Warning: This article includes topics of mental distress and suicide
In one of the darkest moments of her life, Ella Hale, 18, voluntarily admitted herself to psychiatric services at a Victoria hospital.
She’s one of dozens of former patients of Royal Jubilee Hospital’s Psychiatric Emergency Services (PES) unit who shared stories online of being patronized, belittled and discharged while still in crisis.
Defined as a specialized care area within the hospital’s emergency department, PES is listed as an intensive assessment and crisis intervention for patients with psychiatric disorders. The unit has four short-stay inpatient rooms.
Hale, who has been diagnosed with anxiety, depression and borderline personality disorder, was admitted to hospital in April 2020 after attempting suicide. That time, she went to a medical floor. But a few months later – in June 2020 – she was in crisis again and went to PES voluntarily.
She stayed overnight on the unit and saw a psychiatrist the following morning.
“She was very quick to dismiss my problems as teenage problems,” Hale said. “She said I was young and things would be better when I was 25.”
Hale felt dismissed, ignored and gas-lit.
“I have a really hard time validating myself as it is, and so to be invalidated by a mental health professional makes it worse,” she said. “It really nailed in the idea that in order to get help, I have to do something physical to myself.”
|Ella Hale (left) and Emma Epp (right) started a Facebook group to document their experiences at the Psychiatric Emergency Services unit at the Royal Jubilee Hospital. In less than a month, the group has garnered more than 500 members. (Nina Grossman/News Staff)
Hale’s story isn’t singular. She met Emma Epp, 19, at Camosun College, where they both take the Community, Family and Child Studies program.
Epp went to PES for the first time about two years ago and has been admitted involuntarily several times since. But she said it didn’t matter how she got there – the treatment was the same.
“They said there was nothing they could do for me, even though I was saying that my outside supports weren’t helping and that I’m incredibly suicidal. So they let me go home.”
Epp has been struggling with her mental health for eight years but said she still isn’t taken seriously at PES.
“If somebody came to the doctor with stage one cancer, you wouldn’t say ‘come back when you have stage four.’ Because that’s what they’re doing when you’re expressing suicidal ideation but haven’t actually done anything.”
Epp and Hale started a Facebook group on Feb. 27, where they shared their experiences. The group, titled ‘PES: A Pathetic Excuse for Support,’ had more than 513 members and 89 posts by March 15. They’re both saddened and shocked by the response.
Facebook group allegations aimed at PES staff range from shaming and victim-blaming to emotional abuse and dismissal from the unit while patients were still on heavy doses of medication or in the midst of ongoing mental health crises.
“It’s so hard to reach out and it takes a lot of courage to be like, ‘I need help.’ And then you get met with nothing,” Hale said.
In 2014, the B.C. Supreme Court found Island Health and two employees negligent in the case of then 38-year-old Joseph Briante, who was admitted to PES in October 2007. He was interviewed by a psychiatric nurse and doctor and discharged two hours later. Six days after Briante was discharged, he attempted suicide. He survived but suffered irreparable brain damage.
Justice Keith Bracken ruled the nurse and doctor who assessed Briante were negligent in their failure to obtain thorough patient history prior to discharging him, but that they couldn’t be blamed for his suicide attempt. The judge also criticized the PES intake process.
“The PES model in place puts emphasis on efficiency, particularly cost efficiency in processing patients,” Bracken wrote. “The model maximizes the time the emergency room physician has for her normal duties, but in many ways minimizes the time for investigation, analysis and assessment of a patient.”
On March 10, Adam Olsen, MLA for Saanich North and the Islands, presented a series of questions to the Ministry of Mental Health and Addictions in the B.C. Legislature. He asked what was being done to address the “systemic bias and discrimination” stigmatizing people seeking help during a mental health crisis.
“If you present with a mental illness, you get one type of treatment, and if you present with a physical ailment, you get a different kind of treatment,” he said in an interview with Black Press Media.
“I believe the survivors of these stories and I think it’s important that we do more than acknowledge them,” he said. “There’s this intense stigmatization. It’s a culture that’s evolved over the years. And it’s a culture that this government has inherited.”
It’s time for the province to root out and get rid of that culture, Olsen said.
“People are belittled, they’re judged, they’re undermined and they’re sent packing and left to their own devices,” he said. “There comes a time in which the answers need to come pretty clearly to the public about what’s actually going on there.”
In a statement, Island Health said it was aware of concerns from patients about the care they had received at PES. Island Health met with Hale and Epp on March 16 to discuss the issues.
“We take these concerns seriously as we strive to provide the very best care we can,” the health authority said. “People have a right and an expectation to be treated with respect and dignity when they are accessing our services.”
Island Health said trauma-informed training is offered to staff through a wide range of options and models. Anyone accessing mental health and substance use services is screened using the universal IS PATH WARM method (a suicide assessment mnemonic) which considers ideation, substance misuse, purposelessness, anxiety, trapped hopelessness, withdrawal, anger, recklessness and mood changes. Island Health added more thorough risk assessments are completed in clinical interviews with psychiatrists and nurses also use the Tool for Assessment of Suicide Risk (TASR).
“Safety plans are utilized in conjunction with assessment and are developed collaboratively with patients,” the health authority stated.
“Not all patients choose to complete this, but it is usually a method we use to remind the patient what they can do when experiencing a re-emergence of suicidal thinking after discharge.”
Changes have also been made at PES throughout the years, including renovations in 2017 to create a less clinical environment and to improve safety for patients and staff.
If you or someone you know is struggling, call the provincial suicide prevention hotline at 1-800-suicide (1-800-784-2433), or visit crisislines.bc.ca to find local mental health and crisis resources.