The province’s Representative for Children and Youth says that gaps in mental health services for youth could have contributed to a 17-year-old B.C. teen’s suicide.
The report – Missing Pieces: Joshua’s Story – details the life of a Lower Mainland teenager named “Joshua,” whose identity is withheld for privacy reasons. Joshua, described by teachers as bright but shy, jumped off a crane to his death on BC Children’s Hospital grounds in July 2015, following a long battle with mental-health issues that started at age two.
The report, release Wednesday, says his death sheds light on a problem that’s been well-identified for more than a decade: the need for acute and emergency mental-health services for youth, as well as ‘step down’ facilities and ongoing support for families as youth transfers out of hospital care and into long-term programs.
“If the province commits to developing a true integrated service strategy, children such as Joshua, who clearly needed more help than he received in the three years prior to his hospital admission, may no longer fall through the cracks,” the report says.
— Ashley Wadhwani (@ashwadhwani) October 4, 2017
While Joshua’s single mom and off-site father struggled to support Joshua and his sibling, Joshua’s life suffered from poverty and a lack of mental-health support, leading to violent rages, self-harm and suicide attempts.
His mom could not take care of Joshua, the report notes, due to his extreme behaviours. But each time mental-health officers and social workers intervened, they saw improvements in his coping mechanisms and pull back, allowing further deterioration.
“I think people cared, but I don’t know if there was enough of a safety net to catch the kids like this… he’s not the only one that’s sitting at home locked inside a room,” Joshua’s mom said in the report.
Joshua’s symptoms displayed early
Joshua lived in the Cariboo region when his earliest concerning behaviours were first noticed, such as hitting himself and banging his head against a wall, according to interviews conducted for the report.
His mom – who struggled with depression, economic challenges, social isolation and a fractured relationship with her ex-husband – attempted several times to contact the Ministry of Child and Family Development, but Representative for Children and Youth Bernard Richard says the family slipped through the cracks.
In 2002, when Joshua was four, he and his sibling joined their mother moving to the Lower Mainland for her career and education advancement. The move was a rocky one, as the trio, lived out of a car for the first month.
Although Joshua’s father and new girlfriend moved to the Lower Mainland a year later, they had to move back to the Cariboo – a decision both parents believe impacted Joshua.
The report details a number of instances through his early years where ministry and school officials struggled to co-ordinate efforts when dealing with “major outbursts” that would end in Joshua being sent home.
At age seven, he was diagnosed with oppositional defiant disorder, an adjustment disorder, and a possible underlying dysthymic clinical depression.
While his mom was not comfortable with his medications for anxiety and aggression, Joshua was placed in the school’s Social Responsibility Support Program to address his behaviour.
During this time, health professionals described Joshua as emotional, socially awkward and reserved – but with a “kind heart,” though his severe aggression continued.
The report suggests Joshua was eight when he first expressed suicidal urges, telling school staff: “I want to die… nobody cares, nothing can be done.”
For the next five years, his school attendance became spotty and he would lock himself into his room, refusing to attend for months on end.
Gaps in service lead to further mental deterioration
Ministry and high school staff struggled to convince him to return. At age 15, he was placed at an alternative school in a therapeutic day program, however, he continued to isolate himself in his room, playing video games and using his computer.
In 2014, an online relationship with a woman from Texas was the first external trigger for Joshua to consider ending his life, according to friends interview for the report. Joshua was apprehended under the Mental Health Act in November of that year after telling them of this planned suicide.
Joshua was discharged the same day and was referred to the Child and Youth Mental Health offices for support. Weeks later, he dropped out of the program.
In February, Joshua was apprehended and hospitalized again at age 16, after walking more than 15 kilometres to a park with a rope and razor blades. He was admitted to a Lower Mainland hospital’s secure adult-psychiatric unit, as all nearby facilities lacked a unit for children and youth.
The report notes Joshua had ongoing suicidal thoughts and was considered by doctors to be at a high risk for another attempt. He was diagnosed with major depressive disorder, A month later, he was discharged.
A week after his release, Joshua was in a forest when he attempted suicide a third time, taking prescription pills and drinking two bottles of schnapps. He suffered hypothermia and wounds from self-harm, and was flown by helicopter from his isolated location.
Placed at BC Children’s Hospital, a medical team, ministry professionals, an intensive youth outreach clinician and his mother met weekly to plan for his ongoing care and eventual discharge.
It became clear to to professionals that his mother couldnot take care of Joshua upon his release, and health-care officials struggled for four months to create a solid plan.
On July 31, 2015, Joshua was given a doctor-recommended pass to go for unsupervised walks on hospital grounds.
Within half an hour, the teen entered a construction site on hospital grounds and jumped off a crane.
Reported as missing by hospital staff within hours of his disappearance, his body was not found until five days later.
Watchdog turns to new mental health ministry for change
Joshua’s story is a compelling and tragic one that reinforces the need for action now, Richard told a news conference Wednesday.
The advocate is calling on the province’s new Ministry for Mental Health and Addictions to implement a plan focused on children and youth mental health.
The plan is recommended to be complete within a year, and implemented within two.
Although a majority of the time that Joshua spent during his final stay in hospital was for treatment, his release was delayed due to a lack of ‘step down’ facilities, meant to transition youth to independence, said.
In response to the report, Mental Health Minister Judy Darcy announced the recommendations will be acted on.
“We absolutely agree that we need to collaborate across government and across service providers to create a system that supports families like Joshua’s with the full range of mental-health services they need,” Darcy said.