Warning: This story deals with disturbing subject matter that may upset and trigger some readers. Discretion is advised.
According to his sisters, James Zimmer was a “typical kid” of the ’70s and early ’80s.
He loved skateboarding, music and playing the guitar, and was likely labelled a “daydreamer” by teachers at school. He also had a knack for resolving conflicts among friends with a few simple words.
“We had a lot of inside jokes. He had a good sense of humour, if you kind of understood his sense of humour,” his younger sister Cindy Zimmer told Global News. “He was a good guy.”
Cindy said her brother grew up to be a “proud uncle” and “gentle soul” who would “give you the shirt off his back.” He was a carpenter, loved beaches and spent lots of time outdoors with his dog.
But Zimmer also struggled to “process emotions” and work through things that were hurtful to him. His mental health challenges, Cindy added, likely flew under the radar when he was at school.
As an adult, she said, he periodically struggled with alcohol use. Due to a lack of formal assessment and support, he may never have understood his own struggles, she added.
“(B.C’s mental health system) created the crack that my brother fell into and we had no say in the matter,” Cindy said. “We had no opportunities and I just do not want this to happen to anybody else.”
On Feb. 9, Zimmer, 50, took his own life within hours of being discharged from the Royal Jubilee Hospital in Victoria. He had been in treatment for withdrawal, delusional thoughts and auditory hallucinations for nearly three months, involuntarily, and had articulated clear plans for suicide.
In the three days leading up to his death, his family said Zimmer had been transferred from the Royal Jubilee Hospital to a treatment facility in Vancouver. He asked to leave the centre on Feb. 7, returned to the island, and later that night, was involuntarily admitted back to Royal Jubilee after telling his other sister, Crystal Kenzie, that he felt unsafe and needed help.
Under B.C.’s Mental Health Act, a patient can be involuntarily held for 48 hours with signoff from two physicians, if they have a mental health disorder, require treatment at a designated facility, and need supervision to prevent health deterioration or pose danger to themselves or others.
Under those circumstances, a near relative must be notified of the patient’s discharge.
Nevertheless, Zimmer was discharged on Feb. 8 and given a crisis line number and information on available mental health resources without his family’s knowledge.
That night, his sisters said he returned to the hospital and told staff he needed help. He was admitted voluntarily that time, and discharged again on Feb. 9, without his family’s knowledge.
Crystal and Cindy found out what happened on Feb. 10.
“This mental health system really failed my brother and it’s failing so many people,” Crystal said. “When we urged him to go back for help and he agreed, we trusted that he would be safe.”
Prior to his death, Zimmer had consented in writing to having family notified of his discharge from the hospital. Just before his Feb. 9 discharge, however, Zimmer changed his mind.
Doctors can reassess a patient’s clarity of mind and ability to consent. Despite the previous paper trail of Zimmer wishing for his family to be notified, staff approved Zimmer’s change in consent.
“I think it’s negligent not to have made that call,” Crystal said. “That call could have saved my brother’s life.”
In a written statement, Island Health said it could not comment on the specifics of the case, but “patients assessed as having the capability to make decisions have the right to change their consent,” including their consent about alerting family members about their discharge.
Mental Health and Addictions Minister Jennifer Whiteside said the Mental Health Act contains “very clear and strict” requirements for the involvement of relatives in discharge planning, but more work needs to be done.
“We have a system now of auditing compliance of the process that designated mental health facilities undergo in this regard,” she told Global News on Thursday. “That is a very rigorous process that we continue to report on quarterly.”
While she couldn’t provide patient details, Whiteside called Zimmer’s case a “tragedy,” and said the ministry is also collaborating on developing additional guidelines for health-care workers in emergency departments responding to patients who need extra “care and support.”
Island Health’s Patient Care Quality Office, meanwhile, is in touch with Zimmer’s family.
When a patient experiencing a mental health crisis signs a consent form for family notification, Crystal said that consent should not be allowed to be withdrawn because there’s “no way of knowing” what’s going on inside a patient’s mind.
Cindy said she would like to know how the province measures its compliance with provisions of the Mental Health Act. She also called for “more humanity in the system,” and for staff to confirm and plan the patient’s family, friends and community support network upon discharge.
“You want to set them up for success,” she explained. “Help the medical staff to be able to do the right thing.”
“We can’t just sit quiet. We need to fight for what should have been fought for, for our brother,” Crystal added. “All we can do is fight for those that are left.”
As it stands, a private member’s bill dealing with involuntary apprehension under Mental Health Act is currently making its way through the legislature.
If passed, BC United MLA Elenore Sturko’s bill would require emergency room doctors or nurse practitioners to seek additional information about a patient’s health background from someone knowledgeable, such as a family member or first responder, before releasing them.
Sturko has said the amendment could help save lives, ensuring health-care workers have a more complete picture of a patient’s needs and history before discharging them.
If you or someone you know is having thoughts of suicide, help is available 24-7 through the Crisis Intervention and Suicide Prevention Centre of BC at call 1-800-784-2433.
If you or someone you know is in immediate danger, call 9-1-1.
Mental health support and information on resources is available around the clock in B.C. at 310-6789 (no area code needed).
For online, real-time support, YouthinBC.com also operates a daily chat between 12 p.m. and 1 a.m. PST, and telephone support 24/7 at 604-872-3311.