B.C. family who lost brother challenges hospital procedures for discharging patients under Mental Health Act
WARNING: This story contains distressing details
James Zimmer will always be remembered as a kind-hearted carpenter who dreamt of supporting people like himself who were struggling with mental illness, his family says.
"He wanted to start out with being a peer supporter," said sister Cindy Zimmer.
But the dream never came to fruition. On Feb. 9, James, 50, took his own life after being discharged from Royal Jubilee Hospital in Victoria, his family unaware of his whereabouts.
The family is the latest in B.C. to protest hospitals' lack of compliance with the part of the Mental Health Act that requires loved ones to be notified of a patient's admission or discharge from hospitals — something advocates claim health facilities often fail to do.
Issues around consent
James had always willingly gone to the hospital and consented to notify the family of any plans to discharge him, Cindy says.
According to his family, James was always involuntarily held — meaning he could be in the hospital indefinitely — because of symptoms like paranoia, delusions and suicidal thoughts.
The Mental Health Act stipulates that an individual can be involuntarily held in hospital if they have a mental health disorder that impairs their ability to live in the community, require psychiatric treatment, require supervision to protect themselves or others, and if they cannot be adequately treated in a community-based facility.
Two doctors are required to sign off on the hold within 48 hours to keep a patient at the hospital.
"If [the new doctor] doesn't see that individual meets those four requirements to be held involuntarily … they discharge them," said Crystal Kenzie, another sister of James.
Section 34.2 of the act also specifies relatives must be immediately informed of a patient's admission and discharge when they are involuntarily held. The process is started upon the completion of Form 15 during the intake of a patient at a mental health facility.
According to the B.C. Ministry of Mental Health and Addictions, families should be informed to protect the health and safety of the patient and for the purpose of continuity of care.
"If the primary caregiver is actively involved with the patient, then the physician is required to inform them, even if the patient has not given permission to do so," it said in a statement.
In cases when a patient does not consent to the disclosure of personal information, the ministry states only necessary information can be released in order to minimize the invasion of a patient's privacy.
B.C. United mental health critic Elenore Sturko says it's clear consent is not required to notify the family of a patient's discharge after they have been involuntarily held.
"James Zimmer came in with suicidal ideations, but [the hospital] didn't do anything," Sturko said.
"It's a failure of the system, especially when [the family] had consistently provided support and [contact] information."
On Feb. 7, Cindy admitted James to Royal Jubilee Hospital. At the time, she says, he had consented to notify his family should he be discharged.
But Cindy says the hospital claims James had revoked that consent on Feb. 8 before being discharged. Then, a few hours later, James returned to be readmitted to the hospital for having suicidal thoughts.
On Feb. 9, she says James was discharged again. The hospital claims he had still revoked consent to notify his family.
"So somewhere along that time when he was discharged, I didn't get a call," said Cindy, adding James's change of mind should have been a "red flag" to hospital staff of his mental state.
The family remained unaware that he had been discharged a second time until Feb. 10, when they discovered he had left the hospital's Psychiatric Emergency Services (PES).
A few hours later, police informed them of James's death.
WATCH | James's family says they thought they had an understanding with the hospital:
Ombudsperson's report finds hospitals often fail to comply with Act
In a statement, Island Health says patient information, including discharge alerts, is not shared without patient consent.
It adds that patients deemed to have "the capacity to make decisions have the right to change their consent."
Island Health did not respond to follow-up questions on whether this protocol applies to patients who have been involuntarily held.
In 2019, the B.C. Ombudsperson's report made 24 recommendations to address hospital compliance with the Mental Health Act.
The report found hospitals typically did not complete legally required forms for each involuntary patient file, including forms 15 and 16, providing contact information of a near relative to inform them of admission, detention, and discharge of the patient.
The report states, "These forms are not mere paperwork" but important documentation, without which families cannot be made aware of a loved one in distress.
James' sisters say information to contact them should have been on his file from previous hospital visits.
Among the Ombudsperson's other recommendations were an increase in oversight and accountability in the form of regular compliance audits.
The report also noted that the Ministry of Attorney General had "committed in principle to develop an independent rights adviser service that would work in designated facilities in the province and provide advice to patients about the circumstances of their detention and their options if they disagree with the detention or a related decision."
Three years after its first report, the B.C. Ombudsperson, in July 2022, found that hospitals continued to fail to comply with and follow the notification regulations of the Mental Health Act.
Spokesperson Sara Darling says hospitals are still not completing the required intake forms 100 per cent of the time for involuntary patients.
"People are always welcome to come to the Ombudsperson's office with a complaint for investigation … if they feel they've been treated unfairly," she said.
She says the province is working to lay the foundation for an independent rights advice service to inform families and patients of their rights when involuntarily held.
"It's widely known that [the act] isn't being followed," said mental health advocate Ella Hale, 20.
When she was 17, Hale says a psychiatrist at Royal Jubilee had dismissed her concerns as "just teenage problems."
"I have been in and out of the mental health system since I was about 12 … after that [experience], I was just completely hopeless," she said.
In 2021, Hale and a friend started the Facebook page, "PES: A Pathetic Excuse for Support" — a space to vent about Royal Jubilee and the province's mental health system.
"We're hearing these tragic endings of families not [being engaged] in the care … and it's leading to tragedy.
"But there's no accountability, like this section isn't being followed, families aren't being notified, but who's responsible for that?
"[We're] advocating for ourselves, relieving the worst days of our lives, just trying to make it better for the next person."
Cindy says the hospital should have known his mental health history and the family's history of support, which would have been reason enough to notify them without his consent.
"We know nothing is going to change the outcome," she said.
"James had a loving family who would have shown up for him in an instant if we had that opportunity."
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