The ‘killing’ of Justin St-Aubin

Justin Scott St-Aubin  was 25 when he died of a heart attack in the Rivieres des Prairies detention centre in Nov. 2007. The young Montrealer had been held in isolation for five days, never receiving the emergency psychiatric care recommended by two doctors.

St-Aubin's case echoes that of Brian Bedard, a Montrealer suffering from schizophrenia who died of a heart attack in the same institution under similar circumstances in 2000. His case launched a public inquiry and promises of reforms from the Parti-Quebecois government of the time. There have been at least seven other deaths of psychiatric patients in Quebec detention centres since.

In a coroner's report on the St-Aubin incident, Dr. Paul Dionne concluded that his death was a preventable accident. "If the recommendations in (the 2001 Bedard) report had been put in place," wrote Dionne, "Mr. St-Aubin would probably not have died."

St-Aubin's family has since launched a $445,000 lawsuit against Quebec's attorney general, the Philippe Pinel Psychiatric Institute, and two physicians, hoping to pressure authorities into finally reforming a broken system.

On Nov. 23, St-Aubin was brought to Rosemont-Maisonneuve Hospital by police following an altercation with his mother. A doctor in the emergency ward requested he receive an emergency psychiatric evaluation. Instead, he was  held for five days in isolation at the RDP detention centre. He was physically restrained and given anti-anxiety and anti-psychotic drugs prescribed over the phone by the jail's doctors without ever seeing him. On the 27th, St-Aubin was seen by a doctor from Pinel who recommended an emergency transfer to the Institute.

It was never done.

He died the next day during a period of severe agitation and struggling with eight guards. He was in the midst of an 'excited delirium'—a psychiatric condition seen in schizophrenic and bipolar patients that can lead to cardiac arrest.

His case highlights the ongoing failures of the public safety, health and justice systems in dealing with the mentally ill. These failures include a lack of training and resources within the criminal justice system, the inadequate medical care in the system, and the political inertia involved in implementing necessary changes.

After the report on the Bedard incident, an inter-ministerial committee was put in charge of implementing the recommendations put forth by the coroner. "Les ministres se disent convaincus que la mise en place des recommandations contenues dans ce rapport contribuera à améliorer de façon significative la situation des contrevenants présentant des troubles de santé mentale au Québec," said the 2001 government press release.

No recommendations where im-plemented.

"It's always the same thing," said Dionne in a phone interview. "The people change, the government changes, there's no clear leadership.Do I sound pessimistic? I've been doing this job for 21 years. I realize things never really change unless there's public pressure. If you read between the lines of my report, I think the big crunch is where I recommend the three ministers show some leadership. That's where the problem is."

Bernard Cote is the director of PECH, a Quebec City organization offering on-call services for police to help in interventions involving people with mental health disorders. PECH assisted police in 1,500 interventions last year. In 85 per cent of the cases, the person was not jailed.

"Sadly, there's too many stories that end badly," he said. "Too many people with mental health problems end up in jail. It's a failure of the front-line mental health services."

Jail is a dumping ground for the mentally ill because "les reseaux renvoit la balle," Cote said. "It's like ping-pong, people give away responsibility."

Once in jail, they often spend five to eight days in detention before receiving even an initial psychiatric exam. Further, "the increased stress (of jail) worsens the situation. It's a horror," he said. "We create the crisis, or increase it, worsen it."

Quebec City is dealing with its own incident, a 2007 case involving a bipolar man who died of self-inflicted wounds while in police custody. It's under investigation by the coroner's office and the Surete du Quebec.

There have been small improvements. Dionne's report notes a genuine effort on the part of the  public security ministry to improve the situation (they are currently not commenting on the case). Montreal set up a municipal mental health court this spring. A committee made up of provincial and municipal bodies is looking at short-term changes to improve the system.

However, the system still lacks psychiatrists and space (the caseload at Pinel increased from 600 to 1000 in five years) and training remains inadequate for police and correctional officers. "They don't have the training, they don't have the support, they don't have all the necessary organization," said Dionne.

Dionne also noted that the Ministry of Health and Social Services did not seem willing to implement the changes recommended in its own mental health plan."It's a complex subject, (but) essentially, we take too long to do things and we use excessive criminal interventions," said Cote.

"People go into the system alive. They come out dead."