Not criminally responsible verdict pushes crisis centre protocols into spotlight

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This article was published 18/10/2023 (721 days ago), so information in it may no longer be current.

Manitoba’s health authority has not made any changes to security and supervision protocols at a Winnipeg mental health crisis centre, almost two years after a man left the facility against a doctor’s advice, later killing his parents and stabbing a colleague.

“If someone they feel is a danger to themselves or others, they should take more steps to prevent them from leaving and get proper care,” said Candyce Szkwarek, a former Winnipeg nursing supervisor who survived a near-fatal attack at Seven Oaks General Hospital.

Speaking outside the Winnipeg Law Courts building Wednesday, Szkwarek questioned why Trevor Farley was allowed to walk away from the Mental Health Crisis Response Centre and go on to kill his parents, before also stabbing her multiple times.

On Tuesday, a Manitoba judge found Farley, 39, not criminally responsible for the Oct. 27, 2021, crimes.

According to an agreed upon statement of facts read in court, a psychiatric health team had placed Farley under an involuntary hold shortly before the attack — an action reserved for patients believed to pose a threat to themselves or others.

Despite this, Farley walked out of the Winnipeg facility and went on a bloody, three-hour rampage.

The crisis centre is not a secure facility, so it is possible for patients to leave at anytime through unlocked doors, a Shared Health spokesperson said in an email statement.

The health authority did not detail what, if anything, has been done to improve supervision and security measures at the crisis centre or the nearby Health Sciences Centre, saying: “Conversations are always ongoing as to how processes can be improved to support patient care and protect public safety.”

Shared Health noted there is a difference between patients placed on an involuntary holds and those who are involuntarily admitted — with the latter patients typically being transferred to a secured psychiatric unit within HSC.

“An individual waiting for inpatient admission who has been placed under involuntary status at the CRC will almost always reside in one of our assessment rooms, where assessment and provision of care continues until an inpatient bed is available,” it said.

“If staff believe the person is at high risk to leave the CRC and there is a likelihood of them harming themselves or others, they are typically moved to a locked secure room under constant observation, where ongoing staff support is provided.”

Shared Health was also unable to comment on Farley’s case (citing privacy legislation), making it unclear whether he had been assessed as high risk or was awaiting transfer to HSC.

Szkwarek called such ability to leave the centre unhindered “extremely” concerning.

More resources are needed for mental health services, particularly more beds for inpatients on a psychiatric unit, she said, pointing to Farley’s repeated visits to other hospitals in the days and weeks before the attacks.

“I believe it is very hard to get psychiatric care and there doesn’t seem to be follow up with individuals who do present themselves to emergency,” Szkwarek said. “Those (arrangement) should be made for people in crisis… They should be able to identify it sooner rather than later.”

In April 2022, 29-year-old Ji Kim was involuntarily admitted to HSC, but stepped outside the downtown facility to smoke a cigarette and failed to return. His body was found three days later in a Winnipeg park.

Kim’s death by suicide prompted the Office of the Chief Medical Examiner to order an inquest, with an explicit goal of determining what, if anything, could be done to prevent similar events from occurring in the future.

Shared Health said involuntary patients are permitted to leave HSC psychiatric units for up to 15 minutes at a time, provided they are not believed to pose a safety risk to themselves or others. If the patient does not return, police are notified.

Both cases highlight shortcomings within the provincial health-care system, which — when working optimally — should provide immediate, ongoing intervention for people experiencing a mental health crisis, said Marion Cooper, chief executive officer of the Canadian Mental Health Association’s Winnipeg branch.

“When someone is involuntarily admitted to a hospital for mental health assessment and is released prematurely without adequate treatment, several aspects need attention to improve the situation,” she wrote in an email Tuesday.

“Often, brief assessment are done with focus on safety, and if a person says they are not going to hurt themselves they are released without a comprehensive assessment.”

Cooper noted mental health care is complex and needs vary between individuals, adding limited resources and staffing levels can negatively impact outcomes and contribute to premature discharges.

She outlined a series of recommendations, including more robust assessments, continuous care plans and family and peer involvement.

According to Manitoba’s Mental Health Act, a psychiatrist and physician must agree a person suffering from a mental disorder is a danger to themselves or others before they are involuntarily admitted.

Once inside the facility, health-care officials have the authority to detain an individual for up to 21 days, as they undergo ongoing treatments and assessments.

While the provincial legislation governs health-care providers have the authority to do, it is up to Shared Health to manage each facilities and treatments, a provincial spokesperson said.

— With files from Dean Pritchard

tyler.searle@freepress.mb.ca