Purple armband policy in hospital 'an affront to the patient's dignity,' advocates say

Doctors and patient advocates say a London, Ont., hospital policy that forces patients assessed for potential aggression to wear armbands is an alarming

LHSC staff use armbands, exclamation mark signs to warn staff about high-risk patients

An exclamation mark outside of a patients' room at the London Health Sciences Centre denotes that someone inside could potentially be violent or aggressive. (Supplied)

Advocates say a London, Ont., hospital policy that forces patients to wear purple armbands if they've been deemed a risk to staff is alarming, stigmatizing and violates patients' dignity.

Patients who refuse an armband have a large paper with an exclamation mark on it hung outside their room.

"I don't think slapping a purple bracelet or a paper on a curtain does anything but stigmatize a person," said Robert Lattanzio, the executive director of Arch Disability Law Centre and a patient advocate. "It's a complete affront to the patient's dignity."

Staff at the London Health Sciences Centre now use a violence assessment tool to screen patients for a history or potential for violence. Internal emails obtained by CBC News show that psychiatrists worry the policy violates their vow to not harm their patients, discourages people from seeking treatment and is "a disaster" for the hospital.

The policy has been in place for years but the violence assessment tool has been used since May, a result of a settlement reached between the Ontario Nurses Association and the hospital, who worked with a mediator from the Ontario Labour Relations Board.

Psychiatrists have been wearing "End the Stigma" bracelets since May as a silent protest of the policy.

Other hospitals in the province are considering similar violence assessment tools and flags because of their obligation under the Occupational Health and Safety Act to protect staff from violence.

The violence assessment tool is used on all patients in the hospital. 

However, there are special screeners in the psychiatric units and at the First Episode Mood and Anxiety Program (FEMAP) office on Richmond Street. FEMAP treats patients with mental illness who are between 16 and 25 years old.

Those working in the mental health field say the tool unfairly tragets their patients. 

The entrance to Victoria Hospital at the London Health Sciences Centre. (Dave Chidley/CBC)

People previously flagged and returning to the hospital get a purple armband, as well as those deemed to pose a "medium to high risk of violence," anything from appearing agitated or boisterous to withdrawing from drugs or being confused.

"For those of us who work to treat people who struggle with their mental health and to ensure they get the services they need, this is frankly quite alarming," said Camille Quenville, the Ontario CEO of the Canadian Mental Health Association.

"Security of staff and treatment and stigma of those struggling with mental health are both top of mind," said Quenville. "We need something that is fair and reasonable for the patients and the staff and the families of patients who should have access to seeing their loved ones. That's the broader conversation we should be having."

Putting arm bands or exclamation marks to flag people could actually escalate situations, said Lattanzio of the Arch Disability Law Centre.

"It could make staff really, really really nervous, which would make the situation more tense than it really needed to be," he said.

Staff should instead focus on how best to help a patient, taking into account the context of their disease, their culture, or their disability, he said.

The Ontario Medical Association, which represents doctors, said in a statement there is already a lot of stigma surrounding mental illness and that a one-time assessment is too simplistic.

"There should also be recognition that illness manifests differently in stressful situations, even requiring hospitalization, but this manifestation cannot be confused with violent tendencies," the statement said. "Assessments must be carried out in a manner that is consistent, objective and medically validated."

Policy could harm patients

Several London psychiatrists say in the internal emails that they believe the policy is harming patients.

NDP MPP Peggy Sattler has worked with the London Health Sciences Centre and the Ontario Nurses Association because of complaints to her office about the policy since the summer.

"I know there are real issues that people are raising about the potential for stigmatization and I now that families of people who are experiencing mental health issues are also very concerned," Sattler said.

"Violence against health-care professionals is escalating rapidly and so I absolutely support the need to keep health-care workers safe ... One of the issues is that the tool is very sensitive in terms of identifying a potential, so a single incident at any point could result in an armband. If everybody is wearing a purple armband, it's the same as no one wearing an armband."

Victoria Hospital psychiatrists have started wearing these "Stop The Stigma" bracelets to protest a new screening tool that assesses patient risk based on past violent or aggressive behaviour. (Supplied)

In Windsor's Hotel Dieu Grace Healthcare is considering a similar policy as it tries to figure out how to protect nurses, doctors and non-clinical staff from potential harm.

"We have a duty under the Occupational Health and Safety Act to warn workers about a history of violence," said Sheri McGeen, the hospital's director of human resources and occupational health and safety.

"Most hospitals are considering it best practice to have a chart flagging patients with a high risk of violence, or visitors or family who have exhibited high risk in the workplace. We're working on developing a policy."

McGeen said Hotel Dieu Grace has been experimenting with purple magnets on white boards to denote potentially violent patients. Some areas of the hospital put notations on patient charts. Others, like the dietary department which wouldn't look at a patient's chart, get a flag on the printout about a patient's meals.


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