Mental health group ‘hard at it’: Minister

An article published in yesterday's edition of Metro Halifax:

Health minister likes what she’s seen in mental health strategy

Liberal health critic says it’s time to focus on mental health issues

By Alex Boutilier

Nova Scotia’s minister of health says she expects a provincial mental health and addictions strategy by the end of the year.

Maureen MacDonald [pictured] said yesterday the volunteer working group putting together the strategy requested an extension of 30 days over their previous deadline of the end of September.

“The working group are hard at it, and I’m anticipating I should have this strategy certainly by the end of the year,” she said.

MacDonald said she was pleased at the pace of the working group.

“They’re a group of volunteers, they’re doing this on their own time, and I totally appreciate how much time it’s taken,” said MacDonald.

“They did a public consultation, they’ve seen more than 1,200 people participate in that process, they have some commissioned research.... It’s a big piece of work, and I’m very much looking forward to when they complete it.”

Some of the preliminary themes have been shared with MacDonald, and she said they look “great.”

MacDonald was responding to a call from the opposition Liberals, who demanded an update on the strategy’s progress.

Liberal Health Critic Leo Glavine said he suspects the strategy won’t see the light of day until 2012.

“There’s such a great need to get this out, to get it acted upon,” said Glavine.

“We’re hearing more and more from the school system and the early adult population that have major mental health needs … and we hope the strategy is going to address some of those.”

Taser guidelines still in works

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

Mental health session draws ideas, skeptics

An article published in today's edition of The Chronicle Herald:

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)

Photograph by Eric Wynne / The Chronicle Herald

Committed to improvement

A letter to the editor published in today's edition of The Chronicle Herald:

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

Province Hosts First Atlantic Mental Health Summit

An October 29th media release from the Nova Scotia Department of Health:

Health representatives from the Atlantic provinces gathered in Halifax this week for the first Atlantic Mental Health Summit.

They have been discussing ways the provinces can work together and raise the profile of mental health issues at all levels of government. During the summit they have also heard from national and international experts.

Health Minister Maureen MacDonald [pictured] offered to lead the summit at the Atlantic health minister's meeting in January.

"The great thing about a summit like this is we gather from all walks of life, social workers, practitioners and experts to share ideas and best practices," said Ms. MacDonald during her opening remarks. "The knowledge that is shared here will help us make the right decisions for our province's mental health strategy, as we work to provide better care, sooner."

Delegates are participating in sessions and workshops to discuss mental health and homelessness, child and youth mental health, mental health promotion and prevention, public policy and a national strategy.

One in three Canadians experience mental illness in their lifetimes, and many more are directly or indirectly affected through their relationships with friends, family and co-workers.

The province announced the 12 members of the Mental Health Strategy Advisory Committee in September to help fulfill a commitment to revamp mental health and addiction services.

The summit ends today, Oct. 29.


FOR BROADCAST USE:

Health representatives from the Atlantic provinces are meeting in Halifax this week to discuss ways to work together and raise the profile of mental health at all levels of government.

Health Minister Maureen MacDonald offered to lead the summit at the Atlantic health minister's meeting in January. She says it's a perfect opportunity to share new ideas and best practices in mental health care.

-30-

Media Contact:

Nicole Brooks
Department of Health
902-424-2608
E-mail: brooksnl@gov.ns.ca

Two representatives from the Schizophrenia Society of Nova Scotia participated in the Atlantic Mental Health Summit. They were Stephen Ayer, Executive Director, and Cecilia McRae, President.

To view the Atlantic Mental Health Summit agenda, please click here (PDF).

Photo credit

Hospitals told to meet mental health standards

An article posted today by CBC.ca:

Health minister sends letters after AG's report

Nova Scotia's Minister of Health has sent hospitals across the province a reminder about their obligations when it comes to mental health services.

Maureen MacDonald [pictured] has ordered top hospital administrators to comply with seven orders, in a one-page letter sent to all nine of the province's district health authorities.

MacDonald said the directive is a response to criticism levelled against her department in a recent report by the province's auditor general.

"I was surprised when I saw the auditor's report," she said Thursday. "There is no point in having standards if you don't implement and monitor the standards."

Last week, Auditor General Jacques Lapointe released a report that looked at whether Nova Scotians were able to access timely mental health care, no matter where they live in the province.

He said Nova Scotia was failing to meet its standards when treating mental illness, and said there is no plan to fix the situation.

Lapointe also said there was inadequate oversight of the system and no effective monitoring of the standards.

The auditor general's office found that of 538 Nova Scotians who received mental health care in Colchester-Hants counties, the Annapolis Valley and the Capital District Health Authority in Halifax, only 14 per cent of the patients got care that met mental health standards.

MacDonald said the letter — sent by Deputy Minister Kevin McNamara on her behalf — was sent to the CEOs of the health authorities on the same day Lapointe's report was released.


DHAs


"District health authorities are not spending their own money and they're not spending my money, they're spending the public money and they need to be accountable for that," she said.

"I'm accountable for the health care system on the floor of the house of assembly but the district health authorities are accountable to me for how they deliver health care services."

MacDonald said as part of her seven directives, she reminded hospitals they cannot refuse to admit patients simply because they do not live in the district.

"There are no geographic barriers to getting health-care services within the province of Nova Scotia," she said.

The Health Minister said she has not yet heard from any of the health authorities in the week since she issued the directives.

Health authority responds

Peter Croxall, the director of the mental health program in the Capital District Health Authority, said one of the problems is that the standards are vague and hard to measure.

"Full of, really, of too much mental health jargon and not really written in a clear, explicit fashion," he said.

Croxall said statistics show one in five Nova Scotians will develop a mental illness.

That large number makes the issue difficult to address, he said.

"The fact that we only have … four per cent of the health budget, I think you can draw your own conclusions from that," said Croxall.

"I'm not saying that we're doing terribly badly but we certainly could use more resources or a redistribution of resources within health into the mental health area."

Croxall said in his experience, there was nothing to indicate Nova Scotians were getting substandard care, despite the auditor general's findings.

Act to ensure rights of the incapacitated

An article published in today's edition of The Chronicle Herald:

By Davene Jeffrey

Nova Scotians will soon be able to retain more autonomy should they become incapacitated.

The province’s new Personal Directives Act becomes law on Thursday, replacing the Medical Consent Act, which gives people the right to name a proxy to make health-care decisions on their behalf.

Health Minister Maureen MacDonald said the new legislation goes beyond instructions for health care.

She said people will be able to assign someone to make sure their wishes for personal needs such as recreation and hygiene are followed.

"It means that people, and particularly, I imagine, people who are older or persons with disabilities, with perhaps some kind of a condition that has a degenerative element, would have the security of knowing that how they wish to be treated will be respected."

As of Thursday, forms will be available through the Justice Department website or through Service Nova Scotia offices, said Health Department spokesman Ryan Van Horne.

There will be two forms, one to appoint a delegate and the other to outline details of expected care and treatment. A booklet explaining the act also will be available.

"The Personal Directives Act covers a wide range of things, including personal-care decisions," Van Horne said.

"For example, if you are admitted to a nursing home and you are a vegetarian, you could ensure that you get a vegetarian diet or that you got fresh air for an hour a day."

The directives will have to be reasonable and legal, Van Horne said.

For instance, anyone living in a nursing home could not expect to receive treatment that the home could not offer to other residents, he said.

"If you want to ask for something that they do provide to everybody else, then you’ll get it," Van Horne said. "If you want something that they don’t provide to everybody else, then you need to make some other type of arrangement."

The act was passed in May 2008 after it was introduced by Cecil Clarke, who was then the justice minister in the Conservative government. MacDonald couldn’t say why it has taken almost two years for the act to take effect, but she said regulations had to be written and staff in health-care settings and elsewhere had to be trained in the new rules.

Van Horne said officials had hoped to bring the act into force last fall but it got sidelined by the H1N1 crisis.

With David Jackson, provincial reporter.

Also see:

Powers of Attorney and Health Care Directives (Nova Scotia)

Tough decisions must be made

An article published in today's edition of The Chronicle Herald:

Mental health strategy will include eating disorder help

By Michael Lightstone

Access to eating disorder pro­grams in Nova Scotia is likely to be addressed in the province’s new mental health strategy, Health Minister Maureen MacDonald [pictured]said Thursday.

Though the plan is in its in­fancy — it was announced in the Dexter government’s throne speech at Province House in Ha­lifax — she hinted it could in­clude some sort of expansion of the province’s existing program. “We have a small eating disor­der treatment program for young people here in the metro area," MacDonald said after the speech. “So, people from other parts of the province . . . have to come here, and the wait lists are long." MacDonald cited the size of the program and its waiting list as examples of “some weaknesses, perhaps, in the (mental health) system that need to be examin­ed."

She was short on details, how­ever, and couldn’t provide a cost estimate for the NDP’s mental health blueprint. The govern­ment is projecting a $525-million deficit for the 2009-10 budget year.

“We will have something in the near future, and we will be look­ing forward to having a compo­nent that will allow for public in­put in the development" of the strategy, MacDonald said in an interview.

Part of that consultation ele­ment, she said, will be a regional conference in Halifax this fall to be hosted by the provincial gov­ernment.

Although MacDonald didn’t provide specifics, she acknow­ledged the province-wide strate­gy won’t be note-perfect or all-en­compassing.

“I’m not prepared to wait as minister of health until we have some perfect strategy developed before we take action," she said. “We already know that there are some things that are needed."

Critics of Nova Scotia’s mental health system have long com­plained there are deficiencies.

And a recent Chronicle Herald investigation found resources for treating the mentally ill are thin in some areas of the prov­ince and non-existent in others.

Asked about the stigma many people still attach to mental ill­ness, MacDonald said public opinion of those with emotional problems or in a treatment pro­gram has changed.

“There’s a lot less stigma today than there has been in the past," she said. “So, I’m hopeful. I don’t think that changing attitudes is an impossible thing, but I don’t think that it’s something that will be solved quickly."

Photo credit

Flu program delays deal for psychiatrists — minister

An article published in today's edition of The Chronicle Herald:

By David Jackson, Provincial Reporter

Health Minister Maureen MacDonald [pictured] said Tuesday her department’s focus on swine flu has delayed a new deal for metro-area psychiatrists.

Half a dozen doctors were at Province House to draw attention to the department missing an Oct. 31 deadline for an agreement.

Dr. Nick Delva, the Capital district health authority’s chief of psychiatry and the head of Dalhousie medical school’s psychiatry department, said he thinks a deal could get done in a week to 10 days.

But with the biggest immunization program in provincial history underway, that’s not a time frame Ms. MacDonald is looking at.

"I think it’s pretty clear what I’m looking at in the next 10 days, and it’s not sitting down and doing collective bargaining, sadly," said Ms. MacDonald, who has been under opposition fire for the government’s handling of the H1N1 vaccine rollout.

"We will get to this issue as soon as we can, but we are dealing with a public health emergency in the province, and that’s where our focus has to be for the time being."

The psychiatrists had a memorandum of understanding with the previous government and Doctors Nova Scotia to get an agreement, called an academic funding plan, done by the end of October. The last one expired more than three years ago.

Dr. Delva said the new arrangement would add about $3 million in annual costs to about a $20-million budget. That covered 70 full-time-equivalent positions at 1,840 hours each per year, but Dr. Delva said psychiatrists have done a lot of work for free.

"We were providing far, far more hours (of) clinical work and far more hours (of) academic work than this," he said. "We did it for free for a number of years, and it was an unsustainable situation."

Aileen Brunet, a forensic psychiatrist and president of the Nova Scotia Psychiatric Association, said doctors won’t support the province’s new mental health court until an agreement is done.

The court starts sitting Thursday, with four cases scheduled. The Justice Department plans to pay for a private psychiatrist, if necessary, before an agreement is finalized. Dr. Brunet said psychiatrists would never withdraw services they are already providing, but they won’t be offering new ones until the deal is in place.

Premier Darrell Dexter said in question period that he expects a new deal to be done soon.

Liberal Leader Stephen McNeil said the Dexter government doesn’t seem to have a plan for mental health services.

"Clearly, what happened here today is the premier said one thing on the floor of the House, and the minister said something quite different outside. They’re not on the same page. Who’s telling the truth?"

Also see:

Psychiatrists threaten to skip mental health court

More training in mental illness

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 training

More police, paramedic training urged for excited delirium

Paramedics needed in delirium cases: report

Excited delirium is a real risk, Nova Scotia report into taser death warns

Excited delirium: Consideration of selected medical and psychiatric issues