A mother's plea to ERs — treat people addicted to drugs with kindness, not contempt

This story is part of a series by CBC Cape Breton examining the use of street drugs on the island. Click here to read more stories in this series.

Ashleen D'Orsay didn't want to be there, sitting for hours in the emergency room of the Cape Breton Regional Hospital, feeling like she was being judged by medical staff who didn't understand her complex mental health problems or drug and alcohol addiction.

Two days later, on Jan. 12, the 26-year-old died from sepsis contracted from a dirty needle she used to inject opioids. Her family had begged her to seek treatment sooner, but following years of difficult ER visits she only went to the Sydney, N.S., hospital after much hesitation.

It's a delay her mother believes was a factor in her death.

"Naturally, my daughter wouldn't go back if your deepest fear and your deepest belief about yourself is that you're a piece of garbage and you're a burden," said Colleen D'Orsay, Ashleen's mother. 

D'Orsay wants to see improvements to how ERs handle patients like her daughter. She is urging for better training for ER personnel on how to help people suffering from multiple disorders at the same time, like a mental illness compounded with an addiction.

Nova Scotia Health is changing  how it trains its ER staff. Dr. Barbara O'Neill, the director of emergency services for the province's eastern health zone, which includes Cape Breton Regional Hospital, said the health authority began developing a program to address concerns around stigma in ERs in 2016.

The in-person training was piloted and refined over the years and began to be more widely distributed in the fall of 2019. O'Neill said the training deals with things like conveying warmth, concern and empathy, as well as being mindful of body language. 

Staff in 11 hospitals in the eastern zone have undergone the four-hour training sessions, but it stopped due to the pandemic. O'Neill said the hope is to start it again soon. 

D'Orsay, who was inspired to become a counselling therapist in order to better appreciate her daughter's struggles, believes attitudes need to change. She wants people to understand why some become addicted to drugs and alcohol and that anyone, no matter their background, can struggle with addictions, especially if they've suffered trauma.

"Ashleen was a person who was deeply loved, with an entire family and support system who had done everything that we could to get her better."

'Frequent flyer'

Ashleen was what some medical professionals call a "frequent flyer." She was in the ER a lot over the years because of a borderline personality disorder, which often led to delusions and psychosis. 

In the months before her death, Ashleen had gone to the ER for things like wounds caused by injected drugs, psychiatric help and a persistent cough, but D'Orsay said staff would sometimes roll their eyes and she was often dismissed.

Ashleen's grandmother, a former registered nurse, once went with her to try to advocate on her behalf but was told Ashleen was there too often and would be the last to be seen.

But on Jan. 10, it was apparent to her family that something was seriously wrong. Ashleen couldn't eat and she was coughing up blood. She had called her mother and said she worried staff would be mean to her if she went to hospital.

After some convincing, she finally went to the ER. She left, feeling uncomfortable. She returned, bringing her boyfriend for support after her family begged her to stay put.

Her oxygen levels were dangerously low and then her organs started failing. Two days later she was taken off life support.

A history of mental illness

D'Orsay describes her daughter as a loving, creative and quirky young woman who never really cared about fitting in.

Ashleen grew up in Sydney, but her family moved around, eventually landing in Halifax. Her problems began in her early teens when she began to experience anxiety and depression. She started using the drugs such as MDMA, Ritalin, speed and cocaine, as well as alcohol. 

Her mother believes a traumatic divorce helped sparked the substance abuse. Ashleen bounced between living with her mother, father and grandparents as she would often get frustrated by boundaries put in place by each. 

She was eventually diagnosed with a borderline personality disorder. Later, she was sexually assaulted and forced into the sex trade, compounding her existing mental health issues.

"For so long my daughter had not been seen as a real person with real value," said D'Orsay.

Ashleen struggled in her early 20s when she was living in Halifax. She often lived in homeless shelters because she suffered from delusions that made it dangerous for her to be around her younger siblings.

She would sometimes end up in the ER because of the delusions, which included telling staff her mother was murdered and her younger brother was kidnapped. 

Eventually, she was arrested on mischief charges stemming from those incidents. According to D'Orsay, part of Ashleen's release conditions restricted her access to the ER and police station.

Unable to stay

But Ashleen would sometimes leave the ER herself even when she was admitted, despite her family's protests. She found it difficult to wait for help, especially when support people were no longer permitted during a long stretch of the pandemic.

According to the Cape Breton Ally Centre's outreach street health nurse, people with addictions often get frustrated by the treatment they receive or a lack of understanding of the conditions they suffer from. The wait itself, though, can be intolerable for other reasons.

"When they go there … they waited for a long period of time but they started to go into withdrawal or they just couldn't tolerate due to anxiety or whatever other condition they may have," said Sharon MacKenzie.

Ashleen's life started to improve after she ended up in the Nova Scotia mental health court program after the mischief charges. Participants acknowledge responsibility for their crimes, and follow a support plan with the help of the court team.

Ashleen was working with social workers and was back on medication for her borderline personality disorder. Then she was accepted into Nova Scotia Community College's social services program in Sydney.

"She was so incredibly proud of herself," said D'Orsay.

The pandemic hits

Ashleen was in a good place before the pandemic, but when school went virtual her mental health took a toll. She missed her classes and the support she received at the college. 

She also went off her medication because she found it made it harder to learn. That brought back the psychosis she had so often suffered from, but the pandemic made it difficult for her to access a psychiatrist. In August, Ashleen was pressured into using opioids intravenously for the first time. She was hooked immediately.

All of this, D'Orsay feels, led to Ashleen's death on Jan. 12.

D'Orsay believes under-staffing and burnout of ER staff is part of what makes vulnerable people not seek help when they need it. She thinks pressure could be taken off staff if mental health services like psychologists were more accessible to the general public.

Nova Scotia's new premier, Tim Houston, has promised to make mental health more accessible and affordable. 

• More stories from CBC Cape Breton's examination of street drug use on the island

In Gaelic, Ashleen's name means dream or vision. Before she died, Ashleen's dream was to get a social work degree and start a program to teach health-care professionals about unconscious bias, the kind her mother said Ashleen faced during her short life.

D'Orsay is hopeful the changes Ashleen wanted will happen. As a counselling therapist herself, she now specializes in helping people struggling with past trauma.

"If I couldn't help her, I could help somebody else's child."