People with disabilities lose hopes, skills in psychiatric hospital, inquiry told

Leaving people with intellectual disabilities in a Halifax psychiatric hospital has created "an unnatural setting" where skills and hopes fade away as years go by, a behavioural therapist told a human rights inquiry Thursday.

Nicole Robinson, a behavioural therapist who works in an acute care unit of the Nova Scotia Hospital, testified that seven of nine patients she treats have been medically discharged but are in limbo because of the lack of supported housing in the community.

She said one of the men has been on the ward for about four decades.

The inquiry is examining a 2014 complaint by 46-year-old Beth MacLean and 45-year-old Joseph Delaney that the province has violated the Human Rights Act by failing to move them from a hospital-like setting into a community home.

"People are faced with a roadblock to go on to the next step. They're kind of held there," Robinson told the inquiry.

No way of using skills

She then proceeded to give evidence that was a rare glimpse into a locked-door hospital setting that frustrates the efforts of highly trained staff.

She explained that applied behavioural analysis is used to reinforce positive habits and patterns that range from table manners to simple tasks such as washing your own hair.

However, Robinson said to make the skills stick, people with disabilities need to apply them in homes with roommates, a quiet atmosphere and trained staff they see regularly.

If that doesn't happen, the work by the therapists often falls apart as the skill the person has learned atrophies and the patient reverts to a life of reliance on institutional staff and routines.

The constant refusals to provide a home also creates a depressing cycle for her clients, she said.

She recalled meetings with Department of Community Services staff informing them the client was ready to leave and receive community-based care.

However, she said she would encounter an ever-changing set of criteria from the department.

"We continue to work on the goals they provide, we achieve them, they may come up with another set of goals, and then we continue this cycle," she said.

Shortage of small-options homes discouraging

Robinson was hired to bring intensive behavioural therapy to the hospital and the outreach teams in 2015.

Her position was among those recommended in a scathing 2006 independent report that warned a human rights case could unfold if ways weren't found to house the medically discharged patients elsewhere.

However, during her testimony, Robinson told the inquiry she's found it challenging to make progress due to the shortage of small-options homes.

"I can't adhere to what I've been trained to do, which is to teach a skill [have the patient]learn it and generalize it to other settings. It's not a healthy place to be," she said.

Part of the problem is that there are inadequacies in the facility itself, which has one van available for outings and a gym that is often used by community groups.

The patient's motivation levels to learn and change behaviours frequently plunge in a hospital environment, where trips are cancelled and promises aren't kept, said Robinson.

She gave the example of one patient who has been told if she would "use ... gentle hands" rather than hitting, she could move to a group home.

"But she's been in the hospital five or six years. You can understand that if you're being told you're going to achieve this outcome and it doesn't come, I feel like I've done her a disservice. She loses her motivation and we need to find new territory to motivate her," she testified.

She said she'd worked with both MacLean and Delaney, and helped prepare them to depart.

'The most unnatural settings'

After 15 years on waiting lists, MacLean was moved to a hospital-like setting at the Community Transition Program facility in Halifax in 2016, and briefly was able to live in a group home, but has since returned to the Community Transition Program.

Robinson testified there's little difference between the transition program and Emerald Hall, as they are institutional environments with staff working on shifts, scheduled activities and locked doors.

"The main outcome of my work as a behaviour analyst is to teach someone to independently use their skills in a natural environment," she said.

"The settings I've described are the most unnatural settings."

The provincial government has said it is preparing more small-options homes, but that it can't place patients with more complex needs until homes with safe and appropriate levels of care are available.