Tag Archives: Hamilton

The Failure in Police Reactions to Emergencies – Amended After Toronto

By Dr David Laing Dawson

Within the span of a few days the Hamilton Police demonstrated good judgment and remarkable restraint keeping two unruly mobs apart on Locke Street, saved a little girl’s life with quick compassionate action, and killed a teenager, a boy obviously in the throes of some kind of psychotic episode.

Why do they perform so well, even heroically, in some circumstances, and so poorly, tragically, in others?

I am not asking the question rhetorically, for the question may be worth serious consideration.

The first of these three situations was the most dangerous. It could easily have erupted into violence followed by five years of lawsuits.

The second required quick, focused action despite the horrifying sight of a child being caught under a moving train.

The third required a calm assessment of imminent danger (there was none) and then a calm slow approach.

In the rush to arrive at an unfolding situation each officer will develop heightened arousal. Stress hormones, adrenalin, breathing pattern, heart rate, blood pressure will all be aroused. This is commonly called the fight / flight response, but it is a complex system of brain/body arousal that allows for increased awareness of danger, heightened ability to focus, increased startle response, decreased pain sensation, decreased attention to ‘unimportant’ internal and external stimuli (e.g. time, hunger, thirst, chirping birds, other people), and heightened reflexes.

For the little girl with the severed limb this served her well. The officer reacted quickly and with full focus and efficiency without external distraction.

For the containment of the two mobs there had been enough planning, preparation, structure, and organization that each officer was able to quell or override their fight/flight response and diffuse the potential for violence.

Not so in the third example. The officers arrived in fully aroused state and entered the situation with heightened reflexes and heightened fear. Guns were drawn, triggers pulled.

Each circumstance is different. But in all the unnecessary police shootings of the past few years there has been one consistency: Police arrive in a rush on a call labeled as dangerous in some way. They are in a state of heightened arousal. They do not pause. They do not collect their thoughts or information. They do not pause in safety to slow heart rate, breathing, to scan the environment. They are hyper focused. They push forward. There is no thought of backing up.

In this state a cell phone can be seen as a gun. Awkward movements and slow response to commands can feel dangerous and threatening. The fact that no third party is at imminent risk does not register.

In a recent police shooting in the U.S. you can hear the heightened arousal, the full fight/flight response in the voices and breathing of the officers.

I have to conclude that some things are missing from police training. The first would be a pause upon arrival at the scene to determine if there is indeed a truly imminent threat to a third party. (Not a suicide threat, refusals, waving of arms, bizarre behavior, bad language, verbal threats – but a truly imminent threat to a third party. Is there anyone else on the street car, in the back yard, nearby in the field, nearby in the park, in the arrival lounge?). The second is the option to hold, rest, backup, breathe, take the time to dampen the state of arousal one is in at that moment, and then and only then proceed in a sane, calm, safe fashion.

And all that I suggest was done by the Toronto police officer when he confronted the driver of the van that had just wreaked havoc on Yonge St killing 10 and injuring many others. When the officer arrived, no one was in imminent danger. He even had the presence of mind to return to his cruiser and turn off the siren as it was distracting and preventing the officer and the subject from hearing one another. That also gave  him time to calm his nerves. At times, he backed away and, presumably when he realized that he was not in danger himself, he advanced and the suspect gave up.

We can only hope that this incident will serve as a training tool for others who might find themselves in a similar situation.

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Families, Privacy and Hospital Suicides

By Marvin Ross

One of the constant themes in my writing of mental illness is the need to involve the family. And so, when I read a lengthy account of the suicide of a young 20 year old girl that appeared in my local paper, what jumped out at me was that she had requested that her family not be involved with her illness or treatment. She wanted to spare the family grief and, it seems that the doctors went along with her.

The young girl had a number of suicide attempts while in hospital and the family was told none of it. Dr Peter Cook, one of the psychiatrists, told the newspaper that “We were obligated to protect the privacy of Nicole. She was an adult.” The other shrink said that confidentiality between patient and doctor is “sacrosanct.” Nicole did not want to share her medical information with her family.

Sadly, this young lady is not the only suicide in the past little while at this hospital. There have been 9 – 3 in hospital, 2 of patients on leave and 4 outpatients. To its credit, the hospital did commission an external review to see if things could be improved. One of the recommendations was for “closer collaboration with families.”

Now, maybe the outcome would not have been different if the family was involved but we don’t know that. And, the privacy legislation is pretty confining but there are ways to get around them if the medical staff really care. The hospital recently established a family resource centre as the result of a donation from a philanthropist friend of mine. It was difficult to get them to accept the gift but they did and it is being used and it is being well publicized to families.

At the time we were negotiating for a family resource centre at the hospital, I wrote an op ed for the local paper on the need that families have for inclusion with staff when their loved ones are being treated. Aside from pointing out the anger that families have towards being ignored, I mentioned the very sensible guidelines that were produced by the Mental Health Commission of Canada for family caregiver inclusion. And I mentioned this:

“Very few, if any, mental health facilities have adopted these recommendations despite the fact that about 70 per cent of those with serious mental illness live with their families according to the Mood Disorders study. And family caregivers spend 27 hours a week caring for their ill relative according to the EUFAMI survey. That is five hours longer than the average in other countries surveyed by EUFAMI.”

I don’t know if St Joes ever did adopt these recommendations and I do know that the Privacy Act is very restrictive. But, with a little effort, it can be sidestepped as I pointed out in a Huffington Post Blog.

I was basing what I had to say on an excellent paper on the topic that had recently been published by Dr. Richard O’Reilly, a professor of psychiatry, Dr. John Gray, an adjunct professor of psychiatry along with J. Jung, a student in the Faculty of Health Science at Western University.

I said this in my post:

They point out that clinicians often don’t even bother to ask their patients if they have permission to involve family.

If they do and the patient refuses, then they should take the time to explore the reasons for this refusal. Many patients don’t understand why it is important and do agree to allow their families information once it is explained to them. In some cases, there is some information they do not want shared (like sexual activity and/or drug use) and the staff can ensure that this information is not shared. Staff can also inform families of pertinent facts in meetings with the patient present. This often allays patient fears and is similar to the approach recommended in the UK and by the Mental Health Commission of Canada.

In those cases where no consent is given, the staff can give general information to the families and receive vital information from the family. The family can tell the doctors about new emerging symptoms, worsening of symptoms and medication side effects, all of which should be crucial information.

Until such time as political jurisdictions reform the privacy legislation, mental health staff can do far more to open the channels of communication with families for the betterment of their patients. It is time they do so.

I was pleasantly surprised that at a meeting with St Joes staff just after this was published, one of them told me that this blog was being read by staff and was being circulated within the hospital.

It seems that not sufficient attention may have been paid to that. I hope that more attention is paid to involving families so that these tragic events can be minimized going forward.