HALIFAX -- Nova Scotia's government has committed to finding homes in the community for two complainants in a human rights inquiry who have fought for years to move out of a psychiatric unit and other hospital-like settings.
The inquiry is examining a 2014 complaint by Beth MacLean, 46, and Joseph Delaney, 45, alleging the province violated the Human Rights Act by failing to move them into a small options home with appropriate care.
Following his testimony on Tuesday afternoon, Jim Fagan, a director of resident services at the Regional Residential Services Society, said in an interview that the Department of Community Services has asked his service to find small option homes for MacLean and Delaney.
"There is a commitment for small options for both of those individuals," he said.
He added that for MacLean the commitment was provided early last year, while the commitment for Delaney was in the last few weeks.
"We're at the very beginning stages. It will be some time before we can bring those homes to the community."
Asked by lawyer Vince Calderhead under cross examination if he believed that both MacLean and Delaney were ready for this move "many, many years ago," Fagan replied, "I believe so. Yes."
After 15 years on waiting lists, MacLean was moved from an acute care unit at the Nova Scotia Hospital 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.
Delaney is still at the Nova Scotia Hospital awaiting a placement in a small options home, even though the inquiry heard he was medically discharged in 2010.
A third complainant, Sheila Livingstone, has since died, but her story is being told by family members and the complainants' lawyers.
Dr. Mutiat Sulyman, a psychiatrist who specializes in patients who have both intellectual disabilities and mental illnesses, also testified on Tuesday about conditions at the Nova Scotia Hospital.
She told the inquiry that when she first came to the Emerald Hall unit in 2012, she understood it was an acute care facility for people with intellectual disabilities who needed psychiatric care and who couldn't live in the community due to their mental illness.
Sulyman said it has proved to be a "holding area" for many patients, as the province did not have community homes to send them to.
She testified there are still six or seven of the nine patients at the hospital whose psychiatric conditions have been treated, but can't leave due to a lack of suitable homes.
Having people with intellectual disabilities remain in the hospital means that access is blocked to others who need acute psychiatric treatment, and leads to relapses of psychiatric conditions for those forced to stay in Emerald Hall, said Sulyman.
Sulyman added that stable patients have been exposed to newcomers who are suffering from psychosis.
"You can imagine the psychological impact in the same environment when you have somebody who is making noise and who is very unwell. It has a negative impact on a patient who is recovering and is ready to leave," she said.
The psychiatrist said she's often reluctant to admit new patients with intellectual disabilities who are suffering from psychiatric illness because she worries they'll have trouble getting out once they're better.
She also said patients who have spent many years waiting for placement in the community can fall into a cycle of becoming withdrawn and apathetic.
"They become dependent on staff for daily needs, and that in turn brings about problems for when they are integrated back into the community because they've become quite dependent," she said.
"Sometimes patients no longer want to be discharged because of the sense of that dependency."
Sulyman said outbursts of aggression are not necessarily a reason to keep patients at the hospital, as it could be that they need behavioural therapy or other assistance that would be better provided in the community.
She said the overall environment at the Emerald Hall unit was similar to that at the Community Transition Program or the Quest unit in Halifax -- where some patients have been transferred in recent years.
A spokesman for the Department of Community Services said the province can't comment on individual cases such as MacLean's or Delaney's.
"The decision to place an individual into a small option home is based on priority, which, in turn, takes into account many factors based on clients' changing needs," wrote Bruce Nunn in an email.
"Getting people the care they need is a priority for the Department. ... We are investing significant time and funding into building a sustainable system that is more proactive and responsive."