I can't speak to mental health issues generally. I can only speak to dementia. Certainly, when we're talking about someone with dementia, we are typically talking about somebody who is fairly advanced in the disease. This is someone whose brain has become so damaged that their ability not only understand their behaviours but also to appreciate the consequences has become very damaged. Being held to account for that behaviour would by and large be inappropriate and unhelpful.
As we said earlier, and as we just heard from Dr. Keith and others, it's important that we do take the time and have the resources to be able to understand the antecedents for the behaviour. P.I.E.C.E.S. is the acronym for a model that's very widely used across Canada to really take apart why that person on the previous shift might have been violent or aggressive. In Ontario, we have GEM nurses in emergency departments and other areas who can be resources to staff as they step back and try to understand what might have triggered this behaviour. We need to understand that emergency departments, for example, are among the most toxic places for most of us, but particularly for people with dementia. The noise, the lights, the alarms, the sirens, the sounds and the people throwing up—all of that happening is an absolute recipe for frustration and aggression for someone with dementia.
We do need to think about physical design and education, but we also need to think about resources to staff in the moment to try and step back and figure out what might be going on and what they know about the person.