Public guardian system could be improved, but needed to protect vulnerable Manitobans: chief psychiatrist

Most Manitobans will never encounter the province’s chief psychiatrist, but if a doctor has decided you’re mentally incompetent, the trajectory of your life is in his hands. 

The Public Guardian and Trustee of Manitoba is an arm’s-length government agency that makes the personal and financial decisions for more than 2,700 people deemed medically incompetent by a doctor.

Once a doctor makes that designation, it’s Dr. Jim Simm who signs the final order of committeeship that indefinitely places someone under the care of the public guardian.

Simm, who has been Manitoba’s chief psychiatrist since July 2022, says it’s not a rubber stamp, and he reviews every recommendation to make the best decision.

“You’re taking away someone’s constitutional rights. So you really have to tread carefully,” he said in a wide-ranging interview with CBC News about the public trustee and guardian.

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But four people profiled by CBC News in a recent investigation said they were placed under guardianship with little notice. Once in the system, they felt trapped and lost in the shuffle, dealing with an overworked and understaffed agency.

“It’s just like jail. You eat what they give you, you sleep where they tell you. You don’t go out. You can’t go out,” said Boyd Noble, 74, who CBC spoke to about the challenges of getting released from a guardianship. 

WATCH | ‘It’s just like jail,’ says Boyd Noble:

Boyd Noble says life under guardianship is like being in prison

Boyd Noble, 74, was under the guardianship of Manitoba’s public trustee for over a year. He says the lack of control made him feel like he was a prisoner.

Others who spoke to CBC about their experience in the system included Lorne Kiss, 58, who was placed under a guardianship when he was gambling away his money and had threatened suicide.

Simm argues that these decisions are more nuanced than simply being the result of a gambling addiction or medical emergency. 

“There’s usually more to the story,” he said, arguing a doctor should only fill out the form deeming a person mentally incompetent if they believe the person suffers a long-term disorder.

In making his decision, Simm said he looks to see if the person can manage their affairs, pay their bills, find housing, and clothe and feed themselves.

In about a third of cases where people are placed under guardianship, it’s in order to protect them from elder abuse or to keep their funds from being misused.

“A lot of the reason for the public trustee and the orders of committeeship is really to protect people that are vulnerable and unable to care for themselves,” he said.

Extra money saved for special occasions

Once someone is placed in the trustee’s care, their finances are taken over by the public guardian, who doles out an allowance budgeted for the person.

Simm admits there are “a lot of people that aren’t pleased” to see things like their carbon rebate cheque go to the public guardian rather than into their own pockets. 

“There are people that believe that the public trustee is not giving them all the money that they’re entitled to.”

But he says after a client’s bills are paid, any extra money is squirrelled away in funds for special occasions for them, or make purchases like new winter clothing.

A portrait shows a man sitting on a bed in a small room.
George Kinsman was deemed mentally incompetent and placed under the public trustee’s guardianship after he was hospitalized in 2022. He told CBC he gets more than $2,000 monthly for his pension and old age security payments, but under guardianship, is given an allowance of $140 a week. (Prabhjot Lotey/CBC)

Clients are also charged a monthly fee to cover their eventual funeral costs.

The public guardian also charges fees for its services, depending on the transactions of the client. George Kinsman, for example, pays $12 a month.

He told CBC he receives more than $2,000 monthly from the government for his pension and old age security payments — but that money is no longer his to spend. His mail is redirected to the public trustee, and he’s given $140 a week to spend on things such as food for his cat, groceries and cigarettes, he said.

Not just ‘drive-by’ assessments

While he makes the final sign-off for guardianship, Simm rarely actually examines the person.

He relies on the doctor’s notes and a social history that goes through the reasoning behind finding someone mentally incompetent. 

Asked if he should examine every person, Simm said that would be ideal in a “perfect world.”

But his office gets about 300 referrals from doctors yearly — so it would mean quadrupling his staff, he said. 

“I also have to have some trust in my colleagues,” he said.

WATCH | George Kinsman scored within normal ranges on a cognitive assessment. Here’s his reaction to a question about that assessment:

‘I felt like I was getting beat up,’ George Kinsman says after reading cognitive assessment

George Kinsman was placed under the guardianship of Manitoba’s public trustee after he was found mentally incompetent following a hospital stay. He began to cry when asked what it felt like to read a cognitive assessment that said he scored within normal ranges.

Doctors aren’t usually doing a “drive-by assessment,” and patients are also observed by nurses, social workers and occupational therapists, said Simm.

“These usually aren’t … filled out because somebody’s a bit of a nuisance or spending their money in ways that we wouldn’t think are terribly healthy choices.”

He recalls a case where he received a doctor’s referral requesting public guardianship for a person who was spending all their money on an “intoxicant” and eating at soup kitchens the rest of the week.

Simm denied the order, arguing the person was making a rational decision that ensured they had enough food to eat. 

“The system could be improved. But I think as it stands now, there is enough safeguards that we’re not just taking people’s rights away randomly.”

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