Synopsis of 18 recommendations in review

A Nova Scotia government review released today lists better tracking and more frequent assessments of forensic psychiatric patients among the 18 recommendations prompted by the death of Halifax gay rights activist Raymond Taavel in April.

Following is a synopsis of the 18 recommendations:

Community Access

  1. Develop a structured risk assessment process that includes:
  • Specific criteria to assess a patient's risk of violence and Absence Without Leave (AWOL).
  • Definitions of low medium and high risk in the short and long term.
  • Clear guidance on how risk impacts community access decisions.
  1. Develop a protocol for a daily assessment of a patient's mental state before proceeding with a leave; require more patient and staff interactions.
  2. Revise policies to provide clarity around the quality and quantity of documentation expected in community access privilege decisions.
  3. Develop mechanisms that ensure that:
  • Observations and recommendations of all staff in contact with the patient are included in risk assessment and decisions around community access.
  • Dissenting opinions are documented.
  • Community-access recommendations are signed by all staff.
  1. Ensure that everyone involved in risk assessment is trained to a level appropriate to their involvement.
  2. Include a statement about the role of the "person in charge of the hospital" in the Community Access Levels Policy.
  3. Amend Community Access Levels Policy to confirm that only supervised community access privileges will be granted to patients awaiting a disposition hearing by the review board.
  • Minister to direct facilities to provide onsite smoking facilities.
  1. Establish a committee of senior clinical and administrative members, external to the patient's clinical team, to advise the person in charge of the hospital whether to approve the proposed level of community access against an explicit set of criteria.
  2. Suspend leaves after an AWOL incident until appropriateness of community access is reviewed. Identify a process for reassessment and reinstatement.
  3. Develop written procedural guidelines for the Criminal Code Review Board.
  4. Prepare detailed written reasons for each Criminal Code Review Board  disposition order. Develop criteria for decisions including key facts, evidence, issues and reasoning related to the Criminal Code Review Board  legal mandate. 

Public notification 

  1. Define absent without leave in the AWOL policy.
  2. Include identification of any risks to potential victims and any related notifications that need to take place in the AWOL policy.

Patient Surveillance 

  1. Explore the possibility of using cell phones and pagers to monitor patients on leave.
  2. Strengthen tracking of AWOL statistics:
  • Provide Deputy Ministers of Justice and Health and Wellness with an annual AWOL report 
  1. CDHA will adopt an audit and regular quality review process.
  2. CDHA will develop a review process for every AWOL incident including clinical review of leave decision.
  3. Commence meetings more regularly focused on information sharing, reporting and performance.