Tag Archives: mental health

Even as Many Eyes Watch, Brutality at Rikers Island Persists

From the New York Times

On Sept. 2, four correction officers pulled Jose Guadalupe, an inmate classified in medical records as seriously mentally ill, into his solitary-confinement cell at Rikers Island and beat him unconscious.

A little over two months later, three guards wrestled another inmate, Tracy Johnson, to the floor, pepper-sprayed him in the face and broke a bone in his eye socket. Then, on Dec. 9, yet another group of officers beat Ambiorix Celedonio, an inmate with an I.Q. of 65, so badly that, as surveillance footage later showed, he had bruises and scratches on his face and blood coming from his mouth.

The brutal confrontations were among 62 cases identified by The New York Times in which inmates were seriously injured by correction officers between last August and January, a period when city and federal officials had become increasingly focused on reining in violence at Rikers.

It was in August that the United States attorney’s office in Manhattan issued a damning report about brutality at the jail complex and threatened to sue the city unless conditions there improved. And in November, Mayor Bill de Blasio declared that ending pervasive violence at Rikers had become a top priority for his administration.

But The Times’s examination makes clear that the violence has continued largely unabated, despite extraordinary levels of outside scrutiny, a substantial commitment of resources by Mr. de Blasio and a new team of high-ranking managers installed by the correction commissioner, Joseph Ponte, who took over the job in April.

This reminds me of the many conversations I had about jail with former inmates.  The stories are not all that dissimilar.  

Also: Some architects are wondering if the design of prisons themselves make them more violent.

Today, prison design is a civic cause for some architects who specialize in criminal justice and care about humane design. There is a lot of research documenting how the right kinds of design reduce violence inside prisons and even recidivism. Architects can help ensure that prisons don’t succumb to our worst instincts — that they are not about spending the least amount of money to create the most horrendous places possible, in the name of vengeance — but promote rehabilitation and peace.

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.

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.

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

Randy Quaid has lost it

Randy Quaid and his wife Evi are on the run and living out of their Prius in Canada

People started noticing there was something seriously amiss with the Quaids about three years ago, when Randy left the Broadway-bound musical Lone Star Love and was then banned for life from the Actors’ Equity Association, the stage union, for physically and verbally abusing his fellow performers. Then came the arrests and the couple’s bizarre appearances at various court dates: They wore pink handcuffs. Evi carried Randy’s Golden Globe and had a "valid credit card" affixed to her forehead.

By the time they arrived in Canada, calling themselves "refugees" and claiming they were targets of an assassination plot, the Quaids had gone viral.

I asked them when they believed their troubles began. They said it was in Marfa, Texas, the rural artists’ community where Giant was shot. They said they had traveled there in the summer of 2009 to "look at ranches and stuff" and erect a "Randy Quaid museum." (They’d been fixing up a building in the middle of town-reportedly without the proper permits.)

Already, Evi said, "something really weird had started happening with Randy’s mail. His royalty and residual checks weren’t coming. We were really, truly panicked." Adding to their unrest was the recent demise of the actor David Carradine, a friend of Randy’s whose death from apparent auto-erotic asphyxiation in Thailand the Quaids believed to be suspicious.

"They" — the aforementioned Hollywood Star Whackers — "decide, O.K., if we knock off David, then what we can do is simply collect the insurance covering his participation in the television show he was working on overseas," Evi said. "It’s almost moronic, it’s so simple."

She said she also suspected Jeremy Piven’s falling ill from mercury poisoning was another sign of a dastardly plot by the Broadway producers of Speed-the-Plow to collect insurance money. "It was an orchestrated hit," she said. "They could have put mescaline in his water bottle." Jeffrey Richards, one of the producers of the play, declined to comment.

It’s kind of sad.  This gets the attention because of Quaid’s body of work and notoriety.  For many people it just happens and they end up on the street, confused and lost. via

It’s still chilly out there

I posted this over at the Salvation Army Community Centre’s blog and I thought I would link to it here.  There has been a lot of media reports about guys who are sleeping outside in –40 below weather.  I know some of them personally and the guys do have options for places to sleep.  If they are sober, they can stay here.  If not, there is Larson House (or even the city cells).  If for some reason, we can’t house them, we provide them other places to stay.  Not only that but Social Services is trying to help them as well.

It’s frustrating because when I talk to them, we explain all of this to them.  Guys listen, tell me how much they appreciate us but say, “I’m not really ready to come indoors yet.”  There has been a lot of articles written on the need of a wet shelter but I am not even sure if that would deal with this problem.  I think it isn’t so much a shelter problem as it is an issue with the mental health system.  Either way it seems to be a growing problem.