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Following are a few case histories of the tragedy resulting from professionals’ refusal or failure to share information with family members or otherwise to communicate with them. The case histories are drawn from Greater Vancouver. Fortunately, professionals who won’t talk to families and share information with them are gradually growing fewer in number.
Case history 1
A young man is in hospital and is pronounced ready for discharge. His mother, from long experience and knowing her son’s clinical history quite intimately, picks up clues that his delusions are just under the surface. The psychiatrist, however, refuses to discuss the issue with her or to share observations. The patient is discharged prematurely. Before long he deteriorates and ends up with “command hallucinations” driving him to a suicide attempt that almost succeeds.
Case history 2
A psychiatrist and therapist on a mental health team refuse to talk to a patient’s family without the patient’s permission, citing the need to build trust with the patient and, with that, a strong relationship. Unfortunately the patient has limited insight together with paranoid thoughts about his family and won’t grant that approval. The team argues that their special relationship with the patient is necessary to keep him coming back to the team for his medication, which is given to him by injection. The family, familiar with the patient’s history and seeing recurring psychotic symptoms, knows better but, with the taboo on communication, has no way of getting this across. The patient is on “extended leave,” where, although discharged from hospital, he is still legally “committed” and is obliged to take his medication. The team, however, doesn’t bother renewing the extended leave. Predictably, in this case, the patient doesn’t come back for his medication, and when the distraught family shames the team into making a call on their ill relative, he tells the team to “f... off.” The special relationship, excluding the family from the treatment process, doesn’t hold up for even a few weeks. After that, the team no longer bothers. The ill relative becomes wildly delusional, and the family is left to pick up the pieces. Their persistent efforts, including an emergency call to the police, result in his being recommitted, but much damage has already been done. The profound psychotic break, which should have been avoided, keeps the ill relative in hospital for another 18 months and, because of the break, his subsequent level of recovery is less than it would otherwise have been.
Case history 3
A young man with schizophrenia is sharing an apartment in dedicated psychiatric housing with several other “ex”-mental patients. The organization in charge of the housing believes in “respecting the client’s wishes.” The young man, however, goes off his medication and shows other worrisome signs of a major relapse.
When he attempts suicide, following a classic pattern - giving away his possessions and taking a room in a hotel where he takes an overdose - nobody informs his family. The family, meanwhile, aware that their son is deteriorating, but getting no real help from the care team, in desperation decides to try a “tough love” approach, in hopes that their son will listen to them and get back on his medication. They tell him they can’t help him financially any more until he goes back to see his psychiatrist and starts his medication again. Had they known of the recent suicide attempt, they would have never taken that approach and also would have been able to argue more forcefully for pro-active care-team intervention. Shortly after, the young man returns to the shared apartment, but in his deteriorating condition, he has difficulty fitting in. His roommates tell him his behaviour is not acceptable and that he can’t stay there any longer. The young man makes his way to a wooded park where he hangs himself from a tree branch.
Case history 4
An 18 year old female student at the
University of British Columbia in Vancouver
attempts suicide and is hospitalized. The
health providers subsequently
release her without, however,
contacting next of kin. They do
give her a phone number for the university's
mental health team but make no attempt to
ensure that she follows through, which she
doesn't. The woman’s mother lives
in Portland, Oregon, a mere five hour
driving distance or an hour’s flight away. A
month later the daughter attempts suicide
again, this time successfully, and
her mother is informed by the RCMP about
what has happened. The mother is
distraught. She learns for the first
time about the earlier suicide attempt. Had she known of that initial
incident, she would have rushed to her
daughter’s side. Now it’s too late.
The media discover the story. Both a
hospital spokesperson and the UBC
Vice-President for Students claim that
confidentiality provisions did not allow
them to inform the mother of
the first suicide attempt. It is evident
from these explanations that those
responsible don’t know much about the
applicable Freedom of Information and
Protection of Privacy Act (FIPPA) or have
misinterpreted it. They certainly hadn’t
paid heed to the Ministry of Health’s fact
sheet on the Act which makes it clear that
such information can, and should be, shared
in such circumstances, where someone is at
risk and where family involvement is important to “continuity of
care.” Both the health providers and the
university were derelict in their failure to
notify the woman’s mother, who could have
provided much-needed support and may well have prevented her
death. |
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