Andrew Sleeping on the streets of Toronto
Andrew when well
By Marvin Ross
Andrew Bryenton is a 39 year old male from PEI, an assistant manager of a bank, husband and father, who developed a severe mental illness much like people develop cancer or heart disease. Instead of getting treatment like others with illnesses, he is wandering the streets of Toronto, homeless, and being supported with food, drinks and money by complete strangers who have learned of his plight thanks to his mother and her facebook page. He is one of thousands in cities and towns across Canada who are faceless and anonymous wandering our streets, begging and living in parks and alleys.
People with severe mental illness often do not recognize they are ill which is part of their illness. Called anosognosia, it is a common and a well recognized symptom for those with severe mental illness, strokes and Alzheimer’s Disease. That is why treatment resistance is so common.
In Andrew’s case, he became ill about five years ago, was hospitalized and put on medication but he then refused to take it and to follow up with his doctor. He left PEI about 9 months ago for Halifax then on to Moncton and finally Toronto. When a missing person is over 18 and found, all the police can do is tell them the family is concerned. They can do nothing more unless he is visibly a threat to himself or others. Andrew’s family applied to a justice of the peace (JP) for a form two and demonstrated to him or her that Andrew needed to taken to hospital for a medical/psychiatric assessment. The JP was satisfied, signed the document and the police were instructed to locate him and take him to a hospital.
This was done and Andrew was taken to a local hospital for evaluation. A person in these circumstances can be held for 72 hours for assessment and either agrees to stay voluntarily or, if the patient refuses, and the doctor determines he needs treatment, the patient can be held for a longer period of time. So that no person is held against their will indefinitely, there are time limits and rights of appeal for people.
The doctor that Andrew got decided that he was fine and that he had no grounds to hold him. Even though the doctor in PEI felt that with hospitalization and treatment Andrew could be restored to 90% of his previous self, and the family wanted the Ontario doctor to send him back to PEI on a medical transfer, the Ontario doctor refused. Andrew was discharged and back into the streets.
Since the discharge, he has continued to walk the streets for long distances with nothing but an old sweatshirt and torn pants. Through a facebook page set up by his mother, people all over Toronto are reporting his whereabouts to her, giving him food, water and money.
The doctor undoubtedly discharged Andrew because he did not feel that he posed an immediate danger to himself or to others. Those are the only conditions that can be used to hold someone in Ontario although there are advocates who find that even those are too many. A committee made up of Ontario elected representatives from all parties issued a report in 2010 recommending that the criteria be expanded. That report has been ignored.
In contrast, the British Columbia Mental Health Act has four criteria including “Requires care and supervision to prevent deterioration or protect themselves or others”. Andrew would likely come under that category as he is probably going to get worse with no treatment wandering the streets of Toronto. So many preventable tragedies have occurred because people were discharged when they should have been hospitalized and treated. Vince Li comes to mind as the most infamous. He was picked up by Toronto Police wandering the streets and taken to hospital where he was looked at and released.
He continued to wander the country becoming more and more psychotic until he murdered his seatmate on a Greyhound Bus in Western Canada and tried to detach his head from the body. Arrested, found not criminally responsible and hospitalized in a secure forensic facility, Mr Li no longer suffers from the symptoms of schizophrenia and is living in the community. I can only imagine the remorse he must feel for his actions and the ongoing sorrow of his victim’s family. It should never have happened.
But, just having slightly expanded confinement rules is not sufficient. An individual can be held because of danger but is then given the freedom to decide if they want treatment or not. This has resulted in people being kept in hospital for years when they do not agree to that treatment. In a study conducted by Solomon, O’Reilly, Grey and Nikolic called Treatment Delayed – Liberty Denied in the Canadian Bar Review, 2009, the authors found that “the Ontario law imperils the physical and mental health of involuntary psychiatric patients, and often results in subjecting them to prolonged detention, mental anguish, physical and chemical restraint, and solitary confinement.”
The Consent and Capacity Board (CCB) can rule that a patient requires treatment when they refuse but no treatment can be started until the board rules. Those decisions can then be appealed to the courts who rarely overturn the decision. In a 16 year period, only three cases were overturned. On average, it takes eight months for an appeal to be heard whereas patients treated can be discharged in an average of three weeks.
Involvement of family and providing information to family is also an Ontario impediment to successful treatment. The Select Committee reference above (P 18) noted that:
“British Columbia’s legislation permits the release of personal health information to health care professionals, family members, and others involved in a client’s care without the client’s consent, for the purposes of “continuity of care” and if it is in the best interests of the client. The Select Committee believes that the B.C. legislation may provide a better balance between the autonomy of the client and a caregiver’s need for important health care information.”
The Committee reported that:
“Many people told the Select Committee of their frustration at being emotionally and financially responsible for their loved ones while not being considered a partner in care by the health care system. One mother was not certain how seriously she should take her son’s occasional threats of violence, because he would not allow his psychiatrist to release more information about his condition. Some caregivers did not know that a loved one was in hospital, or about to be released, until he or she showed up at the door, or worse, was later found wandering the streets. Yet others have provided information about symptoms to a psychiatrist, only to have this information immediately passed on to the client, exacerbating paranoia and diminishing trust.”
the recommendation from the committee stated:
The task force created to investigate and propose changes to Ontario’s mental health legislation and policy should also investigate and propose changes to the Personal Health Information Protection Act, 2004. The changes should ensure that family members and caregivers providing support to, and often living with, an individual with a mental illness or addiction have access to the personal health information necessary to provide that support, to prevent the further deterioration in the health of that individual, and to minimize the risk of serious psychological or physical harm.”
NOT DONE EITHER.
Andrew’s mother, Marlene, has begun a petition called Please Help Bring Andrew Bryenton Home to PEI and to lobby for new legislation to bring in an Advance Medical Directive to deal with similar situations. In that effort, she is working with Sean Casey, a Liberal Member of Parliament for Charlottetown and Susie Dillon, a Conservative Member of the Legislature of PEI. It is hoped to introduce this as a private members bill in the Senate called Andrew’s Bill. Signatures to the petition are increasing daily and yours would help.
Meanwhile, at the time of writing this, Andrew is wandering the streets of Toronto being helped by total strangers thanks to his mother’s Facebook page.
How many others are in the same situation?