Psychiatric crisis leaves mentally ill in jail, documents say

Mentally ill people are languishing in jail due to a severe shortage of psychiatrists and beds at Forensic Psychiatric Hospital in Port Coquitlam, according to court documents obtained by the Times Colonist.

On Jan. 29, Dr. Johann Brink, vice-president of medical affairs and research for the Forensic Psychiatric Services Commission, wrote to Chief Judge Thomas Crabtree to inform him of what he called a “crisis situation” at the Forensic Psychiatric Hospital.

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“Specifically, I need to inform you that the Forensic Psychiatric Hospital presently is unable to meet its legal mandate … to provide specialized psychiatric services for adults who are in conflict with the law,” Brink wrote.

The Forensic Psychiatric Hospital treats and rehabilitates individuals who are deemed unfit to stand trial or not criminally responsible due to mental illness. It also serves individuals transferred temporarily from correctional facilities to be assessed or receive treatment for a mental illness under the Mental Health Act.

In his letter, Brink advised Crabtree that 21 mentally ill men were waiting to be admitted to the hospital. Of these, 13 were in jail waiting to be assessed.

Brink said the hospital would request 30-day extensions to assessment orders more frequently, and said it “may not be able to complete assessments on male accused persons in time for court.”

The chief judge forwarded a copy of Brink’s letter to the judges of the provincial court, then wrote to Brink to advise him that it was being circulated, a provincial court spokesman confirmed.

Brink’s letter and an affidavit describing the crisis at the 190-bed psychiatric hospital came to light during a hearing before Justice Brian MacKenzie in B.C. Supreme Court on Feb. 27.

Victoria lawyer Chris Brennan applied to the court for an order to have his client, a young man with bipolar disorder, transferred from the Vancouver Island Regional Correctional Centre to the Forensic Psychiatric Hospital for treatment.

Although Victoria provincial court Judge Sue Wishart made an order on Feb. 13 that the 24-year-old be assessed at the hospital within 30 days, no beds were available.

Instead, the man, whose identity is protected by a court order, was held in segregation at the jail from Jan. 27 to Feb. 24 because of his acute psychosis and refusal to take sufficient levels of antipsychotic medication. A psychiatrist who assessed him at the jail certified him under the Mental Health Act and recommended he be transferred to the forensic hospital for treatment.

MacKenzie dismissed Brennan’s application, but directed the administrators at Forensic Psychiatric Hospital to give the man priority for admission “even though I readily appreciate everyone on the waitlist is acutely ill and in need of treatment.”

At the man’s bail hearing in provincial court on March 12, Judge Evan Blake said it was “regrettable in the extreme” that a person required to undergo a psychiatric assessment should spend significant periods of time in jail. “Even more regrettable, that they should do so in segregation.”

In his letter to the chief judge, Brink warned that the “chronic, severe shortage of psychiatrists and high bed occupancy rates” will get worse: few psychiatrists want to work with violent patients and the financial compensation is not attractive enough.

Recruiting and retaining psychiatrists is always a challenge, Brink wrote. Over the past 41Ú2 years, half of the hospital’s psychiatrists have left.

The hospital is operating with eight psychiatrists, but only one is full time and two are leaving at the end of March. Three full-time positions have remained vacant for several years.

Brink blames the hospital’s inability to recruit psychiatrists on the “non-competitive nature of the compensation in B.C. for forensic psychiatrists as compared to general psychiatrists.”

Several years ago, forensic psychiatrists were paid more than normal psychiatrists, but have now fallen behind, said Arden Krystal, executive vice-president and chief operating officer of the Provincial Health Services Authority.

The FPSA is trying to work with the Ministry of Health to develop competitive compensation packages, she said.

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