01/25/2012 12:51 EST | Updated 03/26/2012 05:12 EDT

Hey ER: Protection for the Mentally Ill Is an Emergency

In the first week of 2012, the Toronto area has witnessed two likely examples of what the U.S.-based Treatment Advocacy Center calls preventable tragedies in the treatment (or lack of treatment) of serious mental illness. These are two current examples of what I called "Society's Shame" in the title of my own book on schizophrenia. Two people are dead and their families and friends devastated.

The first example is that of Cindy Ciarafoni, a mother of two and a grandmother of four. Ms. Ciarafoni had schizophrenia and had been, her family reports, taking her medication irregularly of late resulting in a return of her symptoms.

According to theToronto Star, she was walking her dog on New Year's Day when she handed him over to a stranger. Acting in a bizarre manner, she left her dog and wandered into a coffee shop. Police were called and then arranged for an ambulance to take her, somewhat unwillingly, to the Humber River Regional Hospital's Church St. campus.

In the six months prior to this, she had been hospitalized about once a month for medication non-compliance usually at William Osler hospital in Etobicoke. What happened after this most recent admission is unclear. The family thought she was safe in the care of the hospital until they received a call from police the next day. Ms. Ciarafoni was struck by a car on busy Highway 7 about 10 kilometres north of the hospital possibly trying to walk back to her Woodbridge home. The only identification she carried was a piece of paper with the family phone number on it. She later died in surgery after being rushed to Sunnybrook Health Sciences Centre.

What happened in hospital is a question the family wants answered. All that is known is the ambulance personnel turned her over to a triage nurse 30 minutes after reaching the ER. A physician then tried to interview her six hours later but she did not respond. What happened next is a mystery and the hospital is not talking.

According to Dr. John Grohol, the founder and editor-in-chief of the popular U.S. website PsychCentral in his report of this incident, "while most ERs are setup to handle people with a serious mental illness fairly well, ERs aren't exactly known for their warm-fuzzy, emotionally-supportive environments. So people slip through the cracks."

In another all to familiar incident, a young man on suicide watch at another Toronto area hospital, Southlake Regional Health Centre, was discharged back to his family. The next day, 22-year-old Seneca College student Andrew Roelink was charged with first-degree murder after his mother was found dead. Police had originally taken him to the ER on a mental health warrant.

In order for the police to detain him under the mental health act, they would have needed to be assured that he was a danger to himself or others. If that was the case, why was he discharged so quickly? At least this hospital is co-operating with the police according to the Toronto Star.

Unfortunately, quick discharge from the ER for those presenting with mental illness is an all too common occurrence. Emergency rooms tend to be dumping grounds for those with mental illness who need special care and treatment. As Dr. Grohol said in his report, hospitals should review their procedures to ensure that these incidents do not happen again.