When the hospital is behind bars

Sometimes he thinks he's a rock star. Sometimes he thinks he's a member of the Hells Angels. But when he's thinking clearly he knows he's not well.

Sometimes he thinks he’s a rock star. Sometimes he thinks he’s a member of the Hells Angels.

But when he’s thinking clearly he knows he’s not well.

James is not his real name. The News has agreed to protect his identity while his mental health stabilizes.

At 19 years old, James is more familiar with psychiatric care than most teens. He had his first episode at 11 and was diagnosed as bipolar at 15.

Since then he’s been in and out of hospitals, trying to regulate the extreme mood swings that interrupt his life.

On July 7, a territorial court judge found James not criminally responsible for his actions because of his mental illness. He was ordered sent to hospital. His family believed their loved one was going to be treated as a patient.

James is in custody at the Whitehorse Correctional Centre. As an adult, he’s never been convicted of a crime.

In cases like James’s, the Yukon’s only correctional centre is also its only psychiatric hospital.

While other jurisdictions have secure psychiatric facilities for people with mental illness who are working their way through the justice system, in the Yukon, in most cases, that’s the jail.

In 1993, the Yukon minister of health designated Whitehorse Correctional Centre a hospital “for custody, treatment or assessment of an accused,” pursuant to section 672.1 of the Canadian Criminal Code.

That’s all it takes. No other rules, regulations or policies are required.

 

Stuck in limbo

In late June, during what his mother calls an “absolute highly manic, psychotic, delusional state,” James was found with a group of people and a small amount of cocaine in the car, his mom says. He was charged with possession.

Days later, in the same state, he was charged with uttering threats and intimidation.

He’s now in a much better, more stable place, his mom said.

Even though he’s been found not criminally responsible, his case is not officially over until a hearing by the Yukon Review Board. It’s the board’s job to determine an appropriate plan for what’s next. After that the charges will be dropped.

In severe cases the board can order treatment at a hospital Outside. Other times supports in the community are enough.

But that won’t happen until Aug. 8. By then, James will have been in jail more than a month.

In the meantime he’s stuck in limbo. He’s not a criminal, but he is an inmate. He hasn’t been convicted of a crime, but he’s in a cell, living with the general population, including people who have.

“How can you hold somebody as an inmate when they’re not criminally responsible?” James’s mom asked.

Anne (also not her real name) said she encouraged her son to consent to being found not criminally responsible, after being assured by everyone involved that he would be a patient with the same freedoms as a person being held at the Whitehorse General Hospital and not a jail.

“He agreed on not being criminally responsible in faith because they told him, ‘You would be designated as a patient… and with that you will have privileges.’ That’s why he agreed to it.”

But the word “patient” appears nowhere in the judge’s order. It’s not part of the jail’s lingo either.

“An inmate is described as anyone who is held at the correctional centre,” said Department of Justice spokesperson Dan Cable. “It could be a person on remand, it could be a person under the review board. Some people don’t like the description of inmate, but that’s the general description.”

If the jail is going to be designated a hospital, it should have the same level of support as a hospital, Anne said.

 

No room at the actual hospital

The secure medical unit at Whitehorse General Hospital has a total of seven rooms: five single rooms and two seclusion rooms.

The unit is designed “to allow for the optimal care and treatment of clients with a primary diagnosis of a mental health concern, during an acute phase of the illness,” according to the hospital website.

“Dedicated mental health nurses (registered nurses, registered psychiatric nurses and licensed practical nurses) staff the unit around the clock to provide assessment, support, medications and education.”

But it’s not the place for people to stay if they are involved with the justice system, the Department of Health and Social Services says.

“The secure medical unit can handle the acute care needs of a forensic mental health patient (someone in custody),” spokesperson Marcelle Dube explained in an email.

“So, if a person deemed not criminally responsible is in custody at WCC and breaks their arm or needs an appendectomy, the SMU will take care of them. Once that issue is resolved, the patient goes back.”

Cable acknowledged that the jail is not a forensic hospital.

An inmate assessment is done for each person who arrives at the jail, he said. Medical professionals on staff help decide what the needs are.

“Do we supply medical care for inmates? Of course we do. We have nurses on full time, we have doctors, and we have a psychiatrist on contract. We also offer other types of health care as well.”

A March 2014 report for the Yukon Department of Health and Social Services found that “psychiatric care at the jail, with a high risk population, is limited to two hours weekly.”

If an inmate were to have a psychotic break while at the jail, Cable said staff would “of course” transport them to the hospital and make sure the room at the SMU was appropriately secure.

If security is possible in some cases, why not all cases?

“It’s not necessary,” Cable insisted.

“If someone is stable, or reasonably stable in the facility and the doctors are saying that they’re reasonably stable, then they can be held at the facility.”

Human rights commission has ‘major concern’

As James sits in a cell in jail, the family is considering a human rights complaint.

The Yukon Human Rights Commission “has identified the treatment of people with mental illness in the Whitehorse Correctional Centre as a pressing human rights issue that requires immediate attention,” said Colleen Harrington, acting director of human rights for the commission.

Harrington wouldn’t talk about specific cases, but called mental illness a disability. By law, people with disabilities have the right to be accommodated.

“While inmates lose some rights while they are incarcerated, they certainly do not lose all of their rights. Human rights law gives people with mental disabilities the right to be accommodated for their disabilities while incarcerated,” she said.

“Based on our experience with a number of inmates at WCC, it appears that inmates with mental disabilities are not always being accommodated. Instead, their incarceration at WCC appears to have caused the mental condition of some inmates to deteriorate.

“This is a major concern. Other jurisdictions have secure psychiatric facilities where people with mental disabilities can receive appropriate medical treatment.”

 

Jail is no hospital

Anne knows what it means to leave a mentally ill child behind in a hospital. But at the jail there are significant differences, she said.

At the Whitehorse General Hospital’s secure unit, James could go outside. He could get phone calls. He could get food brought to him. With a doctor’s permission, he could sign out on day passes and spend time with his family.

“If there’s somebody very unwell, of course they’re not going to meet the criteria to get a day pass,” Anne said.

“But if they’re doing well and their doctor deems them well enough… they should be provided that right.”

Now, whenever she wants to see her son, Anne has to go through the jail’s screenings for weapons and drugs.

At the hospital, James could be seen by the doctors he knows and trusts. They could work on adjusting his medications, she said.

Anne says her son doesn’t trust the psychiatrist who is on contract with the jail. And she doesn’t trust the staff to adjust his medication. That’s something that needs to be done under 24-hour watch, she said.

“You can’t do that in a jail. They’re not equipped to do a med review and a med change.”

The phone rings while Anne is talking. The recording on the other end tells Anne she has a call from an inmate at the Whitehorse Correctional Centre.

James wants to know when he can get out of there.

“You got a lawyer,” she tells her son.

“Your new lawyer is going to try and get you into the hospital,” she says, pausing. “… As soon as she possibly can. OK?”

Anne says she’s concerned about what being in jail is doing to her son.

Seven months ago, he tried to kill himself.

“His doctors are considering a med change or a med review that would help prevent that depth of depression from occurring again. He needs a hospital for that,” she said.

As part of his illness he feels a lot of anger and anxiety. Being in jail “just feeds that,” she said.

Anne questions why the territory wouldn’t have an appropriate psychiatric transition facility to help with cases like this.

She accuses the government of being afraid.

“They’re scared that ‘if they build it they will come’ and it will show the scar on the Yukon of how many youth we have with severe mental illness.”

She says mental illness is everywhere, but no one wants to talk about it.

“Mental illness scares the hell out of people, even though it’s in everybody’s backyard. But it doesn’t appeal to the popular vote.”

If you look online, the policies and procedures for the Whitehorse Correctional Centre cover everything from emergency procedures to cell cleanliness rules. Yet a policy specifically dealing with people being held at the jail as a hospital is nowhere to be found.

That’s a concern for the NDP’s justice critic, Lois Moorcroft.

She says it’s not uncommon for correctional centres across Canada to be designated as a hospital.

“Before you take on having a hospital, you need to make sure correct policies are in place,” she said.

In an email, Cable said there is “a full health-care manual established with the expertise of our health-care service providers, although this is not online, and inmates who arrive at the correctional centre receive the same care or better of persons in the community. The standard of care is based on the community standard of care.”

Anne said her son knows he needs help. He thought that’s what he was going to get going this route.

“I’m not saying that people shouldn’t be held responsible. My kid is going to do whatever he can to right his wrongs, to get well, and to be a productive member of society. That’s all he wants.”

Contact Ashley Joannou at

ashleyj@yukon-news.com

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