Province hopes to free up police by offloading potentially violent patients on nurses: union

Manitoba's largest union representing health-care workers says a provincial program to train nurses and health-care aides is troubling because health-care staff who go through the training could be expected to intervene in violent situations.

A Manitoba Health document obtained by CBC News details plans for early implementation of health-care legal changes that would involve training in violence prevention and management, de-escalation, and emergency mental health and addiction for security guards, health-care aides, mental health liaisons and emergency department nurses at three Manitoba hospitals.

The goals of the changes include reducing the amount of time peace officers spend tied up in hospital monitoring potentially violent patients, who are sometimes picked up against their will and who may be experiencing psychological distress.

Michelle Gawronsky, president of the Manitoba Government General Employees' Union, said health care workers should not be asked to put themselves at risk.

"There should be no expectation that they have the ability to do anything, or the expectation that they are going to do anything but protect themselves and wait for security officers to come to be able to intercede with that patient until the police can get there," Gawronsky said on Friday.

"Having had experience working in an emergency room in rural Manitoba in a rural hospital, the training that I was provided as a health-care aide, and that my fellow nurses had with me, was to be able to get myself out of a situation that could be dangerous and move away from it until the police were able to get there," she said.

In larger hospitals, security officers are trained to deal with potentially violent situations, she said.

"Security officers apply for the job to be able to provide the security for those folks that provide the nursing care, so let's not mix it up — let's keep it clean and make sure Manitobans are safe."

The early implementation is set to take place at the Health Sciences Centre in Winnipeg, Brandon Regional Health Centre and Selkirk Regional Health Centre. 

HSC guard stabbed

The plans came to light this week after a Health Sciences Centre security guard was stabbed in the head by a violent patient in the waiting room of the crisis response centre.

Gawronsky said the man told the security guard he was HIV positive after stabbing him — a detail police refused to confirm, citing privacy reasons, saying only that the man was agitated and stabbed the guard and was then arrested.

Staff and security guards regularly encounter violent patients, Gawronsky said, and the Wednesday incident underscores the need for more guards in hospitals.

She met with provincial officials on May 30 and learned about government plans to roll out the project at Health Sciences Centre, as well as Brandon and Selkirk regional health-care centres.

Under the Mental Health Act, peace officers have the right to take a person who needs psychiatric help into custody against their will, with oversight from doctors or health-care management.

The Mental Health Care Amendment Act, or Bill 3, passed in 2016. It has yet to be proclaimed but if it is, it would give peace officers the ability to transfer custody of a patient detained under the act to "qualified persons at health care facilities."

Different authorities from peace officer

The province's report says regional health authorities are currently planning for this change to take effect and identifying health-care aides and staff to undergo the special training.

The training would aim to give nurses and health-care aides new tools to care for such patients experiencing mental health issues, including psychotic or substance-related disorders, and "effective crisis interventions and information."

It would help them manage and de-escalate aggressive behaviours, the report says, though trained nurses and health-care aides would not have the same authorities as an officer.

"If, while in the custody of a qualified person, a detained individual becomes violent, and the situation becomes out of control, health care facility personnel will contact the police service of jurisdiction, and request that they return to re-establish control," the report reads.

"A qualified person is expected to take custody of individuals detained under the [Mental Health Act] from the peace officer and make reasonable efforts to maintain custody of that individual until such time as they have been examined by a physician and prevent, where possible, harm to him/herself, the detained individual and others."

Nurses union concerned

Data from RCMP and the Winnipeg Police Service suggests "less than 10 per cent of Mental Health Act detentions involve incidents of violence" and most are "not criminals or facing criminal charges," the report says.

However, Manitoba Nurses Union president Sandi Mowat said the issue isn't only about potential violence — it's also about ensuring patients who may pose harm to themselves remain in hospital in order to be assessed.

Hospital security staff don't have the power to detain patients in Manitoba, she said. If police aren't there to stop them, she's concerned patients may get up and leave before they can be assessed.

"It's concerning to me that we're only talking about the violent incidents," she said. "I understand that we don't want anyone to be hurt, but we also have to be cognizant [that] these people need some kind of medical intervention, they need an assessment, and we want to make sure they're there to have that assessment."

Adding to nurse workload: union

The nurses union raised concerns about the bill when it was passed in 2016, and Mowat said she still believes it could add to the already significant workload of Manitoba health-care workers.

Mowat said she understands the rationale behind reducing the number of hours police spend in hospitals. But she believes it should be security staff, not health-care workers, who take over that responsibility — provided security staff are granted the power to detain patients against their will, and that police remain if there's a concern about violence.

"Certainly, they tell us that if there was any worry about the patient or the individual becoming violent, that the police will remain," she said.

"I can't speak for security, because we don't represent them. But I can say that if security is given the appropriate education, and the supports and the training, then we would be comfortable with the process."

Mowat said the union will likely send a letter to the province next week detailing its concerns with the bill and reiterating long-standing requests for increased security staffing at Manitoba hospitals, some of which don't have guards on shift 24 hours a day.

A Manitoba Health spokesperson was only able to provide limited information, citing rules surrounding byelections. A byelection was officially called in the St. Boniface riding on Tuesday.

However, an Elections Manitoba spokesperson told CBC News in an email Friday that "there is no media blackout during a byelection. There is a restriction on government advertising during a byelection, as per Section 92 of The Election Financing Act."

Results from the early implementation will be reviewed after a year, the report states.

The review will look at how much policing time was saved, the number of times custody of a detained person is transferred to trained health-care workers, the number of times police are called back to hospital after transferring custody, and the overall experiences of trained health-care staff.

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