Toronto’s CAMH to implement 12 recommendations from external review after three patients went missing

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An external review launched after several high-profile patients went missing from Toronto’s Centre for Addiction and Mental Health is recommending the immediate development of a secure outdoor area, better communication with police and electronic management of passes to reduce the number of disappearances.

The review panel’s report, which was given to The Globe and Mail in advance of its public release Wednesday, makes a total of 12 recommendations for how CAMH should improve its policies and procedures around passes and privileges for some forensic patients.

Adalsteinn Brown, chair of the external review panel and dean at the Dalla Lana School of Public Health at the University of Toronto, said the changes will help balance the needs of patients and the community.

“Over all, the system works,” he said. “But there are a number of things … that can help advance both those goals of making sure that people get healthy and that community safety gets continually protected and maintained.”

CAMH accepts all of the recommendations and will take immediate steps to implement them, said Catherine Zahn, president and chief executive of CAMH.

The review was launched in July after three forensic patients who were granted some form of outside privileges failed to return to the facility over the span of a few weeks. The most high-profile case involved Zhebin Cong, a patient who had been found not criminally responsible (NCR) for murder in 2016. He fled the country July 3 while on an unsupervised day pass and remains missing.

Mr. Cong’s abscondment sparked a public debate about the treatment of NCR patients, with Ontario Premier Doug Ford stating that people who commit violent acts should be locked up indefinitely.

Dr. Zahn said she is disappointed that NCR patients continue to face prejudice and discrimination.

“I think I was surprised to see that the stigma associated with mental illness is still so strong,” she said. “Our patients are human beings and they have human rights, civil rights and health-care rights.”

By law, people with an NCR designation are detained in the forensic units of psychiatric facilities and their cases are managed by external review panels that help determine whether they are eligible for privileges, such as supervised or unsupervised community visits. The goal of the program is to rehabilitate patients and help them reintegrate into the community.

While abscondments are rare, the review panel’s report said “more can be done” to reduce the risk.

The first recommendation is for the hospital to immediately create a secure outdoor area where forensic patients can get fresh air or exercise. Currently, most forensic inpatients can’t step outside unless they are accompanied by two security guards and a CAMH staff member, a cumbersome process. The panel wrote that the lack of outdoor access may encourage patients to leave out of frustration and boredom.

Nearly half of the passes CAMH grants to forensic patients each week are to allow patients to exercise or use the hospital grounds, so creating a secure outdoor space for those individuals would allow staff members to focus on other patients, the panel wrote.

The physical space housing most forensic patients is no longer fit to achieve its purpose, Mr. Brown said. The panel is recommending that the planned redevelopment of the forensic unit be expedited to help patients and reduce the risk of abscondment. The province would be responsible for speeding up that process.

Hayley Chazan, a spokeswoman for Ontario Health Minister Christine Elliott, said in an e-mailed statement the government will work with the hospital on “how to support” the recommendations. But it did not commit to new timelines.

The panel also recommends CAMH develop a memorandum of understanding with the Toronto Police Service to help clarify what type of patient information can be shared and when it should be shared. CAMH and the Toronto Police should also develop key indicators to monitor and track trends in returning patients to the hospital after they go missing, the panel said.

CAMH should also start using electronic records to streamline the processes involved with giving day passes and set up automatic alerts when patients return, the panel said.

Other recommendations include developing new programming to help forensic patients progress toward rehabilitation and promoting a better understanding among members of the public about how the NCR program works to reduce stigma.

While abscondments from psychiatric facilities make headlines, they are rare. From April to June, the hospital granted more than 26,000 passes to forensic patients and during that time, there were 10 abscondments.