Good morning.

In the weeks before 11 people were killed by an SUV speeding through a Filipino cultural festival last spring in Vancouver, Kai-Ji Adam Lo was showing signs of acute paranoia.

The day before the April 26 attack, he complained to Mounties that chemicals had been spilled in his SUV and that a virus had been installed on his dash cam. He had purchased a US$1,159 instrument used to identify chemical-warfare agents and toxic chemicals.

Lo had complained about the side effects of his medication, according to documents reviewed by The Globe and Mail. The documents noted that if he did not take it as prescribed, he would be at a “high risk” of becoming mentally unstable.

At the time of the festival attack, Lo was involuntarily under the care of a community mental-health team in a form of medical supervision known as "extended leave."

Should Lo, now the suspect in that attack, have been taken back to hospital against his will?

Five sources have told The Globe the details of Lo’s condition and medical treatment, as reported by the paper, should have raised red flags for members of his health team, who are trained to recognize them. The sources included former members of the Mental Health Review Board of British Columbia and a forensic psychiatrist with direct knowledge of Lo’s care.

The Globe is not identifying the five sources. The review board members have been advised not to speak to the media about the case. The forensic psychiatrist is not authorized to speak to media.

Three of the sources said Lo’s health team should have alerted Vancouver Police to ask for an officer to return Lo to hospital on April 11 of this year, the day Lo’s psychiatrist determined his mental health appeared to be deteriorating and his delusions increasing.

But doctors with experience in B.C.’s mental health care system say the system is so stretched in urban centres that there is not the bed space or the time to give everyone adequate treatment.

Dr. Bill MacEwan, the former head of psychiatry at St. Paul’s Hospital in Vancouver, said health care workers in emergency rooms and psychiatric wards are constantly triaging people with complex mental-health problems.

He said when lots of psychiatric patients arrive at hospital emergency rooms during the same period, ERs struggle to find beds for them while also juggling the admission of other patients who arrive in need of medical attention or even surgery.

“It doesn’t mean that everyone will be inappropriately discharged, but it does create tension and pressure for getting access to beds for people in emerg,” MacEwan said.

Another clinician, a forensic psychiatrist and former member of the province’s Mental Health Review Board, said it is the rule – not the exception – that people with psychosis are discharged too quickly.

It takes four weeks for hallucinations to dissipate for patients experiencing psychosis, the psychiatrist explained. For delusions, it takes four months. But in Vancouver, patients with psychosis are generally discharged within a week because of insufficient beds, they added.

The Globe is not naming the psychiatrist, who does not have direct knowledge of Lo’s case, because they were not authorized to speak about the health care system.

In a statement, B.C.’s Health Ministry denied that patients are discharged before it is medically safe to do so.

“We recognize that hospitals are experiencing significant demand for mental health services, which can create pressures on bed availability,” the statement said.

But it added that it is ”our expectation that health authorities have clear discharge plans in place for every patient to ensure continuity of care.”

After The Globe’s reporting on the Lapu-Lapu Day attack last spring, Vancouver Coastal Health released a statement saying Mr. Lo’s care team was following him closely and that there was no indication he was violent.

But publicly available data back up the clinicians’ concerns that B.C.’s mental-health system is overstretched.

This summer, there were approximately 5,915 patients on extended leave in the province, double the number from 2020. But while that number has exploded, the number of those who have been forced to return to hospital after their psychiatrists or social workers recognized their condition was deteriorating has remained relatively steady in recent years at roughly 1,350, according to data supplied by the B.C. Ministry of Health.

Other figures tabulated by the Canadian Institute for Health Information show that as of 2023, B.C. had the lowest number of health care professionals per capita of any province.

Lo now faces 11 charges of second-degree murder and 31 counts of attempted murder. He has been found fit to stand trial.

If the court proceedings don’t canvass issues surrounding his care, the B.C. government has promised a public inquiry into gaps within the mental-health system.

This is the weekly British Columbia newsletter written by B.C. Editor Wendy Cox. If you’re reading this on the web, or it was forwarded to you from someone else, you can sign up for it and all Globe newsletters here.