On Sept. 10, 2023, three people in Vancouver were attacked and Blair Donnelly, a patient at the BC Forensic Psychiatric Hospital (FPH) who was on unescorted leave, was arrested and subsequently charged with three counts of assault with a weapon.

Government retained Bob Rich to conduct an external review of the policies and procedures in place at the FPH to grant leave from the hospital and to determine whether those processes sufficiently addressed public-safety considerations.

The review offered recommendations aimed at strengthening the patient-care model and risk-management processes, especially for higher-risk patients. They are:

• Recommendation 1: Implement a triad patient-care team model of care 
  Assign a consistent team, comprised of a psychiatrist, a nurse and a social worker, to each patient and for that team to stay with that patient throughout their time at the FPH. This continuity of care also clarifies areas of responsibility and improves communication related to caring for patients and assessing their risk in the community.

• Recommendation 2: Update the policies for the Program and Privilege Committee 
  More structured policies should be implemented with clear lines of accountability to improve the decision-making process for granting leave privileges. A recommended draft policy is included in the report. Since April 2024, the new policy is being trialled by the committee.  

• Recommendation 3: Develop an elevated-risk patient policy 
  An elevated-risk patient policy should be implemented to strengthen risk-management processes, such as risk assessments by external experts. This will help determine if a patient presents an elevated risk and guide the need for additional safeguards. 

• Recommendation 4: Additional staff training 
  Staff training in forensics and how to use risk-management tools should be improved. While select staff are required to complete similar training, training more staff would improve the overall quality of point-of-care risk assessments. Refresher training for psychiatrists in the use of long-term risk assessment tools is also recommended.

• Recommendation 5: Audits 
  To support implementing recommendations, a compliance-and-assessment process should be developed to assess the effectiveness and consistency of new and improved policies.
   
• Recommendation 6: Counsel at Review Board hearings  
  Given the complexity of legal issues that can arise at Review Board hearings, legal counsel should represent the FPH director. This will help ensure the director’s recommendations for the next steps for a patient and the necessary expert evidence are provided to the Review Board, particularly related to high-risk patients.

• Recommendation 7: Technology and risk management
  Risk-management technology to monitor patients on leave should be incorporated. This would help staff ensure patients on leave comply with restrictions placed on their leave request. It is recommended that a GPS tracking system for patients on leave be field-tested and implemented if found to be effective.

All recommendations have been accepted and actions to address the recommendations are underway, such as recruitment planning and following new polices for granting leave privileges at the hospital.

Learn More:

To learn more about the BC Psychiatric Hospital, visit:
https://www.bcmhsus.ca/forensic-psychiatric-services/forensic-psychiatric-hospital

To read the full report, visit:
https://www.bcmhsus.ca/sites/g/files/qpdaav151/files/2024-09/BC-Forensic-Psychiatric-Hospital-Review.pdf