking to him.”3 Understanding this is to understand Mr. Hyde’s humanity and recognize in him, ourselves." (P. 388, footnotes removed)
I might conclude just by saying, briefly, something about the value of understanding this report as a form of scholarship. If the highest calling of scholarship is to reveal the truth of the world, and perhaps further to reason about what that truth should be, then this report fits within the core of that ambition. The report contributes to our knowledge about mental illness, the interaction between human beings experiencing a form of mental illness and the criminal justice system, and the potential to recognize and appreciate the fullness of the human experience. It is, in that regard, scholarship of discovery. In addition, Judge Derrick draws together diverse strands of evidence and weaves those together analytically, in a way that demonstrates the scholarship of integration. Finally, the report’s provision of thoughtful and detailed recommendations is exemplary of scholarship of application.
The report’s conclusion section opens with a quote from T.S. Eliot. It might be used to reveal the connection between the work of Judge Derrick in this report and the explorations we all take as scholars:
We shall not cease from exploration
And the end of all our exploring
Will be to arrive where we started
And know the place for the first time.
– T.S. Eliot
By The Canadian PressImage credit
New provincial guidelines on the use of Tasers by police in Nova Scotia have been approved and will be released soon, Justice Minister Ross Landry [pictured] said Thursday.
Three weeks ago, in response to an inquiry report into the death of a mentally ill Halifax man, Landry said the guidelines would be released within two weeks.
He now says he has reviewed and signed off on the guidelines and expects they will be made public within the next week or so.
Landry declined to say whether the rules would restrict Taser use against mentally ill people, but added that they would not be a major departure from national standards.
"We’re in line with the overall federal position," said Landry. "I think there are a couple of areas that we’ve probably tightened up ... and I believe it will meet our needs at this time."
The issue is a contentious one because the inquiry into the death of Howard Hyde recommended that Tasers not be used on emotionally disturbed people unless all attempts at de-escalation have failed.
Hyde died in November 2007 at a Halifax jail, 30 hours after police had Tasered him multiple times during a psychotic episode. But the inquiry concluded the Tasering did not cause his death.
Federal guidelines say the use of stun guns should be avoided where possible on women known to be pregnant, the elderly, young children and visibly frail people. The rules also say that the weapons should not be used on a restrained subject or on a person in control of a moving vehicle.
There are no references to mental illness in the national rules, but Landry said it would be addressed in Nova Scotia’s guidelines. He didn’t elaborate.
By Marilla Stephenson (pictured)Image credit
What’s the difference between "excited delirium" and "autonomic hyperarousal state?"
Not much. In fact, in the provincial government’s response to the Hyde Inquiry report, the second term is used as a replacement for the first.
The inquiry, headed last year by provincial court Judge Anne Derrick, studied the death of Howard Hyde, a Dartmouth man who died in custody in 2007 at the Central Nova Scotia Correctional Facility in Dartmouth. Hyde suffered from mental illness and the cause of his death was initially identified by a coroner as "excited delirium."
Derrick rejected that as a "red herring." She found that Hyde died as a result of a restraint technique used on him by guards during a struggle.
Hyde had been repeatedly shocked with a stun gun during his 30 hours in custody. Derrick found that while the use of the stun gun did not cause Hyde’s death, the repeated shocks contributed to his deteriorating mental state.
Derrick’s report also strongly called for improved training for law enforcement officers who come in contact with people suffering from mental illness. The judge painted a clear path towards the use of de-escalation techniques in advance of the use of stun guns.
But the province seems to be struggling to find the right balance between public safety issues and the use of stun guns by officers. It has yet to finalize its guidelines for stun gun use, though Justice Minister Ross Landry said Thursday they will be released within a few weeks.
The minister did not explain why there has been a delay in issuing the guidelines or why, if only a few more weeks were needed, the province’s response to the inquiry report was not delayed so the documents could be released together.
But it speaks volumes that the use of the stun guns has already dropped by over 70 per cent since Hyde’s death in 2007, as The Canadian Press reported on Thursday.
In addressing what is now being described as an "autonomic hyperarousal state," the report released Thursday did not rule out using a stun gun on a person who may be mentally ill. But plenty of work remains to be done on the training side of the equation.
"Law enforcement officers must have appropriate tools to assist them in maintaining public safety," says the report. "At the same time, people living with mental illness may already be experiencing a high level of anxiety and the use of restraint could escalate the situation.
"The province and policing partners agree that the use of conducted energy weapons should only occur when a person’s behaviour is aggressive or violent and could harm the person or the public or the police officer. Additional direction is required regarding the restraint of individuals with mental illness."
The delay in providing that direction is not explained but Landry is clearly not comfortable with the current level of knowledge and training.
"It’s very difficult in situations where . . . there’s a high level of disturbance for the police officer to determine whether the person is suffering from mental illness," the minister told reporters on Thursday after the response was released.
In fairness to police, officers are often called on to make very quick decisions about the use of force in highly charged situations. But the death of Howard Hyde, among other cases, provides a reminder of the responsibilities that accompany the use of force, including the use of stun guns and other various forms of restraint.
There are federal guidelines available to help officers make those judgment calls and the province has said its stun gun rules will consider the federal document as well as expert advice provided by a panel of psychiatrists.
Derrick was clearly on the right track in emphasizing the need for much better levels of training. And in fairness to the province, some progress has already been made in addressing areas of concern raised in the inquiry report.
But the wheels continue to grind slowly towards the judge’s most important recommendation, adopting a provincial mental health strategy. The government is still waiting for a report from stakeholders.
It has been nearly two years since the NDP formed government and promises to improve mental health policies and services are growing stale.
(mstephenson@herald.ca)
Justice minister promises rules resulting from Hyde inquiry will be released soon
By Michael MacDonald, The Canadian Press
More than three years after the jail cell death of a mentally ill man, the province’s Justice Department has yet to introduce new guidelines describing when peace officers can use Tasers.
Howard Hyde died on Nov. 22, 2007, after a struggle with guards at a Halifax-area jail. His tragic story attracted national attention because Halifax police Tasered him multiple times during a psychotic episode about 30 hours before he died.
In December of last year, provincial court Judge Anne Derrick released a fatality inquiry report that concluded the Tasering did not cause the death of the 45-year-old musician, who had long suffered from schizophrenia.
However, Derrick did find that the Tasering worsened Hyde’s rapidly deteriorating mental state, and she recommended that stun guns should not be used to immobilize emotionally disturbed people unless crisis intervention techniques have failed.
In its formal response to Derrick’s report, the provincial government said Thursday its revamped guidelines are still being finalized.
Justice Minister Ross Landry [pictured] said he is still concerned about the ability of police officers to recognize mentally ill people in distress.
"It’s very difficult in situations where . . . there’s a high level of disturbance for the police officer to determine whether the person is suffering from mental illness," Landry, a former RCMP officer, told a news conference.
Landry said he had hoped to have the guidelines ready before the government issued its response to Derrick’s inquiry. He didn’t say why there was a delay, but he confirmed the new rules will be released within two weeks.
During Derrick’s fatality inquiry, which lasted 11 months, Halifax Regional Police argued that its officers are trained not to stun anyone until de-escalation techniques have been tried. But Derrick rejected that position, saying police policy and the province’s standards made no mention of this requirement.
Despite the absence of new guidelines, the government’s response indicates police have already changed the way they use so-called conducted energy weapons.
Since 2007, the year Hyde died, police use of the type of stun gun used on the man has dropped by 74 per cent in Nova Scotia.
Landry said the dramatic decline was the result of a growing body of knowledge about the weapon. He said police were still learning about the impact of the weapon in 2007 when a medical examiner declared Hyde’s death was caused by a condition known as excited delirium.
The condition, also known as autonomic hyperarousal, is characterized by increased strength, paranoia and suddenly violent behaviour marked by profuse sweating and an elevated heart rate. Hyde demonstrated most of the traits in the hours before he died.
However, Derrick’s report rejected excited delirium as the cause of death, finding instead the death was caused by Hyde’s struggle with jail guards. The judge concluded the guards applied restraint techniques that may have interfered with Hyde’s breathing.
Kevin MacDonald, the lawyer representing Hyde’s sister, Joanna Blair, said his client was troubled by the fact that the government’s response says that police and corrections officials require a clear understanding of how conducted energy weapons may affect people in an autonomic hyperarousal state.
"There appears to be a suggestion that the police be trained to recognize the symptoms of (excited delirium) when . . . judge Derrick’s report states that the province should not emphasize in its policies or training the phenomenon of excited delirium," MacDonald said in an interview.
"It’s significant because excited delirium . . . can be used as a justification for the use of force, which is what happened in Mr. Hyde’s case. I think it’s wrong that they’re taking this position. It’s contrary to what judge Derrick found, and it indicates there’s not an acceptance of the cause of the death."
In her inquiry report, Derrick said she agreed with one expert who testified that citing excited delirium as a cause of death resulted in Hyde being "identified as the culprit."
"(Derrick) specifically cautioned police officers . . . from looking for signs of excited delirium," MacDonald said. "And here is the province suggesting they’re going to train them in recognizing it."
Most of Derrick’s 80 recommendations called for improved training, more funding for mental health services and better co-ordination and communication between justice and health officials.
On Thursday, Health Minister Maureen MacDonald said the province has already implemented some of the judge’s recommendations, but some will have to wait because the government has yet to receive a final report from a committee appointed last year to draft a provincial mental health and addictions strategy.
"There are a number of actions and activities that are very significant that will make a real difference for people who are suffering from a mental illness," MacDonald said, adding that 911 dispatchers have been given a standardized checklist that will help them recognize mental health issues.
Among other things, the province has increased crisis intervention training for police and health-care professionals, and it has established a new, psychiatric intensive care unit at the East Coast Forensic Hospital near Halifax.
As well, a new mental health and justice committee has been appointed, and the province is spending $4 million this year on residential units for people recovering from mental illness.
Aside from the money for the residential units, the province provided no other cost estimates.
Stephen Ayer, executive director of the Schizophrenia Society of Nova Scotia, said the government’s moves represent an important first step.
"There’s a lot of work to be done yet," he said after the government report was released. "Things have changed immensely because of (Howard Hyde’s) death . . . I think that things are going to change substantially."
Committee seeks input from people affected by addiction, other issues
By Pat Lee, Staff Reporter
A public session on how to improve services for those with mental health or addiction issues elicited lots of input Tuesday on where the system needs improvement and a healthy dose of skepticism about the exercise.
While those attending the afternoon-long session in Halifax agreed there is an urgent need for a better way to treat and support those with mental illness or addictions, especially among the young, some said the problems have been studied for decades.
"These are the same issues that have being going on for 25, 30 or 40 years now," one person said. "What’s going to be different?"
Terry Taylor of the Nova Scotia Health Research Foundation, which was handed the task of running the consultations, said he’s not surprised by the skepticism.
"A question we’re asked, not infrequently, (is), ‘What’s different now?’ " Taylor said.
He said people should be optimistic that change will occur because Health and Wellness Minister Maureen MacDonald, who struck the committee a year ago, is "100 per cent committed and passionate about this issue. She has said publicly that she would like this to be her legacy."
Tuesday’s gathering was one of six public consultations organized by the committee that is charged with creating the province’s long-awaited mental health and addictions strategy. The committee is composed of a dozen health experts, researchers, mental health clinicians and people living with or affected by mental illness.
During Tuesday’s session, interest peaked when the discussion turned to the need for improved addiction services around the province, particularly for young people.
Of the 134 beds set aside for the treatment of alcohol or drug addiction, none are specifically for young people, Taylor said.
Many in attendance said it’s next to impossible to get help for mental illness or addiction unless someone has reached a crisis point.
It’s well known that a child in a mental health crisis will not be seen at the IWK Health Centre unless they are thought to be suicidal, Dr. Bob Frederickson said.
"That has to be publicly stated because that’s crazy," he said.
Dr. David Pilon, program leader of specialty mental health services for Capital Health's mental health program, said his staff is overwhelmed. He said 80 or so clinicians assess and treat more than 600 new referrals a month, on top of many other specialty treatment and programs offered at the hospital
"We have reached a critical point where we’re up against a wall," he said. "Less than four per cent of the total health care budget goes to mental health and it no longer computes."
"Psychiatric and addiction care is one of the worst services we have in Nova Scotia," said another physician, who did not want to be named.
"We need more timely access. My perception is that the system is mired in paperwork and passing the buck and working nine to five."
Along with public input, the committee is seeking input from health-care providers, government agencies, non-profit groups and any others involved with or impacted by those with addictions or mental health concerns.
Taylor said the information gathered, which will result in recommendations sent to government sometime in the fall, comes on the heels of work done by Senator Michael Kirby in the area of mental health advocacy. Closer to home, there has also been the Hyde Report by Judge Anne Derrick.
While the report on Howard Hyde, a [man with schizophrenia] who died after struggling with jail guards, focussed on dealing with the mentally ill within the justice system, Taylor said the report also highlighted the need for an infusion of funding within the mental health care system as well as other related recommendations.
Along with the public meetings, including one this Thursday from 9 a.m. to 12:30 p.m. at the South Shore Regional Hospital in Bridgewater, Taylor and his group have met with 67 other groups and plan to talk to about 40 more before the end of the month. The group expects to hear from about 1,000 people before it’s done.
People can also provide input online or through the mail. For more information, go to bit.ly/kCWwE2 or call 424-4043.
(plee@herald.ca)
By John McPhee, Health Reporter
The committee charged with creating the province’s long-awaited mental health and addictions strategy will embark on a series of public meetings next week.
The provincial advisory committee will hold the first of six meetings Monday in Greenwood to get feedback on how programs and services can be improved.The NDP government first announced its intention to create a strategy last spring. The committee co-chairpersons — Michael Ungar [pictured], a professor of social work at Dalhousie University, and Joyce McDonald of [The Empowerment Connection] — were announced in June and the rest of the committee in the fall.
It is composed of 12 health experts, researchers, mental health clinicians and people living with or affected by mental illness.
The committee kept a low profile since that time, but it has been holding consultations with health-care providers and advocacy organizations, said a spokeswoman from the Health and Wellness Department.
"We’re just letting them do their work and we don’t want to complicate that or distract them," Patricia Murray, acting executive director of mental health and addictions, said in an interview. "It’s a huge job they’re doing and we’re just anxiously anticipating the end result that they’re able to submit."
The committee has met with about 50 groups and more meetings are planned, a recent Health and Wellness Department news release said.
The move to revamp the system has been sparked by concerns about long waiting lists for treatment and how mentally ill people are treated in the justice system, as highlighted by Judge Anne Derrick’s report in December 2010 on the death of Howard Hyde. Hyde died Nov. 22, 2007, after a violent conflict with jail guards at the Central Nova Scotia Correctional Facility in Dartmouth.
Mental health advocate Stephen Ayer of Halifax has criticized the province for being too slow in dealing with the problems in the mental health system. Ayer, the executive director of the Schizophrenia Society of Nova Scotia, welcomed the consultations.
One committee member and staff from the Nova Scotia Health Research Foundation met with the society about three weeks ago. "It was very useful," Ayer said in an interview.
But he is concerned the consultation thus far has been with the people who provide the services, not with those who use the services. At his urging, the committee will meet with people with mental illnesses next month.
As for the strategy, "we are looking forward to seeing some movement in terms of improvements in access to services," he said.
Besides the public meetings, people can also provide input online or through the mail. For more information, go to www.nshrf.ca/mentalhealthandaddictionsstrategy or call 424-4043.
The committee is expected to submit its recommendations to Health and Wellness Minister Maureen MacDonald in the fall.
SCHEDULE
Schedule of public meetings on the province’s mental health strategy:
- April 18: Greenwood, 8 a.m. to noon, 14 Wing Greenwood, Birchall Training Centre, Chamber Room
- April 26: Amherst, 8 a.m. to noon, Tantramar Theatre, 98 Victoria St. E.
- April 27: Sydney, 8 a.m. to noon, Cape Breton University, 1250 Grand Lake Rd., multi-purpose rooms A and B
- May 3: Halifax, 1 to 5 p.m., Saint Mary’s University, Burke Building, Burke Theatre B (entrance off Inglis Street)
- May 5: Bridgewater, 9 a.m. to 12:30 p.m., South Shore Regional Hospital, lecture rooms 1 to 3 (third floor)
- May 16: Halifax, 8 a.m. to noon, Universite Sainte-Anne, Campus de Halifax, 1589 Walnut St. It will also be broadcast to campuses in Tusket, Petit de Grat, Church Point and Grand Etang.
I am disappointed in the comments in your newspaper of Stephen Ayer, executive director of the Schizophrenia Society of Nova Scotia, that recommendations from the Hyde report will not be instituted quickly and suggesting a lack of action on my part.
Judge Anne Derrick’s first recommendation in her report was that the provincial government needs to develop a mental health strategy. Before her report was even written, I had appointed a mental health strategy advisory committee representing a board spectrum of people with first hand-knowledge of the justice system, schizophrenia and other mental illnesses and disorders. Work on the strategy is well underway and we will provide for consultation in the New Year. The president of the Schizophrenia Society of Nova Scotia is on this committee.
Additionally, I have visited Mental Health Services at Capital Health and at the IWK Health Centre to discuss what can be done to improve wait times and program outcomes, and steps are being taken on these fronts. Our government’s first budget included funding for an expanded Mobile Crisis Service here in the Capital District.
Is there more to do? Absolutely, and I am committed to seeing that it is done. Mental health services are an integral part of Better Care Sooner, our plan to implement the Ross report. Judge Derrick’s extensive recommendations offer an opportunity for Nova Scotia’s justice and health care systems to make real and positive changes — and we will.
Maureen MacDonald, Minister of Health
Hyde Report a positive step, says schizophrenia society bossPhotograph by Peter Parsons, The Chronicle Herald.
By Ian Fairclough | FIVE QUESTIONS
Last week, a provincial court judge released a long-awaited report from the inquiry into the death of Howard Hyde, a Nova Scotia man with schizophrenia who died in jail a day after being arrested by police.The report contained 80 recommendations and was welcomed by Stephen Ayer [pictured], the executive director of the Schizophrenia Society of Nova Scotia.
Q: What’s the most important lesson to be learned from the death of Howard Hyde?
A: There are three really important lessons; it’s hard to pick one of them.
The most important lesson is a combination of the need for increased education around mental illness and what to do when encountering a person who is in a state of psychosis.
There is also the need for communication not only with the individual who is in the psychotic state, but also communication between different agencies that would be interacting with that person, from the mobile mental health crisis team to 911 to the responding officers. Communications has to be better.
In relation to that is response. If we could increase the education and training of people who respond to situations where an individual is in a crisis with a psychotic episode, they would be able to communicate effectively between themselves and the other agencies or services involved, and then the response would be the most appropriate response for that individual.
Q: What’s the first thing that should be done?
A: We have to have some empathy and some humanity in terms of dealing with people who have a psychiatric emergency, no matter what the circumstances may be.
Q: What do you think it would take to change the way police and the justice system deal with mental health consumers?
A: One of the deputy sheriffs did a great job trying to calm Mr. Hyde down to the best of his ability. He took two hours to talk to Howard Hyde to get some insight into what was going on, so there are people who are understanding and empathetic within the system already.
I’m sure there are more than (him). I think police and correctional services need to take a look at their staff and identify people who would be most appropriate for training in regard to working with people who are having a psychiatric emergency and being able to understand how to deal with it appropriately and get the person the help they need.
Q: How are the supporters of people with schizophrenia reacting to the results of the inquiry?
A: Very positively, and I am as well.
As I reflect now on the report and having delved deeper into it over the last couple of days, my response is the same as it was initially. This is an incredible piece of work by an incredible person — Judge Derrick — and when this was released, I said it’s a watershed day for the people of Nova Scotia and all people who live with mental illness in their families. It’s so comprehensive and the recommendations are so thorough and so important. I continue to believe that and hope the report will be taken seriously by government and others who need to make changes within the way they provide services.
Q: How optimistic are you that at least some of these recommendations will be instituted quickly, and how likely do you think it is that they’ll all be accepted?
A: In terms of the word quickly, I’m not very optimistic at all. In fact, I’m quite pessimistic, because this government has shown that even though it talks the talk, so to speak, and we have a health minister who is a former social worker and who worked at the Nova Scotia Hospital years ago and campaigned on the fact that mental health was going to be a high priority, when push comes to shove and the rubber hits the road, she’s nowhere to be found in terms of making some changes.
That includes support for community organizations such as ours that are on the front lines dealing with crisis calls.
BY THE NUMBERS
- About one per cent of Nova Scotians are living with schizophrenia.
- About 23,000 family members are affected by schizophrenia in that they are trying to help their loved ones deal with it.
- About 30 per cent of people with schizophrenia completely recover, and another 40 per cent recover well enough to work with limitations. The other 30 per cent are so affected they are difficult to treat.
- The Hyde Inquiry [report] contained 80 recommendations among its 462 pages.
Source: Schizophrenia Society of Nova Scotia
- In the past year, the Schizophrenia Society of Nova Scotia answered more than 500 crisis calls and provided advice, information and assistance.
(ifairclough@herald.ca)
In Judge Anne Derrick, Howard Hyde finally has an advocate who sees the bigger picture. Sadly, proper perspective is the very thing he desperately needed from someone — anyone — the day he died three years ago.
That much is obvious from reading Judge Derrick’s findings into the chain of events that led to the death of this emotionally disturbed man. But those who comb through the inquiry report looking to pin blame will be disappointed. Howard Hyde — who suffered from schizophrenia, was off his medications and experiencing psychosis — was not a victim of incompetence. He was a victim of incoherence.
During every step of his odyssey in police, medical, court and correctional custody, Mr. Hyde came across professionals acting professionally. Even the most controversial and publicized episode — which led to Mr. Hyde’s multiple Tasering at a Dartmouth police station — is not a slam-dunk of police misbehaviour.
Judge Derrick notes that the booking officer who produced a tool with which to cut the lace on Mr. Hyde’s shorts before putting him in a cell did not mean to provoke or panic him.
“S/Cst. MacCormick uttered the words: ‘We’ll have to cut one of those balls off’ innocently, with no appreciation of the effect they would have on Mr. Hyde," she wrote.
Judge Derrick makes it clear that the Tasering did not cause Mr. Hyde’s death. Nor did he die of schizophrenia, as the medical examiner unhelpfully concluded. He did die some 30 hours later as a result of a struggle with Burnside jail correctional officers whose use of force, and of a restraint hold, she determined to be “reasonable and proportionate."
Ultimately, the real problem was not the performance of Mr. Hyde’s custodians per se, but crucial omissions cascading through the chain of custody. From the moment he was first picked up by police on a domestic abuse complaint, a pattern developed whereby relevant facts weren’t passed along. Legal and medical professionals got their wires crossed, made incorrect assumptions, acted on incomplete information. Cops were unaware of mental health resources available to them and guards didn’t know how to de-escalate confrontations with the emotionally disturbed.
Clearly, the province must begin by training its sights on retraining front-line staff.
(edits@herald.ca)
By Clare MellorKaren Ellet [pictured] says she still misses Howard Hyde’s amazing voice.
“I miss his voice, his beautiful singing voice," the Dartmouth woman said Thursday.
Ellet, who was Hyde’s common- law wife, said she has been dealing with her grief since he died on Nov. 22, 2007, after a violent conflict with jail guards at the Central Nova Scotia Correctional Facility in Dartmouth.
But she is taking comfort in the recommendations resulting from the provincial inquiry into his death.
If the suggestions outlined in a report released Wednesday are adopted, they will make a huge difference in the way mentally ill people in crisis are dealt with, Ellet said.
“I am very pleased. She is a very compassionate judge," she said of Anne Derrick, the provincial court judge who helmed the 11-month fatality inquiry.
She said Hyde would be pleased with Derrick’s report, too.
“He would be ecstatic about it," Ellet said. “He would like to see (the recommendations) implemented, so the (report) is not sitting on a library shelf."
In her report, Derrick rejected a medical examiner’s conclusion that Hyde died of excited delirium and found instead that the struggle with the jail guards played a role in his death.
Hyde, a 45-year-old musician who was diagnosed with schizophrenia in his 20s, was having a psychotic episode at the jail when he was forced to lie on his stomach with his hands behind his back. The restraint technique may have interfered with his ability to breathe, Derrick found.
“He did not die because he was mentally ill," she wrote in her report.
Ellet said she still has difficulty thinking of the emotional and physical pain that Hyde endured in the last 30 hours of his life.
On the night of Nov. 21, 2007, Ellet called a crisis hotline to complain that Hyde had assaulted her while in a psychotic state.
Police arrested Hyde, but not before Ellet told them her husband had not been taking his medication and needed psychiatric help.
“Howard didn’t understand why he was in jail," she said. “He couldn’t comprehend his surroundings."
Ellet said she has been keeping a low profile due to her grief, but she believes it is important for her to speak up about the changes she thinks Hyde would have wanted to see in the justice system and in society at large.
“I believe he would want to have a professional such as a mental health provider to be with people who have a mental illness when they are in crisis, to speak on behalf of them," she said.
Ellet said Hyde would want all professionals to be issued handbooks so they could learn more about the signs and symptoms of mental illness and how to handle somebody who is having a psychotic episode. “Howard would want more housing available (for mentally ill people)," she said. “Howard found it horrific to know that people with mental illness are living in shelters and on the streets. It really upset him. He wished he could have done something but he didn’t know what to do."
Ellet said Hyde also would have wanted more research into the development of psychiatric drugs.
“Not all medications agree with each particular person," she said. “There are so many sideeffects."
More mental health funding and clubhouses, support groups and associations in support of the mentally ill would also be on Hyde’s list, Ellet said.
“I believe there is a large amount of fundraising that can make miracles happen to help (prevent) people with mental challenges from living on the streets," she said.
“Mental illness is no different from somebody walking around with diabetes."
Some of Derrick’s recommendations concern stun guns — she said they should not be used on people in a state of agitation due to a psychological disturbance, and changes should be made in the training for how to use them.
The judge also recommended that crisis intervention training be provided to all correctional officers at the Dartmouth jail and that several aspects of training in general be improved for jail guards in the province and for front-line police officers and doctors.
Ellet said it is poignant that the report on Hyde’s death came out on the 30th anniversary of the murder of John Lennon.
Hyde, who sang and played the saxophone, was also an extraordinary musician, she said.
“Howard had the musical ability to play anything," she said. “He had the most astounding voice you can imagine."
Also like Lennon, Hyde despised war. “He just wanted peace in the world," Ellet said.
(cmellor@herald.ca)
By Marilla Stephenson (pictured)
In the end, who failed Howard Hyde?
Perhaps, to some degree, we all did.
There is really no way to dress up the realities of mental illness. It is not pretty, and it can be a very tough challenge to support people in crisis. The people who live closest to those who suffer from mental illnesses are victims of the illnesses, too.
There is also no way to disguise or excuse how our society has continued to respond to people who experience mental illnesses. The stigmas are clear and well understood, even by young children in our schools. The branding begins early.
Hyde is the Dartmouth man who died in custody in 2007. He suffered from schizophrenia. The police were told of his mental illness when he was taken into custody over allegations of domestic abuse. He later died after an intense struggle with prison guards.
Provincial court Judge Anne Derrick released the fatal inquiry report into Hyde’s death on Wednesday. She firmly rejected a previous finding by a pathologist that he had died due to a condition termed "excited delirium."
Derrick dismissed that finding as a "red herring" that did not exist in Hyde’s case.
She also found that while the repeated use of a Taser on Hyde during his time in police custody "worsened the situation," it was not the cause of his death. She did, however, remind justice officials that so-called stun guns are to be used as an alternative to lethal force rather than as a front-line option to subdue suspects who are emotionally disturbed.
His death was accidental, Derrick found, but it came as a direct result of his struggle with prison guards.
In the comprehensive list of 80 recommendations, Derrick tossed the ball firmly into the hands of the provincial government.
She begins by calling for the establishment of a long-promised, but still absent, mental health strategy. It is clearly not by accident that this basic framework is at the top of the list as a necessary building block from which other improvements would naturally evolve.
The judge also calls on the province to increase funding for mental health, but not to do it by reallocating funds from within the existing envelope of health-care funding. This reflects the fact that mental health issues have for too long languished on the list of health-care priorities.
We are left with a fractured, often inaccessible mental health system where vanishing waiting lists are proudly waved around by government as proof of treatment for patients. Improvements are being made, and Derrick’s report makes note of policy changes that have already occurred in the justice system in the wake of Hyde’s death.
But it is hard to comprehend that none of the guards involved in the struggle with Hyde minutes before he died had any training to help them deal with prisoners who suffer from mental illness.
One seemingly innocuous recommendation, No. 49 on Derrick’s list, speaks volumes. Directed at justice system staff and other front-line officials who are in contact with prisoners who suffer from mental illness, it is brief and to the point:
"Training should have, as its overarching purpose, the development of a culture of respect and empathy for persons with mental illness in the justice system."
This is a statement that reaches beyond the justice system and into our society as a whole. While mountains have been moved in reducing the acceptance of stereotypes linked to mental illnesses, many of the most basic government services — justice and health among them — are still handcuffed by systemic ignorance.
The judge called for alternatives for people with mental illness who come in conflict with the law, and says the responsibility reaches well beyond the justice system.
"As the evidence before the inquiry has vividly illustrated, grasping this nettle is not just the responsibility of the justice system; creativity and commitment to change are required of the health system and the community, too."
The principles of respect and empathy provide a good place from which to start.
( mstephenson@herald.ca)
The Honourable Judge Anne S. Derrick (pictured) filed her report from the Fatality Inquiry into the Death of Howard Hyde on Wednesday, December 8th, 2010.
MacRury headed inquiry into jail cell death of mentally ill man
By LAURA FRASER Cape Breton Bureau | FIVE QUESTIONSDan MacRury [pictured] spent most of his first year as chief Crown attorney for the Cape Breton region juggling his new job with his responsibilities as counsel for the Howard Hyde inquiry.
The inquiry into the death of the mentally ill man while in custody was one of the province’s longest fatality probes.
But MacRury said he is used to tackling more than one job at a time. He will be the incoming vice-chairman for the criminal justice section of the Canadian Bar Association, and treasurer of the Nova Scotia branch.
He has also sat as president of the Legal Information Society of Nova Scotia and the Canadian Criminal Justice Association. And in his spare time, he goes fly-fishing and makes pasta.
He recently sat down with The Chronicle Herald to talk about his 24-year career shortly after he won the Canadian Bar Association’s 2010 John Tait Award of Excellence.
Q: What sparked your interest in public prosecution?
A: I’ve been involved in public service pretty well my entire career. First, I was at (Nova Scotia) Legal Aid and then moved over to the Crown.
I think it was sort of natural for me because public service and volunteerism are sort of virtues of my family. My entire family works as public servants.
My father worked as a hospital administrator and a city councillor here in Sydney. My mother was a nurse in detox. Both sisters work in health care, and in fact, I married a public servant. My wife’s a public servant.
It’s certainly something that was instilled in my family as being very important, to give back to your community and try to make a difference, and that’s really what I’ve been trying to do throughout my career.
Q: So what was it initially that interested you about law?
A: I had a very good professor who was sort of a mentor and went on to be a senator. John. B. Stewart was my professor at St. F.X., and he was somebody that always encouraged people to go into law, and I guess that was where my interest was tweaked at that point in time.
And certainly as a lawyer, I’ve had some great opportunities. I’ve been involved as a defence counsel in two murders and as a Crown in seven murder cases. I’ve appeared before the Supreme Court of Canada three times, one being the (John Robin) Sharpe case that dealt with the constitutionality of the (child) pornography provisions of the Criminal Code.
And I was a legal adviser in 2002 to the G7 finance ministers conference in terms of the law and its relation on lawful assembly and protests.
Q: Recently, you were the counsel for the Howard Hyde inquiry regarding the death of a man with schizophrenia who died 30 hours after he was Tasered while in police custody in Halifax. Can you tell us about that?
A: The Hyde inquiry, of course, was the longest fatality inquiry in Nova Scotia history, and that dealt with issues of how the mentally ill are dealt with by the criminal justice system and the mental health system. We’re now awaiting Judge (Anne) Derrick’s report and certainly hoping that there will be recommendations in relation to those areas as well.
One thing that I’ve found both as a legal aid lawyer and as Crown over the last 20 years is that, really, there are too many people that suffer from mental illness that are being dealt with by the criminal justice system instead of the mental health system. That’s something that I always felt was important to try to improve if we can.
Q: What do you remember about your first case?
A: When I first started out in New Glasgow (as a lawyer with Nova Scotia Legal Aid), you dealt with a lot of people, and you realize that people don’t choose, and don’t have control over some of the circumstances (that affect criminal behaviour), whether it’s poverty or substance abuse. So a lot of times what you found as a legal aid lawyer is that people are just looking for help.
I guess one case that sort of stuck out in my mind is I represented a young man who had been institutionalized for most of his life, and disabled. It certainly brought home to me that sentencing sometimes has to be flexible because it was a serious offence that he was charged with and the jails couldn’t cope with him. We were able to speak with (the) correctional services (division of) Nova Scotia at the time and we were able to have him transferred to a hospital setting, which was more appropriate for him. He was able then to get at rehabilitative programs, and it was the only time he’d been involved in the criminal justice system that he was able to get programs to assist him. Certainly, that was very rewarding from my point of view. What we find is that when things aren’t as simple, you have to be a little innovative in terms of coming up with solutions to problems.
Q: You said that you’ve prosecuted seven murder cases.
A: One I got parachuted into. I think what you learn in this business is things happen on short notice. I had a vacation booked for New York City, and a colleague became very ill. With two weeks to go, I ended up being involved in the case in Halifax (R. vs. Assoun). And that was a long case where the accused fired three lawyers and was then self-represented, which was certainly a challenge.
I was involved in another case (R. vs. Tran) that was simultaneous translation in Vietnamese. In fact, while I was dealing with the Tran case . . . at the same time we were prosecuting another case called Simpson, which was somebody on a Cuban vessel that murdered somebody in Halifax Harbour. So, literally, we were going to jury on one case, and then up at the provincial court starting the other case, which was translated in Spanish.
The challenge in the case in the gentleman from Cuba is that all the witnesses were in Cuba and so we had to deal with Foreign Affairs to try to get them back in the country to testify . . . so it wasn’t your standard subpoenas. Certainly, that was a challenge, but an exciting case as well."
(lfraser@herald.ca)
Pursuant to the Fatality Investigations Act, S.N.S. 2001 C. 31
Presiding Judge:
The Honourable Judge Anne Derrick of the Nova Scotia Provincial Court
Inquiry Counsel:
Dan MacRury Q.C., Chief Crown Attorney for the Cape Breton Region
No psychiatric exam had been set up for Hyde; man didn’t show acute symptoms, woman says
By Michael MacDonald, The Canadian Press
The nurse who admitted a man to a Nova Scotia jail where he later died knew about a doctor’s note requiring the inmate to receive a psychiatric exam, but the nurse told an inquiry Wednesday she didn’t consider it an official physician’s order.Sandra McLeod was the nurse in charge at the Central Nova Scotia Correctional Facility [pictured] when Howard Hyde — under arrest for an alleged assault — was dropped off there by deputy sheriffs on Nov. 21, 2007.
Hyde, a 45-year-old musician with a long history of mental illness and run-ins with the law, died the next morning as he struggled with guards, yelling there were "demons" in the jail.
McLeod told the inquiry she knew Hyde had not refilled his prescription for an anti-psychotic drug for about four months, and that he had been Tasered by police after his arrest and later sent to a hospital for treatment.
As well, McLeod confirmed she had read a handwritten note on Hyde’s health information transfer form, written by Dr. Janet MacIntyre, that said he had to be returned to hospital if he did not receive a court-ordered psychiatric assessment.
McLeod testified that when she read the note from the emergency room doctor, she called the Mentally Ill Offender Unit to determine if they were expecting Hyde for a court-ordered psychiatric assessment. But she was told nothing had been scheduled.
The form also said Hyde required ongoing treatment for schizophrenia and psychosis. As well, it said he had demonstrated aggression towards others and the potential to hurt himself.
The nurse said she saw no reason to send Hyde back to the hospital because he wasn’t displaying any acute symptoms.
"He wasn’t disoriented, he wasn’t agitated, he wasn’t hallucinating and he was following direction," she testified during her second day in the witness box.
McLeod said MacIntyre’s note did not constitute a physician’s order because it was written on a form she was unfamiliar with and lacked instructions on a specific time and place for an appointment.
"This isn’t the same kind of form that we follow through on," she said.
Still, McLeod said she asked one of the jail’s support clerks, Maureen Walford, to contact the hospital to make sure Hyde had been medically cleared.
Walford, who also testified Wednesday, confirmed Hyde had been cleared and said she also asked the hospital about MacIntyre’s note.
Recalling the conversation, Walford told the inquiry: "(A hospital administrator) just said, "No, he doesn’t have to come back. I have nothing here.’ "
McLeod said she would have contacted an on-call doctor had Hyde started displaying psychotic behaviour.
She also testified that she was not made aware that Hyde had been given an anti-psychotic drug when he was at the hospital.
However, Hyde did not have any prescriptions with him when he arrived at the jail, which McLeod did not find unusual.
Hyde was placed in a health-care cell, which meant guards would check on him every 15 minutes, but McLeod confirmed the guards were not told to watch for anything unusual.
Most of the guards who have testified at the inquiry have said they had little or no training on how to deal with the mentally ill.
The inquiry, which began in July under the direction of provincial court Judge Anne Derrick, is trying to determine why Hyde didn’t get the psychiatric help he needed, and what can be done to prevent similar tragedies in the future.
Earlier in the inquiry, MacIntyre testified that she would not have discharged Hyde if she had known he would be sent to a jail cell rather than a psychiatric hospital. She said police had assured her Hyde would receive a court-ordered assessment.
The inquiry has also heard that the Halifax police officers working on Hyde’s case knew they did not have the authority to follow the doctor’s instructions once he entered the court system.
The deputy sheriffs escorting Hyde to court did not hand the health form to lawyers handling the case because legislation at the time forbade them from sharing such information with anyone but health-care providers, such as McLeod.
By Marilla Stephenson [pictured]A DEBATE OVER whether so-called "excited delirium" is a valid condition is a waste of time. What is more significant — in terms of how police and jail guards react to it — is the risk of death for a person in this state and how to best respond when high-risk situations unfold.
Last week Justice Minister Ross Landry released a report from an expert panel struck to review the condition last year. The panel was formed in response to the 2007 death of Howard Hyde of Dartmouth. He died in custody after a struggle with police. He had been shocked with a stun gun by them 30 hours earlier.
A death inquiry, led by Judge Anne Derrick, is already underway and its outcome is separate from the report. A pathologist has already concluded that Hyde died of excited delirium — a condition the panel says would be better labelled autonomic hyperactivity syndrome (AHS) — and not from the stun gun shock he received the day before.
We can expect from the inquiry, at the very least, another truckload of recommendations targeting how first responders deal with mentally ill people. A doctor who checked out Hyde after he was shocked with the stun gun has already testified that she would never have released him to the police had she known he would not receive the psychiatric assessment she had requested. Hours later, he was dead.
Dr. Stan Kutcher, a psychiatrist at Dalhousie University, served as chairman of the panel. He told The Chronicle Herald in an interview that "the most important thing here is to realize that this is a medical emergency and that this situation requires the combined efforts of law enforcement and medical first responders."
Police and jail guards will get extra training to ensure they are better equipped to recognize the symptoms of AHS and to call in medical assistance in those circumstances, says Landry. This is one of the key recommendations in a report that contains many useful guidelines for moving forward towards better responses to people experiencing AHS.
Symptoms — which can lead to hyperthermia, cardiac arrhythmia and sudden death — include extreme agitation, aggressive behaviour, paranoia or delirium, incoherent and rambling speech, extraordinary strength, numbness to pain, and profuse sweating.
The report says that "mortality rates are increased in the presence of the signs and symptoms of excited delirium — even with medical intervention or in the absence of use of restraints by law enforcement."
The panel also found that "it is reasonable to consider that, when further stressed by physical struggle or the application and continuation of physical restraints (including the CED), an individual exhibiting the syndrome of excited delirium may be at increased risk for sudden death.
"Similarly, the pre-existence of a medical or psychiatric condition (such as a psychotic illness, pre-existing cardiac condition, delirium with or without the use of psychostimulant drugs) may increase the risk for sudden death in an individual showing signs and symptoms consistent with excited delirium."
That is the nub of the issue: People who suffer from mental illnesses that end up in a state of excited delirium are at an increased risk of death. While police and jail guards may well be the people who are first required to be on the scene of such a situation, additional training is clearly needed to ensure they know when it is paramedics, rather than restraints and a physical struggle, that is more likely to bring a safe outcome to the situation.
Police officers and jail guards are often in very challenging, high-stress situations, where public safety, their own safety and the safety of the person they are trying to subdue must be judged at lightning speed.
They must be provided with every tool possible to make the right decisions in those moments. If that means more training to properly assess, arrest and/or subdue people with mental illness, then it should happen as soon as possible. Calling for medical assistance should be considered a first option, not a last resort.
Even one Howard Hyde outcome is one too many.
Report: Emergency workers need latest information on excited delirium
By David Jackson, Provincial Reporter
Police and jail guards will get more training to recognize mental illnesses and how to deal with people afflicted with them, Justice Minister Ross Landry said Friday.
The province commissioned an expert panel last year to look at the phenomenon called excited delirium and what role it could play in in-custody deaths, to examine the risks of using stun guns and other restraints on people in that state, and to recommend how law enforcement officials should deal with those people.
Mr. Landry said the most significant recommendation in the eight-member panel’s new report is ensuring that front-line justice workers are trained to recognize people with symptoms of excited delirium, or as the panel suggests calling it, autonomic hyperarousal state.
The minister, a former RCMP officer, said officers do get training in dealing with people with mental illnesses but new information is always coming along, as with this condition.
"A couple of years ago, who knew about this?" Mr. Landry said in a telephone interview. "It’s not that long ago. And yet, people over time have passed away in this condition."
It was the death of Howard Hyde, a Dartmouth man who had a history of mental health issues, that led to the panel’s review. Mr. Hyde died in November 2007, 30 hours after Halifax Regional Police Tasered him when he scuffled with them at the police station.
The province’s chief medical examiner, Dr. Matthew Bowes, said Mr. Hyde died of excited delirium due to paranoid schizophrenia. Dr. Bowes said the death was accidental and he found no evidence that the Taser caused the death.
The death led to a provincial review of Taser use, and that led to the review of excited delirium.
The panel, of which Dr. Bowes was a member, said the symptoms of excited delirium are common to other medical and psychiatric conditions and recommended that the term autonomic hyperarousal state be used for people showing those symptoms.
Panel chairman Dr. Stan Kutcher, a psychiatrist at Dalhousie University, said there’s been a useless debate about whether excited delirium is or isn’t a medical diagnosis. He said the panel found the phenomenon well-described in medical literature going back 120 years, just under different names.
The symptoms include extreme agitation, aggressive behaviour, paranoia or delirium, incoherent and rambling speech, extraordinary strength and numbness to pain, and profuse sweating, the report said.
Dr. Kutcher said the key thing to keep in mind in dealing with people in that state is they need medical attention.
"I think the most important thing here is to realize that this is a medical emergency and that this situation requires the combined efforts of law enforcement and medical first-responders," he said in an interview.
The panel recommends creating a provincial training program for all first-responders in recognizing signs of mental illness and responding appropriately.
The report also says call-takers and dispatchers should get special training to help them recognize whether a call involves someone with a mental illness.
Dr. Kutcher said a dispatcher can get an indication of that by asking certain questions, such as whether the caller knows if the person they’re calling about is aware of his or her surroundings. The information would help a dispatcher know whether to send police and paramedics to the scene right away.
The panel recommended first-responders first try to calm the person in a hyperaroused state by talking to them, but if that doesn’t work, to restrain them quickly because a prolonged struggle could jeopardize the person’s life.
Dr. Kutcher said the panel couldn’t find scientific evidence suggesting that one form of restraint is better or safer than another, including stun guns. He said that’s why the panel recommended the province create a database on incidents involving the use of force.
Halifax Regional Police already adhere pretty well to the review’s goals, said Const. Brian Palmeter, the force’s spokesman.
"Our training and practices are consistent with the recommendations," he said.
"That being said, we are looking forward to working with the province to review and update our training where necessary."
Still, Const. Palmeter doubts there will ever be a single case in which an officer would be able to handle the crisis and follow all the recommended advice completely.
Mr. Landry said his department will consult with police, jail guards and sheriff’s services in developing procedures for dealing with people with mental illnesses. He said officers often have to make split-second decisions when dealing with people, so he wants them to have the information to help them make good decisions.Joanna Blair holds a photo of her brother Howard Hyde, taken when he was in his early 20s. (BRIAN MEDEL / Yarmouth Bureau)
Dr. Hunter Blair, whose wife Joanna Blair is Mr. Hyde’s sister, thinks a dispatcher won’t always be able to get enough information from an excited caller to know whether to send an ambulance to a scene involving a person with mental illness.
The main issue, he said, is how to handle that person once you get there, and the review doesn’t seem to contain much new information.
"They’ve produced what you would have expected them to produce, given the current state of knowledge or non-knowledge," he said from his Shelburne home Friday.
He is happy with the recommended plan to track all calls to study the outcomes of various restraint methods and treatments.
"That’s a good move," he said. "They started doing this in Ontario some time ago."
Health Minister Maureen MacDonald said officials in her department will consult with district health authorities and Emergency Medical Care Inc., which provides ambulance services, about the report.
HANDLING EXCITED DELIRIUM
The following is a summary of the nine recommendations found in the Panel of Mental Health and Medical Experts Review of Excited Delirium:
- The panel prefers the term autonomic hyperarousal state (AHS) over excited delirium, which is confusing and incorrectly suggests a defined medical diagnosis.
- People showing signs of AHS should be considered at risk of sudden death by hospital emergency staff who should be trained to identify and treat them. Once restrained, these individuals should undergo a thorough medical examination. Hospital staff should be ready to resuscitate.
- When it comes to first-responders called to possible cases of AHS, whoever takes such a call should dispatch police and Emergency Health Services simultaneously. If police encounter someone who may have AHS, they should call for EHS and backup immediately. Officers should de-escalate the situation by removing potentially hazardous objects and people from the area and trying to calm the individual without challenging him or her. If restraint must be used, it should be applied quickly. Immediately take the person to hospital and monitor him or her along the way.
- When restraints are used, they should be the least restrictive means that would bring the subject under control. If such a person is restrained, it should be treated as a medical emergency and EHS should be called immediately.
- A database should be created to track the use of various restraint methods to see their effect on people with AHS.
- Studies should be done to review the relationship between the characteristics of subjects and the outcomes of different methods of restraint.
- There should be a unified provincial training plan to help first-responders recognize signs of mental illness and respond correctly. Dispatchers and other call-takers should be trained to recognize signs of mental illness.
- A formal protocol should be developed in each area of the province describing the role of law enforcement and health professionals concerning mentally ill people, including those with AHS.
Source: Panel of Mental Health and Medical Experts Review of Excited Delirium
- An evaluation process should be set up to evaluate the effectiveness of the above-mentioned recommendations.
With Dan Arsenault, crime reporter
