Category Archives: Forensic Psychiatry

Family Day, Serious Mental Illness and Murder

By Marvin Ross

I’m posting this on Family Day in Ontario. This is a new statutory holiday promised by former Premier Dalton McGuinty during the election campaign of 2007. It was, of course, part of his platform so that he could win re-election by giving people an extra day off between New Year and Easter and sold as an opportunity for people to celebrate family.

Unfortunately, families with serious mental illness in them lost out when the recommendations of an all party Select Committee on Mental Illness and Addictions Report of 2010 was largely ignored by that government. There is little for many of these families in Ontario to celebrate as you will see from my Huffinton Post blog that follows. It was published on February 9 and I will update it at the end.

Was Ontario Complicit in a Father’s Murder?

Last Spring, I mentioned the problems that a Richmond Hill, Ontario family was having with acquiring adequate service for their son with schizophrenia in one of my Huffington Post blogs. That was one of the many blogs I write on the pathetic state of care that we have for the treatment of those with serious mental illness.

Sadly, the father in this case, Bob Veltheer, was murdered on Sunday evening February 7 and, the next day, his son Jacob was arrested. Bob and his wife talked to me before I wrote the blog wanting to reveal just how badly people with serious mental illness are treated by the health system but decided to remain silent other than what I reported then.

Before I outline what I know of the care their son received, I should mention that Bob was the founding member and president of Home on the Hill, an agency set up to try to get housing for the mentally ill when their families could no longer keep them at home. I had been invited to speak at their monthly meetings a few times as had my blogging partner in another blog we share, Dr David Laing Dawson.

Last year, Jacob, who suffers from schizophrenia, was found sitting on a bus at the end of the line in Newmarket, Ontario presumably having failed to get off when it passed through Richmond Hill. He was suicidal, so the police were called and he was taken to South Lake Hospital. After a week and still suicidal, according to the family, he was discharged against the wishes of his family and that is what I reported.

Upon discharge, he ran off, as do many people with schizophrenia, and the York Regional Police went looking for him. He was found after three days and returned home only to disappear again. This time, when he was found, he was admitted to MacKenzie Health in Richmond Hill. After a brief stay, he was discharged with a community treatment order to a residence. A community treatment order is a legally binding order that the individual must accept regular medical help and medication. If they fail to abide by this, they can be returned to hospital by police.

Jacob, it seems, was too sick for the residence to cope with (but not sick enough to be in hospital) and was evicted from the residence. What should the parents do but what all parents do and that was to take him home. Just recently, the team that supervised his orders (the South Lake Assertive Community Treatment team), wanted him discharged to the care of the family doctor. His mother had just made contact with a local Richmond Hill psychiatrist and was waiting to hear back to see whether that doctor would see him.

Friday night, Bob had a meeting with a member of Home on the Hill executive at his house and I was told that Jacob was so distraught that he was pacing about the house talking to himself (or his voices or demons) in a loud voice. That Sunday night, the police allege that Jacob murdered his father.

This horrific tragedy could probably have been prevented had Jacob been kept in hospital long enough to stabilize him properly and, if that was not possible, to give him a secure place where he could live. The number of psychiatric beds in Ontario has been declining considerably over the past few decades but the total extent is not available since statistics on that can’t be found. And I’ve tried. The most recent Ontario report released in December of 2015 called Taking Stock found that access to services varies across the province and is inconsistent.

Late last year, the brand new psychiatric hospital in Hamilton closed a ward because of budgetary problems although that hospital has 6 vice presidents, 31 directors, a medical director earning $500K a year and a CEO making $750K a year. And, as I wrote a year ago, Ontario has had 17 reports on the sad state of mental health care between 1983 and 2011 but little has been done.

This is not the first preventable death, nor will it be the last unless we finally start to care. In my book on schizophrenia, I describe a case where a family in Mississauga, Ontario desperately tried to get help for their son. They could not and he ended up killing both his parents. I met the son a couple of years ago and found him to be a very pleasant and sane individual. But that was after years in a forensic psychiatric hospital where he has been getting treatment. Imagine if his family were able to get that when they first tried.

I am not Emil Zola nor was Bob Veltheer, but I accuse the complacency of the Ontario government for his death. Government bureaucrats have been informed repeatedly both verbally and in writing about the need for accountability, program evaluation, transparency regarding mis-spending, mis-use of privacy legislation and the historical resistance to partner and collaborate with families. The Central Local Health Integration Network where Bob resided, I’m told, had recently been notified about the profound need for hospital beds by Home on the Hill.

Home on the HIll has been attempting to meet with the new Health Minister, Jane Philpott, whose constituency is near Richmond Hill but have not heard back yet.

I would like to see either a Coroner’s Inquest or a Royal Commission into the circumstances that led up to this horrific event. And I would like to see Ontario finally do something other than commission studies which they then ignore.

Update

This blog received a great deal of attention as it was distributed widely and to a number of politicians where the Veltheer family live. I attended the funeral on February 13 along with politicians from the all three levels of government. The local town councillor who is a supporter of the work of Home on the Hill plans to bring this to the attention of the Ontario Minister of Health as is the local representative in the Ontario legislature. The representative who sits in the Canadian House of Commons is planning to raise this event in the House of Commons and a meeting has been arranged with the Federal Minister of Health.

We all hope that Bob’s death and the pain that his family is going through will result in some positive changes. Ontario which has direct responsibility for providing health care needs to get off its duff, stop generating reports which they ignore, and start providing the services that have been recommended so many times by so many reports.

The Federal government needs to take the money they are wasting on a Mental Health Commission that has no direct authority and does nothing but generate its own reports and put it to providing funding programs in the provinces. And just maybe, Prime Minister Justin Trudeau whose mother, Margaret suffers with bipolar disorder, will understand and do something.

Doing something would be a welcome change and would honour the memory of Bob and all the others who have been sacrificed by our lack of resources.

What is Wrong with Luka Magnotta? Reflections on Forensic Psychiatry

David Laing DawsonBy Dr David Laing Dawson

Does he have schizophrenia or not? And if he does suffer from schizophrenia, is it the cause of his terrible behaviour? (murder, cutting up his victim and mailing the body parts to various people)

Actually, I’m not going to try to answer that question. Our courts decided he was responsible for his actions, whether or not he suffered from a mental illness.

But this case highlights an absurd inequity in our system. Mental hospitals have been closed, psychiatric beds reduced, psychiatric services limited, but for the past 20 years Forensic Psychiatry has been a growth industry. In some instances our old, a little run down, but functional and humane mental hospitals have been simply converted into maximum secure jails for mentally ill offenders. If Dorothea Dix were alive today she would be writing outraged petitions to our legislators.

We have made it harder for the average family with a mentally ill member to access psychiatric service by excluding the family (privacy laws), by reducing the number of psychiatric beds and staff, and by making it far more difficult to get that family member to the hospital and have the hospital keep him long enough to assess, treat, and stabilize. (Mental health laws and modern hospital management practices).

If that average family with a mentally ill member does get to see me on referral from a family doctor, I will spend about one hour figuring things out, “making a diagnosis”, about one half hour explaining, discussing and instituting treatment, about fifteen minutes documenting all this, another ten minutes trying to get a social worker involved, and then have them come back for “follow up” in two weeks. If I think the ill person needs to be in hospital I will spend half a day, on and off, while they wait, trying to find a bed and negotiate an admission. If my first impressions prove correct, and the treatment starts to help, we will have a series of half hour appointments perhaps every second week to once per month over the next couple of years to get treatment and rehabilitation and recovery on solid ground.

That’s it. We do have other mental health services in many of our communities that are better resourced, but for the most part they specialize with strict criteria and long waiting lists.

Now Luke Magnotta. The only real decision being made so expensively was whether he would be spending the rest of his life in a Prison or a Maximum Security Forensic Psychiatric Hospital. He would probably be safer in the Forensic Hospital, require isolation within the Prison, and perhaps be allowed escorted leaves from the Forensic Hospital a decade from now. In either facility he would receive psychiatric medication, perhaps with a little more care and expertise in the secure Forensic Hospital.

And to make this decision we spent a small fortune. I don’t have a figure but I can guess. Courts and lawyers and psychiatrists. Hours and hours of time spent by more than one psychiatrist examining, writing, reporting and testifying. Twenty-five thousand, a hundred thousand dollars of psychiatric time? A million dollars to house, feed, monitor and treat Mr. Magnotta over the next twenty years?

Now I don’t know if Mr. Magnotta has a treatable psychiatric illness, and if consistent treatment over the past five years would have prevented this tragedy. But it would have been a hell of a lot cheaper.