By late November, Ottawa wedding photographer Ryan Parent was in crisis. He was struggling under the weight of depression and anxiety, a burden made worse by his fear of returning to hospital.
Parent, 37, had gone to The Ottawa Hospital in June because a friend was alarmed by his manic behaviour and by his online posts about the Earth being flat.
In the emergency department, doctors referred him to the hospital’s Psychiatric Emergency Services (PES) unit for a more thorough assessment.
Both the General and Civic campuses have secure PES units inside their emergency departments. The units feature spartan, windowless rooms to limit the visual stimulation of patients. They’re designed to ensure that both patients and staff are safe while the individual is assessed and a mental health referral is made.
Parent spent 56 hours in one of the rooms at the General campus, waiting for a bed to open up on the hospital’s psychiatric ward. Ryan’s grandmother, Ruby Parent, visited him in the PES unit on June 3. She said his room opened to a small anteroom, from which a locked door led to the hospital hallway. The anteroom featured a window with bars through which patients could speak to a nurse.
Ryan, she said, was well treated by staff and received permission to go for a walk. “But it was not a nice place, it was just like a cave,” she said, “and I think it must have been very despairing for him.”
A bed did not become available, so Parent was eventually discharged without a new diagnosis. At home, he told his mother he would never go back to what he called “that jail cell.”
“He said it was the most traumatic time of his life,” said his mother, Ellen Parent.
Ryan continued regular visits with an outpatient psychiatrist, but his mental state declined that summer. His fear of returning to The Ottawa Hospital mounted.
On the evening before he died, Ryan was in a paranoid state. He closed all the blinds, set the family’s home alarm system and discussed with his mother his fear that he had done something wrong, and would be locked up. They talked about going back to the hospital for help the next day.
“On the morning of his death, Ryan came into my room and said that he loved me but that he didn’t want to go back to the hospital,” Ellen Parent said. She told Ryan that was OK.
Ryan returned to his room. Later that morning, Parent discovered him slumped in his closet. He had hanged himself.
“My son who so badly wanted to live took his own life,” said Parent, who firmly believes her son’s experience in the PES unit played a role in his death.
“I do feel strongly about the fact that the ‘cell situation’ prevented Ryan from seeking more help — he was left with feelings of hopelessness and unrelenting fear. … I’m not saying that was the cause of his suicide, but he became terrified of the hospital.”
Ryan Parent is not the only patient who has been unsettled by the hospital’s secure and sterile PES unit. This newspaper spoke with two other psychiatric patients who were also disturbed by their experiences in the units.
But Dr. Katharine Gillis, head of The Ottawa Hospital’s department of mental health, defended the PES units as state-of-the-art.
She said they were created to give patients a private, safe and calming environment where they could be assessed by a dedicated team that includes psychiatrists, mental heath nurses and social workers. Previously, Gillis said, people who were having a mental health crisis were assessed in boisterous emergency departments, often in cubicles that offered little privacy.
Many people who come into the PES unit, she noted, are having an acute mental health crisis. “You have individuals who are really struggling: They’re over stimulated; they’re sensitive to their surroundings, to people being around,” Gillis said. “So we deliberately, in crafting these types of spaces, aim to have them provide low stimulation.”
Security measures, she said, are tailored to the individual. “When we think about a good patient experience, I think safety is an essential component.”
Although she could not speak to the specific details of the Ryan Parent case, Gillis said secure, low-stimulation PES units are now a standard hospital feature. “These elements may potentially appear unusual to someone who may see it, but these things are really part of what we want for this very acute, agitated phase,” she said. “This is not unique to The Ottawa Hospital.”
Dr. Gillis said there’s no defined limit of time for a patient stay in the PES unit. Staff will take the time they feel is appropriate to make a good assessment, she said, while keeping patients reassured and informed about the process.
“Our patient guiding principles are respect, compassion and safety,” she said.
Ellen Parent, however, contends the units are inhumane; she wants to see them eliminated.
“I feel it’s my duty to try to prevent anyone else from every going through that experience again,” she said. “A patient in distress does not need to be put in solitary confinement for hours on end.”
Ryan is not the only patient who has expressed concern about the units.
Joanne, 34, said she was three months pregnant and extremely depressed when she went to The Ottawa Hospital in April 2016. She went to the emergency department and explained to medical staff that she could not stop crying. She said she was having suicidal thoughts.
Joanne said she was sent to the PES unit for a psychiatric assessment. She spent 24 hours in the unit before being transferred to the hospital’s psychiatric ward.
“It was a very scary experience,” Joanne said of her stay in the PES. “It honestly felt like a jail cell.”
Joanne would spend two months in hospital and be diagnosed with depression, an eating disorder and obsessive-compulsive personality disorder. But it is her time in the PES that bothers her most.
“I would like them to remove it or at least don’t make it seem like we’re in jail,” said Joanne, who gave birth to a healthy son late last year. “We have mental illness, but we didn’t ask for that.”
Another psychiatric patient, Deanna, has twice stayed in the PES unit. She suffers from anxiety, post-traumatic stress and chronic pain. She called the unit “a dungeon.”
Deanna said her shoes, clothes and phone were taken when she entered the unit. She had to obtain permission to go outside for a smoke, and was accompanied to the bathroom by staff. (Gillis said security measures are individualized based on an assessment of each patient’s condition.)
Deanna said she felt so humiliated and isolated after her second stay in the PES that she has vowed not to go back.
Now 34, Deanna said the psychiatric ward is a more “humane” place where patients can wander around — the ward’s doors are secured — and visit a common area to read, watch TV or talk. She said she’d like to see the PES units revamped along similar lines.
“I don’t want to be treated like I’m an inmate down at Innes (the Ottawa-Carleton Detention Centre on Innes Road),” she said.
Parent contends psychiatric patients should be treated like anyone else who comes into the hospital, and assessed in the emergency department, not sent to a unit that can magnify their sense of isolation and paranoia. This is the situation at most other Ottawa area hospitals, including the Queensway Carleton Hospital, where a crisis-intervention team assesses acute mental health patients in regular emergency department cubicles.
“It’s just so wrong to send vulnerable people into that cell kind of situation, it has to stop,” Parent said. “I think every day of the people being put in there.”
Gillis said the hospital will be consulting with its patient and family advisory group before designing a PES unit for the new Civic campus, which is expected to open in 2026.
Resposted from: http://ottawacitizen.com/news/local-news/grieving-mother-launches-drive-to-reform-emergency-psychiatric-units