Taser rules coming

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

By The Canadian Press

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.

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Mental health strategy still seems elusive

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

By Marilla Stephenson (pictured)

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)

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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


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Focus on training, not terminology

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

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.

Also see:

Vulnerable targets

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

New Mental Health Court to Open in Dartmouth

From the Nova Scotia Department of Justice website:

Justice Minister Ross Landry (left) tours the construction site of the new Mental Health Court which will open in Dartmouth, Nov. 2. He is joined by Stephen Ayer, Executive Director of the Schizophrenia Society of Nova Scotia. Minister Landry said the new court will help people who are in greater need of counselling and treatment instead of being held in custody or put in situations that may lead to confrontations.

Photograph courtesy of the Nova Scotia Department of Justice.

Nova Scotia sets up mental health court

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

Service intended to divert those who need help into treatment

By Michael Tutton, The Canadian Press

Nova Scotia is setting up a special court to divert some of the province’s mentally ill away from the criminal justice system and into treatment programs.

Justice Minister Ross Landry, standing in the gleaming new courtroom Thursday, said the new mental health court would balance the needs of the public and the mentally ill.

"It ensures public safety, and at the same time ensures the accused’s health needs are met," said Landry.

The once-a-week sitting at the court will not hold trials, but rather will serve as a setting where the court can work out alternatives to jail sentences and set up treatment programs, Landry explained.

Under the system, which begins Nov. 2, provincial court Judge Bill MacDonald will take cases recommended by a mental health court team.

The cases would include crimes normally brought to provincial court, like thefts and assaults, but not more serious acts such as murder and sexual assault.

The person being tried must either admit to the crime prior to appearing in the mental health court, or have been found guilty in a regular court and then referred.

In some instances, the mentally ill would have criminal charges against them withdrawn if they successfully complete their treatment program and fulfil the court’s conditions, Landry said.

The province’s handling of the mentally ill has come under scrutiny during the public inquiry into the death of Howard Hyde, who had a long history of schizophrenia and involvement with the courts.

Hyde died in jail on Nov. 21, 2007, about 30 hours after he was arrested for an alleged assault and Tasered during a struggle inside a Halifax police station.

Landry said he couldn’t say whether a mental health court system would have helped Hyde avoid his conflict with the law. But he said he believes that overall, it will improve the chances of treatment of mentally ill people who come before the courts.

He said a mental health court in Saint John, N.B., that has operated for over eight years has had positive results.

Statistics kept by that court for last year indicate that almost nine in 10 people using the court complete their treatment programs, and 86 per cent avoid further conflicts with the law.

However, during Thursday’s news conference the mother of a mentally ill man posed questions to Landry about whether the new court would be likely to accept people who have trouble recognizing their own illness.

Mary Elizabeth Greene, a Halifax-area social worker, told the minister her son has psychotic episodes and can’t recognize when he has done something wrong.

"He doesn’t believe he has a mental illness and he wouldn’t choose to go to a mental health court and there are many like my son who don’t have insight," she said.

The minister invited the woman to come to his office and talk, and said they would consult with medical experts. He said he hoped that once a mentally ill person receives treatment following a psychiatric assessment, he or she would agree to use the new court.

Greene said in addition to the courts, the province badly needs better group homes where her 24-year-old son could be monitored more often and treated.



Mary Elizabeth Greene watches as Justice Minister Ross Landry announces the province’s first court to help those with mental health issues during a news conference in Dartmouth on Thursday. Ms. Green’s son John Can­dow is in the mental health system as a patient.

Photograph by Eric Wynne, The Chronicle Herald.

Also see:

Hyde’s sister doubts mental health court would have helped

Justice Minister Announces Opening of Mental Health Court

A news release circulated today by the Nova Scotia Department of Justice:

The province's first court to help people with mental health illnesses will open in Dartmouth on Nov. 2.

The court was set up to help people who are in greater need of counselling and treatment instead of being held in custody or put in situations that may lead to confrontations.

"The government is seeking new ways to help those offenders who have mental health issues," said Attorney General and Justice Minister Ross Landry, today, Aug. 27.

"This court will look at the person and their illness, not just their crime when it comes to administering justice."

Two years of planning of the made-in-Nova Scotia court included input from representatives from police agencies, RCMP, Public Prosecution Service, legal aid, judiciary and several government departments.

The specialized court will sit one day a week at the provincial court building. Judge Bill MacDonald will hear the cases which have been recommended by the mental health court team as being eligible for the program. A team of mental health clinicians and lawyers will be at the courthouse to assess potential clients and assist with their needs through counselling and other support.

The mental health court program is based on the best practices of other jurisdictions, and is tailored to meet the needs of Nova Scotians.

FOR BROADCAST USE:

The province's first court to help people with mental health illnesses will open in Dartmouth on November 2nd.

The court was set up to help people who are in greater need of counselling and treatment instead of being held in custody or put in situations that may lead to confrontations.

Attorney General and Justice Minister Ross Landry says the government is seeking new ways to help those offenders who have mental health issues.

He says this court will look at the person and their illness, not just their crime when it comes to administering justice.

The court will sit one day a week at the provincial court building.

-30-

Media Contact:

Sherri Aikenhead
Department of Justice
902-424-3313
E-mail: aikenhsl@gov.ns.ca