It is difficult to predict when a person suffering from a mental health disorder will become violent or dangerous, an emergency psychiatrist testified at a coroner’s inquest Friday.
“Some of the reasons for that is that violence is a very rare event and suicide is a very rare event,” said Dr. Mara Goldstein, an emergency psychiatrist at St. Michael’s Hospital. “The vast majority of people with mental health issues are not dangerous.”
Goldstein was speaking at an inquest into the deaths of Reyal-Jardine Douglas, Sylvia Klibingaitis and Michael Eligon, who all suffered from mental health disorders and were holding sharp objects – knives or scissors – when they were shot by Toronto police.
She said that the types of disorders that tend to cause violent behaviour, such as schizophrenia or psychosis, are more unpredictable than disorders like depression, which tend to cause people to harm themselves. Despite their best efforts, mental health professionals don’t have a strong track record in predicting when patients will become violent.
“For the most part, a depressed person will be able to speak to their experience… The patients are more predictable in terms of their behaviour,” she said.
“When it comes to the loss of touch with reality, which is the realm of psychosis, it becomes much less predictable, because the patient is responding to voices they might be hearing and paranoia they might be experiencing, and the way they are interpreting their environment is very different and can be very unpredictable.”
Psychiatrists do observe people closely and consider their past behaviour, which is the best indication of their future behaviour, she said.
The vast majority of people with mental health issues are not dangerous.
Goldstein testified about details of the Mental Health Act, the provincial legislation that allows police to apprehend people who appear to be suffering from a mental health disorder and take them to hospital.
Police can take the person in for a physician’s assessment if they appear to pose a danger to themselves, a danger to others or an inability to care for themselves. The physician has to first agree these dangers exist, before detaining a person for up to 72 hours for an assessment.
After the assessment, the person is either released, can choose to stay under a voluntary admission, or is held under an involuntary admission for up to two weeks. After that period, the physician can fill out another form holding them for an additional month; after that, another form must be filled out to keep them for two more months.
The hospital has the right to refuse admission even when a person is requesting it – or when a police officer believes it is appropriate.
“In 2013, it is quite difficult to gain access to an inpatient psychiatric facility. The demands for admission are far greater than supply, and over the past several years there’s been an increase in outpatient services in an attempt to keep people in the community,” Goldstein said.
“While somebody might be experiencing a crisis and their belief is that they need to stay in the hospital, there are many alternatives that are likely more appropriate.”
The inquest has heard that all three of the shooting victims had failed interactions with the mental health system.
Eligon, 29, escaped from the psychiatric ward of Toronto East General Hospital and was wandering around a residential neighbourhood, wearing only a hospital gown and carrying two pairs of scissors, when he was shot by police on Feb. 3, 2012.
Klibingaitis, 52, visited the Centre for Addiction and Mental Health just 10 days before her death and asked to be voluntarily admitted for mental health issues. She left the hospital without the doctor’s knowledge, later saying she felt fine and had changed her mind. Police shot her on Oct. 7, 2011 after she left her home with a knife.
Jardine-Douglas, 25, was taken by his family in the early hours of Aug. 29, 2010, to Scarborough Hospital for a mental health assessment, but he fled because he believed he was being chased. Hospital staff recommended he visit Ajax Pickering Hospital instead. Later that day, he was shot by police after he pulled a knife on a TTC bus.