Colton Clarkin needed a kind of care P.E.I. doesn't offer, psychiatrist tells inquest
Jury hears man's time at Hillsborough Hospital left both him and his doctor frustrated
Warning: This story deals with suicide. If you or someone you know has been struggling with mental health, you can find resources for help at the bottom of this story.
The psychiatrist who treated Colton Clarkin during his stay at the Hillsborough Hospital says he was "flabbergasted" when he learned his patient had died by suicide after running off from the facility's grounds in July 2023.
Dr. Declan Boylan spent more than four hours testifying before the coroner's inquest into Clarkin's death on Thursday, detailing what happened during the 10 months he treated Clarkin in the psychiatric hospital after he was sent there by the province's Criminal Code Review Board.
"I was absolutely flabbergasted when he died," Boylan told the inquest jurors.
"I found Colton such a nice man to work with. Though he had major problems with addictions, he was trying his best. It was a huge disappointment we did not get to send him to a forensic facility."
The inquest has heard that Clarkin was found not criminally responsible on several weapons charges in the fall of 2022 and was involuntarily committed to the Hillsborough Hospital based on a report by an out-of-province forensic psychiatrist. His past record of being charged with armed robbery and assault was also taken into account.
Prince Edward Island does not have any psychiatrists who have specialized in forensics. Those professionals normally work in forensic psychiatric units of hospitals, treating people who have committed crimes due to underlying psychiatric and addiction issues.
P.E.I. is the only province in Canada without such a facility.
The author of that initial report spent a little more than four hours with Clarkin and determined that he could have schizophrenia, but a period of sobriety from drugs would be required in order to make a definite diagnosis.
No forensic hospital, no agreements
Boylan told the inquest that within a month of Clarkin's arrival at Hillsborough in September 2022, it became clear to him that Clarkin likely did not have an underlying psychotic illness, since his symptoms faded when he abstained from heavy opioid and stimulant use.
What followed was a series of events that left both Boylan and his patient feeling frustrated.
Hillsborough Hospital is a psychiatric facility that does not itself provide addictions treatment but connects stabilized patients to programs that suit their needs once they are given approval to go out into the community.
"Certainly we are not able to manage him in this unit," Boylan wrote in his case notes in October 2022.
Already the treatment team was having trouble with Clarkin leaving the facility without permission and using drugs, or bringing substances like opioids and psilocybin mushrooms back with him when he returned from an approved leave.
Boylan told the jury he believed Clarkin's core issue was addiction, and due to his flight risk, he would be better treated at a forensic psychiatric hospital off-Island.
He told the inquest another Island patient in a similar situation had been transferred to the Waterford Hospital in St. John's, N.L., with good results. But preliminary conversations between the Hillsborough Hospital team and the Newfoundland facility led them to believe it would be easier to transfer Clarkin to the East Coast Forensic Hospital in Dartmouth, N.S.
On Wednesday, the inquest heard that the treatment team's bid to have Clarkin transferred there was unsuccessful — getting a final refusal just two weeks before his death.
The inquest heard that because P.E.I. has no facility of its own and no binding agreements signed with any off-Island facility, there is no way to compel a forensic hospital to accept a P.E.I. patient in situations like this.
Other jurisdictions, like Nunavut, have signed such binding agreements with forensic hospitals in Ontario.
The jury heard that P.E.I. has since signed a memorandum of understanding with the East Coast Forensic Hospital, but the agreement outlines transfer protocols and payment structures; it still requires a clinical lead who is willing to agree to take each patient on a case-by-case basis.
Mental health deteriorated
Boylan's case notes, shared with the inquest, painted a picture of Clarkin's time in the Hillsborough Hospital, which Boylan said did Clarkin a disservice because it did not meet his very specific needs.
He was sometimes co-operative and not causing issues, but other times he had to be locked down in the safe and secure unit due to his disruptive behaviour and flight risk. There Boylan described Clarkin's mental health as deteriorating.
Boylan also said Clarkin would go periods without addiction treatment. Since the hospital did not provide that, he needed to be stable enough to be trusted to travel to the program in Mount Herbert alone by taxi, and then behave appropriately once he got there.
The problem was how was he going to move forward?— Dr. Declan Boylan
He was seeing an addictions counsellor who would come to the hospital during some of these periods, but Boylan said he did not feel that was a substitution for immersive treatment.
"There was no real treatment going on to get him help with his addictions," Boylan said.
"We weren't getting anywhere."
Ultimately Clarkin's fate was in the hands of the provincial Criminal Code Review Board that had committed him to Hillsborough Hospital, since Boylan and others there did not have the power to discharge him based on their medical opinion that he was not improving in the facility. So he stayed — for 10 months.
"The problem was how was he going to move forward?" Boylan said Thursday. "Because the [Criminal Code Review Board] was not going to let him move forward if he was using substances in the hospital."
He 'always wanted to get clean'
Clarkin was committed to another year in the facility in May of 2023, around the same time Boylan told his patient they were at a standstill: He was occasionally using drugs when he left the facility — the facility that was not able to treat him, and that he had fled several times.
Clarkin also did not want to go to a forensic hospital or sign the paperwork to go to the transition unit in Mount Herbert on a day program, Boylan said.
Despite that, Boylan told the inquest he and the team were still committed to helping Clarkin and doing the best they could. They also allowed him to leave on passes with his family, which helped provide him some structure and the hope he could re-integrate into the community one day.
"Mr. Clarkin always wanted to get clean; he was just having great difficulty," Boylan said Thursday.
Clarkin eventually got did start going to a day program at the Provincial Addictions Treatment Facility in Mount Herbert, the inquest had heard on Wednesday. On the day he absconded from Hillsborough for the final time, he had been told he was no longer welcome at that program because of his behaviour toward a woman taking the same program.
Red flags noticed by nurse
The inquest also heard that Boylan had interacted with Clarkin during morning rounds on the day of his death, where he noted the 27-year-old seemed engaged and co-operative. That was the last time he saw Clarkin.
During testimony on the first day of the inquest, a nurse told the jury he had flagged concerns to Boylan after noticing that Clarkin had changed his facial hair and removed his belongings from the facility. The nurse thought he might be preparing to run off again.
But Boylan told the inquest he had no memory of that conversation, and that he only learned about those red flags while reading social work case notes in the days after Clarkin's death.
"Something would have made me wonder why he had done that and I would have done something about it," he said Thursday.
In the final moments of his questioning of the doctor, a lawyer for the Clarkin family asked Boylan: Would you have changed your mind on allowing him to have a grounds pass on that last day had you been aware of all of those issues?
"I don't know," Boyland responded.
Testimony will resume for a third day on Friday.
If you or someone you know is struggling, here's where to get help:
- Canada's Suicide Crisis Helpline: Call or text 988.
- Kids Help Phone: 1-800-668-6868. Text 686868. Live chat counselling on the website.
- Canadian Association for Suicide Prevention: Find a 24-hour crisis centre.
- This guide from the Centre for Addiction and Mental Health outlines how to talk about suicide with someone you're worried about.
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