schizophrenia, involuntary admission and family members

the following is a press release from vancouver’s north shore schizophrenia society.  since no-one seems to have picked it up yet, i’m publishing it here.  it addresses the important question of when involuntary admission for serious mental illness is applicable, and the involvement of family members.

vancouver coastal, in a review of the death by suicide of marek kwapiszewski, has ducked the leading question they needed to answer: why is “dangerousness” still considered a requirement for involuntary admission rather than “to prevent the person’s… substantial mental or physical deterioration,” as spelled out in the mental health act?

what was promised by CEO david ostrow to have been an “independent” review, moreover, turned out to be not so independent after all, with senior managers under question in the review taking part in drawing up its recommendations.

kwapiszewski, 54, of vancouver, who suffered from schizophrenia, jumped off the granville street bridge to his death june 29, 2008. his sister, halina haboosheh, together with her lawyer, had made 16 different attempts to get him the treatment he needed – treatment which required involuntary admission since kwapiszewski, like many suffering from schizophrenia, did not have insight into his own condition.

instead of dealing with the factors leading to kwapiszewski’s death, the review came up with three brief items in a so-called action plan, which involved no changes or improvements in practice, nor was any fault determined although it was an obvious case of clinical failure.

“the ‘action plan’ should have been called an ‘inaction plan,'” NSSS president herschel hardin commented. “it was as if a review had not taken place.”

the so-called action plan was presented to haboosheh and the north shore schizophrenia society, which made the original submission in the case, at a meeting july 26, in vancouver coastal’s boardroom.

the first item, to facilitate a discussion to consider development of an operating definition of “deterioration,” makes no commitment to ultimately do anything, and is highly questionable to begin with in any case. nor does it apply to the kwapiszewski case, where the deterioration was quite clear and substantial.

the second and third of the three items were bureaucratic filler, not representing anything new and showing no grasp of what the problem was.

the review also completely missed two other crucial factors in the case: the failure of vancouver coastal staff to involve the sister, halina haboosheh, as an integral member of the treatment team, following best practices, and the concomitant failure to share clinical information with her. if that had been done, marek kwapiszewski might well be alive today.

it was also learned that the items were not the independent work of the external lawyer and psychiatric consultant hired to undertake the review, but were a consensus arrived at with senior community mental health managers and, possibly, vancouver coastal’s risk management officer. in effect, they had a veto over what would be presented.

as well as forfeiting the review’s independence, this meant that a major shake-up of senior mental health management, called for in NSSS’s 2009 submission, could not even be addressed. instead, the primary subjects of the review, as NSSS considered them, were parties to the review’s outcome.

in response to vancouver coastal’s items, NSSS has presented four recommendations of its own to vancouver coastal and has asked ostrow and his board for leave to speak directly to the recommendations at a board meeting.

for more information, please go to the NSSS media center.


  1. As much as it always saddens me to read about situations like this I’m glad that you’ve posted about it, and am very grateful for the excellent work of the North Shore Schizophrenia Society. In the absence of a mental health ombudsperson in the province, the NCSS is a vital watchdog and advocacy organization. Without their efforts to engage with VCH and the media, probably things would be even worse than they are.

    I’m a consumer who’s been hospitalized dozens of times, spoken with hundreds of peer co-patients and consumer/survivors off and online. All of us who were inpatient (even when admitted voluntarily) had to meet the “danger to self or others” rule of thumb. Facilities/funding don’t meet the needs of the population who have deteriorating conditions but aren’t in an mortal crisis situation, because the beds are always full with patients who are at the “dangerous” stage. NSSS knows it, you know it, family members, consumers, doctors, nurses, it’s not a hidden secret at all and yet services continue to be cut.

    I’ve also heard so many heartbreaking stories from family members of people who have illnesses without insight (schizophrenia, bipolar disorders, dementias) that doctors have not involved them in care, not communicated, not listened. This is one result. Homelessness, criminalization and victimization happen because of it too.

    I hope the NSSS is successful in pressuring VCH to make changes to its policies. In the 11 years I’ve lived in Vancouver I’ve just seen services deteriorate more and more. Perhaps VCH will convene a meeting to examine and define *that* deterioration one day…

  2. It reads like a classic bureaucratic cover up.

    In Australia the situation with mental health services is similarly appalling.

    A family member of mine was recently in a psych ward for a few days. It was just awful. Thankfully they got through their crisis and are doing well – but this is very much despite, not because of, the pysch services.

  3. This is such a sad situation. Unfortunately, I understand how it can happen. Here in the U.S. this issue is too often made my insurance companies that do not even speak with the patient. It is also very difficult to 5150 individuals. Bizarre behavior/thoughts do not qualify. I person needs to be actively suicidal usually. The hospitalization system does not have enough beds. Unfortunately, I could go on.

  4. there are so many challenges …

    the bar is so high, unless you meet some far-off criterion (“dangerous”, “actively” suicidal, etc.) it’s incredibly hard to get help. another problem is the state of the psych wards. if they were better places to be, there would be less problems with involuntary admission.

    i’m looking forward to seeing what impact the NSSS will have.

  5. I have no words. Even a few years ago when there was “more” funding in the system, people were left out. Of course, we don’t have to look further than our downtowns to see those that don’t meet the criteria but certainly require the intensive treatment and support had they been deemed “dangerous”.

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