Better health communication in the Kamel report?

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The commission of inquiry into the death of Maureen Breau and by Isaac Brouillard Lessard continues in Trois-Rivières.

• Francis Beaudry (View profile)Francis Beaudry

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Coroner Géhane Kamel questioned communication problems within of the health system on the second day of hearings into the death of police officer Maureen Breau.

During the testimony of Dr. David Olivier, who was Isaac Brouillard Lessard's psychiatrist from 2012 to 2018, the question of the lack of follow-up between the different cogs of the health system and psychiatrists was raised by Ms. Kamel.

Dr. Olivier said that at the beginning of November 2017, Isaac Brouillard, who then lived in Lévis, was in the middle of a mental health crisis: he frankly decompensated, he explains.

It was his parents who reported the deterioration of his condition to the health system through of an occupational therapist who was previously assigned to their son's case, but who had not looked after him for over a year.

The psychiatrist then learns that his patient has failed to appear twice in a row appointment for an injection of antipsychotic medication which takes place in a clinic in Lévis, that he is therefore unmedicated and that he is more at risk of having mental health crises.

Coroner Géhane Kamel questioned communication within the health system in the provinces.

At this point, Coroner Kamel interrupted the doctor's testimony to highlight the work of psychiatrists who have to deal with a system that is stretched to its limits of arms, and which the speakers do not speak to each other.

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She deplored that the psychiatrist had not received any communication from Lévis staff indicating that his patient was not taking his medication, especially since he refused any follow-up at home from health staff.

She also said that she was considering adding this problem to the recommendations of her investigation.

Isaac Brouillard Lessard's mental health crisis led to his hospitalization in psychiatry in Shawinigan, from November 7 to December 22, 2017.

Psychiatrist Marie-Frédérique Allard, who worked with the patient during his hospitalization in Shawinigan, was also called to testify on the second day of the hearings.

Dr. Allard describes the difficulties experienced by psychiatrists having to manage patients who refuse to follow their treatment, even if they have an order to comply with it from the Administrative Tribunal of Quebec (TAQ).

If we want to have a treatment prescription, therefore force someone to take their treatment [. ..] the person must be incapable of consenting to care, then there must be a categorical refusal, she explains.

To obtain this order, psychiatrists must therefore contact the Superior Court of Quebec.

Psychiatrist Marie-Frédérique Allard described a complicated legal environment for psychiatrists.

For a patient deemed dangerous who we wish to force to report to the hospital to receive care, it is rather to the Court of Quebec that we must contact to obtain a judgment under the law P-38.

It's not for nothing that we have full-time lawyers working for our establishments, because almost every day, a psychiatrist goes to testify in court about one of these things; to either be kept in the hospital or seek treatment, she laments.

Ms. Allard states that due to delays in various courts and the difficulty of obtaining a judgment quickly, psychiatrists must often play the role of guardian of behavior, in order to ensure that for their own good, patients respect the conditions imposed by the TAQ.

It becomes very heavy because we have clinical work, we have nursing work […], but we find ourselves in a position where we monitor, but at the same time we want to treat, then we want to create a therapeutic alliance, we want to take care of people, so it's a very difficult position, she explains.

As for solutions, Dr. Allard isn't sure how to approach the problem.

We have lots of people in breach of conditions, but if they are not dangerous, we can do nothing; is it to judicialize breaches of conditions? […] And then there is the definition of dangerousness, it is not even defined in the law, explains- She.

With information from Julie Grenon

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