Mitchell Hurst holds a tattered pink sheet of paper for his mother to view through the glass pane separating them in the Edmonton Remand Centre's visiting room.
In a childlike scrawl, he has written down his Christmas list, not what he wants to receive, but what he wants to give.
His mother is getting some hand lotion, his grandfather a bottle of wine or $50. It is only mid-October, but that doesn't seem to bother Hurst, nor does he understand he may not be out for Christmas.
Hurst has a range of mental health problems, most prominently fetal alcohol spectrum disorder (FASD). His IQ places him closer to a young child than a 26-year-old man. He can be rash, impulsive and aggressive.
"His behaviour is unpredictable. At the same time he can be a really nice guy who is funny and joking around all the time," said his mother. "People like him, but he is very difficult. You have to know where he is all the time."
He also stands accused of arson, facing charges a month after being released from Alberta Hospital Edmonton — a place he tried to go back to.
Hurst has spent the last seven months in either the remand centre or the Fort Saskatchewan Correctional Centre as his court proceedings played out.
Last week those proceedings turned a page when Hurst was deemed mentally unfit to stand trial.
Morinville RCMP officers charged him with arson in June following a fire in Cardiff that destroyed a home and could easily have claimed a life.
The home was a total loss and had a neighbour not alerted someone sleeping inside, the fire could have been fatal.
He was arrested at the scene with lighters in his possession. Several witnesses spotted him nearby.
In the month before the Cardiff blaze, Hurst lived in a supportive living home just a few doors away. For the three years before that, his home was Alberta Hospital Edmonton.
Seeking help
To know when and where he went between his release from the psychiatric hospital in May and the fire in mid-June, we can only rely on Hurst's troubled mind.
He was clearly struggling and tried to get help from a mental health care system with little to offer.
Hurst's mother, Lois Thurstan, is a passionate advocate for her son. She is horrified by what he is accused of doing and angry because she believes it didn't have to happen.
"It is avoidable that someone innocent got so hurt," she said. "I can't imagine what it would be like to have a house burned down."
During his month in Cardiff, Hurst went missing for several days. He would go into Edmonton to take part in programming and services, but on several occasions did not come home afterwards.
He used illegal drugs and met up with people he knew from Alberta Hospital, staying out for days before calling for help or calling to come home.
He was briefly admitted to the Royal Alexandra Hospital and also went to emergency rooms at the Sturgeon Community Hospital and the University of Alberta, though it is unclear what he told doctors.
Beyond Hurst's recollections, these visits are substantiated in emails Thurstan received from Hurst's public guardian. Hurst is also adamant he tried to return to Alberta Hospital Edmonton.
Today Thurstan is successful in her work and happy with her family.
When she was pregnant with Hurst, she was battling her own demons. Her regret about his condition and her responsibility for it is palpable.
In the remand centre's visiting room, Hurst didn't understand he might have to go back to the hospital because, as far as he is concerned, the hospital doesn't want him back.
"I tried to go back to Alberta Hospital," he said. "They turned me away."
He didn't comprehend there was a difference between walking up to the front door unannounced and being sent there by a judge.
Unfit for trial
Hurst doesn't remember allegedly setting the fire at the Cardiff house, but he is remarkably candid about what he can remember.
"I was high on drugs. I am always high on drugs when I go into the city," he said. "I wasn't thinking straight."
Hurst was declared unfit following a brief hearing in front of Provincial Court Judge Norman Mackie, who ordered him detained at Alberta Hospital Edmonton.
Psychiatrist Dr. Niti Bhatia testified Hurst's conditions make it very difficult for him to learn, communicate and comprehended what is happening to him.
She told the court Hurst has FASD, attention deficit disorder and anti-social personality traits.
FASD has a range of presentations, but Bhatia told the court there are some common characteristics.
"One of the real cardinal ones is a lack of a learning from mistakes and impulsivity," she testified.
Last week's hearing establishes Hurst is not presently able to stand trial because he could not assist with his defence or make informed decisions.
"At no point do I believe he would be able to argue in an abstract manner or be a reliable historian," Bhatia told the court.
Hurst sat in the prisoner's box and looked directly at the people speaking, but Bhatia said that, given his mental state, there was no telling whether he actually understood.
With treatment and tutoring, Bhatia told the court Hurst might reach a point where he could be fit to stand trial but she could not say for certain.
Hurst will be held at Alberta Hospital Edmonton for a minimum of 45 days. If he improves he might be brought back to court to stand trial.
If that happens — in addition to determining his guilt or innocence — the court will likely assess whether he can be held criminally responsible for the fire given his mental state when it occurred.
Bhatia testified that was an open question.
"I am not perfectly confident that he understood the consequences of starting the fire."
Placement problems
When Hurst was released in May, he was sent to the supported living home in Cardiff after his public guardian arranged for a placement. His diagnosis along with his very low IQ means the guardian helps Hurst make decisions.
Alberta Hospital initially planned Hurst's release in February but his guardian asked his physician to hold off because they had not found anywhere for him to go.
In a letter copied to Thurstan, his guardian said it was difficult to find Hurst a home because he had been disruptive and anti-social.
He also wrote Hurst's physician at that time and said Hurst's placement in the community had to be done slowly and carefully.
"Much care and forethought has to be given to an appropriate residential setting if Hurst is to have any success."
His guardian was clear that, without the right placement, Hurst would have problems.
"Hurst will fail very quickly and quite dramatically in the community."
Thurstan is upset that prediction came true so quickly and there was nowhere for her son to turn when he did start to fail.
"If he was struggling, why couldn't someone have done something? Why couldn't there have been a safe place for him to go?"
Brenda Lee Doyle, the director of the public guardian's office, said the department takes its responsibilities very seriously when it comes to the roughly 2,000 Albertans in its care.
She said it represents people only when there is no one else and the court orders a guardian to be appointed.
"We are the last resort. It is where nobody else is able to take on that role."
The housing placements guardians make are done in consultation with the represented adult, ideally looking for somewhere near services and family members, she said.
"We don't just look at the first option that comes up. We investigate all the options to determine what would be a suitable placement."
The average caseworker in the office is placed in charge of between 40 and 60 people, but Doyle said the number fluctuates based on the needs of the adults represented.
For privacy reasons, Doyle could not comment on Hurst's case or discuss whether it has sparked any kind of review of the office's procedures.
System over-capacity
Medical professionals who work in mental health find Hurst's story troubling but not at all surprising.
Dr. Krista Leicht, a psychiatrist at Alberta Hospital Edmonton, said even with the government abandoning its plans to close beds at the facility, there is still never enough room for the patients who need a space.
"It is just a zoo. We get people streaming in from dawn until dusk and all through the night."
Lately the hospital has had patients sleeping in common areas on cots and in hallways. Under those circumstances, doctors sometimes have to take the best option available when it comes to a patient's discharge.
"I think sometimes people are rushed out the door, the odd time anyway, where perhaps we would prefer something that is a bit better," said Leicht.
Mental health patients take longer than most to get healthy as medications take time to stabilize a patient and don't all work identically in every case.
Leicht said the pressure to move patients has been growing with the system increasingly focusing on efficiencies and cost savings.
"We tend to take a lot longer and that has been pointed out to us, so I think there is a lot more pressure on us, as a medical staff particularly, to get our patients moving, more so than there was."
Donna Wilson, a nursing professor at the University of Alberta, studied local hospital admissions with an eye for mental illness and the impact it has on the system.
"I am surprised there aren't more people with stories like the one you are telling me right now. Someone who was so sick that they had to be in hospital for three years, finally is stable enough that they thought they could send him out and it clearly didn't work."
She said in crowded emergency rooms doctors have to make difficult decisions all the time about priorities and mental health can easily fall down the list.
"They have people with heart attacks, they have people who have been in terrible car accidents and they are bleeding to death and then you have someone who comes in with a psych problem and you are full. Who do you admit?"
She said treatment times also make mental health resources scarce because patients don't turn around overnight.
"Health care has gotten a lot better for people with heart attacks, a lot better for people with strokes, a lot better for people having major surgery, but for psychiatric illness there aren't that many quick fixes."
Representatives from Alberta Health Services were unavailable to speak about mental health issues when contacted earlier this week.
A health care capital plan the agency announced last week did include $100 million for addiction treatment facilities, but no funding for upgrades to Alberta Hospital Edmonton.
Thurstan wants to see her son returned either to Alberta Hospital or to a place with similar programs, structures and restraints.
Bhatia felt the same way when she testified.
"Living in a structured setting, a very carefully monitored setting, would be helpful for him."
Thurstan said the home in Cardiff was run by people who treated him well but he was bored and restless, which is when he typically gets into trouble.
While in the short-term Hurst is going back to Alberta Hospital Edmonton, where he will live in a year or two is completely unpredictable. He might live permanently at the hospital, the system might find a group home for him or a he might commit another crime and be returned to the justice system.
For his part, while the justice system and the health care system try to figure out how to handle him, he has very simple ideas about what he would like to do.
"I want to live in the city," he said through the visiting room glass. "I want to play my Xbox 360.
