Psychiatrist Bill MacEwan says recent suicide shows dilemma faced by staff
Doug Ward, Vancouver Sun
Published: Saturday, June 09, 2007
The recent suicide of a Delta man points to the dilemma faced by hospital medical staff when deciding whether to hospitalize mentally ill patients under the provincial Mental Health Act.
"We can all make mistakes, it can be a tough call," said Dr. Bill MacEwan, a psychiatrist at St. Paul's Hospital.
Tyler Lekei, 23, a diagnosed schizophrenic, was taken by police to Surrey Memorial Hospital on May 28 after being spotted walking over the Alex Fraser Bridge.
The police believed Lekei was delusional and was considering leaping from the bridge. He was assessed at the hospital and then released the same day. A few days later Lekei killed himself.
Lekei's mother, Jean Macdonald, said Friday that she did not know all the details of what happened to her son at Surrey Memorial, including whether he was assessed by a psychiatrist.
But the grieving mother said she is confident that he would have willingly been detained.
"He wanted to go to the hospital. He knew that was what he needed," Macdonald said.
She said that "Tyler told the police he wanted to be admitted and he went willingly in an ambulance."
Fraser Health Authority officials have declined to discuss details of Lekei's case, including whether he was willing to be hospitalized.
St. Paul's psychiatrist MacEwan said the number of people detained against their will, on the certificate of a physician, is low in B.C. considering the number of mentally ill people suffering from psychosis.
The reason, MacEwan said, could be the difficulty psychiatrists have in judging whether the patient is suicidal, homicidal or unable to care for him or herself -- and whether a crisis is imminent.
This challenge is even more daunting, said MacEwan, when the patient refuses to be detained -- often because the patient is in a delusional state and fears being kept in a hospital or clinic.
"The art form of [emergency] psychiatry is how do you help out people who because of their illness don't want to be helped," said MacEwan.
It is also tricky for psychiatrists to know whether the patient's crisis is a short-term one caused by a personal trauma, such as a breakup with a wife or boyfriend, or by substance abuse with drugs such as crystal meth -- or a mixture of the two.
Gary Glacken, executive-director of the B.C. Schizophrenia Society, said too many mentally ill patients are discharged too early from hospitals. "That has been an issue that has risen over and over again in our experience with families that we serve," said Glacken.
This shouldn't be the case, he added, because physicians have enough authority under the Mental Health Act to detain mentally ill patients.
Until 1999, the act only allowed patients to be hospitalized against their will if they were in need of protection. But in that year the grounds for hospitalization were expanded so that people can be detained if psychiatric staff decide the patient's health will deteriorate.
A patient can be detained for an assessment period of up to 48 hours based on the certificate of a physician. During this initial assessment period, a second physician must complete a second certificate stating whether the patient meets the "dangerousness" or "deterioration" criteria for admission to a psychiatric facility.
Glacken cautioned that he did not know the details of Lekei's assessment at Surrey Memorial, including whether the patient was examined by a psychiatrist.
