Family asks why suicidal woman allowed to leave hospital unsupervised

It took 45 minutes for Stacey McKinnon-Smith to leave her room in the psychiatric unit of Charlottetown's Queen Elizabeth Hospital and walk down the highway to the Hillsborough Bridge.

She left the hospital on an unescorted smoke break.

Although her body has never been found, her family believes McKinnon-Smith ended her life that night in the last place she was seen — on the bridge between Charlottetown and Stratford.

Now, her family is asking why a woman, who made at least four threats to end her life in the previous three months, was allowed to leave the hospital alone, especially since her family had specifically asked that she not be allowed out unsupervised.

"I don't think anybody in that state of mind should be let out by themselves, especially with her history," said her sister Samantha Younker. "For a suicidal person to be let out by themselves. It just didn't —  it doesn't make sense." 

Since the hospital doesn't allow smoking on its property, patients have to leave the grounds, including psychiatric patients like McKinnon-Smith. They typically end up right next to the Hillsborough River to smoke.

Ten days after McKinnon-Smith's disappearance on Jan. 15, 2018, the hospital reported unsupervised smoke breaks for psychiatric patients would no longer be allowed — a policy that was later changed.

'She struggled a lot of her life'

McKinnon-Smith had struggled with her mental health for years, according to her family.

She had been living and working in Alberta for about a decade, handling shipping and receiving for a business related to the oil fields, but got too sick to work and decided to return to P.E.I. in July 2016. "She drove across Canada and things just fell apart." recalled her mother, Gail Myers.

"She struggled a lot of her life.… It was just more this time. She moved home and she was in a bad place," Younker said.

Her family said McKinnon-Smith overdosed on prescription medication a few months after returning to P.E.I. and was admitted to the QEH for about a month.

Over the next year or so, the ups and downs continued. She was getting counselling at the McGill Community Health Centre and was readmitted to the QEH for short stays a couple of times, according to her family.

In the fall of 2017, she was admitted to the QEH for the last time and for her longest stay — her condition never improved enough to allow for her release, said her family. They're not sure what her official diagnosis was, but they believe she was being treated for depression.

Oct. 15: Pattern of self-harm

Incident reports obtained by CBC through a freedom of information request paint a picture of a woman with a pattern of self-harm. The reports do not name McKinnon-Smith, however the family's detailed accounts of dates and details match the details in the incident reports.

Her family believes she was an involuntary patient during some of her stay, and voluntary at other times. The incident reports do not mention this. According to the P.E.I. Mental Health Act, voluntary patients are allowed to leave the hospital at any time. Involuntary patients who are found to be suffering from a mental disorder and are at risk of harming themselves or others, can be detained in a hospital.

On Oct. 15, 2017, Smith was found in her parked car at Brackley Beach. She had overdosed on prescription medication and was admitted to the QEH, first to the intensive care unit, then transferred to the psychiatric unit (Unit 9).

Soon after her admittance, according to the incident report, nursing staff found her crying, banging her head against the wall of her room, refusing her medication and saying she wanted to kill herself. 

Staff had to restrain her wrists and medicate her, and even then she continued attempts to harm herself, so she was moved to a private room, put in full restraints and monitored.

The incident report noted that "self-harm has been a continued feature of this patient's symptoms since admission. Code whites are called when we can not contain or distract the patient for her safety. Staff followed protocols and patient was much better later in the day."

She felt safer there.… She wanted the help.— Samantha Younker

Her family found her moods fluctuated from day to day. "Most of the times she definitely was trying her hardest to keep a smile on her face and stuff and I'd try my hardest to do that too," said her son, Coady McKinnon, who visited her almost every day.

"I mean sometimes you go in there and like, she wasn't the happy-go-lucky person she was always known to be," said Myers.

Some days she wanted to go home, but on others she didn't want to leave the hospital. "She felt safer there. She always did," said Younker. "Anytime that she was in there, any time that they would talk about releasing her, she would act out things to really stay in. Like she really, she wanted the help."

McKinnon-Smith smoked and her son used to accompany her so she could leave the property to have a cigarette. Over time, she was permitted to leave the grounds unsupervised for half an hour, for a smoke break, or punctual, as the hospital called them. 

Nov. 5: Found in the river

On Nov. 5, three weeks into her hospital stay, McKinnon-Smith left the hospital alone at 8:30 p.m. for an approved half-hour cigarette break and didn't return. According to an incident report she was reported missing five minutes after she failed to return and Charlottetown police were notified. Staff found a note in her room saying "She wanted to not be a burden to anyone and wanted to be in a better place," according to an incident report.

Her family joined in the search. "I mean any time she went missing we went looking for her," said Myers.

Security found her walking in and out of the Hillsborough River, by the smoking area, suffering from exposure, and EMS took her back to the hospital.

After she was brought back to Unit 9 by security, her unsupervised smoke breaks were decreased, according to an incident report.

The incident report also notes a staff recommendation, that she not be allowed near the smoking area by the hospital, near the open water, and that she be restricted to a fenced-in area.

It's not clear from the reports whether this happened.

According to the incident reports, on Nov. 13 staff suggested a chart review of her case, which was done Dec. 15, to "determine what if any gaps might exist in patient care or processes that would be improved to prevent such an event from happening again."

The report doesn't say whether any gaps were identified or acted on.

Nov. 19: Violent episode

Two weeks later, on Nov. 19 McKinnon-Smith had another episode.

Just after 10 p.m. she barricaded herself in her room with a chair. When staff forced open the door, she was holding a butter knife to her throat, crying and screaming at staff.

A staff member convinced her to hand over the knife and she was sedated. She had what were described in the report as "multiple superficial cuts" to her forearms, according to the incident report.

There were talks about getting her a room at a community care facility, but McKinnon said his mother was adamantly opposed to that.

Dec. 18: Missing for hours 

A month later, on Dec. 18 McKinnon-Smith left the hospital at 8:30 p.m. alone on an approved smoke break and failed to return by 9 p.m. Staff searched the hospital and the grounds, but couldn't find her, so police and her family were called at 9:30 p.m. She had left a suicide note at the hospital according to the incident report.

At 12:30 a.m. — four hours after she left the QEH — police found McKinnon-Smith at Joe Ghiz Park, about a kilometre from the Hillsborough Bridge. Police returned her to the emergency room, where she was warmed up and readmitted to Unit 9.

I don't think anybody in that state of mind should be let out by themselves.— Samantha Younker

According to the incident report, she told staff she had been planning all day to leave the hospital that night. The report said she told staff she was feeling lonely and a burden, had planned to jump off the Hillsborough Bridge that night, and didn't think her caregivers could have done anything to keep her from leaving.

According to the incident report, she hadn't appeared to be in distress earlier in the evening.

Dec. 21: Family meeting

A family meeting was arranged for Dec. 21.

It was at this meeting that Myers and Younker say they asked staff to discontinue her unsupervised smoke breaks, for her own safety.

"That's not a very good thing for, you know, people with depression or anything like that, to let them smoke down there near the water," said Younker. "I don't think anybody in that state of mind should be let out by themselves especially with her history of trying while she was doing it."

The day she went missing I called her that evening. And she told me she just wanted to be by herself that day.— Coady McKinnon

Given her history, said McKinnon, to let her out on her own "doesn't really make a lot of sense."

"I was worried that she was going to go and that she wasn't going to come back. And then that's exactly what happened."

The family said they were told their request would be passed along to her doctor and they thought the unescorted breaks would end.

The family also requested McKinnon-Smith be transferred to the more secure Hillsborough Psychiatric Hospital and say they were told that request would be considered.

"She had a really hard time on Christmas," McKinnon said. "It was not a good day." He had skipped his own Christmas dinner to be there with her. "She didn't want that, but I wanted to be there with her."

There were no hospital incident reports about her for the next month.

McKinnon, though, said his mother was on a new medication and she was having a difficult time adjusting to it.

He used to call his mother before he went in to the hospital to see how she was doing, and sometimes she told him not to come in.

 "Actually the day she went missing I called her that evening. And she told me she just wanted to be by herself that day," he said.

Jan. 15: Stacey McKinnon-Smith disappears

On Jan. 15, 2018, four weeks after she threatened to jump off the bridge, McKinnon-Smith signed herself out of the hospital at 8:25 p.m. for an approved unsupervised half-hour smoke break. It was a dark and cold evening. She was wearing a winter coat, pants and a pink toque.

A hospital security camera captured her leaving the QEH at 8:28 p.m.

When she didn't return by 9, staff searched her room. They didn't find a suicide note.

They did search the unit and the outdoor smoking area, then declared her missing, and at 9:30 p.m. called her family and then police.

"When they called me they just said she didn't return to her room and had I heard from her and I said 'No'. And she said 'Well we don't think it's that drastic.' Well it was drastic," said Myers.

According to hospital incident reports, staff talked to McKinnon-Smith's friends and family who had talked to her on the phone earlier in the day. At 7:30 p.m. she told one friend that she was going to spend the evening colouring and reading. Another relative said he'd talked to her on the phone around the same time and she seemed fine. Another said she had been active on Facebook as late as 8:53 p.m., which is after she left the QEH.

Police say they got a call from a motorist who'd seen a person sitting on the Hillsborough Bridge railing with their legs dangling over the side at 9:15 p.m. The driver pulled over after crossing the bridge to call 911, but according to police, when the driver went back across the bridge a couple of minutes later, the person was gone.

Meanwhile, the family was still waiting for word from the hospital.

"My mother waited up all night for updates and they didn't call. She had to call them in the middle of the night just to see if they had heard anything," Younker said.

Myers said she called the hospital every hour through the night to see if her daughter had been found. But there were no updates to give.

Police searched the area with dogs and searched the river with underwater drones on Jan. 17, but failed to find any sign of her. 

Using E-watch cameras police pieced together images they believe to be McKinnon-Smith walking from the QEH to the Hillsborough Bridge. She was last spotted walking onto the bridge at 8:54 p.m. There was no surveillance camera on the bridge at the time to show what happened next. 

Officially, McKinnon-Smith is still listed as a missing person. However her family believes she ended her life that night.

Still searching for answers

The family met with hospital staff about a week later to try to get more information. They hoped to find out who she had talked to that day — "if anything would have triggered or if anybody would have picked her up, like just anything and they wouldn't, they wouldn't let us have access to anything," said Younker. She said they were told hospital staff couldn't release any information about her sister, until she was officially declared dead because of patient confidentiality.

They want the hospital to explain why McKinnon-Smith was allowed out unsupervised, given her pattern of self-harm.

"I just feel like if they had of done what, you know, they were supposed to do, then you know we might not have this conversation," said Younker.

It's just something that you never get over.— Coady McKinnon

Although the unescorted punctuals ended for psychiatric patients a week after McKinnon-Smith left the hospital, that policy has since been changed. In an emailed statement to CBC in January 2020, Health PEI said permission for inpatient psychiatric patients to leave the grounds, supervised or unsupervised, "must be approved by each patient's treating psychiatrist and such passes are based upon the psychiatrist's assessment of that patient's safety."

The statement did not say when the policy changed, only that "There has been considerable work done in reviewing our policies."

Health PEI did not respond to questions about why McKinnon-Smith was allowed out of the hospital unsupervised.

McKinnon-Smith's family hopes hospital officials discontinue the unsupervised breaks for good. "It won't bring her back. I just hope they own up to what they did," said Myers. "I hope it never happens again."

"They did something wrong," said McKinnon. "I would never wish what we went through, or are going through, I would never wish on anybody, because it's the hardest thing. It's just something that you never get over."

Anyone needing emotional support, crisis intervention or help with problem solving in P.E.I. can contact The Island Helpline at 1-800-218-2885, 24 hours a day, 7 days a week.

For more information about mental health services on P.E.I., find resources from Health PEI here, or from the Canadian Mental Health Association P.E.I. Division here.

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