If Not Here, Then Where? And Why?

**trigger warning - this post contains information about suicide** 

Image a family member, perhaps your brother or sister, or your friend or partner. Imagine they begin acting strangely. Isolating themselves. Saying bizarre things. Pacing. Tearful. Unable to be reached. Imagine they try to hurt themselves. Frightened and concerned, you would do what anyone would do and try to get them the help they so obviously need. Drive them to hospital, call 911, anything that was required.

We have psychiatric inpatient services for these sorts of situations after all. Places where those experiencing mental illness that are at risk of harm to themselves or others can get around the clock supervision and access to the most comprehensive emergency psychiatric services that are available. Of course these are complicated mental health problems. Psychiatric inpatient units are ill equipped to ‘fix’ people. Instead, their role is usually to provide supervision, manage acute risk, and stabilize. Often, the hard work of getting better needs to be done after discharge, in the community. Outpatient psychotherapy. Medicatio adherence. Group programming. Family supports. Follow-up. 

Now imagine your family member doesn't get the chance to be discharged and to start the hard work. Imagine that they find a way to kill themselves while at the very place that is supposed to be supervising them and keeping them safe from themselves. This is exactly what the Tiwari family went through when 20-year-old Prashant Tiwari hung himself in a bathroom of the Brampton Civic Hospital on June 26, 2014. The family has said that staff were supposed to check on Prashant every 15 minutes, but left him alone for up to 3 hours that day. They filed a 12.5 million dollar wrongful death lawsuit against the William Osler Health System in Brantford today. 

Questions invariably arise. For example, is it fair to expect that patients will be kept safe under any and all circumstances in hospital? It is a common adage in mental health circles that if a person really wants to kill themselves they will find a way to do it. This is a crass way of recognizing that personal rights and freedoms must always be balanced with safety and risk of self-harm. Was that balance appropriate in Prashant's case? It's impossible to say. The family asserts they are still without answers about what exactly happened to their son and brother. 

Other questions about mental health and the role of emergency services loom large over this tragedy. What are the policies to keep people safe? How are they enacted? Are they effective? What happens when they fail? How many deaths have occurred in supervised psychiatric units? As things stand now, the answers to these questions may never be made public.

Not all people can be protected. But if they can't be kept safe in a psychiatric unit designed for supervision and stabilization of individuals in the throes of acute mental illness, what is a family to do? And if the family and the public can't get information about what happened and why, how are we supposed to do better as a society?