Updates to Victoria emergency psychiatric care are insufficient, say teen advocates

Content warning: this article deals with suicide and self-harm

Psychiatric Emergency Services at the Royal Jubilee Hospital released an update last week on their efforts to improve care for people in a mental health crisis. But the two teens who brought it all into the public eye last spring are not satisfied—and now they’re asking for an independent investigation.

Reform efforts started in March when two teenagers, Ella Hale, 18, and Emma Epp, 19, started a Facebook group called PES: a Pathetic Excuse for Services. They’d had bad experiences at Psychiatric Emergency Services—known as PES and pronounced “Pez” like the candy dispensers—and wanted to know if they were alone.

They weren’t. Within days, over 1,000 people joined the group and started sharing their own experiences. A common theme emerged: staff had been dismissive, uncaring and even suggested better ways to commit suicide to patients who had just made attempts.

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.

“It was an overwhelmingly positive response. A lot of words and people trying to do the right thing,” she begins—“And then cancelled meetings , plans not working out, not really following through. It was a lot ofcourtesy meetings.”

Island Health and PES kept working on their improvements—even after cancelling bi-weekly meetings with the young women in June, moving to an “as needed” schedule, which had resulted in one meeting, called by the two—and released an update on their progress on Sept. 8. Their list includes things like streamlining the Patient Care Quality Office, improving follow-up after a patient is discharged, using peer support workers, and improving staff education.

Hale says they’re still missing the real problem: the culture at PES.

“All these things on the list are amazing and it would be great to have those resources, but what are we doing to address the main concern that people are being told that they’re not suicidal? Or, they need to cut deeper? Or, if they actually want to kill themselves they should … ? Those things are not being addressed. And whenever we bring them up, they’re like, ‘Oh it’s an HR issue, we can’t talk about specific people,’” Hale said.

Epp doesn’t get the sense that PES really believes in the changes that need to be made. Reading through the revitalization plan, Epp reads parts aloud to mock them: “‘Island Health is aware of and concerned about some people’—2,300 people, but okay—‘indicating they are reluctant’—we have said, so many of us, that we would rather die than go back to PES. I think that’s more than reluctant but okay,” she says.

One of the frustrations for the two women, whose advocacy has become a constant occupation since the spring, is that names of certain psychiatrists and nurses at PES are mentioned over and over again.

“They know the people we have our biggest issues with, they say they’re disciplining them, that they have—what are they called, Ella?” Epp asks.

“Mandatory professional development opportunities,” Hale fills in.

“But we still get the same stories, so whatever they’re doing isn’t working,” Epp finished.

The day before their last meeting with PES in mid-July, the women received a note from someone who’d just been released after a suicide attempt. She said she was told, “If you were going to kill yourself you’d use something better than a razor.”

Hale and Epp relayed the story to PES management, saying, “This was your staff telling a vulnerable 19-year-old girl how to kill herself. That is on you. If she went home and took her life… “ Hale’s voice trailed off. “And they basically said, ‘You can’t blame us for anyone taking their own life, and we don’t believe any of the stories unless they’re reported officially.”

That process for formal complaints is unwelcoming to people in a vulnerable mental state, Hale said, and it’s hard to go back to the same place where you’ve had a bad experience to complain about it, also knowing you might be a patient again in the future. She and Epp have been working with the Patient Care Quality Office to improve the process, but don’t seem optimistic that it will result in real action. They want an independent person who can hear complaints, possibly making them anonymous, and do the formal paperwork on the patient’s behalf.

That office is separate from PES, but still part of Island Health, so people don’t trust that complaints will be acted on, Hale said.

That’s why they’ve called for an independent investigation, with the support of their MLA Adam Olsen. They want an impartial look to hear complaints from patients and staff. they don’t trust Island Health to investigate itself, but also say they’ve been contacted by Island Health employees with their own bad experiences at PES. The employees told Hale and Epp they’re afraid for their jobs if they speak publicly.

“It’s hard because I don’t think we’re asking for a lot. We’re not asking to be treated like supermodels, but when somebody goes to the hospital in a mental health crisis, they need to be treated respectfully. Bare minimum, just treat people like humans,” Hale said.

No one was available for an interview at PES, but Island Health said since June it’s been busy implementing changes, including a new director responsible for adult psychiatry services at Royal Jubilee Hospital, which includes PES.

It has also involved five patient partners to give input and feedback, added patient representatives to an oversight committee, started a trial of hosting peer support in the emergency department and PES, drafted a tool for steps a client should go through if they have suicidal thoughts, and more.

In a statement, Island Health said, “People have a right to be treated with respect and dignity when they are accessing our services. Island Health is committed to an open and transparent process to achieve improvements to PES, a process that involves patients, their families, care providers and support staff. The goal of the work underway is to identify and implement short and longer term actions that will create a supportive environment for patients in crisis and the staff who support them.”

But still, just two days after PES posted their update, someone commented on the Facebook group saying she “relapsed and texted everyone saying my goodbyes.” Later, at the hospital, she says the doctor told her, “If I really wanted to die, I wouldn’t tell people goodbye and just do it.”

“Emma and I are not giving up. We’re not settling for fancy PowerPoints,” Hale said. “Until we’re not receiving stories on a weekly basis with consistent themes coming up, we’re not going to be satisfied with the response.”

If you're having thoughts of suicide or self-harm, you can contact the 24/7 Canada Suicide Prevention Service hotline at 1-833-456-4566.