Coroner’s inquest: Housing options were slim for Attila Csanyi, psychiatrist says
Care team was ‘just happy that he got a place to sleep’
A lack of adequate supportive housing in Hamilton has emerged as a common thread in an ongoing coroner’s inquest into Attila Csanyi’s overdose death four years ago on the roof of Jackson Square.
“I believe housing should be supported. I believe it should have integrated treatment for both medical issues, psychiatric issues and perhaps concurrent issues,” Dr. Michal Siekierski, a psychiatrist with St. Joseph’s Healthcare who treated Csanyi, said on Day 4 of the inquest.
Csanyi, who had severe schizophrenia, would have fared better with his own room — rather a shared one — to afford him more privacy and a home with fewer rules, he said.
That’s due, in part, to his “horrendous” history of trauma, said Siekierski, referring to the early-childhood abuse he suffered alongside his twin brother while in a foster home.
The flexibility to smoke — “a big issue” for many patients — and host guests at night also would have been helpful for Csanyi, who was “quite a sociable person,” he noted.
“So I do think that he would have done better in a more tolerant, more open setting, with some support more on his terms. That would have been a good start.”
The inquest has heard that Csanyi’s stays at a pair of privately run lodging homes, also known as residential care facilities, were turbulent, drawing complaints over visitors, indoor smoking, hoarding and aggressive behaviour.
In March 2020, he was abruptly evicted from Sampaguita Lodge and Rest Home on Bay Street South, a rupture that preceded a spiral that ended with his drugoverdose death on Jackson Square less than two months later.
Siekierski, who treats patients with schizophrenia, noted there were few housing options at the time of Csanyi’s discharge from an extended hospital stay in 2018.
“We were just happy that he got a place to sleep, to be honest. Ideally, he would have been discharged to a very different setting. He would have been discharged to a setting that matched his needs and preferences. He would have had some choice.”
In 2018, his team didn’t discharge patients to emergency shelters, but now, “unfortunately, some patients are being discharged to shelters,” Siekierski said.
Coroner’s inquests are designed to result in recommendations to improve systems and organizations with the aim of preventing similar deaths, but not meant to assign blame.
The exploration of Csanyi’s death overlaps with escalating homelessness in Hamilton, punctuated by tents pitched in parks, as shelters struggle with the compounding pressures of untreated mental illness and a toxic drug supply. It also comes amid a shortage of affordable housing.
Starting in his late teens, Csanyi started to show symptoms of what would later be diagnosed as schizophrenia. His brother, Richard, tried to help him as they struggled to find housing and psychiatric care in Toronto, Mississauga and lastly Hamilton.
In May 2018, when they found him “running into traffic,” police apprehended Csanyi under a provision of the Mental Health Act and took him to St. Joseph’s to be assessed, Siekierski recalled.
“It was clear that he was very ill,” Siekierski said about Csanyi, who was also diagnosed with polysubstance disorder.
During his involuntary 83-day stay, he didn’t “like being” at St. Joseph’s. In fact, he left without permission on two occasions, but was quickly returned.
But gradually, he showed a “significant response” to treatment of injected antipsychotic medication.
“He tolerated that medication very well. He had no side-effects and he was treated with large doses.”
In fact, the result was “remarkable,” said Siekierski, noting “no evidence of psychotic symptoms” toward the end of his time at St. Joseph’s.
He was discharged to outpatient care under a community treatment order (CTO) that obliged him stick with his medication, attend regular appointments and meet other conditions.
In the community, Csanyi continued to respond well to the treatment, the inquest heard, but there would be other concerns, such as his deteriorating hygiene, indication of drug use and hoarding at Sampaguita.
“We often, to be honest, don’t know what our patients are using, and sadly, these days, our patients don’t know what they’re using,” said Siekierski, pointing to volatile supply of street drugs with unpredictable mixes.
An autopsy found that Csanyi had died of a drug overdose involving methamphetamine and fentanyl.
Siekierski said his team loses five or six patients a year; just a few weeks ago, like Csanyi, one died of an overdose after an eviction.
“There’s this pervasive sense that there’s a lot of risk that we’re not able to mitigate. So people are dying and we’re not sure what to do about it.”
The inquest is scheduled to continue Tuesday.