An article
published in today's edition of
The Chronicle Herald:
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."
Also see:
Province Releases Plan to Improve Care in Custody
Building Bridges: Improving Care in Custody for People Living with Mental Illness
Hyde Fatality Inquiry
Image credit
An article
published in today's edition of
The Chronicle Herald:
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.
- An evaluation process should be set up to evaluate the effectiveness of the above-mentioned recommendations.
Source: Panel of Mental Health and Medical Experts Review of Excited Delirium
With Dan Arsenault, crime reporter
Also see:N.S. excited delirium report recommends first responders get more trainingMore police, paramedic training urged for excited deliriumParamedics needed in delirium cases: reportExcited delirium is a real risk, Nova Scotia report into taser death warnsExcited delirium: Consideration of selected medical and psychiatric issues
