Tag Archives: Saskatoon Health Region

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.

Video: Reduce the lead time for Mental Health and Addictions patients in RUH Emergency


The Saskatoon Health Region is being driven by Lean Management.  Like any management theory it has a website, newsletters and even some videos.  While the video production quality is horrible, here is a video on how the Saskatoon Health Region is trying to improve intake and evaluation for Mental Health & Addiction Services at RUH.

Expansion of services for 33rd Street Methadone Clinic

From the StarPhoenix

When staff at the 33rd Street pharmacy learned that lack of transportation hampered many of their 250 clients from seeing addictions counsellors, they approached the Saskatoon Health Region, offering to renovate and build a state-of-the-art methadone dispensing and distribution system.

“Because people have to come here to pick up their medication, the idea came up – ‘Is there any way we can help these people access services?'” Carlson said.

The health region agreed to lease the 800-square-foot clinic, which will have a counselling space, a doctor’s office and examination room, and a children’s play area.

It is expected to open around the end of April, said Tracy Muggli, director of mental health and addictions services for the health region.

I think this is a good step for the Health Region, Mayfair, and of course those that use the services.

If I could say whatever I wanted

The nice thing about this blog is every once in a while I can sneak a post past the vast jordoncooper.com editorial team and say whatever I want.  Hopefully it doesn’t upset too many advertisers. 

Over the last couple of years I have become increasingly dismayed at the level of care and effort that the Saskatoon Health Region gives to low income men and women, especially if they are low functioning people with disabilities or mental health problems.

This month at work we have had three cases that would blow your mind if you found out what happened but the scenario was the same in all three cases.  The people all needed medical attention and intervention by medical professional and in all three cases, for some bizarre the decision was made not to give them help they needed and let them carry on.  One was serious enough that the paramedics were not able to handle what they saw, an other had a mental health warrant issued (for the second time), and the third was a highly contagious condition.  All were refused the help that they needed and within minutes/hours the hospital put the problem back on The Lighthouse.

Here is the problem with The Lighthouse.  We are funded the exact same amount of money as a flop house.  We get the same amount of money for rent as the Barry Hotel did in it’s prime as a slum landlord.  We get the same amount of money as another slum hotelier in the city.  We get a small amount of money for food that doesn’t increase despite rising food costs.  Our food services people do a great job and make a tremendous amount of food from scratch.  I thought it was because they are amazing (they are) but they tell me it’s also cheaper (it is but they are still amazing).  Many of our residents have complex medical needs, HEP-C, HIV, and quite a few have full blown AIDS which have special nutritional needs.   Some are battling terminal cancer and most have concurrent disorders of mental health and addictions.  To provide care for them, we are paid the same rate as a slum landlord does.  If we did nothing more than collect rent we would get the same amount of money.

We don’t do that.  Every bit of The Lighthouse is on camera.  We are double staffed for the safety of our residents and staff.  We offer case management, we offer trustee programs for those that need help with their money.  Today, staff are bringing a bunch of residents to Table Mountain for a day of snowboarding and fun.  How many slum landlords do that?  Past outings have included Banff, Calgary Zoo, Cyprus Hills, and quite a few others.  These are life changing events for many of our residents.  If you want an uplifting time, come down and ask them about them.  I have heard stories of people getting lost (not seriously), exploring an abandoned church, and yes, some stories about going on skis for the first time.  The boss is talking about a trip east some day to Canada’s Wonderland for our residents some day.  For many of them who have never been out of the city, this is a big deal, even if it does involved strapping a piece of wood to their feet and going downhill.

There are classes to help them with self-esteem, special meals, I make everyone a personalized birthday card on their birthday, and staff last year made a list, checked it twice, and went out and bought everyone in the supported living rooms and the emergency shelter their own Christmas gift.  Yes, they hit the mall and shopped for 80 people.  They came back with the gifts and post traumatic stress disorder. Not only that but each was hand wrapped and given to them on Christmas morning.   You know what, not many other places anywhere in Canada do anything like this but The Lighthouse does.  I am proud to be a part of it.

It can be hard.  Our residents beat the crap out of our 107 year old building.  It’s the nature of the business.  It’s not so much violence but a bunch of them are developmentally challenged which means that despite having a 40 year old body, some are children inside which means they rough house and goof around.  It means the occasional door gets wrecked, elbows go through drywall and plaster.  Everyone once in a while someone has a temper tantrum and kicks a hole in the wall.  All of this adds a lot of expense to what we do.  It’s mad worse by the rather odd paint decisions the owners of the Capri Hotel made.  Like hotels even today, the walls are covered with a fabric wallpaper which means that if a hole is made, the repair job is horrible.  As we renovate and keep using a standard shade of off white paint, it should get easier and cheaper to maintain and keep up but our residents are “the hard to house” and this is one of the reasons why.

At the same time there are things that we can not do.  We aren’t paid or staffed to be a care home.  Our residents grow older, they grow weaker, and they need some place to give them a higher quality of care.  You are supposed to be able to rely on agencies like CPAS to help you.  With one person they just said he was too high maintenance and none of their homes would take him and left him at The Lighthouse.  I had no idea up to that point that I need to be low maintenance and have a high income to get into a nursing home.  I thought that is why we have a social safety net in place, for guys like this one who can’t take care of himself and has no family.  Apparently not.  Of course homecare was suggested but they don’t clean up rooms.  Service Master was suggested but that would be $1500 a month and no one would pay that.  We were expected to.  In then end we would have to pay $1500 a month to room him for $609 a month.  That is the system at work.  I know it is because of a shortage of beds in the system but who pays for that?  The hardest to house and those with the biggest need.  It’s the exact opposite of how you would expect the system to work.  The easier to house get the best treatment because they are low maintenance.  No one wants the high maintenance residents so they get the worse treatment.

You know how you get help for people who have struggles that you can’t deal with?  You need to have them sent to the hospital and then you tell them you won’t take them back.  After that happens I get berated by a series of doctors, nurses and administrators and chastised for being a “drain on the system”.  I have heard the phrase “piece of shit” tossed at my by a doctor as well.  Stay classy guys.  I was reminded by a co-worker a couple of years ago that the role of a hospital is not to help people but just to get them out of the hospital.  It explains why I have seen people come to the Salvation Army asking for help to have their wounds to be changed because the hospital won’t and just sent away with bandages and not even any understanding of what to do with them.  Recently another cognitively challenged person I know has a staph infection.  She was discharged with the medication to treat it including a IV tube to inject the antibiotics without any knowledge how to do it.

Others we have gotten mental health warrants for their own protection.  We can persuade a judge to issue one that has a track record of turning them down but 20 minutes after being at RUH, the client was released because he kept it together for 20 minutes.  I was chastised over that.  The guy they released is a threat to himself and others but for 20 minutes he was okay and played a victim and they let him go.  A couple of years later we got another warrant because his untreated condition was getting worse and escalating.  Same result.  Same lecture from RUH and the person is still untreated for a treatable disorder that has destroyed his life.

Finally, Wendy started work as a casual staff at The Lighthouse yesterday.  A resident had a contagious condition that needed immediate medical treatment.  We called homecare but they weren’t scheduled to come by for a couple of days.  We called CPAS and got nowhere.  We called Mobile Crisis who told us to call her Social Services worker.  We called Social Services but the phone message said that the worker would not be returning phone calls that day.  Finally my co-worker was about to snap and I called The Salvation Army who authorized a cab to the hospital.  Hospital didn’t treat her, sent a low functioning women who can’t read or take care of herself back with a prescription to treat the contagious condition.  What do you do?  Well Wendy and DeeAnn took on the job of basically providing medical services that no one else would.  They did a good job but the problem overwhelmed even them, the prescription, and the problem is still more or less unsolved.  On top of that they found out that one of the services we were talking to has been lying about the care they are giving. 

The end result of this is that she is going to have to be evicted to a group home.  It’s not that we want to kick her out but if no one else will do what they are supposed to be doing, we can’t keep her there as she can’t take care of herself.  What really bothers me is that she is happy there, just no one wants to be a part of her solution because her problem don’t fit into the slot of solutions that are offered.

I could go on.  During H1N1 outbreak the Health Region sent infected people to a shelter that has congregate sleeping arrangements and then demanded we provide a segregated area.  Staff hadn’t even been given inoculations yet. (no one caught it but me).  They have referred people that have had tuberculosis to sleep in a congregate area.  The same congregate areas where others with compromised immune systems sleep.  Luckily (in some cases) the guy disclosed it and we found other safer housing for him.  It’s not just health.  Many times Social Services has referred clients who have had contagious airborne diseases to shelters but don’t tell us.   Apparently it is because of confidentiality reasons.  Somehow confidentiality trumps the protection of 70 other people but in the end, it is because it is just easier to make it someone else’s problem.  Then there is this.  Many clients over the years who told me that Social Services told them to lie to the shelters about being on Social Services so they (the Saskatchewan government) could pay a lower subsidized rate.  So there you go, your donations to agencies go to subsidize people because of social workers being dishonest.

So around all of this, the City is going to debate five bylaw enforcement officers who will walk around and harass panhandlers and give the impression to downtown shoppers that a very safe downtown core, is indeed really safe.  Later plans include a downtown referral centre for those that need assistance which will be yet another agency that can’t do anything.  Housing problems are not solved with referral centres but are solved with access to housing units and supports, two things that aren’t in play right now.

I know some city councillors and MLAs read the blog and I chat with a lot of them about these issues but I am constantly amazed at how far apart their solutions are from the real problems.  Part of it comes from “they have to play the cards they have dealt”.  The other reason is that they don’t seem to want to take on the real problems of just a messed up system that is full of people who are conditioned to pass off a problem than confront it.  I think our politicians sometime suffer from the same condition.

That being said, I was encouraged to see that my MLA Cam Broten proposed a Senior’s Bill of Rights this week in the Legislature.  It’s a start.

The System (and how it doesn’t work)

This week one of The Lighthouse’s residents hadn’t been seen for a couple of days.  He has limited mobility and poor health and no longer can take care of himself.  As one healthcare professional said, “we have a failure to thrive”.  I went up to his room thinking that I would find a dead body but he was okay but had some health issues.  We talked for a minute and I talked him into getting an ambulance to the hospital.  There is no way he should have been housed at The Lighthouse but here is where the system fails.

When someone is housed, the system ignores him because there is such a shortage of housing, especially care home beds.  The higher level of care one needs, the less there are for options.  CPAS couldn’t help him because no one wanted someone that had that high of needs.  Home care didn’t want to help him because his room was so disgusting and he needed that much care.  We were told to get a cleaning service in but places like Service Master would charge more than we got paid for in room and board to keep him.  While Marcel, The Lighthouse’s maintenance person did a good job cleaning his room, the resident is incontinent and you can imagine the mess.  So no group home, no home care, and no other supports were able to be acquired for him.   Sadly the suggested course of action was to evict him and toss him out to the street.  If we did that, then we would force the Saskatoon Health Region to have to do something.  That’s right, the recommended course of action to get assistance for a senior citizen is to kick him to the street.

It’s actually quite common.  It’s often how the system takes care of it’s hardest to deal with cases.  When I was at The Salvation Army, many people with physical and mental health problems were dropped off at the curb of 19th and C with a bag and the car just drove away.  You would wander outside (or they would wander in) and be dazed and confused as to what had happened.  Often it was care home operators who dropped them off.  With such a shortage of beds in the system, operators were actually rewarded for this behaviour as they get someone more to their suiting. 

Hospitals can be just as bad.  Over the years the hospital would say anything to get you to take someone was discharged, including the time they sent us people with H1N1 into a congregate setting before staff even had the vaccine.  Over time they developed such a reputation for lying to discharge someone, we used the phrase, “No one lies to us like a hospital”.  They can’t by law discharge to the street so they do everything they can to discharge to the shelters, even if that means being dishonest.  The worst example I ever experienced was on a Easter morning where a nurse wanted me to put an suicidal girl in a hotel room because her family had kicked her out.  Suicidal.  Homeless.  The best that they could do was to suggest a hotel room where this girl would be alone.  I guess getting her help, keeping her around others, and even calling in a psychologist was too much work.  I have been told numerous times that a man could handle the two flights of stairs at the shelter only to have them unable to walk or have a wheelchair.  One time we were told that a person was fine and they had to use two ambulances to deliver him and his breathing equipment to the shelter.  No one lies like a hospital.

So for our resident, we had little other option when we called for an ambulance.  The paramedics went into his room and were overwhelmed by the smell and sight.  Yes we managed to overwhelm paramedics.  They took him and we informed the hospital that we would not take him back.  The family was supportive of the move as well but it is still really, really tough.   It’s hard not to feel like we are taken advantage of by the system.  It’s also hard not to be disgusted over how we take care of seniors with a disability in this province.

The second story that I have about this is a women with significant mental health issues who again would struggle from a failure to thrive.  Same kind of story.  In better shape physically but far more difficult mental health issues.  We have been told that she has burned her bridges with all of the mental health group homes in the city which could be said for most of our population (more on that later).  She isn’t that unpleasant, we chat every day but has some struggles taking care of herself.  Home care is willing to come in but they want a schedule and sometimes when you have mental health issues, keeping a schedule is not one of the things that you do well.  The result is no home care which means that it affects her mental and physical health.  The solution is to put her back into a group home (if they can find one for her) but that is way more expensive than it is at The Lighthouse and she hates it there which means that she will burn her bridges there and end up back here or in an unsupported environment which will lead to further health deterioration and an even more expensive solution.

Finally, here is a somewhat positive story.  We have several really good mental health professionals that are always in and out of the building.  The mental health nurses have a really hard job and I don’t know if it the common dark humour we share or we just all really appreciate working together but when they are in the building, things seem a little better.  One of the residents is really violent to his room.  He’s not violent to people and is actually quite nice but he punches holes and does other damage to his room that is both annoying and costly.  He gets evicted all of the time and has landed at The Lighthouse where we are now an owner of a really beat up room.  His worker works well with him and us and I think we are making incremental progress but… the room and the facility are paying the cost.  Being funded by Social Services, he can be charged with an overpayment because of room damages that will take off $15 off his check but that’s it.  A person on Social Services could trash 10 rooms and still, it would be $15 off the check for the overpayment.   It’s been suggested that as a course of treatment and consequences, all of it comes off (he is still paid his room and board) but that can’t be done because the system allows for $15 to come off his check.  Remember, it’s not the money to us that it the issue.  In the end Wendy and I will probably be joined by some other staff over pizza, some wall patching materials, and paint on a Friday night to fix up his room.  His caregiver wants to do this as a course of treatment and responsibility but the system doesn’t allow for that to happen.   Also I was tossing around the idea of using special institutional wall coatings for his room that are impossible to damage but who is going to pay for that.  A $30,000 room upgrade would do wonders and is a lot of money but again, a lot cheaper than him being homeless, in emergency shelters, hotel rooms or the Dube Centre over a couple of months.  He would realistically live there for years and when his demons were under control and dealt with, the room could be used for someone else like him.  A single room could conceivable save the system hundreds of thousands of dollars over a decade but no one is building it because those that could benefit from placing people in that room, aren’t the funders of rooms.

The biggest issue is that the province is organized into silos.  We call them ministries but they don’t cooperate enough.  Social Services has it’s own budget and mandate and Health has their own and within there are all of these other silos which allows people to fall between them or even worse, need services from both.  I criticize Social Services lots but they do a pretty good job in writing checks but what about those that need more than money.  Social Services doesn’t offer anything else than check writing services anymore in the province (for adults anyways). Mental health does a good job of providing medication and supports but they sometimes need more cash to give out because sometimes money does solve problems.  CPAS, well they just normally disappoint but their big issue seems to be a lack of care beds, especially for high need seniors in poverty (two tier healthcare is totally fine when it comes to care homes apparently).

This isn’t a partisan issue.  This isn’t about housing first or housing last, this is about dealing with the issue from a government centric approach rather than a client centric approach.  The government centric approach is always going to be more efficient for most of the people.  Your doctor’s office is the best example of this.  I need a doctor’s appointment and so I phone over, make the appointment, show up at the appointed time, read an out of date magazine, and then see him and hopefully things work out okay.  Now this can fall apart if your doctor isn’t available or if you are too sick to get to an appointment or if you can’t get to an appointment.  American city’s homeless “depots” are famous for this.  You go to the intake centre, go to the shelter and spend the rest of the next day going back to the intake place and back to the shelter to sleep that you can’t really make progress on being homeless.  The bigger the city, often the bigger the problem.

The solution is someone in charge and someone responsible for the problems.  I have listened to Tim Richter, Iain Dejong, and Sam Tsemberis talk about housing first models and their stories and they ignore one thing.  Someone (them) is responsible getting homeless off the streets.  In Calgary’s situation Tim isn’t alone with the Government of Alberta and the Premier taking the lead in helping solve the problem and making a commitment to change things.  In Saskatchewan we aren’t at that point yet.  It still is everyone’s problem which as we all know, makes it no one’s problem.  Saskatchewan doesn’t need more money in place, it needs someone to look at at elderly’s man’s “failure to thrive” and notice that every government department passed the buck and make someone fix the problem.  It mean’s looking at a kid who has some inner demons and realizing that his living situation needs some help and demanding that it get fixed.  Saskatchewan is a small enough of a province that we can do it this way.   It is just that no one wants to name that person to make it happen.