Matthew Meisner, 30, has been a patient at the Nova Scotia Hospital on a locked-down unit for nearly 12 years.
The Blandford, N.S., man has a severe form of autism and a mood disorder which makes his behaviour aggressive and unpredictable.
All 15 residents of the hospital's locked unit, known as Emerald Hall, have a "dual diagnosis:" an intellectual disability as well as a mental illness or behavioural issue.
Matthew wears a padded helmet to protect his skull from banging his head against the scuffed-up walls. His arms are covered with scabs from where he bites himself. His eyes are dulled from heavy medication. Matthew can talk but communication is limited.
Two male workers watch him during waking hours — at an estimated cost of $250,000 to $300,000 a year — to prevent self-injury and property damage.
Daily notes from the staff show Matthew spends most of each day in his room or at the end of the hall in a big chair in front of a window with a view of Halifax Harbour. Walks to another part of the hospital or even to the common room to watch TV have become rare.
His mother, Tracey Meisner, visits twice a week and has lobbied for her son to be moved to part of the hospital where he will have more support. Realistically, she doesn't expect her son will ever be able to live outside the hospital, but she hopes moving him off the locked-down unit will mean his quality of life and his behaviour will improve.
She has been told a plan is in place to move Matthew soon.
"We feel that Matthew needs to get away from Emerald Hall," Meisner said.
"We would like to see the Department of Health develop a more therapeutic environment. On the unit, he is just being managed and watched and staff are waiting for the next outburst.
"It's a vicious cycle of medication that will stupify him for a bit and then he comes back — that's what his day is like."
Matthew's mother says he has a history of kicking and throwing things which excludes him from most recreational activities because clinical staff deem it "too risky."
"A lot of patients do have significant challenging behaviours," said Dr. Mutiat Sulyman, the clinical leader of the Emerald Hall unit.
"Some of them slap themselves or they hit their head on the wall and become aggressive to themselves. It's a risk assessment on a daily basis."
For the past two years, Matthew's mother has pushed the hospital to bring in an accredited behavioural specialist. Meisner says her made progress and participated in activities with the help of such a specialist in the past.
"When there was expertise and behavioural support provided, he did very well," Meisner said.
"He went swimming a couple of years ago at a community pool, he was getting out for van rides. Then those services [behavioural therapy] were allowed to lapse. He went many months without them. He's on a locked unit, he can't get out. It's a catch-22 — then these behaviours crop up again."
The Nova Scotia Hospital recently hired a second behavioural specialist. There is no music therapy at the hospital, but a recreation therapist starts for the first time this week.
No place to go
Matthew arrived at the Nova Scotia Hospital in 2004, just after his 19th birthday. Court documents show within two months, he was assaulted by two male staff who were later convicted of assault and dismissed from the hospital.
Matthew has also been violent — an internal hospital document shows more than 40 reported incidents in 2012 in which staff took abuse from patients. Matthew was involved in some of those incidents.
Before coming to Emerald Hall, he spent his teen years in the Kings County Residential Rehabilitation Center and several group homes run by community services.
As a child, Matthew responded so well to early intervention at the IWK Hospital that his family was told he was a "success story." Now that seems like a long time ago for his parents who say they have seen their son spiral downward since then.
Highs and lows
Besides Matthew, a 44-year-old woman named Beth MacLean has lived at Emerald Hall for 15 years. She's diagnosed with mild mental retardation and a mood disorder and will be the focus of a human rights inquiry later this year.
"Emerald Hall was originally meant to to be an acute psychiatric unit for folks with a dual diagnosis," Dr. Sulyman said. "It's not supposed to be a place for people who have nowhere else to go.
"But we find ourselves in this situation where we have complex patients who can't be managed in the community or in a group home. I think we need a provincial strategy for people with intellectual disabilities."
Tracey Meisner hopes other families won't have to go through the same ordeal hers did.
"For the last 25 years, it's been highs and lows. What I would like to see from the [government] is a commitment toward these individuals, just to stay with them and provide ongoing support so they don't end up in situation like Emerald Hall."