Getting psychiatric care for loved one can be challenging for families
TORONTO - The parents of Faisal Hussain, whose shooting spree Sunday in Toronto's Greektown left two people dead and 13 injured, say their son had struggled all his life with psychosis and depression, but none of the medications or therapies he tried were able to overcome his mental illness.
In a brief statement, Hussain's parents said they had done their best to seek care for their son, who was found dead from a gunshot wound after exchanging gunfire with police during the weekend incident.
Their story illustrates the difficulties many families face in getting help for a loved one suffering from a severe psychiatric illness, especially given an acknowledged lack of access to mental health services in Ontario and elsewhere across the country.
So what are such families to do?
"I've actually had clients sit in my office and ponder if there's nothing that they can do and are they at a point where it's time to get a divorce, for example, they feel so hopeless," said Lisa Feldstein, a Toronto lawyer who helps families navigate the mental health system.
"Or they feel they've done everything they can for their child and now they just have to accept there's nothing more."
While Hussain's family revealed no further details about his diagnosis, treatment or emotional state prior to the attack, Feldstein said there are cases in which treatments simply aren't effective.
"It is possible that he could have had the best of care and nothing was working," she said, noting that treating mental illnesses is both "an art and a science."
For families dealing with serious psychiatric illness in a loved one, getting help could mean reaching out to such advocacy organizations as a local Schizophrenia Society or the Canadian Mental Health Association, which can offer support, information and advice on how to effectively make their way through the often thorny mental health system.
And if a loved one's condition appears to be deteriorating - the person isn't caring for themselves or is threatening harm to themselves or others - families can take steps to have them admitted to a hospital for psychiatric care, either voluntarily or involuntarily.
Dr. David Goldbloom, a psychiatrist at the Centre for Addiction and Mental Health in Toronto, said some individuals with conditions such as psychosis-inducing schizophrenia or bipolar disorder may not recognize they have a psychiatric illness and refuse to acknowledge a need for treatment.
"The first step is trying to engage that person in getting some help and figuring out who has the best leverage with that person," he said. "Who does that person trust to engage them to get some help voluntarily?"
If that is unsuccessful, families may be forced to turn to what may seem a more draconian measure.
In Ontario, for instance, a family doctor can complete Form 1 under the Mental Health Act within seven days of examining a patient, which would authorize police to apprehend - not arrest - them for transfer to a hospital for a psychiatric evaluation. A patient can be held involuntarily for 72 hours.
Form 3, which must be completed by a second physician, authorizes a hospital to keep a patient with severe symptoms for up to two weeks, said Goldbloom. Form 4 stretches that period to two months.
A patient who is "formed" can contest such an order within a week of admission before a special board; and under Ontario law, the person also has the right to refuse treatment.
"There is ultimately no upper limit on involuntary hospitalization in terms of duration, but every time it is rendered the patient has an opportunity to challenge it," explained Goldbloom.
"But at all times the goal is hopefully to work toward voluntary hospitalization," he said, adding that the same is true for persuading a patient to take prescribed medications.
"There's a variety of ways it plays out ... the clinical staff aren't just sitting there staring at them - they're trying to engage them to earn their trust.
"And if that's successful, the person may start to think 'Maybe I should do this.' But others will say 'No, no, no - I'm not touching any of that medication. I want my hearing."
A hearing by the Consenting Capacity Board is designed to ascertain whether a person is capable of agreeing to treatment.
The board determines if someone has the ability to understand the nature of the treatment, its benefits, risks and the alternatives, "which includes the consequences of not having treatment," said Goldbloom.
"And it's about understanding intellectually but also about appreciating it at a personal level," he said. "So you could understand a treatment but not appreciate that it would be of benefit to you."
Goldbloom said the core of treating a person with mental illness is creating a therapeutic alliance between patient and practitioner.
"The engagement isn't just about 'take your meds,"' he said. "The engagement with whoever's providing the treatment should be about more than that. It should be about a common cause of trying to improve somebody's functioning and quality of life."
But Feldstein said families often see the mental health system in a far different light, finding it difficult to get a loved one "formed" and admitted to hospital.
"They view the system as very rushed and often physicians have very little time to get to know their loved one," she said. "I can't tell you how many times I have heard families say 'My loved one acts differently in that brief interaction with the doctors."'
But without information from the family, a physician may have no idea the patient had been threatening self-harm or harm to others.
"And frequently families feel that smart, manipulative patients can talk their way out of being formed or out of the hospital," Feldstein said.
"And then they go back to their life and their family sees a completely different side."
In the case of Hussain, Feldstein said the question is whether anybody suspected he was at risk for harming other people.
"Doctors and hospitals are in a terrible position of having to decide 'Do I infringe on someone's liberty or do I let them go and they may be dangerous? And I don't have the tools to know exactly what's going to happen in the future.'
"There is no way," she said, "to perfectly predict dangerousness."