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mental health

3 IDF soldiers from the same unit kill themselves within weeks of the Gaza ceasefire

This is messed up

In the weeks after Israel and Hamas agreed to an open-ended ceasefire, three Israeli soldiers decided to end their lives with their own weapons. And what was especially striking about their suicides was that all served in the same unit, the Givati Brigade, which had a reputation for its ruthless ferocity, considerable bravery, and the use of Old Testament religiosity to justify the merciless operations of its commander, Colonel Ofer Winter.

So why did it happen?

A contributing factor, according to Staff Sergeant J., who served in the Givati Brigade in the middle of the last decade, and does not want to be named, is that secular Israelis are now avoiding the military or declining to continue after mandatory service. “Those who do continue feel a religious and political duty,” he says. This has been discussed as a concern by Israeli academics and analysts for years.

The staff sergeant said that when he was in the Givati Brigade in 2007 or so, it was “openly secular.” He recalls “there was a group who had come from the yeshiva,” but “often they were uncomfortable… they felt sidelined.” As secular Israelis left, however, the vacancies were filled by settlers, he said.

Could any of this, or some of this, or none of this have affected the decision of three Givati soldiers to take their own lives? The Daily Beast reached out to several post-traumatic stress disorder specialists for their analysis.

“It is strange that they hadn’t seen a mental-health counselor,” said Mooli Lahad, an Israeli psychiatrist and psychotrauma specialist with over three decades of experience. He was citing reports that the Givati soldiers hadn’t received treatment. “This isn’t common for the IDF,” he said.

Lahad stressed that suicide usually has to do with pre-existing issues, such as depression, and an accumulation of factors can lead to a sense of hopelessness, which counseling helps to prevent.

“Sometimes, if there is a particularly macho culture, seeking help for depression or PTSD is seen as showing weakness, which is discouraged,” Lahad said. “If there’s a commander who thinks God is whispering in his ear, this can make things even more difficult.”

The article also speaks of religious radicalization of the Israeli military due to the role of fundamentalist settlements. 

Less force, more service

How much of this is applicable in Saskatoon.  The vision for the future of Toronto Police.

“What I see is the traditional model, which has outlived its utility and relevance,” Mukherjee said of a system that has historically relied on uniformed police officers heavily equipped with hardware, where the bulk of training is in use of force.

“The need out there has changed,” he said, adding that 80 per cent of the work police are now called on to do isn’t crime fighting per se. Officers are instead dealing with the safety of young people, domestic violence issues, and people suffering mental health issues.

Mukherjee envisions organizational shifts that could involve hiring youth workers, domestic violence workers and social workers. And that could even include taking guns away from some (or many) police officers.

“My vision of the police organization is it is actually a network of many different services,” Mukherjee said. The human rights facilitator is keenly interested in the approach to policing in the United Kingdom, thought to be at the forefront of innovation.

These are not simple changes.

During Thursday’s interview, Mukherjee noted that two years ago he pushed for zero deaths in police interactions with the mentally ill and was told by top brass it was “impractical.” (In a report released last week, retired judge Frank Iacobucci also called for a goal of “zero deaths,” one of several recommendations Blair said would “gather momentum” and not dust.)

This would be a fascinating discussion to have because I see the Saskatoon Police force working in both ways.  While I am not sure how much value the SWAT assault vehicle they have is, they do have a lot more hardware now than they did before.  How much does a police force need?  How much social work should they be doing?  Interesting questions.

Why We Don’t Like Stories in Which the Mentally Ill Heroine Recovers

Basically people who recover undermine how psychiatry is practiced now.

The story of modern psychiatry, for many, is triumphant one. The quick-and-dirty history goes like this: Human ingenuity and scientific advances led us from the dark ages of hydrotherapy and solitary confinement to cognitive-behavioral therapy and expertly prescribed medications. While we used to believe the mentally ill were unwell as a result of wayward behavior or demonic possession, we now know that psychic anguish is the result of brain chemistry and nurture, and we’re working harder to analyze the former. We moved, in other words, from mental illness as a moral failure to mental illness as a medical condition.

But if you zoom in on the late 1940s through the early ’60s, a different battle is being waged—a battle between those who believed mental illness was biologically located in the brain, and those who thought mental illness was a matter of emotional disturbance. Back then, those intent upon transforming psychiatry into a reputable science (as opposed to a touchy-feely art) worked tirelessly to develop new methods of medical intervention for the mentally ill. The best-known method was “psychosurgery” (aka lobotomy), which was introduced by neurologist Egas Moniz in 1936. In 1949, Moniz won the Nobel Prize for his work on psychosurgery, and by 1951, the operation had been performed close to 20,000 times.1
Contrast this obsession with the physical brain—slicing it, shocking it, or tranquilizing it—with the ethos held by Chestnut Lodge, the elite private institution where Joanne Greenberg began treatment in 1948. The clinicians at Chestnut Lodge fervently believed that no patient, however psychotic, was impervious to psychotherapy. The champion of this viewpoint was the Lodge’s most famous employee, the gifted psychoanalyst Frieda Fromm-Reichmann. Fromm-Reichmann was Greenberg’s primary analyst and, in both the novel and in real life, led her from insanity to wellness. In the book, Fromm-Reichmann is “Dr. Fried,” and Greenberg so positively depicted the humble German that for years she received letters from struggling fans desperate to track down Dr. Fried and undergo analysis with her. 

Fromm-Reichmann immediately recognized something special in her teenaged patient: Greenberg was quick-witted, well-read, and seemed to retain an appetite for life that many of the doctor’s older, chronically ill patients had lost long ago. Greenberg’s symptoms were often referred to as “florid”—interpretable, extravagant, and suffused with meaning, like a story. When Joanne was struggling, Fromm-Reichmann openly empathized. When she began to retreat, the doctor begged to follow. “Take me along with you,” Dr. Fried tells Deborah during a session. She insisted to her young patient that they must pose a united front. “I believe that you and I,” Greenberg has her say in Rose Garden, “can beat this thing.” And, together, that’s just what they did.

This narrative is a little too pat for our contemporary sensibilities. Perhaps that’s why the book is not as well known as, say, Sylvia Plath’s The Bell Jar. (The Bell Jar still sells briskly; the fiftieth-anniversary paperback edition is ranked 1,730 on Amazon, compared to Rose Garden’s 21,792.2) But Rose Garden does not appeal for another reason: It’s easier to think of the psychiatry of yore as entirely backward and as the poetic casualties of it—Plath, Arbus, Sexton—as victims of that ignorance. Their tragic stories, paradoxically, make us feel more secure in the march of psychiatric progress.

The demise of these women—and the subsequent autopsy of past mental healthcare failures that their paper trails encourages—permits us to rest serenely in the knowledge that the world is moving steadily toward a more scientific, humane psychiatry. But, one has to wonder if this is entirely the case. Frieda Fromm-Reichmann spent four years with Joanne Greenberg; she hiked up to the Disturbed Ward to see patients when they were lying limp in restraints. Now, psychiatrists evaluate patients for 45 minutes before diagnosing them and sending them off to fill prescriptions, and many patients go months between appointments. Efficiency is the goal here; medication the cure, meaningful human connection a distant second priority. It is increasingly rare to find a psychiatrist who also performs talk therapy, despite its many proven benefits.

This might be an even greater tragedy with regard to treatment of schizophrenia, where holistic treatment—that is, one that recognizes both the medical and the emotional components and allows for feedback between the two—might hold particular promise. According to Dr. Allen J. Frances of Duke Medical School and the author of Saving Normal: An Insider’s Revolt Against Out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life, “Cognitive therapy and social skills therapy are very valuable in treating schizophrenia, but they are rarely available.” And the idea of “complete recovery” is downplayed.

If you are a regular reader of this blog, you know that my wife Wendy has struggled with depression for most of her life.   As she has written about before, like many others, she was sexually abused for an extended period growing up and it took a toll on her as she has grown older. It has never gone away and returns with a vengeance each and every summer and causes chaos and pain around here until fall.

This is the process we have to go through to get help.

She needs to go to her family doctor who prescribes depression medication and then writes a referral to the psychiatrist.  Since that is a year to two year wait, she goes back to her family doctor who ups her medication, ups it again, ups it again and then realizes it doesn’t work.  So then she is weaned off her medication and then the doctor does it again.  If that doesn’t work.  Repeat.

Finally she gets to see the psychiatrist (18 months later), she walks in, explains her situation, he tells her she has PTSD and then gives her a prescription for a stronger medication.  Out in 10 minutes.  

That medication may or may not work.  If not, she can go back and is back out in five minutes with a new prescription.  If it does work, it works for about 8 months and then when she tries to go back, she is told that her file is closed.  She needs another referral (and a year wait).

That is what is covered by Saskatchewan Health.  What she really needs is talk therapy as well which is not covered by Saskatchewan Health and runs over $100 a session.   Since it isn’t part of her health care or any kind of continuum of care, the therapist and psychiatrist don’t talk which means that once summer went spent thousands on therapy that did nothing because Wendy’s medication was off.

What we are told is that Wendy’s condition will be with her for the rest of her life and she just needs to keep taking her medication.  In some ways that may be correct but the reality is that it doesn’t have to be as bad as it is or as costly if we spent the resources to treat mental illness like we do other illnesses.  I think that is what makes people so uncomfortable, we know we can do better but do not because of a shortage of psychiatrists and clinical psychologists in our system.  Heck we don’t even benchmark mental illness treatment in Saskatchewan.  How do we hope to get better when we don’t define success?

It’s been a frustrating process to see Wendy struggle like this.  Her public presence like many is far different then her private one and I have been more than willing to move to get her treatment.  We have explored selling the house and our stuff and moving south to the United States but the equity in our house won’t touch long term treatment costs.  So like a lot of families and people who struggle with depression, we stay and try our best to work in the cycle of madness and fight the assumption that mental illness can’t he cured.

Poverty’s Toll on Mental Health

This is discouraging

One of the most insidious effects of living in high-poverty, chronically disadvantaged neighborhoods is the severe strain these areas have on residents’ mental and emotional health. New research shows that poverty imposes a psychological burden so great that the poor are left with little mental “bandwidth” with which to perform everyday tasks.

The constant anxiety and stress resulting from witnessing and experiencing trauma and violence in distressed neighborhoods, negotiating the sacrifices and trade-offs caused by food insecurity, living in unstable housing conditions, struggling to pay bills, and dealing with numerous other worries burn up cognitive capacity that could otherwise be used for productive activities like navigating public assistance systems, providing for an entire family on a limited budget, and helping children with schoolwork.

For children, the long-term mental health effects of poverty are even more alarming. In addition to occupying cognitive resources needed for education (arguably the clearest path out of poverty), poverty is toxic to children. Persistent stress and exposure to trauma trigger harmful stress hormones that permanently affect children’s brain development and even their genes. The damage to childhood development is so severe that medical professionals now describe the early effects of poverty as a childhood disease.

Because of the debilitating cognitive effects of poverty on both adults and children, clinical mental health services are a central component of the Urban Institute’s Housing Opportunities and Services Together (HOST) demonstration. HOST is testing an intensive, dual-generation, case management model for children and adults who live in public and mixed-income communities suffering from concentrated poverty, chronic violence, and low levels of trust and social cohesion. HOST’s coordinated and comprehensive place-based intervention aims to stabilize whole families and improve a range of educational, health, and employment outcomes.

Baseline survey data from the first two HOST sites—Chicago’s Altgeld Gardens, a large public housing development that has high rates of crime, and Portland’s mixed-income New Columbia and Humboldt Gardens—clearly illustrate a relationship between distressed neighborhoods and mental health. Rates of elevated worry among HOST adults in both sites are up to six times higher than rates among adults nationwide, and depression among adults in the Portland site is nearly four times more prevalent. Even more disturbing, youth in the Chicago HOST site experience long-term anxiety and worry at levels seven times higher than those of youth nationwide.

In other words for many youth, even if they escape the economic impact of poverty, the mental health part of it remains.

Your Brain on Poverty: Why Poor People Seem to Make Bad Decisions

And why their “bad” decisions might be more rational than you’d think.  From a comment on the research from Gawker that kind of sums it all up.

I make a lot of poor financial decisions. None of them matter, in the long term. I will never not be poor, so what does it matter if I don’t pay a thing and a half this week instead of just one thing? It’s not like the sacrifice will result in improved circumstances; the thing holding me back isn’t that I blow five bucks at Wendy’s. It’s that now that I have proven that I am a Poor Person that is all that I am or ever will be. It is not worth it to me to live a bleak life devoid of small pleasures so that one day I can make a single large purchase. I will never have large pleasures to hold on to. There’s a certain pull to live what bits of life you can while there’s money in your pocket, because no matter how responsible you are you will be broke in three days anyway. When you never have enough money it ceases to have meaning. I imagine having a lot of it is the same thing.

Poverty is bleak and cuts off your long-term brain. It’s why you see people with four different babydaddies instead of one. You grab a bit of connection wherever you can to survive. You have no idea how strong the pull to feel worthwhile is. It’s more basic than food. You go to these people who make you feel lovely for an hour that one time, and that’s all you get. You’re probably not compatible with them for anything long-term, but right this minute they can make you feel powerful and valuable. It does not matter what will happen in a month. Whatever happens in a month is probably going to be just about as indifferent as whatever happened today or last week. None of it matters. We don’t plan long-term because if we do we’ll just get our hearts broken. It’s best not to hope. You just take what you can get as you spot it.

I have written about this before and at the end of the day, this seems to sum it all up better than I ever have.  Make sure you read the entire post at The Atlantic.

Column: Prison no place for mentally ill

Today’s column in The StarPhoenix

Of the 15,400 people in federal prisons last year, 610 of them were women. This number has grown about 40 per cent in the last five years and the number of aboriginal women in prison has increased by 80 per cent during the last decade.

These are just some of more interesting numbers that the federal Correctional Investigator Howard Sapers makes in this 2012 annual report. Perhaps the most shocking stories are about how women with mental health are treated while in prison.

A little more than a third of women in prison have been found to have mental health issues. The report says prisoners diagnosed with a mental illness are typically afflicted by more than one disorder and often a substance abuse problem on top of that. These are people who need a lot of mental health assistance.

At conferences during the years I have heard speakers say that some function at a childlike level. Not only do they have no concept of their crimes, but they can’t function at even a basic level in society. For their inability to survive in society, we toss them in prison.

Many imprisoned women have behavioural problems and according to Corrections Canada’s inspector, they are being treated as security problems rather than humans struggling with mental health issues.

The report lays out offenders who hurt themselves typically are isolated, have pepper spray used against them and are moved to more secure parts of the prison. In the case of our own regional psychiatric facility, Corrections Canada put them into Canada’s first padded jail cell when what they really need is treatment.

It is hard not to make a connection between poor mental health care in prison and the rate of suicide in prisons. The report states that in the last five years, the amount of self harm – including suicide attempts – have more than doubled. Women offenders have a very high proportion of attempted suicides.

The report found that when a person tried to commit suicide, that person was punished rather than given needed help. This, of course, creates more suicide attempts, which brings about even more sanctions. It’s a ridiculous cycle.

After reading the report, one is left with the conclusion that mental health issues in prison are still treated as behavioural issues, rather than illnesses. A prisoner who breaks his or her leg or develops cancer is treated. If the prisoner is schizophrenic and suffers from depression, it is a behaviour issue and punishment is handed out.

The numbers show that the system is failing women with mental health issues and we are using prisons as the institution of last resort. One could draw a comparison to the insane asylums of years gone by where many of those who had mental health problems were locked up and forgotten.

Outside of the ethical issues of why we continue to treat people this way, there is another reason to get this fixed now. Those struggling inside of the jail will eventually get out and move back into our communities. We want them to get the best treatment they can inside of prisons so that can reintegrate back into society when they are released.

That doesn’t always happen. Protocols are ignored, medication isn’t released with the offender and if that person had psychiatric help inside the prison, he or she is released with no treatment plan. When the warrants expire, all help (if any was received) is terminated. It’s a recipe for failure.

We forget that failing to help offenders hurts us all.

Canadians don’t pay a lot of attention toward corrections at either the federal or provincial level, but we should. An 80 per cent increase in the numbers of aboriginal women entering our prisons says that something has gone wrong in the last decade. The fact that 69 per cent of the women entering our federal correctional system have mental health problems says that we are failing them.

The Harper government loves to talk about being tough on crime. I am not going to take them seriously until they start improving the conditions of those they put behind bars. Prison should be a place where we start to rehabilitate those who are behind bars, not release them in worse shape than they entered.

© Copyright (c) The StarPhoenix

Column: Health Privacy Needs to Be a Priority

My column in Tuesday’s The StarPhoenix

Two seemingly unrelated stories that came out recently are more connected than we realize.

Bell’s Let’s Talk campaign hit full speed last week. The campaign is designed to raise awareness about mental health in Canada, and Feb. 12 brought a full-court press of media to raise awareness across the country.

And in a week when we were supposed to be more open than ever about mental illness, we also had the story about employees at the Regina Qu’Appelle Regional Health Authority (RQRHA) snooping into people’s confidential health records and in one case, altering information.

The reason Bell is trying to raise awareness about mental health is the stigma that’s still attached to it. Despite advocates such as the late journalist Mike Wallace and TSN host Michael Landsberg talking openly about their battles with depression, mental health conditions are something that many fear and others are reluctant to get treatment for.

The Mental Health Commission of Canada talks about stigma existing even among doctors – the same health professionals to whom sufferers are referred initially when they have problems. Progress is being made on removing the stigma, but there’s a long way to go. For those seeking treatment, it can be a daunting task and one that many people choose to do privately.

This is why the news out of Regina about health region staff and the privacy commissioner’s report about the medical record breaches are so discouraging.

In Saskatchewan, our health records are protected by the Health Information Privacy Act. HIPA’s stated goal is to improve the privacy of people’s health information while ensuring that enough is accessible to provide health services.

Yet at the RQRHA, there appeared to be a culture in some departments of looking at anyone’s health records.

As one staff member said during the investigation, “Everyone is doing it.”

Privacy commissioner Gary Dickson’s report calls out the Regina health authority but mentions other privacy breaches in health districts across the province. He refers to a “culture of entitlement” among employees of health regions who feel that they are allowed to look at anyone’s files.

So back to Bell’s Let’s Talk campaign. It encourages Canadians to speak out about mental illness, but then we learn that if we do seek help, it could be read and shared by those who have no right to see that information.

No wonder that Diane Aldridge, director of compliance for the privacy commission, told the CBC: “It’s about patient confidence, not only in the electronic health record but in the system itself.”

This isn’t just about mental health. It’s also about the loss of the confidence we all have when we go for treatment that our treatment will remain confidential.

The HIPA violations and Dickson’s report are serious enough that something needs to be done. Yet the report notes over and over that recommendations aren’t being followed. Over the decade that HIPA has been in place, not a single charge has been laid over a violation of it.

What’s the point of bringing in a privacy act if no one is going to enforce it or care? If we want to get serious about treatment of mental health or other illnesses that carry a stigma, then we need to get serious about protecting the records of people who need help.

It will take money to upgrade legacy computer networks and build the systems that are common among organizations that actually do protect our personal information. It will also take the political will to strongly punish those who break confidentiality agreements.

Dickson pointed out that the risk of job loss wasn’t enough to deter staff from snooping in and altering personal health records.

If firing or suspension isn’t working, perhaps it will take the year-long jail sentence for offenders that’s allowed in HIPA provisions.

It’s also going to take someone asking some really tough questions about why people who have no reason to access files are allowed to do it. Confidentiality is more than an agreement staff sign – and apparently ignore. It is protecting the information so that it can’t be viewed in the first place.

If the “trustees” of the system in our health regions can’t get this right, we need someone else to take leadership and ensure our personal information is safe.

Bell suggests Let’s Talk, but let’s also make sure that for those who want it to be, it’s a private conversation.

© Copyright (c) The StarPhoenix 

Elyn Saks: A tale of mental illness — from the inside

"Is it okay if I totally trash your office?" It’s a question Elyn Saks once asked her doctor, and it wasn’t a joke. A legal scholar, in 2007 Saks came forward with her own story of schizophrenia, controlled by drugs and therapy but ever-present. In this powerful talk, she asks us to see people with mental illness clearly, honestly and compassionately.

Column: Ignoring mental health costly

My column this week

Over the last couple of weeks I have received a nonstop series of death threats against me in a variety of forms.

I have been told that I was going to be kicked through a window, my head cut off, and I was going to be killed as I went out to my car or when I went home. They all came from the same person and outside of being heckled when walking home one night, it was all empty threats.

The cause of the threats is complex but there are a lot of mental-health issues there. Our ideas of reality can be somewhat different, but when someone sees their life calling as Batman, you know it’s going to be a long day.

Working at an organization that is a social housing provider, we have an obligation to keep the facility safe for everyone inside it and the community around it. The easiest thing in the world would be to evict troubled clients, who would find themselves on the streets without any supports or help.

Eventually they end up back in jail. By then, however, you have more victims of crimes committed by those who don’t really realize what is happening around them.

Over the years I have repeatedly heard the plea, "he needs help," but mentalhealth help is really hard to get – even in extreme situations. A couple of months ago a client I was working with attempted suicide and was rushed to the hospital.

He was showing signs of obvious mental-health problems but instead of treating it as a suicide attempt, the doctor treated it as a drug overdose.

He was released in a couple of hours in even worse shape than when he went to the hospital.

The next day I called the health region’s mentalhealth intake line and was told that it was quite common for attempted suicides to be treated that way and there wasn’t much they could do other than recommending he see a family doctor and then get referred to a psychiatrist.

I got off the phone and shook my head; if going to the emergency room doesn’t work and if calling the Saskatoon Health Region’s mental-health intake line does nothing, how does anyone get any mental-health help in this city?

Dr. Anna Reid was recently named the head of the Canadian Medical Association. She talked quite openly about the need for quality housing as making a difference in people’s health. On the flip side, easy access to mental-health care for low income patients would make a big difference in keeping people housed.

The mental-health disorders get people evicted from housing and banned from shelters.

For women it leads them to working the streets and for men it often leads to drug abuse and other crime. The issue isn’t the crime, it’s a lack of treatment options, and no one seems to want to do anything about it. We wouldn’t tolerate this level of care anywhere else in the system.

One issue is a shortage of psychiatrists, available beds, nursing home beds, and a lack of spaces for really hard-to-care-for individuals. It strains everyone across Canada.

Another issue is voter apathy. As voters we care passionately about surgical and emergency room wait times and so they get improved. On a recent trip to RUH’s emergency room, they had signs up telling people that they may be timing your wait in an effort to speed things up. It works. My experience was excellent but the pain from a partially torn rotator cuff is a lot easier to deal with than someone who is struggling with schizophrenia or is trapped in a delusional world of fear.

Saskatchewan Health does a lot of benchmarking. Twenty-one different factors are tracked as part of the 2004 Comparable Health Indicators Report but almost nothing is said about mental health. If it’s not bench-marked, how can we expect change?

Across the country we have seen what happens when we underfund mental-health programs. It leads to an increase of people on the streets, it forces police into becoming mental-health workers, and in some situations it leads to deaths. Mental health is a complicated field but until we start to publicly address how we doing, how is it going to get better?

The bar to get help is too high, takes too long, and people end up too close to the edge. We deal a lot with the symptoms in our society – why not tackle the problem directly?

Ontario police to receive training in response to calls that involve suffers of mental illness

Saskatoon Police would benefit from this as well

Standards enforced by the province are minimal and in many cases individual forces have bolstered their training and response methods related to mental illness only after coroner’s inquests have made recommendations following tragic deaths.

A Globe and Mail investigation earlier this year found that the amount of training and how police approach people in psychiatric crises varies widely.

Ontario’s review will attempt to find best practices by consulting experts, including the province’s chief coroner and forensic pathologist, Ms. Meilleur said.

“We read too often in the paper that there’s an unfortunate incident that occurs,” she said. “I’m not attributing blame here because … the police officers arrive on the scene, they don’t know … the individual they face is someone with mental illness.”

The closing of beds and the move away from institutionalized mental-health care in Canada has put the responsibility of responding to people in crisis more and more in the hands of the police, who have limited access to health-care experts in these crucial moments.

“Health issues and health problems are always on my mind,” said Ms. Meilleur, a former nurse, who was appointed to her portfolio last October.

John Pare, the deputy police chief in London, Ont., who sits on the justice committee of the Ontario Association of Chiefs of Police, said he welcomes recommendations from the province. Police are looking to improve their response to people in crisis, he said, but health care needs to improve so police aren’t the default responders.

While officers are instructed to use lethal force when someone poses an imminent threat to a person’s life, advocates say officers could be better equipped to de-escalate crisis situations before they reach that point.

An Urban Rest Stop?

As I write the post, I am reminded of Tim Richter’s tweets when someone says they are adding shelter beds.  It is always “Building housing, not more shelter beds” and I totally agree with him…. in most cases.

My issue as a manager of a housing provider is what do you do for those that are too out of control or unstable to house at 8:00 p.m. at night?  I’ll give you an example.  We were housing a women that had been released from a penitentiary in Saskatchewan without her medication, no housing plan, no provision for her to meet up with doctors, supports, or perhaps most importantly, a psychiatrist.  Oh yeah, she is a violent arsonist. 

Predictably she was evicted and banned from other shelters before arriving at The Lighthouse.  No one told us that she was still on probation, was an arsonist, and was off her medication but that’s more normal than you would think.  We took her in and she was too out of control for us to handle in a congregate setting and too unstable to help.  She was taken for assessment several times and no one would help her.  It’s snowing, it’s cold, she is threatening staff, and we later found out that she was trying to convince a male resident to kill someone for her and then take his own life.  She even provided him a knife which he turned over to me. 

In an ideal world she should have been admitted but emergency room doctors are overworked and often negligent in how they handle mental health cases so each time she was released without treatment.  They even lectured us on wasting their time with her.  The Saskatoon Police Service were involved but when the doctor’s won’t treat her and she presents well to them, what can they do (well actually they made an even bigger mess of things).

The Lighthouse can handle complex housing situations.  We have a Complex Needs Wing with additional support staff and a counsellor.  Most of our residents suffer from concurrent disorders and it doesn’t even phase the staff.  This was something else and she probably needed to be in Saskatchewan Hospital in North Battleford until she was stabilized but she wasn’t.  She was on the street and as she later told us, was being raped there.  In the shelter she was trying to convince someone to kill people and on the streets, she was being hurt.  Of course The Lighthouse being the housing of last resort for the system, it was now our problem.

Variations of this has been happening for years in Saskatoon and as I was leaving The Lighthouse one day, I was walking through our large unused pool area and it hit me, this would make an amazing place to put people that are either too mentally unstable, too violent, or just too much of a jerk to put in a congregate setting in one of our emergency shelters.  Now Quorex is using it as a staging area for the new building (waterslide, pool, and hot tub are all gone) but once they get their stuff out of there and I can get some cots from Cabela’s (they will take 600 pounds), we will open it and keep it open starting this fall..  There are some funds that have been provided from two different funding partners (announcement will be coming) that will keep it going.  There won’t be a big demand for the project as most will be able and want to go into the mens or women’s emergency shelters or into an intox bed.  For those that have no other option because of circumstance or because of their own actions, they will be able to come into a warm and safe space where they will find some cots, easy chairs (one of the people that pushed me to do this project always thought we needed easy chairs), a couple of televisions, and a microwave with some microwaveable soups and sandwiches.  Beds will go on each corner of the building with a lot of room in between them.   To be honest, I hope there is no demand for it but experience has taught me otherwise.  There are those that are not at the point of being housed but they still have the right to be safe.  This is a spot for them to start their journey towards housing and stability.

They will have access to a shower and free laundry facilities as well as breakfast in the morning, can hang out in the drop-in areas, talk to our staff and come up with a plan for that night.  The gamble that we are making is that once that they get to know some staff, they will trust us enough to start taking some steps forward and get off the street.  As I have said at work, I hope that some of them will move from those cots to living in one of the new affordable housing suites some day and break their own personal cycle of homelessness. It’s not an ideal solution but it’s better than we have now.

There is a personal motive as well.  I have known of people that have taken their life in part because they didn’t have any other housing options.  Other times I have seen them make horrific decisions to obtain housing (sex for shelter).  A low barrier (or low threshold) shelter will hopefully give people another option than sleeping outside or putting themselves in a situation where they can become hurt because no one needs to die or get hurt because of their mental health problems.  I am a housing guy and I tend to take people sleeping outside rather personally.  I can’t wait until this opens this fall.  While the demand for it won’t be great, for those that need it, it’s going to be there for them.  You can read about the Urban Rest Stop on The Lighthouse’s new website.

The Opening of The Lighthouse Complex Needs Wing

You can get more details here.

For street people of all ages, mental health a critical issue

From the Montreal Gazette

Dans la rue’s six counsellors and two staff psychologists do what they can to help young people who are hurting. For some that’s not enough.

“We have some cases that are scary,” said Tchitacov. “The person is going to hang themselves or they are going to kill somebody. They are completely disconnected. So we go to a judge and get (a temporary committal order).”

In most cases, within 48 hours, those kids are back on the streets.

That happens in Saskatchewan but often times the order is ignored by an emergency room doctor and the patient never even sees a psychiatrist.  I have seen people sent to RUH on orders only to have them back in 40 minutes because they “presented well”.

“We’ve had people at crisis centres ask my staff, ‘Well, how serious is the crisis?’ You stop and say, ‘What do you mean? Are you a crisis centre? Your mandate is to help people in crisis. Are there degrees of crisis?’ ”

Still, Tchitacov understands their motivation.

“Everybody is scared. Everybody is so overwhelmed that they are reluctant to open their doors to more difficult cases. They know this is going to be a handful, and they try to find ways not to take it in,” he said.

“Imagine the poor kid. It’s a whole other thing to get somebody to the stage of actually coming to you and saying I need help now. You start working like the devil on the phone and you aren’t getting anywhere.”

There are some encouraging signs attitudes and access to programs are changing. Corbin is Dans la rue’s delegate to the Learning Community, a national coalition seeking ways to raise public awareness and break down the stigmas associated with mental illness. And she said the centre for street youth will soon begin a welcome partnership with the psychiatry department at Notre Dame hospital to assist young people experiencing their first psychosis.

But Corbin said there’s another big challenge: getting young people, especially the males who make up 60 per cent of Dans la rue’s clientele, to admit they may need help.

“There’s the whole machismo thing. ‘I’m the one that’s in charge.’ … The whole invincibility of life comes crashing down and you don’t know what to do anymore. So you end up in panic mode,” Corbin said.

“It is hard to break the taboo of a mental illness and see it as an illness and not as a weakness. Someone has a broken leg, you go and get it treated. Well, if you have depression or anxiety or schizophrenia, you go and get it treated.”

It’s difficult enough for many adults to face up to mental illness.

“Add to that the whole ‘I have to be strong’ and all the rest of it when you are young,” she said.

In Saskatoon you have the race aspect as well.  I have listened to more than one mental health professional tell me that those who are aboriginal and from the west side of Saskatoon get far worse mental health care than those that are white and from the suburbs.  It’s really frustrating because there isn’t anything we can do about it. 

I have listened to members on both sides of the Legislative Assembly admit to the problems in the mental health system in Saskatchewan.  While there has been progress (and mistakes) made by both the NDP and now the Saskatchewan Party, there is a long way to go.  If there was one bit of advice that I could give Premier Brad Wall and the future NDP leader, it would be to form a bi-partisan committee to fix and monitor mental healthcare in Saskatchewan.  Take it out of the realm of partisan politics and just fix it.  They are Saskatchewan’s most vulnerable people, they use up a lot of the health budget, use a disproportionate amount of resources for housing and social services but it is also something that as a province we can fix. 

The flipside of it is that if we don’t do something about it, it becomes a problem that can grow out of hand as other jurisdictions have experienced.

Renovations at The Lighthouse

DeeAnn Mercier takes you on a tour of the renovations that are ongoing at The Lighthouse Supported Living right now.  Mental Health Services is providing funding for nine rooms to be renovated and then used for long term mental health beds.   It will provide increased stability for the residents which saves the system a lot of money and with each resident getting their own room, it provides an increased standard of living for each resident.  It’s really a program enhancement where both the individual, the system, and taxpayers benefit.

As for what is going into the room, the bathrooms are being completely gutted and replaced, a laminate flooring is going down, doorways are being widened (to allow for easier wheelchair access), and windows are being replaced.  It will be quite nice.

Choosing to be homeless

A photographer tells the story of why her father chose to live on the streets on Montreal

But the calm didn’t last. They moved to the country north of Montreal after college. Phil’s illness began to creep back. He started hearing voices, and his behaviour grew volatile and aggressive. He couldn’t hold down a job, so they ended up on welfare with a young child. Mum went back to college, taking me with her, to do a teaching degree to support us. That was when Phil’s sanity broke down completely and he tried to commit suicide in the snow. The doctors said he would never walk properly again after he lost his frostbitten toes. But he did figure out how to walk, and even to run again – a mark of the resilience that has helped him to survive all the gruelling years since.

I can’t remember exactly when Phil started living on the streets, but it wasn’t long after he tried to kill himself. He refused psychiatric help or medication because he was too delusional to comprehend that he needed it. I call him Phil now, but he was still Daddy to me then.

Here is how she understands it.

Then something unexpected happened. When I was 19, I started to take photographs of my times spent with Phil. My maternal grandfather had given me my first camera a few years earlier, and I had become hooked on photography. Seeing Phil from behind a lens, in stark black and white, was extraordinary. There it was: the truth about my father, the truth about us. Suddenly, I began to make sense of this vast, murky soup of emotions I’d had for so long. I started to untangle the deep morass of shame I felt. Shame about him, and even deeper shame (and guilt) at myself for feeling ashamed.

Anger bubbled up inside me about why I’d always felt so dirty and tainted, why I’d had to deny his existence. The camera made me face everything. I started making peace with Phil, and with myself. I also told my closest friends about him, and gradually stopped trying to hide the truth from everyone else.

My whole life I’d heard people say that street people were disgusting, that they should get a job, that they stank. I’d seen the callous way Phil was treated by police, the constant discrimination. When I was having a coffee or a stroll with him, strangers would often ask if he was "bothering" me, or if I needed help.

I wanted the photos to show that there’s more to someone like Phil than people realise. Not to deny the hardship and mess of his life, but to reveal the worth and beauty in it, too. I took pictures of him writing his poems, which he’s never given up and still sells on the streets (he hates begging). I photographed him playing his pan pipes, which he also plays to earn money. I photographed him talking to the birds and trees he loves, and also later as he was passed out in an alcoholic haze among them. And, most importantly, I photographed all of us – Phil, my mum and me – because this was our family