No more unsupervised breaks for P.E.I. psychiatric patients

Psychiatric patients at the Island's three large hospitals are no longer being provided with passes for unsupervised breaks, CBC has learned. 

Health PEI's chief of mental health and addictions said the change in policy took effect Tuesday.

"As of this past week, we are not going to have unaccompanied smoke breaks," said Heather Keizer. "We do allow people to have supervised smoke breaks, but they have to be supervised by staff."

Health PEI has clarified the change is in effect at all three hospitals which provide treatment for psychiatric patients: Hillsborough Hospital, Queen Elizabeth Hospital and Prince County Hospital. The agency has also clarified that it applies not just to smoke breaks, but all short breaks, also referred to by health care staff as "punctuals."

Designated smoking areas 

P.E.I.'s Smoke Free Places Act prohibits smoking on hospital grounds within the province, but makes an exception for Hillsborough Hospital, which is allowed to have outdoor designated smoking areas for patients.

But in order to access those areas, patients have to be provided with privileges to be able to take "punctuals," or short breaks to have a cigarette or take a walk.

A spokesperson for Health P.E.I. said passes are issued following an assessment by a psychiatrist, and can allow for supervised or unsupervised excursions.

Recent incidents

Keizer didn't specify what prompted the change, but when asked whether this was in response to a patient who recently went missing from the Queen Elizabeth Hospital she said, "whenever a serious incident happens in a hospital setting, it really is important for us to think … about what we can do better."

There was another incident last November when a Charlottetown man was accused of assaulting two people and setting fire to a residence.

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Crown prosecutors in the case said the accused was an inpatient at Hillsborough Hospital on the day of the offences and went "AWOL from that facility while on a pass." The man was ruled not criminally responsible for his actions.

The Crown attorney's office told CBC News that, according to police, the man had been on a smoke break, although they were not aware whether the break was supervised. Health PEI has not provided information on the case in response to requests from CBC News.

Issue raised in reports

A security review of Hillsborough Hospital delivered in 2016 found there were 17 reports of patients being absent without permission over a period of less than a year, from Nov. 2014 to Oct. 2015.

That review concluded the facility's smoking policy at the time "needs to be reviewed, it currently creates many security breaches."

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Another report delivered in 2015 examining a suicide inside the hospital two years earlier also raised the issue of unsupervised passes.

Patients need to gain more and more responsibility and freedom as they're getting well on units.- Heather Keizer

That report said patients who were confined to the hospital and required to be checked on by staff every 30 minutes shouldn't be issued passes for unsupervised breaks. The report recommended a review of the hospital's observation levels.

Keizer said this week that at no time in the past had the hospital provided leave privileges to patients who were deemed "unstable."

Union concerned about worker safety

The president of the Union of Public Sector Employees Karen Jackson said she is concerned the need for supervised breaks could exacerbate what she feels is an existing staff shortage at Hillsborough.

"We need to ensure that our frontline workers are safe," Jackson said. "Taking somebody off a unit to go out for a smoke-break leaves that unit short-staffed, and if there's anything happens on that unit during the time they're outside, then that could be an issue of safety for our staff."

UPSE represents licensed practical nurses, personal care workers and resident care workers at Hillsborough. 

New policy on trial basis

Health PEI said supervised punctuals take place at specific times, up to five times per day. The agency said patients not provided with punctuals are able to access secure, outdoor locations for fresh air and those who smoke are able to receive nicotine replacement therapy.

When asked by CBC News why Health PEI waited this long to change its policy in light of previous reviews, Keizer said the process of providing passes was important for patients on their road to recovery.

"Patients need to gain more and more responsibility and freedom as they're getting well on units. One of the ways that has been done historically was to provide them with more privileges in terms of punctuals … or smoking passes," Keizer said. "It's an imperfect system, but it is helpful."

Keizer said the new smoking supervision policy has been implemented on a trial basis, and will be reviewed after three to four months.