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System shortages in B.C. put kids who need complex care at risk

Alex Malamalatabua died on the grounds of the BC Children’s Hospital, above, after his move to community care was delayed.

Ben Nelms/The Globe and Mail

On March 17, a troubled teen walked away from his North Vancouver home and disappeared into the woods where he usually found solace.

Two and a half days later, searchers with North Shore Rescue located 16-year-old Alex Malamalatabua in a dense, wet forest. The distraught youth was airlifted out and delivered to hospital. Nearly five months after that, while hospital staff and social workers debated plans to move him back into the community, Alex slipped away from the secure psychiatric unit. His body was found more than three days later. Cause of death has not been determined.

Premier Christy Clark's government has been on the defensive over the recent death of another teen in government care, Alex Gervais, who was left on his own in a budget hotel after being bounced through 16 other temporary group and foster homes. By contrast, Mr. Malamalatabua received wrap-around care during his stay in hospital. But there is a link: Both boys had a long history of ministry involvement, yet they did not have access to the complex care they needed in the community.

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This gap in services is well-chronicled. In dozens of cases involving critical injuries and deaths of children in care, it is a consistent theme. The province has made some changes, hiring more social workers and adding some beds, but these two recent deaths underscore that vulnerable children and youth are still falling through the cracks. Mr. Malamalatabua was waiting, after 19 weeks in hospital, for someone to come up with a plan where he could safely return to the community.

Long before Mr. Malamalatabua was checked into the Child and Adolescent Psychiatric Emergency Unit at BC Children's Hospital in March, his mother knew he needed more support than she could provide as a single, working mother with a second son to care for. He had already been hospitalized earlier in the year because of depression, but was released back to his mother's care without a support plan. Two weeks later, he ran away into the forest. She knew something had to change after he was plucked off the mountainside. She made the difficult decision to sign a voluntary agreement with the Ministry of Children and Family Development, entrusting her son's care to the government. Although she visited him in hospital and took him on outings, the ministry was responsible for coming up with an appropriate placement once he was stabilized. The adolescent psychiatric unit is not designed as a long-term care facility – the average stay is just one month. Mr. Malamalatabua's 17th birthday passed.

His social worker told him he had found him a group home and promised to take him to see it. But the offer was pulled – it appears the medical team at the hospital did not agree with the proposed transition plan – and no alternative was proposed.

"He had been there longer than he should have been. But there was a long-term history, we had chronic issues, he needed individual care," Ms. Malamalatabua said. She does not fault the hospital, nor his social worker. But she struggles with the fact that, until he was in crisis, support was hard to find. He refused to go to school, and she was unable to force him. "Had there been intervention, to help him at the front end, maybe we wouldn't have got to the point were he needed critical care."

Once in BC Children's, Alex started getting better. The medical team there began working with the ministry to find a home-like placement where he would get the one-on-one support he needed. Alex was keen to move out of the hospital.

"He was happiest in the forest among the strong, silent trees, or when he was being buffeted by the wind, feeling it on his face," recalled his aunt Elizabeth in her eulogy. She described a resourceful, passionate boy who excelled in math and loved to play Scrabble. Even in hospital, he made others laugh. "He was a gentle soul," she recalled. "He gladly spent time helping others, regardless of his own suffering."

On the night of July 31, a Friday, Alex negotiated a half-hour, unescorted pass to go for a walk. Police were called in to search when he didn't return, but Alex could not be found.

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On the morning of Aug. 4, a crane operator returned to work after the long weekend at a construction project on the hospital grounds. It was from his perch atop the crane that he spotted Alex's body on the ground, hidden from the sight of searchers at ground level.

Stephanie Cadieux, Minister of Children and Family Development, said she doesn't know what the gap in services looks like today – her ministry's top officials are conducting a review of the mental-health services available and she expects to bring forward a plan to cabinet next June.

The plan may require more resources, she said, but she first wants to decide whether existing dollars are being spent in the most effective way.

"With anything in this ministry, there is always the argument that we could do more with more," she said. "But the other reality is, we have a broad spectrum of services across the ministry: Are they in the right place right now and are they talking to each other as well as they should, is the first thing to address."

Mary Ellen Turpel-Lafond, the Representative for Children and Youth, says she will wait for the hospital to complete its internal review of Alex Malamalatabua's case before deciding whether she will launch a full investigation. But she said it is a deeply troubling case where it appears the ministry failed Alex and his family.

"He basically was living at the hospital – it appears to me he was in a holding pattern because there was nowhere to send him," Ms. Turpel-Lafond said in an interview. What Alex needed was a transition – a step down – to a supportive level of care in the community, but those kinds of beds are in high demand.

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Although the hospital staff and ministry officials are bound by privacy laws that prevent them from speaking to the specifics of Alex's case, Ms. Turpel-Lafond as an independent watchdog has the power to look into such cases. She has published several reports on other instances where the lack of complex-care resources for youth have led to tragedy.

"We need a better care system. We have completely de-funded therapeutic foster care," she said.

Jana Davidson is the medical chief of the child and adolescent mental-health and addiction programs at BC Children's Hospital. She said the internal review will take a hard look at the factors around Alex's death – but she can't comment on those circumstances until the review is complete.

But in general, Dr. Davidson said clinical staff are working on a transition plan almost the moment a young patient comes into care. "We don't want to have any young person in hospital longer than they need to be," she said. Those plans, though, can take time and require co-ordination with multiple agencies. "There are times when discharge take a little bit longer to get to where there is a suitable placement."

The B.C. government acknowledged a shortage in services for youth with complex needs two years ago, in response to one of Ms. Turpel-Lafond's critical reports. The province responded by opening six new beds at the Maples Complex Care Unit in August of 2014.

Doug Kinna represents the province's social workers for the B.C. Government and Service Employees Union. He said those six new beds are helpful, but services continue to be stretched to the breaking point – stories like those of Alex Malamalatabua and Alex Gervais are not isolated cases.

"The need for child and youth mental health resources is incredible all over the province," he said. "They are doing child protection on the cheap – you are trying to manage risk rather than doing what is best for the kids," he said. "It is horrible to say this, but something really bad is going to have to happen to capture the public's attention – so that the government has to respond."

Ms. Malamalatabua agreed to be interviewed after consulting with her other son, Nick. She hopes that talking about Alex's story will help other parents who are also struggling with access to mental-health services. "Nobody can do this by themselves," she said.

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About the Author
B.C. politics reporter

Based in the press gallery of the B.C. Legislature in Victoria, Justine has followed the ups and downs of B.C. premiers since 1988. She has also worked as a business reporter and on Parliament Hill covering national politics. More

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