WARNING: This story references self-harm and suicide.

Paramedics rolled Jeremiah Dixon into the emergency department on a gurney after he'd made multiple attempts to take his own life. Less than a day later, he was discharged and sent by taxi to a local homeless shelter. 

“I was scared and shocked,” the 19-year-old said in an interview at his family home in Dartmouth, N.S. “I was still like dizzy and stuff, and they just sent me off with some snacks and a ride to the shelter.

“I was a little confused as to why … the doctors would send someone in my state out of the hospital where they should be getting help.” 

Jeremiah, who has fetal alcohol spectrum disorder and borderline personality disorder, says he’s experienced suicidal thoughts since he was about eight years old.

For as long as he can remember, he’s struggled to regulate his impulses and behaviour — a common symptom of both conditions. 

On the night of April 13, he was engaging in self-harm and attempted to end his life at home. He then left the house and was later found by police trying to break into a building where he planned to attempt suicide again.

Jeremiah remembers feeling scared when he was sent from the hospital to a local homeless shelter after he attempted suicide. (David Laughlin/CBC)

“I was just kind of in a really negative headspace and there were a lot of dark thoughts that were running through my mind,” he said. 

Paramedics were called and he was taken by ambulance to the Halifax Infirmary where he was assessed and treated for his injuries. 

Jeremiah’s parents, who adopted him and his sister in 2009, said they got the call around 9 a.m. the next morning that their son was at the hospital. 

Kim and Dave Dixon said they spent a few hours in the waiting room before they were allowed to see him. 

They were able to speak with the emergency room doctor and a psychiatric nurse to provide information about Jeremiah’s medical history.

Given his mental and physical condition, the Dixons assumed he'd be admitted to the hospital for at least a couple days, so they went home to check on their other kids.

Around 4 p.m., they said, hospital staff called to say Jeremiah seemed fine and would be discharged.

Kim and Dave pushed back, arguing their son required serious mental health intervention. They told staff they needed at least a day to come up with a safety plan before they could bring him back into their home.

After a few back-and-forths, the Dixons said hospital staff called around 6:30 p.m. to inform them their son was in a cab on his way to the Salvation Army shelter.

Jeremiah didn't have any form of identification or his cellphone with him.

Dave Dixon is Jeremiah's father. He says this situation has left him angry about the state of the Nova Scotia health-care system. (David Laughlin/CBC)

“I don’t understand what kind of person or what kind of system would allow a disabled, vulnerable person who is in the middle of a mental health crisis to be sent to a homeless shelter,” said Dave Dixon. 

“It seemed very much a situation of ‘we just want to clear the bed,’ and that seemed to be the highest and only priority.” 

Dave drove to the shelter and found Jeremiah filling out intake forms with an employee. He said the employee was trying to find Jeremiah a bed in a youth shelter, because she didn’t think the Salvation Army was the right place for him in the midst of a mental health crisis.

Dave and Kim said they wrestled with what to do. They didn’t know if their home was a safe place for their son, but they ultimately decided it was safer than the shelter. 

“You feel isolated and hopeless,” Kim said. 

“It’s so hard to battle the system, that we have to also accept the fact that he may not make it.”

No discharge plan

Nova Scotia Health declined an interview with CBC News to talk about this incident, or about hospital intake and discharge protocol more broadly.

In an email statement, a health authority spokesperson said mental health or addictions crises do not always require hospitalization.

“The decision to keep someone in hospital is made by gaining an understanding of the whole person — not by a single moment or incident,” Keith Corcoran said. 

“For instance, what else is going on in their life that might impact coping skills? What community supports are already in place? If we can identify a plan that includes ongoing care and resources in the community, that person may not need to remain in hospital.”

Corcoran added there is "significant evidence to demonstrate the potential harm of hospital admission for people with particular mental health disorders."

When asked if sending Jeremiah by taxi to a shelter was in line with Nova Scotia Health protocol, Corcoran said “we cannot comment on the details of specific client/provider interactions. In general, a decision to discharge depends on what is agreed upon between the client and provider.”

But the Dixons said there was no clear plan in place for Jeremiah.

Kim Dixon, Jeremiah's mother, says she's almost had to come to terms with the fact that she might lose her son to suicide one day. (David Laughlin/CBC)

They would later learn a followup appointment had been scheduled with a hospital social worker. 

Jeremiah missed the appointment because his memory from that night is hazy, and Kim said no one from the hospital told her about it because Jeremiah is legally an adult and therefore they could not disclose that information.

A few days later, Jeremiah visited his family doctor to get his medications regulated. The Dixons said the physician had no record of their son’s suicide attempts or details from his hospital visit, apart from the fact that he had blood drawn at the Infirmary. 

“He literally just … was left to go to die, it feels,” said Kim. 

‘I hope that I can be successful in my life’

After the Dixons made a formal complaint and CBC News reached out to Nova Scotia Health and the Department of Health and Wellness about the situation, the family received a phone call Monday from someone with the QEII Health Sciences Centre’s psychiatric team. 

Kim said the person seemed sympathetic about what had happened and booked an appointment for Jeremiah to see a psychiatrist next week.

The Dixons said he has been on a psychiatry waitlist for a year and a half.

“For me, there’s a lot of anger and sadness over the brokenness of a system, and a lack of care from people who should care,” said Dave.

The Health Department did not respond to CBC's questions by deadline.

Following a provincial cabinet meeting on Thursday, Addictions and Mental Health Minister Brian Comer was asked about whether Jeremiah's discharge was handled properly.

He said he could not speak to the specifics of the case, but has asked Nova Scotia Health to look into the situation — which he called "concerning" — and follow up with the Dixons.

"Having a concrete discharge plan would be a normal thing to see in a crisis setting specifically, so that would be a rare thing to do it like this unless there was documented reasons," said Comer.

As for Jeremiah, he hopes that with the right therapies, medication and support, he can start to feel better and move forward. 

“I hope that I can be successful in my life,” he said. “I know that’s what my parents want, and I want that too.” 

If you or someone you know is struggling: 

• The Nova Scotia Mental Health and Addictions Crisis Line can be reached 24/7 first at 902-429-8167, or 1-888-429-8167, or by dialing 911.
• The National Suicide Hotline can be reached by call or text at 988. 
• Talk Suicide Canada can be reached at 1-833-456-4566 or text 45645 (between 4 p.m. and midnight ET).
• Kids Help Phone can be reached at 1-800-668-6868 or try live chat counselling.
• Anyone in Nova Scotia who is seeking mental health services can self-refer through the Mental Health and Addictions Intake Service at 1-855-922-1122 from Monday to Friday (8:30 a.m. to 4:30 p.m.), as well as Tuesday and Thursday evenings (until 8 p.m.), or online 24/7 through prebooking.nshealth.ca. For the IWK, intake hours are 8:30 a.m. to 8:30 p.m. (Monday to Friday) and 8:30 a.m. to 4:30 p.m. (Saturday and Sunday).

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