A long battle for change, a small sign of hope

A long battle for change, a small sign of hope

After a few hours of talking to him, a social worker believed Kevin could, indeed, handle his finances.

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Before his life spiraled into debt and death, a London psychiatric patient was cleared to look after his own money, something neither his doctor nor parents said was possible. In the fallout has come a push to tighten an Ontario law one expert calls “a bit perplexing.” Randy Richmond reports


After three decades helping their son, his mother and father believed Kevin Burns’ schizophrenia made him unable to handle his own finances.

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After two years of treating him, a psychiatrist believed Kevin was incapable of handling his own finances.

After a few hours of talking to him, a social worker believed Kevin could, indeed, handle his finances.

That social worker didn’t have to call Kevin’s psychiatrist, mental health nurse or parents — not anyone, really — to see what they thought of his ability to manage his money.

A few months later, Kevin — broke, binge spending and, apparently, binge drinking — died by suicide.

Since his death six years ago, his parents have corresponded with cabinet ministers and high-ranking bureaucrats to point out what seems obvious: If you’re going to assess a psychiatric patient’s ability to handle finances, you should probably call the patient’s psychiatrist to see what they think.

It seems obvious enough in British Columbia that its laws require a doctor’s involvement in assessments. It seems obvious enough that Ontario’s Centre for Addiction and Mental Health (CAMH) has pushed for the same thing. It seems obvious enough that psychiatrists in Ontario hospitals are required by law to do the assessments for their patients. It seems obvious enough that the London coroner examining Kevin’s death expressed dismay his psychiatrist wasn’t consulted in the assessment.

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But in Ontario, the seemingly obvious isn’t so.

All the Burnses have accomplished so far is taking a long journey similar to hundreds of others in Ontario, advocating for change in a complex mental health system. Exasperated and exhausted, they told their story to The London Free Press — without much hope of change, but to warn others about what can happen.

“We’re not going to win the war,” Joan said.

But now, after The Free Press contacted Ontario’s associate minister of mental health and addictions, Michael Tibollo, he’s agreed to speak to the Burns family about their concerns. Two years ago their request for a meeting fell on deaf ears.

“I am grateful for the meeting and certainly would never turn down the opportunity to tell Kevin’s story and our concerns,” Joan says. But, she adds, “I am cautious.”

Her sentiment arises naturally from what she and John have gone through.

Born in 1979, their son Kevin was diagnosed with schizophrenia at 17 and lived with his parents for the next 12 years. Once he began receiving monthly Ontario disability benefits, they kept a certain amount back and gave him the rest, $600, to spend on his own, Joan and John say.

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“He would give the shirt off his back to anybody, and I think some guys took advantage of that,” John says. “As soon as he got money, it’d be out of his pocket.”

“He just spent money till it was gone,” Joan says. “Kevin wasn’t stupid. But he had a disease.”

Medical experts backed up their view.

CAMH
The Centre for Addiction and Mental Health building in Toronto is shown in this Postmedia file photo.

In 2008, a psychiatrist signed a Certificate of Incapacity to Manage One’s Property under the Mental Health Act regarding Kevin. “Pt (Patient) is not organized when he talks about his life insurance and how to pay his bills. The parents are concerned that Kevin spends too much on alcohol and he does not understand what the life insurance is for.”

That same year, Kevin took steps to live on his own, eventually moving to an apartment subsidized and supported by mental health workers. Ontario’s Public Guardian and Trustee handled his finances, ensuring Kevin’s rent and other expenses were paid out of his disability benefits and that he received a weekly allowance.

“He lived on a lot of frozen pizza,” Joan says.

Often, Joan and John would buy Kevin weekly groceries. John ran a home renovation business and paid Kevin to help with odd jobs.

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“He was a good worker. But I had to keep right on him, otherwise he would drift off,” John says.

In December 2015, London psychiatrist Dr. Diane Eastwood took over Kevin’s treatment, diagnosing him with schizophrenia and alcohol misuse. She kept Kevin on his community treatment orders, which included regular visits by a mental health nurse.

“It was my opinion that Kevin remained not capable to manage his finances,” Easton wrote in a letter to his parents.

***

Only later were the Burnses able to piece together what happened in the spring of 2017. Kevin learned he could seek an independent assessment of his capacity to manage his finances, with the $600 fee paid by the public guardian’s office.

On April 19, 2017, an Ontario capacity assessor visited Kevin at his apartment. Kevin’s roommate told the Burnses the assessment took about two hours.

In his report, completed two days later, the assessor said Kevin understood basic math, assets, income and expenses and could handle his bills. He declared Kevin financially capable.

As of April 25, 2017, the public guardian ceased to act on Kevin’s behalf. He was on his own financially. Each month, $680 would go directly to him. He also received a lump sum of $1,600 interest from his registered disability pension plan.

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By the end August, the Burnses later found out, Kevin was $200 overdrawn on his bank account.

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In September, Kevin borrowed money twice — about $500 in total — from a payday loan service. It appears he had blown through the lump sum of $1,600. That same September, Kevin’s mental health nurse learned her patient had been declared capable of managing his finances four months earlier and was in financial trouble.

“Kevin also admitted that he had accumulated substantial debts, and been late in paying his rent. There was evidence of increased alcohol use by Kevin, and perhaps other residents of the home, with stacks of cases of empty beer,” psychiatrist Eastwood told the Burnses in a letter after Kevin’s death.

“At that time, I questioned the basis of the findings of the independent capacity assessor.”

It seemed the increase in alcohol, decline in adhering to his medication and the money struggles were contributing to a deterioration in his mental state, she said. At that point, she and her team scheduled assessments of Kevin’s capacity to manage his finances, knowing he “experienced persistent, severe auditory hallucinations which often gave him advice and instructions,” Eastwood said.

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But Eastwood and her team never got a chance to assess Kevin. After learning about Kevin’s financial troubles, Eastwood called the Burnses to alert them Kevin was no longer with the public guardian.

John recalls calling Kevin that same day, Friday, Oct. 6, 2017. Kevin grew angry when offered help with the rent, John recalls. John let it go. They arranged to get groceries together the next week. See you tomorrow, John signed off.

***

The family was gathering at their trailer in Lambton Shores for Thanksgiving.

“The next morning, he was supposed to go with us up to the lake to meet with the family, and everybody would be there, and, you know, everything would be cool,” John says of his son.

Late overnight, about 2 a.m. on the Saturday, Kevin’s roommate saw him playing video games, according to a coroner’s report. Kevin appeared “quite lethargic” and the roommate suggested he go sleep on the couch, the coroner said.

Kevin’s parents called his apartment around 9 a.m., and Joan asked the roommate to tell Kevin to get up and showered. Minutes later, Joan got a call back from the roommate. Kevin was cold and not breathing.

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The roommate called 911. Emergency crews didn’t try to resuscitate him; rigor mortis had already set in.

Kevin’s roommate told the regional coroner that Kevin had been going on spending binges for things like video games and had stopped drinking two days before his death because he’d run out of money. His schizophrenia was taking over and Kevin believed people were talking to him through the television set, his roommate said.

“Both the parents and I had concerns about the system that allowed this man with severe mental health problems to be judged competent without any input from his treating psychiatrist. As soon as he started receiving his money without qualifications his behaviour changed and ultimately led to his death,” the coroner stated in the report on Kevin’s death.

There was no suicide note. But because the levels of Kevin’s prescription drugs were so high, because of the presence of multiple pills and fragments in his stomach, and because of his behavioural changes in the weeks leading to his death, the coroner determined Kevin’s death was by suicide.

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***

Inside Kevin’s apartment, his brothers found some of his papers, including the notice of assessment that gave him financial independence and documents showing problems with his money. Days later a note from Bell arrived, notifying Kevin he was overdue on this phone bill.

Distraught and angry, the Burnses began their campaign to push for change, each step followed by rejection:

  • An official complaint to the Ontario College of Social Workers. The college decision: The assessor did no wrong and guidelines suggesting assessors contact others for input were not rules.
  • A request to Ontario’s capacity assessment coordinator to make changes so health professionals are contacted during assessments. The response: No changes coming.
  • Letters to the Public Guardian of Ontario. A promise only: To consider suggestions from the Burnses if, and when, any changes to the law were made.

The Burnses contacted London West NDP MPP Peggy Sattler, asking her support to amend the Substitute Decisions Act to include consultation of a medical care team in making assessments.

Sattler’s research team discovered there was support for the changes in a 2017 Law Commission of Ontario report and that B.C. had such a law. A submission by CAMH to the law commission recommended legislative changes “to ensure that financial capacity assessments include input from psychiatrists. The inability of psychiatrists to perform examinations of capacity to manage property with their outpatients is a shortcoming.”

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By July 2020, Sattler had drafted a bill, called “Kevin’s Law,” an amendment to the Substitute Decisions Act that would require an assessment include a medical component conducted by a physician.

Sattler
London West NDP MPP Peggy Sattler campaigns in 2022. (Derek Ruttan/The London Free Press)

Finally, the Burnses had hope of change. But Sattler wrote back in the summer of 2021 with bad news: Advisors warned the amendment might make assessments more difficult to obtain, run counter to privacy rules and have unintended consequences difficult to reverse.

“I know that the (Burnses) want justice for Kevin, and they want to make sure that other families don’t have to go through what they did,” Sattler said in a recent interview. “But the cautions that I received from experts in the field made me realize that this is not the best approach.”

CAMH still supports changes to legislation, while recognizing some privacy challenges, legal director Michele Warner clarified to The Free Press. “The laws of Ontario don’t really work that well together,” she says.

Under the Mental Health Act, psychiatrists are mandated to conduct financial capacity assessments for patients admitted to hospital care, a recognition that symptoms of mental illness can affect a person’s ability to manage their affairs, Warner points out. If a patient is found incapable on admission, the law requires another assessment upon discharge to see if treatment has helped and the patient is capable again, she says.

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“There’s a recognition in the law, that the treating psychiatrists in hospital, by benefit of their expertise and their knowledge of the patient and having direct involvement in their care, are well positioned to do these assessments,” Warner says.

But once a psychiatric patient is living in the community, the Substitute Decisions Act and community assessors take over, leaving the psychiatrists out of the picture.

“It’s a bit perplexing,” Warner says.

***

With lukewarm support for Kevin’s Law, Sattler wrote a letter to the associate minister of mental health and addictions, Tibollo, in July 2021, saying the issue was complex and beyond the scope of a private member’s bill. She urged Tibollo to meet the Burnses and discuss gaps in the system.

“The Burns family can share rare insight on some of the problems that must be addressed,” Sattler wrote.

The Burnses say they never heard from Tibollo.

Sattler says she never heard a word, either.

The Free Press contacted Tibollo’s office in April. There was no response. In June, the newspaper sent another email to a specific member of Tibollo’s staff. This time, there was a response the same day: “We are saddened to hear of the Burns family’s experience and express sincere condolences for their loss. Minister Tibollo will make himself available to meet with the family to discuss their experience and concerns,” wrote Iain Faulkner, an advisor to Tibollo.

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The meeting is set for Aug. 21. Joan and John are getting their research together, for one final attempt to plead their case. They want assessments requiring outside input to be rules, and they want doctors to have a say in those assessments.

“Nobody has a crystal ball. So we don’t know what would have transpired eventually in Kevin’s life. But he should have been given a chance for people to help him,” Joan says. “Kevin can’t be the first person that something negative has happened to. We just wanted to make it a safer process for other families.”

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Tibollo
Michael Tibollo. (Postmedia file photo)

  • In Ontario, a person doesn’t have the capacity to manage their finances “if they do not understand the information relevant to the decision or don’t understand the consequences of making or not making it, or both.”
  • In the community, capacity assessors are trained to evaluate a person’s ability to meet those criteria. They can be doctors, nurses, psychologists, social workers or occupational therapists, guided by the Substitute Decisions Act.
  • In hospitals, psychiatrists are required by law to conduct capacity assessments, directed by the Ontario Mental Health Act.
  • If a person is found incapable, a substitute decision maker, which could be a family member or the Office of the Public Guardian and Trustee, will be appointed.

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