Forensic psychiatry patient detained at West 5th hospital for an extra six years and counting

A forensic psychiatry patient has been stuck at the West 5th Campus of St. Joseph's Healthcare for six years because housing to support his physical and intellectual disabilities can't be found in Ontario.

The case was called an outlier" by Dr. Gary Chaimowitz, head of forensics. But he acknowledged specialized housing can be hard to get provincewide and patients deemed ready to live in the community have remained detained at the hospital for months or even more than a year waiting for a placement.

Occasionally the type of housing just is not available," said Chaimowitz. Every now and then, we hit really big hurdles and it becomes extremely hard to find the perfect accommodation ... We have people who waited significant periods of time."

He said none have waited as long as Wesley Shortt, who became a forensic psychiatry patient after being found not criminally responsible for threatening to kill his father in 2006. He was deemed by the Ontario Review Board and his doctors to be ready to live in the community in 2014. As of Nov. 3, he was still at West 5th.

We struggled to find accommodation," said Chaimowitz. We have a group of dedicated social workers who are looking for specialized beds for this particular individual and a bed has not come up."

The case came to light after a scathing ruling by the Ontario Court of Appeal issued Oct. 16 covered by Toronto Star courts reporter Alyshah Hasham.

Hasham reported the province's top court ordered the Ministry of Children, Community and Social Services to work together with the Ministry of the Attorney General to provide the precise location in the community where Mr. Shortt can be placed no later than the end of 2020."

I think it is a resource issue," said Chaimowitz. It's just additional services that we need."

Finding housing in the community for a patient who has issues with mental health and involvement with the criminal justice system is so tough that the province pays to contract beds from community service agencies.

We don't actually own the homes but we essentially purchase space in the homes," said Chaimowitz. It's actually been a very fruitful collaboration. Because of the relationships with the agencies people can then later occupy other accommodation with the agencies - less supervised and more independent. It's a very positive thing."

West 5th has purchased 10 such beds in Hamilton and they're full.

As you can imagine, we're usually up against a fair amount of stigma and discrimination with people with mental disorders," said Chaimowitz. When you add a forensic component - in other words, when there's a criminal justice and mental health component - the barriers tend to be a little higher."

Chaimowitz says the purchased beds tend to turn over quickly as the patients move on to more independent living, so the wait for them is generally not too long.

The patients who get stuck are those needing more specialized housing such as certain types of staffing, security, lockdown or monitoring.

It tends to be the super-specialized housing that sometimes is in short supply and where we're competing with other people that we run into snags," said Chaimowitz.

While normally West 5th tries to keep patients housed within two hours of Hamilton, the forensic psychiatry program looks across the entire province for specialized beds. The social workers also start looking before the patient is even deemed ready to go.

Waiting lists to get into places may roll over a year," said Chaimowitz. Planning begins when people arrive and we start looking at where they may go should and when their condition improves."

Long waits for community placement are significant considering forensic psychiatry patients do not have a set sentence. There are 90 hospitalized at West 5th until the Ontario Review Board and their doctors deem them well enough to start re-entering the community. Delays can set back their recovery as well as leave them detained well beyond when they have been deemed ready to leave.

We obviously are balancing a risk and the rehabilitation of patients," said Chaimowitz. At some point when someone's mental status is cleared and they're able to enter the community we attempt to find an appropriate community location for them."

It is the Ontario Review Board that determines what type of housing is appropriate - some are able to go to family or live independently right away, others require transitional housing while some need varying levels of specialized services. West 5th has 60 patients living in the community.

The boards are fully aware of the resources in the community," said Chaimowitz. They do try to align with what should be available although some things are better resourced than others."

Joanna Frketich is a Hamilton-based reporter covering health for The Spectator. Reach her via email: jfrketich@thespec.com