Family calls for overhaul of Royal Jubilee’s psychiatric emergency services and Mental Health Act

Glen Fawkes. Photo submitted.

Content warning: This story details suicide. If you are in crisis or contemplating suicide, call the Vancouver Island Crisis Line (1-888-494-3888) or Talk Suicide Canada (1-833-456-4566) to speak with a supportive listener.

Kyle Fawkes has been waiting more than 430 days for an answer from Island Health into the events that preceded the death of his father, Glen, by suicide—a death that came less than three weeks after he was released from psychiatric emergency care at Royal Jubilee Hospital.

He was told to “take back your autonomy” by the psychiatrist who discharged him, according to medical records the family obtained.

His family has written letters to the province, staged Twitter campaigns, and met with BC’s Minister of Mental Health and Addictions, Sheila Malcolmson. Still, Fawkes says, he can’t get a meeting with Island Health leadership to discuss what happened while his father, who had been exhibiting signs of worsening psychosis for months, was under the health authority’s care.

The Fawkes family says they have concerns about the way Glen was treated within Royal Jubilee’s psychiatric emergency services—and, more broadly, with the pattern of care he received in the months leading up to his death.

They’ve filed a complaint with the watchdog that oversees Island Health—but they’ve been waiting for more than a year.

His family’s concerns come as the health authority and Royal Jubilee Hospital face continued scrutiny for their alleged mistreatment of patients in psychiatric emergency care. It’s a situation that has left the hospital on the receiving end of hundreds of online horror stories and repeated calls to overhaul both the hospital’s psychiatric services and the way mental-health patients are cared for in the province.

‘He laughed really big’

Ask anyone around Glen—his wife Lisa, or his sister Heather, or Kyle—and they’ll tell you his laugh is among the things they remember most. It boomed from their Campbell River home and ricocheted off the walls like a mallet strikes a gong.

He had a loud voice—“pretty much everyone in our family does,” Heather says. “He laughed really big.”

He was the eldest of three siblings, a father of two, and a helicopter pilot with a penchant for practical jokes and a sensitive side.

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- Heather (sister)

Glen (middle), pictured with sisters Mel (left) and Heather (right). Photo provided.

- Heather (sister)

Glen (middle), pictured with sisters Mel (left) and Heather (right). Photo provided.

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Glen had no known history of mental-health issues, nor alcohol or substance use concerns. No family genes to suggest a predisposition to suicide or psychosis. He was active; fit for his 61 years. He would run three to four times a week, lift weights, meditate regularly, and hike the woods and hills near the Fawkes family home.

But in the months leading up to his death, he warned loved ones that “very bad men” were after him. He became paranoid; delusional. He would interrupt family dinners and ask to be driven to the hospital—or to be taken to the RCMP station.

He suffered “suddenly and tremendously,” Lisa told Capital Daily.

Despite doctors’ appointments, intake visits to Campbell River Mental Health & Substance Use Services, and trips to the emergency rooms at North Island Hospital and Royal Jubilee, Glen’s family couldn’t find him the treatment they felt he needed—nor a diagnosis that matched what they were seeing at home.

“He felt that he was losing his mind,” Lisa says.

The family feels their concerns were dismissed—or not followed up on—at each turn by the health-care providers they met. They were offered psychiatry referrals for Glen that never materialized, or told he would need to self-refer for treatment, or in some cases, questioned on why Glen needed any help at all. They argue it speaks to a pattern of poor patient care within Island Health and the province.

“I wanted to know, what are the magic words to get someone you love mental-health care?”

A cascade of events

Of all the dozens of dominoes that fell before Glen Fawkes’s suicide, the first came as a tree crashing through the roof. It buckled the eavestrough, tore through shingles, shattered a pair of skylights, and came to a rest mere feet above where Glen was sitting in the family’s upstairs office.

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- Kyle Fawkes

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It was early January 2020. Both Kyle and Lisa were in the house at the time.

“He was right under the spot on the roof where [the tree] came in,” Kyle says. “And he was very lucky in that a beam was there and protected him, but there was about an eight-foot chunk of wood that came right through the roof… I can imagine that jarred him.”

There were other things. By the time February rolled around, the stock market crashed—and with it, the family’s savings. Lisa fell ill for six weeks. The province declared the global COVID-19 pandemic a public health emergency in mid-March.

Glen had built a career out of travelling internationally and training helicopter pilots in developing countries. He grew anxious and couldn’t sleep; in a five-night span, he might get two hours of rest.

He sought the help of his doctor and aviation medical examiner, but Kyle says the symptoms “just kept persisting.” He asked for time off work to get his sleep in order and lost his contract. His sleep and anxiety worsened.

By May, Glen was exhibiting signs of psychosis. He could watch a leaf fall from a tree and be convinced something was wrong, Kyle says. He feared the propane tank from the family RV “was going to blow up neighbourhoods from Campbell River to San Francisco.”

Glen, Lisa, and their two sons, Kyle and Jason, in earlier years. Photo provided.

But his family couldn’t get a diagnosis beyond anxiety—nor could they find a specialist who would listen to what they were seeing at home. And his paranoia made matters more difficult.

Lisa visited the Campbell River Mental Health and Substance Use Services office in hopes of getting help, only to be told that Glen would need a self-referral. She was incredulous.

“I said, ‘How do you get a paranoid man who thinks he’s going to be locked up [in] here?’ She said, ‘I don’t know.’”

It was only the beginning of their frustrations with Island Health and the province’s mental health-care system.

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Access to mental-health care in BC has become a more frequent topic of debate within the legislature. In 2020, BC Green leader Sonia Furstenau lobbied for a 12-month pilot project to have psychologist visits covered under MSP—a proposal that Premier John Horgan told CHEK he would be “open to,” but said would present a “challenge” to find the resources for.

A 2020 Nanos survey found two thirds of British Columbians polled felt wait times to see a psychiatrist were a “very significant” or “somewhat significant” barrier to accessing mental-health care in BC. And those who received care didn’t fare much better. A 2016 study led by researchers from UBC found that of 108,000 people diagnosed with major depression in BC in 2010-11, 13% of them received “minimally adequate” counseling and psychotherapy. That number was even higher among men and younger people.

"What we've seen from [the government] is that they know the mental health system is broken," Vancouver psychologist Erika Penner told CBC in January.

"We have this unbelievably piecemeal system that really benefits folks that can afford a psychologist. Realistically, I can barely afford a psychologist."

Difficulty getting help

The first time Lisa feared Glen was thinking about suicide, the two were on a ridge hike in late July. They’d gone to the Campbell River Lookout Trail, a popular out-and-back trek northwest of the city that leads through old-growth woods and ends at a clifftop. The drop is steep; the hike climbs 535 metres and involves stretches of chain rope. From the summit, you can see all the way to Quadra Island and south to the sawtooth peaks of Strathcona Park.

Glen paced back and forth along the cliff’s edge. He was silent, Lisa recalls; he seemed transfixed. She pleaded for him to step away from the ledge. He relented after minutes that felt like hours.

“This was not my husband,” she says.

Lisa cried on the long walk home. She asked him that night if he’d considered jumping off the cliff. He said no—“he didn’t think it would kill him,” she recalls.

The family staged an intervention days later. Glen confessed he’d been suicidal. He still wasn’t sleeping, and his delusions had worsened.

“He was talking about men being after him with guns… he thought he’d done something horrible,” Kyle says.

Lisa took Glen to the North Island Hospital emergency room, where he met with a crisis nurse—but they left feeling as though little had changed. The nurse assured her she’d spoken with Glen about “the difference between thinking about suicide and intent” and recommended he self-refer to Campbell River Mental Health and Substance Use Services. It was the very place that had rebuffed Lisa less than a week earlier.

Lisa fears Glen hadn’t been honest about the full scope of his symptoms. He downplayed his psychotic episodes in medical appointments, she says. “He was afraid of being locked up.”

Medical records described him as “engaged, calm, ma[king] good eye contact, and dress[ing] appropriately.”

But Lisa hadn’t been permitted to join Glen for his meeting with the crisis nurse. She worried the nurse was missing half the story.

‘I was not above begging at this point’

The delusions persisted. In September, Glen told Lisa her life was in danger.

“I was too exhausted to care at this point. And I was unsure whether he was trying to warn me,” she says. “He was adamant the police and the medical system were after him.”

Lisa Fawkes has been advocating for improved mental health care in BC. Photo: Martin Bauman / Capital Daily

The family had already hidden knives, axes, scissors—“anything that could be used as a weapon,” Kyle told Capital Daily. “We were in safety mode and lockdown 24/7.”

“He believed we intended to harm him,” Lisa says. But they worried he would harm himself.

Kyle took Glen with him to Victoria. Lisa met with a friend, a retired college counsellor, who suggested she write a document detailing all of her fears for Glen’s safety. She filled pages—and at the end of the document, she pleaded for help.

“I was not above begging at this point,” she says.

Kyle and Heather brought that document in with them to Royal Jubilee’s Psychiatric Emergency Services (PES), along with Glen, on the evening of Sept. 19, 2020. But the family feels it was dismissed. Kyle says they were “barred entry” when they tried to join Glen for his intake interview. A security guard confronted them and told them to leave “immediately,” he says.

At the time, the hospital had introduced visitor restrictions that limited outsiders to “essential visits”—which included visits for “compassionate care,” and visits “paramount” to a patient’s physical care and mental well-being. Per Island Health’s guidance, providing “communication assistance” and “supported decision making” both met the criteria to be deemed essential.

Royal Jubilee’s Psychiatric Emergency Services. Photo: Martin Bauman / Capital Daily

Island Health does not comment on individual family cases, but told Capital Daily that when it is “appropriate,” families are involved throughout the entire patient process—“from admission to inpatient stay through to discharge."

That doesn’t line up with the Fawkes’s experience.

Kyle and Heather sat and waited on a bench in the hospital parking lot until an admitting nurse came out with forms for them to sign. Lisa made the drive down from Campbell River. When she came, she had a “five-minute discussion” with a social worker—which, she later found, was the sum total of the background information provided to the psychiatrist.

She asked if a doctor would call her and talk about a care plan.

“I left my cell number. A doctor never called,” Lisa says.

Pattern of hospital indifference

Ella Hale and Emma Epp have heard their share of PES horror stories like the Fawkes’s. They were inundated with them when they launched the Facebook group PES: A Pathetic Excuse for Support in February 2021. The two had been patients themselves.

Hale, 19, had been going to Victoria General Hospital for mental-health support from the age of 14. Her first trip to PES came after a suicide attempt. As she recalls, the psychiatrist told her that she was on too many meds, and if she killed herself, her father probably wouldn’t care.

“I just sat there as she talked to me. It was horrible,” she told the Times Colonist.

Ella Hale (left) and Emma Epp (right). Photo: Zoë Ducklow / Capital Daily

Similar stories flooded online.

“Last time I was in there… they didn’t treat me,” one woman wrote on Facebook. “I wasn’t seen by doctors or nurses, and they left me in a corner for 24 hrs and released me. I was told when I left that because of my Borderline personality disorder (BPD) diagnosis there is no point in [coming] back because they won’t touch me.”

Another woman shared how, at 17, she’d been brought into PES after having suicidal thoughts. The healthcare worker who saw her asked to see her cuts “and then laughed about how she had seen worse and how next time I should cut deeper.”

As their Facebook group gained attention, Hale and Epp were invited to meet with Premier John Horgan, Health Minister Adrian Dix, Mental Health Minister Sheila Malcolmson, managers at PES, and the Patient Care Quality Office (PCQO): a feedback system put in place for patients and their families to resolve issues with Island Health.

Last fall, Hale summarized those encounters as “a lot of courtesy meetings.” She and Epp still feel the province and Island Health haven’t lived up to their promises to change.

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Unlike Hale and Epp, the Fawkes family is still waiting to hear back from the PCQO. The health authority’s website says that complainants can expect any issues “to be dealt with promptly and fairly,” and that the office will “work with [families] to identify a reasonable resolution”—a resolution that includes an explanation of any decisions and actions Island Health takes.

That doesn’t match the Fawkes family’s experience, Kyle says.

“They haven’t engaged with us… it’s just appalling,” he told Capital Daily. Island Health told his family they would receive a response to their complaint within 40 days. “I mean, this has gone on for well over a year now.

“It’s just so frustrating,” he says. “We try and communicate, we try and connect with them. And we get formed responses and the bureaucratic kind of stonewalling.”

‘You don’t need to be here’

After waiting for the better part of two days, in the end the first person to call Lisa was Glen himself. Royal Jubilee had discharged him 36 hours after he’d been admitted to PES under the Mental Health Act. Typically, a patient who’s been involuntarily admitted will stay up to 48 hours, during which time a second physician would review and determine if a patient should stay longer, for up to a month—a process that repeats in greater increments, from three months to six months, as long as the hospital deems treatment necessary.

She phoned PES to find out what was happening, but was told she’d have to ask Glen due to patient confidentiality—only, he wasn’t sure, either. He thought he’d been referred to a psychiatrist on the North Island, but his mental state muddied his recollections. It wasn’t the first referral the Fawkes family had been given without follow-up. Lisa calculates there had been “three or four” other psychiatry referrals in earlier months, and her family “never heard back about any of them.”

A 2019 survey of 30 BC psychiatrists found patients wait, on average, ten weeks for an initial psychiatry consult, and more than 24 weeks for the start of treatment—but at least one physician has told Capital Daily that wait times can exceed six months.

Psychiatry wait times

Wait from GP to psychiatrist (weeks)

Wait from initial consult to treatment (weeks)

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When Lisa arrived at the hospital, Glen was sitting on the curb with his head in his hands.

“He told me the doctor had said to him, ‘I don’t really know why you’re here. You don’t need to be here.’”

Medical records show the psychiatrist who discharged Glen from PES had told him to “take back your autonomy,” and it was Glen’s “job to keep himself safe.”

Nineteen days later, Glen took his own life.

A search for answers

It wasn’t long after the Fawkes family started their inquiries into Island Health’s provision of care that Kyle realized the health authority “was going to be difficult to deal with.”

Lisa had asked for Glen’s medical records from his family doctor, his aviation medical examiner, his counsellor, and Island Health, to piece together his eight-month mental decline. All of his records came back promptly—except for those held by Island Health, who replied that Lisa would need to elaborate on her reasons for requesting the records.

“I [replied] that Glen had committed suicide 19 days after being [at PES], and I had concerns about his frame of mind,” she says. “That wasn't good enough.”

Royal Jubilee Hospital. Photo: Jimmy Thomson / Capital Daily

Under BC’s Freedom of Information and Protection of Privacy Act (FIPPA), a person’s privacy rights carry on after their death. Anyone applying for access to a deceased person’s medical record must prove their request is in the interest of the deceased. Island Health told Capital Daily the law is structured to “strike a balance between preserving the privacy rights of the decedent and enabling the appropriate person, under law, to act within the scope of their duties and powers.”

But Glen’s family argues the law gives too much power to health authorities to decide whether to comply with requests or not—and they say the reasons Island Health quoted in their denial don’t apply in the family’s case. In asking the Fawkes family to elaborate on their reasons for requesting Glen’s records, the health authority had referred to a subsection of the privacy act that states any request must provide “sufficient detail to enable an experienced employee of the public body with a reasonable effort to identify the records sought.”

That doesn’t explain why Island Health denied their request, Kyle argues.

“Nowhere in the quoted legal text did it state that we must detail our purpose, nor explain how the records requested are on behalf of the decedent,” he told Capital Daily in an email.

It took until Feb. 16, 2021 for the Fawkes family to receive Glen’s medical records from Island Health—about 50 days from the time they had first requested them. But when they got them, portions of Glen’s records had been redacted.

What the Fawkes family saw—which detailed Glen’s stay at PES, including notes from the nurses, social workers, and psychiatrists who saw him; as well as his records from North Island Hospital’s emergency department and Campbell River Mental Health and Substance Use Services—gave them “significant concerns” about Island Health’s care, Kyle says.

‘Just trying to get people in and out’

One of the most glaring concerns the Fawkes family had was around who’d agreed that Glen was ready to leave PES.

Records the family obtained show the psychiatrist who discharged Glen had deemed he had “no reason to be there,” Kyle says—but that counters what several other psychiatrists and doctors who saw Glen within his 36-hour stay felt, who, according to Glen’s medical records, believed that he should have stayed at the hospital longer for further assessment.

Royal Jubilee Hospital. Photo: Lotus Johnson via Flickr

The Fawkes family aren’t alone in their concerns about how patients are cared for at PES.

As we reported last fall and in March of 2021, Island Health and Royal Jubilee Hospital have faced mounting pressure from a chorus of former patients who say they were turned away, dismissed, and mistreated by the psychiatric emergency unit’s staff when they needed help. The accusations span decades.

One of those former patients, Joseph Briante, went to Royal Jubilee on Oct. 29, 2007, in the midst of severe delusions.

“I was terrified the whole time,” he told Capital Daily. “I wasn't making any sense, like I was incoherent… my mind was just raining down with delusional thoughts that every step I was taking was not safe and my body was falling apart.”

A triage nurse sent him to PES, where a psychiatric nurse and doctor concluded there was no need for him to be admitted to the hospital. Briante was released about three hours after arriving. He attempted suicide six days later.

Blood loss from the attempt left Briante, a former intellectual property lawyer, with severe cognitive impairments. He wonders if things might have been different had he received more immediate care at PES.

“It’s like some sort of processing mill, like they're just trying to get people in and out,” he told the Capital Daily Podcast. “It had no, like, human warmth… I [didn’t] come out… feeling like I was seen with any empathy.”

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Island Health says it has undertaken steps to improve PES within the last year. The health authority launched a “Psychiatric Emergency Services/Acute Care Revitalization Project” in March 2021—including, among other things, engaging “patient partner participation in feedback processes” and streamlining the complaint process so concerns are “identified, followed up on, and responded to quickly and consistently.”

But Kyle wonders why, if Island Health is seeking patient input, his family hasn’t been involved.

“I am not entirely sure they can claim to have ‘heard’ concerns when they haven't made amends (or even had a discussion) with their sharpest critics,” he wrote in an email.

Broader criticisms of patient care at Royal Jubilee and Island-wide

The concerns around care within PES extend beyond Royal Jubilee to the rest of the province. Island Health—and the rest of BC’s health authorities—have also come under scrutiny from the BC Ombudsperson, Jay Chalke, who, in 2019, found the province’s hospitals and health institutions were regularly violating the Mental Health Act.

Chalke laid his office’s findings out in a 132-page report, which looked at health authorities’ compliance with the Act in a single month: June 2017. In that one-month span, the report found, more than half of patients who had been involuntarily admitted under BC’s Mental Health Act had no record of being notified of their rights—a requirement by law. About a quarter of patient files were missing a Consent for Treatment form. Less than a third contained any record of patients’ relatives being notified of their admission.

In all, about seven in 10 involuntary admission patient files across the province were missing at least one form required under the Mental Health Act. Island Health fared better than the provincial average, but still managed to provide complete records in just 34% of required cases.

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Island Health told Capital Daily in a statement that it has “accepted all the recommendations” from the Ombudsperson’s report, which has included staff training on complying with the Mental Health Act and more rigorous tracking of its compliance. The health authority noted that in the Ombudsperson’s July 2022 report, Island Health had improved its rate of complete records to 52%.

The Fawkes family would like to see the Mental Health Act changed to involve families and loved ones throughout the involuntary admission process—from giving families the chance to provide insight into a patient’s history, to keeping loved ones abreast of any discharge plans.

Capital Daily phoned Minister Malcolmson’s office for an interview to hear what changes, if any, might come to the Mental Health Act.

“We regularly receive suggestions to improve the Mental Health Act and are in the early stages of reviewing sections of the Act,” Malcolmson replied in an emailed statement. “It’s too early to say what changes will be made.”

‘I could have helped’

Lisa still gets emotional when she thinks about Glen.

“[He was a] very kind, smart, funny man who loved his family, loved the outdoors,” she says.

The two had plans for their retirement. They would travel across Canada. Hike together. Spend time with family. Maybe they’d return to Kona, or the coast of Italy, or Edinburgh’s Christmas market.

Lisa and Heather Fawkes. Photo: Martin Bauman / Capital Daily

The grief of Glen’s absence is still there, but what she wants most—what Kyle wants most, too—is a chance to sit at the table with Island Health. There, perhaps, in sharing their story and influencing change within the mental-health system, they could find some closure.

Lisa wishes there’d have been more of a chance to be heard throughout Glen’s mental-health decline.

“I could have helped connect those dots—Glen couldn’t,” she says.

“We're here to help,” Kyle adds. “We want to support [them]; we want to build the programs better.”

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—With files from Zoë Ducklow, Jackie Lamport, Emily Vance, and Nina Grossman