Privatizing Canadian Healthcare is not an option.

By Marvin Ross

Covid and staff shortages in healthcare has led the right wing Ontario government to hint that drastic innovations like privatizing may be required to give health care a new life. Sadly, they are blinded by their own ideology and a lack of understanding of the issues. That may sway some to agree with them.

I for one am impressed with how well the system actually works despite the problems but more of that in a minute. Ontario already has parts of its health system privatized and it is a disaster. Since the election of an earlier right wing government under Mike Harris and his Common Sense Revolution, long term care has allowed for profit homes. Harris would become chair of the Chartwell Chain of residences and Wikipedia estimates he received $3.5 million for his services.

During Covid, it was discovered that the private long term care homes had the worst outcomes with far more elderly dying in their care than in the not for profit or municipal homes. The situation was so dire that the military was called in to help and the troops were shocked at what they found.

In October, I wrote about a private chain that provides so called supportive housing to adults with disabilities and the conditions were barbaric. The Global TV news has just done a multi -part expose on a private chain that provides housing and supports for vulnerable kids. The series outlines the findings of possible human trafficking and mistreatment, over medication, and possible deaths which the government has ignored. In fact, the office that provided oversight was disbanded in 2018 as a cost saving measure by the incoming Ford government. The report on the chain was never completed as a result.

I cannot imagine anyone wanting that type of care throughout the rest of the health system. If we consider what is often put forth for a dual system, that makes no sense. The argument is to allow private care for those who can afford it and keep the public system. The problem is that we only have a limited number of doctors, nurses and other professionals. With a private system, many would migrate to there where they could earn a lot more money leaving very few staff for a public system.

As it is now, nurses are fleeing hospitals because they are overworked and undervalued. The government has capped their salaries to no more than a 1% increase. In order to fill in for vacancies, hospitals and long term care facilities are forced to bring in nurses from agencies at $120 an hour. Why not pay nurses what they are worth. The government categorically refuses to rescind the bill that restricts their pay.

The biggest problem with health care in Ontario is the stupidity of how it is run. As I explained in one of my op eds in the local paper, the problem is a rapidly expanding bureaucracy which has no value added component. Today, the Ministry of Health and Long-Term Care has two ministers and an associate minister devoted to mental health and addictions. In 2005, there was just one minister. All those chiefs need staff so that today we have one deputy minister assisted by three associate deputy ministers. In 2005, it was one deputy and one associate deputy.

Each of the above needs a fairly large staff to report to them to rationalize their existence. The more senior staff you have, the more juniors are needed. Going down one level we have the assistant deputy ministers who, today, number 14. Again, an entire bureaucracy is required beneath them to justify their existence. In 2005, there were only seven assistant deputies or one half as many as today. Has there been any improvement in care and delivery between 2005 and today as the result of this growth in bureaucracy?

No but there is a new organization called Ontario Health which has, I’m told, 30 Vice Presidents.

The provincial premiers are all demanding that Ottawa fork over more money but Ottawa rightly refuses unless their is accountability from the provinces on how the money is to be spent and how it was spent. Ottawa did give Ontario $450 million to improve the wait list for kids seeking mental health care. As a result, the wait list went from 18 months to 40 months and the money was used to develop a Centre of Excellence for mental health – more bureaucrats.

Despite this mess in health care and the delayed surgeries and long wait times, the system is working thanks to the dedication of the staff. At the height of covid, someone with Alzheimers in a good care facility for whom I was power of attorney, wound up in hospital. He was found one morning sitting on the floor at the foot of his bed and staff sent him to the ER at the University Health Network in Toronto.

He was suffering delirium from extreme constipation and was kept for months as he recovered. By this point, he needed long term care but his dementia had deteriorated to violent outbursts and he had to be watched by a staff person all the time. Staff were excellent, caring and compassionate and finally decided to refer him to the Toronto Rehab Hospital across the street where the psychogeriatric unit might have some success with his aggression. That would have made it easier to find him a placement.

Regrettably, he managed to escape from his wheelchair restraint, fall and fracture his hip. He was then moved next door to the ER at the Mt Sinai Hospital where the fracture was repaired. Sadly, and not unusual, he developed a pulmonary embolism and was moved into palliative care. Staff were kind, attentive and kept me updated on a regular basis so I could provide reports to his family in the US, the UK and Australia.

His passing was a tragedy but the care he received and the human contact and consideration was what we would all like. And this was at the height of the pandemic when staff were overworked and stressed.

I have other stories in a similar vein but it all illustrates how well served we are by a very dedicated, compassionate group of professionals.

They and the rest of us do not deserve the idiocy we see from our ideologue politicians.

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Chronic Homelessness – A Trip to Finland for Trudeau

By Marvin Ross

Most of us, on our regular ramblings around whatever city we live in, can’t help noticing the increase in panhandling and tents pitched discretely in public parks. Signs of increasing homelessness are everywhere. Most readers of this blog also know that one significant reason for that homelessness is untreated mental illness. The solution is pretty straight forward.

Thanks to the Auditor General of Canada in her latest report, government efforts in this area have been an expensive waste.

Infrastructure Canada spent a total of $1.36 Billion between 2019 and 2021 on preventing and reducing homelessness without ever knowing if the money had any impact. That sum accounted for 40% of all the money spent on the housing initiative. Canada Mortgage and Housing spent an additional $4.5 billion without knowing who actually benefited from that spending. Rental housing units under the National Housing Co-Investment Fund was to be for affordable rental properties for low-income people but, in fact, many of the homes were not affordable.

Very disappointing but frankly not surprising. Governments give money for projects and groups not with the hope that some good will come of it but to be able to say “we’ve funded that project” now go away and leave us alone. If they truly cared about change, they would give more rationally and they would evaluate the outcomes of what they are doing. Instead, as the Toronto Star asked in its editorial, who is in charge? And then concluded no one!

Contrast what our government has not done with Scandinavia and, in particular, Finland where homelessness is declining. The Finnish solution is simple – give people housing. Not only do they give people homes but they provide services. “Services have been crucial,” says Jan Vapaavuori, who was housing minister when the original scheme was launched. “Many long-term homeless people have addictions, mental health issues, medical conditions that need ongoing care. The support has to be there.”

In one housing building as an example, the 21 residents are supported by 7 staff. That’s a strategy that is not cheap but it pays all sorts of dividends in cost savings and in generating improvements in human dignity. Finland spent 250 million Euros developing housing and hiring 300 support staff but saved an annual 15,000 Euros per homeless persons in emergency medical care, social services and the justice system.

I would like to make a suggestion for Mr Trudeau. I’ve lost track of just how much travel he’s done in the past few months between the Queen’s funeral in England, NATO, the G20 and a few other conferences in places like Thailand and Cambodia but winter is a lovely time to visit Finland. He could relax in a sauna while discussing how to move our Canadian homeless out of parks, ravines and from under bridges and over sidewalk grates into properly supported homes.

How about it Justin? And, before you go, take a look at this one hour long documentary on the absurdity of what is happening in BC. Treatment is ignored in favour of harm reduction in the case of addictions – a government sponsored drug distribution program. Well worth the time spent watching it despite the ads interspersed throughout.

Depression and Repressed Memory

By Dr David Laing Dawson

I recently had a request from a woman suffering from depression who is seeing both a psychiatrist and a psychologist. The psychologist is focusing on the woman’s relationship with her mother when she was a young girl and I was asked what I thought of cognitive behavioural therapy. This is my reply:

Dear

We are complicated creatures and I don’t have a simple answer to your question.

Depression, serious depression, something we used to call “clinical depression”, meaning beyond simple sadness or grief, and usually involving physiological dampening (energy, appetite, sleep, slowed speech and thinking) and even cognitive changes (I described those in a recent blog) is an illness.

The first and most important treatment is medication. We have many of these now to choose from and the choice can be guided a little by science and mostly by clinical experience. If the depression is accompanied by high anxiety (we used to call this agitated depression) then the SSRI meds work well: Cipralex, Zoloft etc. If the depression is more of a flat, can’t get up kind of depression, then the medications with some stimulant quality may work better: effexor, wellbutrin (buproprion). Sometimes a combination works best.

It has long been known that depression can follow a serious viral or bacterial illness, and now it appears this may be because of the bacteria and the antibiotics used changing the gut flora and eliminating all the good serotonin producing bacteria. And it is much more likely this or current events in life trigger a depression than something from distant childhood.

In a state of depression though, our brains dredge up all the things that we have felt guilty about, or angry or aggrieved. These are not necessarily causative, but merely associative, something like thinking about all the previous good times in a current good time, and thinking about all the previous bad times in a current bad time.

But certainly a professional counselor – supportive, non-judgmental and wise – is an important part of treatment and recovery. The actual conceptual foundation for that therapy is not important, providing it does no harm.

Now one of the ways therapy can do harm is to “create memories”. There is no such thing as a “repressed or blocked” memory of significant events. That is not how memory works. We may choose to never think about, dwell upon, or address or talk about something significant but we don’t “forget” it. We may retain accurate memories of a few words, an emotion, the outline of an event, but all the rest is re-created, and re-invented as we talk about it. It is very easy for a therapist knowingly or unknowingly to create false memories in a patient. Surprisingly easy. And very easy to shape a memory into something far more significant than it really is.

Now basic CBT is okay and merely a complex version of “thinking positively” or as the AA people call it, getting rid of the “stinking thinking”. And it is based on the notion that our ways of thinking and the words we use affect the ways we feel. A crisis can be an overwhelming problem and hopeless, or an opportunity.

So give yourself time. If you like your therapist and she or he is not rigid in their philosophies and techniques, stay with it. But mostly talk about people and events in your life in this decade.

Work to find the right medication. Keep balance in your life, adequate good sleep, good diet (there may be a role here for probiotics), exercise, music, routine; maintain all your important and good relationships. You will get well.

Guest Blog – My son’s death revealed the connection between mental illness and addiction

By Sandra Ingram

I am a retired professor and up until 20 months ago, I was the mother of a young man who has since taught me life lessons that I never thought were mine to learn.

Devin, our only child and the centre of our lives, passed away at age 22 on Feb. 7, 2021, from what was later found to be an accidental overdose involving opioids.

While he had been under psychiatric care for the last few years of his life and hospitalized twice, there was nothing that could have prepared my husband or me for this unimaginable loss. 

Devin was a sweet, affectionate and loving child. In adolescence he transformed, becoming increasingly isolated and inward focused, with a developing addiction to video games.

By age 14, he had begun to experiment with marijuana, and while we as parents did not condone it, he secretly continued to use more potent drugs — we now know — to calm the turmoil that was taking root in his brain.

Severe psychiatric diseases often emerge at this age and take years to be fully diagnosed due to their complexity — not to mention the potential medical, legal and social implications of some diagnoses.

By Grade 11, he was being treated for anxiety and depression. By the time of his high school graduation, Devin was so anxious he was unable to attend.

The fact that he achieved that milestone is something we now regard as astounding. 

Shortly after graduation, Devin was admitted to hospital for a psychotic episode. He had lost touch with reality and was hearing voices.

Because drug use can interfere with severe mental illness diagnosis, we were not told at this stage that he had a definitive illness. It was not until the post-psychosis treatment that I heard schizophrenia might be a possibility, but we needed to wait to see how recovery would unfold.

The word terrified me so much that I decided I would not read about it or learn more until, or unless, I had to. In the meantime, I would push on and do my best to help my son rebound from this crisis with the multitude of drugs required for his recovery. 

As a mother, I was worried sick about his developing medical condition. In terms of his drug use, I was angry, guilt-ridden and even ashamed. How could this be happening to him and us?

As a teen, when Devin was becoming more socially withdrawn, we encouraged him to consider volunteering. Despite his pain, he embraced the idea.

He put in more than 600 hours of service — mostly with an organization devoted to increasing the quality of life for individuals with severe developmental disabilities, to help them live their best lives with dignity and respect.

Upon his death, they planted a tree and dedicated a physical space to his memory. They have even created an annual award in his name.

Devin’s condition was moving closer to a schizophrenia diagnosis in the few months before his death, when he went into hospital for a second time. We now know that Devin suffered from two potentially fatal diseases: schizophrenia and addiction. Both of these robbed him of the ability to live out his life. 

And while you may recognize schizophrenia as a disease, I suspect there are many out there who question whether addiction deserves that label. Until this tragic outcome, I was one of them, having had no prior exposure to it and a lot of bias. I thought it was a choice.

Now I know better and see addiction for what it is: a chemical, brain-based compulsive disease. My son did not choose the path to addiction any more than he chose to become mentally ill.

What’s more, there is a grim connection between the two. According to the Centre for Addiction and Mental Health, “people with a mental illness are twice as likely to have a substance use disorder compared to the general population. At least 20 per cent of people with a mental illness have a co-occurring substance use disorder. For people with schizophrenia, the number may be as high as 50 per cent.”

Regardless of education, social status or racial/cultural background, mental illness has the potential to destroy lives and families. It contributes to a vulnerable population who do not necessarily look different from anyone else and are capable of giving extraordinary gifts to society.

Unfortunately, many are also at tremendous risk of being harmed by the ravages of a toxic drug supply and those involved in the trafficking of opioids.

While I am not naive enough to believe that my son’s troubles would have disappeared if he did not have access to opioids, I want people to see the inherent dangers, particularly to those with mental illness, that these drugs pose. 

After all, their lives matter. Don’t they?   

Sandra Ingram is a retired university professor and published author who lives in Winnipeg. This article first appeared on October 8 on the Canadian Broadcasting Corporation First Person Series

Aspergers, for Better or for Worse

By Dr David Laing Dawson

Greta Thunberg has called it her super power. And indeed, her blindness and deafness to the non-verbal nuances of human communication, and lacking the caution that that creates in most of us, allows her to barge ahead confronting world leaders advocating for a change in all human behaviour, though she is but a teenager.

A couple of times, talking with boys on the ASD spectrum, I have quipped that, “I was as smart as you are when I was 14. But then I discovered girls, and sports, and hanging out, and parties, and music, and clubs, and girls.”

It does appear that for most of us, a large portion of our brain is utilized to receive, interpret, and respond to pre-textual and contextual components of language. This includes body language, facial expression, context, assumed role relationship, eye movements, and the prosody and cadence of the text being exchanged. It has been said that up to 80% of the meaning of the words we use in speaking to one another can be found in the non-textual components of language. And it is in the non-textual components of language that we discern the nature of our current relationship and what we can expect in the near future. Just think of the thousand ways one can say, “Hello.”

The neuro-diversity that is Aspergers has benefited humankind in many ways, from the breaking of the Enigma Code, to the development of computer sciences, the understanding of gravity, alternating electrical current, the theory of relativity, and the theory of evolution.

But quite suddenly we live in a world with technology that allows us to forgo that most complex and nuanced world of face to face communication. Emojis help but they cannot replace the raised eyebrow, the constricting of pupils, the tonal change at the end of a phrase, the tiny hesitation before a word is used, the forced laugh, the genuine smile…

I suspect Facebook was originally created to help certain young men acquire girlfriends without the trouble of venturing outside their dorms and actually talking with women face to face. Now Mark Zuckerberg wants us all, or at least our Avatars, to join him in the metaverse, to work and play in a virtual world, where eyes resemble the headlights of an ambulance transporting a talkative Alzheimers patient from the hospital to a long term care facility on a Sunday afternoon.

And Elon Musk.

I have wondered if this particular neurological organization, this particular diversity we call Aspergers, is actually an evolutionary step. What was once a small but useful group who were able to forgo the pleasures and anxiety of always trying to fit in, enabling them to pursue a single mathematical puzzle for days and years, could now become dominant as we merge with machines.

Who else might be content and even happy living with a family of robots in a geodesic dome on Mars?

“I don’t get poetry.” One of my Asperger patients once told me. “If you want to say that you enjoy walking in the woods after the first snow fall, why not just say it?”

Housing for the Disabled in Ontario – A Barbaric Cultural Practice

By Marvin Ross

During the 2015 Federal election in Canada, the Conservative Party thought they could win support by proposing a tip line where citizens could call and report the barbaric practices of presumably their immigrant and likely Muslim neighbours. It was not well received and the Conservatives lost the election.

We do, however, have barbaric cultural practices in how we treat the poor, ill and disabled citizens among us in Ontario. Last Spring, I wrote of the pitfalls of supportive housing from the experience of my family member being exposed to murder, addiction and trafficking. That was followed by a more theoretical one by Dr Dawson. The agency in question renovated old and abandoned buildings into very acceptable housing for those who needed it at affordable rates but then failed to adequately support the residents. The consequences of that is described in the linked articles.

The latest outrage was that one of the residents of that particular supported housing buildings died in his sleep and his body was not discovered for 7 days. It seems that no one noticed that the poor man was not seen even though dinner is served to residents, the staff is comprised of nurses, addiction counselors and others and they talk of wrap around support. Actually, a staff member did check his apartment a day before he was formally found and initially said he was asleep in bed, that there was an odour coming from the apartment but closed the door and walked away. Later, it was claimed that she knew he was dead and that it was so traumatic for her that she ignored it and did not report it to anyone or even call 911.

An outside health agency that the gentleman (Michael Miller) was involved with was concerned when they had no contact with him so they asked police to do a wellness check. That was when his body was discovered but it was in such an advanced state of decomposition that the coroner was not able to determine a cause of death. Michael’s mother told the agency that she was going to the local paper and was asked not to as that would “shame residents”.

When confronted by the press, the director claimed he opposed her going to the press “for the sake of our tenants, for the sake of our elderly, to stop stigmatizing vulnerable people.”

That makes no sense to me and if there is any shame, it belongs to the organization.

As bad as all this is, it pales in comparison to other residential facilities for the mentally ill, disabled and elderly where the service is nothing but barbaric!

The Toronto Star did an investigation into what is described as a grey area “where no one is in charge of proactively making sure these facilities provide a minimum standard of care to an ever-growing number of at-risk residents.” This sector exists because  “homeless shelters, hospitals and rehabilitation centres across Ontario run out of room and affordable housing options start with years-long wait-lists, …. unlicensed facilities have become increasingly popular places to park marginalized people.”

The Star expose dealt with a chain of such homes throughout Southwest Ontario called Supportive Living . Take a look at their glowing website and then compare that to what the Star found in its investigation. The pictures will disgust you. Residents are of various ages and health conditions and many have mental illnesses and/or addictions. Others are older people with dementia or physical conditions who cannot find a placement in long term care.

The majority of the residents receive financial support from the Ontario Disability and Support Services Program and payments are made directly to the landlord to cover room and board. The amount paid ranges from $745 to $1095 a month depending on the region. There was a 5% increase in that allowance recently. The residents themselves get around $75 a month for their personal needs. Thus far, three attempts have been made to impose legislative standards on these homes but those bills never got past 2nd reading in the legislature. One of the attempts was accompanied by 44 municipalities supporting the effort. A fourth private members bill has just been introduced.

The Toronto Star’s sister paper in York Region, Metroland, recently reported on a group home in rural Newmarket north of Toronto for adults with physical and cognitive impairments. One of their residents was killed by a passing car while wandering the roads unsupervised. Local drivers have been warning about the elderly wandering the rural, unlit roads for years to no avail. One driver reported in 2017 that she almost hit an elderly man on the highway at night. He was dressed in pyjamas and “His entire backside, all the way down to his feet, was covered in dried feces.”

She went to the property to get help and found  “many low-functioning residents with very high needs and little supervision”. This is but one of 22 such homes in that region that get subsidies from various levels of government to “look after” those who can’t afford better. Numerous calls from various individuals and organizations to investigate these places have been ignored.

Barbaric is the only word to describe what is happening and is being allowed to continue.

Now, in its wisdom, the Ontario government has decreed that patients in hospitals awaiting long term care placement, rehab, home care, mental health services or complex care can be moved against their will to wherever there is an opening. Even if your family is nowhere near where they want to send you and you have a fragile spouse with no car and not able to use public transit, that is where you go. Take it or pay the hospital per diem ($400) normally covered as part of our health benefits. The homes with vacancies tend to be the for profit homes as, during covid, they had a much worse mortality than did the not for profit or the municipally run homes (See table 2).

I would appreciate comments from those of you outside of Ontario on what the situation is like in your jurisdictions. Ontario, after all, has the largest share of the total Canadian GDP at 38.59% or $891,811 million compared to the other provinces and territories.

Surely, we can do better.

Mental Health Vs Mental Illness – Is the Pendulum Swinging?

By Marvin Ross

Since we began writing this blog, both Dr Dawson and I have railed against the use of the term mental health and mental health issues as a euphemism for illness. Hopefully, others are beginning to realize the foolishness of that term to describe illness. To paraphrase the Bard, An illness by any other name is still an illness.

A recent essay in the New York Times by Huw Green, a clinical psychologist specializing in neuropsychology, is also critical of the use of the term mental health which he states is used to describe both wellness and distress. While its use is supposed to be stigma busting, “it manages a double exclusion. It fails to actually name any mental health problems — those about which we ought to be raising awareness — and it also makes a claim that is sadly untrue; there are many people who, at least some of the time, do not have mental health.”

He then goes on to say what we have always said that by trying to avoid stigma, this term generates more stigma. He says “The change in language was supposed to address stigma. But it has simply moved our attention away from the very people who face the most stigma — those with diagnoses of schizophrenia, for example, or symptoms that do not allow ready participation in the mental health curriculum.”

What he describes is exactly what we see in government and health policy directions for the mentally ill. The emphasis is on the less problematic problems that people have to the exclusion of the very serious and disabling conditions. During the recent election campaign in Ontario, most politicians talked about the need for more psychotherapy to help us overcome the stress of covid, school lockdowns, transitory anxiety and other similar problems. No one talked about the homeless many of whom are people with untreated serious mental illnesses or the lack of psychiatric hospital beds.

It’s all like focusing your cancer care on those with basal cell carcinoma with a 5 year survival rate of 100% and ignoring pancreatic cancer which has a 5 year survival rate of 11%. No one dies of basal cell carcinoma in 5 years while 89% of pancreatic cancer victims die.

The suppression of a word, the avoidance of the use of a word like cancer, leprosy, syphilis, mental illness, or schizophrenia, increases stigma, mystery, and fear. It also does not make the reality of serious illness go away. Terry Fox did not run half way across Canada to create awareness and raise money for “bone health issues.”

What We are Up Against in Our Fight For Improved Psychiatric Care

By Marvin Ross

Despite our best efforts and the science that is emerging on the causes of mental illness and its successful treatment, we continually face opposition. That opposition touts arguments opposed to medication, hospitalizations, labeling as illnesses and the list goes on. Chemical imbalance and the value of anti-depressants as an explanation and treatment for depression has long been under attack.

Thanks to the work of James C Coyne, we now get a peak into the marketing strategy of these contrarians. Coyne is a psychologist and professor emeritus in Medicine from the University of Of Pennsylvania and  was ranked #200 in a 2014 list of the most eminent psychologists of the post-World War II era. He has always poked holes in shoddy research and continues that role in retirement. His most recent interest is British psychiatrist and academic Joanna Moncreiff, a leading figure in the Critical Psychiatry Movement and how she has been able to spread her message.

Moncreiff recently published a critical review of the chemical imbalance concept of depression in the prestigious journal Molecular Psychiatry. Her conclusion was that “serotonin theory is dead and so depressed persons should avoid meds.”

Coyne critiqued that paper in August and concluded with:

On Twitter, they consistently portray psychiatrists as evil cryptoNazi miscreants who believe in eugenics and who deceive patients and poison them with drugs that are not only ineffective but dangerous. Psychiatrists are further ridiculed if they protest this portrayal is unfair or if they insist that they do not and never have subscribed to the notion that treatment of depression involves eliminating a chemical imbalance.

There is no sense of the nuance and humility required by scientific rigor in antipsychiatry groups’ Twitter attacks. Only wild-eyed social media radicals can be so certain in a world of uncertain scientific findings.

The Moncreiff article, however, was extensively read and that is what the subject of Coyne’s follow up article deals with.

As anyone who has tried to read a research or academic paper knows, the articles are behind a paywall. Journals make money through very high subscription fees to universities, drug companies and the sale of reprints. Unless you have a university affiliation with an institution that can afford those rates and can access them through the library, you are out of luck. The vast majority of the media read about research from the press releases and report on the findings from the press release and their interviews with the researchers. Good medical reporting requires that the journalist also talk to an expert in that field not associated with the research to comment and to add some objectivity. That doesn’t often happen.

Recently, some journals like Molecular Psychiatry have had open access but charge the authors to publish their articles in it. The higher the circulation and the more prestigious the readers, the more they charge. In 2021, Molecular Psychiatry charged authors over $11,000 US.

Coyne found that Moncreiff’s audience was enormous. He described it as “like nothing the network or most laboratories had ever seen, reinforcing the claim that the review was a real coup, a victory in the war of antipsychiatry against psychiatry, analogous to the blowing up of the bridge linking Crimea to the Russian mainland.”

As of October 11, the article was accessed 740,000 times with 8247 tweets, 621 news outlets and 11 wikipedia pages. Rarely was there a critical response. On twitter, the public outnumbered scientists, healthcare professionals, and science communicators five to one. Many of the twitter accounts were associated with those claiming to be damaged by psychiatry while the larger twitter accounts tended to be from right wing commentators who are also anti-vax and conspiracy theorists.

I highly recommend that you read the full article as I’ve only touched on the high points and there is a great deal more in it. You might also like to sign up to get on his mail list for further substack articles by him.

My question is how do we make inroads against such successful misinformation? I’m not sure we ever will. The purveyors of alternative reality really do a first rate job of spreading their information and we have to learn how to do the same. Some of you who’ve known me for a long time may remember my involvement is exposing the vitamin scam we called Pig Pills. That started over 20 years ago when a couple of Alberta entrepreneurs began hustling vitamins they claimed cured a bipolar like ailment in pigs. See Pig Pills Inc Bad research at the University of Calgary using those pills was shut down by Health Canada and the US Office of Human Research Protection in the US condemned the Calgary partners at the University of Utah but the media loved it and gave them tremendous publicity. People went off proven meds for the vitamins at considerable financial cost and, in many cases, with disastrous outcomes.

Just last month, I received an interview request from a prestigious news magazine interested in that work thinking that it was novel, groundbreaking and legitimate.

In my lifetime, we’ve gone from hailing the development of polio vaccines as a modern miracle to the present time when a significant number of us look upon age old public health practices and new vaccines as a conspiracy of Bill Gates and the World Economic Forum. But then, maybe what I write is influenced by having full covid immunity including the latest bivalent vaccine. The chips Gates implanted in me are doing their job.

Guest Blog – Response to the Globe and Mail Advertorial on Schizophrenia

By a Nova Scotia Mother

As a parent to an adult child with psychotic illness, I found the recent Globe and Mail offering “Schizophrenia: Out of the shadows with a new emphasis on recovery and individuals reaching their potential”, incredibly misleading and disappointing. For me and other parents like me, we are keenly aware of the limitations of some of the brightly heralded triumphs enthusiastically proclaimed within this article by Schizophrenia Society of Canada CEO, Dr. Chris Summerville. The general public – not so much, and therein lies the problem.

This disappointment stems from the reality that Chris has a responsibility and obligation to speak truth to power. He has missed, or rather, thrown away, an incredible opportunity to educate Canadians with little exposure or understanding of psychotic illnesses, to the intensive challenges and impacts that they create for those who suffer with them as well as their families.

He appropriately acknowledges the early history of the Schizophrenia Society of Canada (SSC) and the families who worked incredibly hard to create a national organization that could advocate for the rights of those family members with severe mental illnesses. At one time it used to be families who advocated for their loved one’s care and treatment which made sense because it was most often the families who would help care for and support their loved ones with these illnesses. Families still retain similar caregiving roles today, but now their voices have largely been diminished and extinguished by the “family blaming” tendencies of the psychiatric and consumer survivor movements.

The reality is that while Chris has heaped glowing praise on these families within the article, historically he has treated families who support loved ones with psychotic illnesses quite differently.

For example, in 2012 Chris was responsible for planning a Mental Health Commission of Canada Conference (MHCC). This conference hosted various speakers who throughout the course of several different presentations, engaged in family blaming; a commonly held view within the psychiatric and consumer survivor movements. In an unrelated instance, and taken from Susan Inman’s article “The New Mental Illness Stigma? Offering Support” : “In an interview in Canadian Christianity, he (Chris) spoke of families being the obstacle to people getting treatment because they don’t want to let out the “family secret.”

Taken from the Globe and Mail article, Chris goes on to say: “The growth of peer-support networks for families and individuals with mental illnesses and the strengthening of the person-centred, recovery-oriented model of treatment have helped drive positive change in mental health services.”

When he says a “person centred recovery orientated model of treatment” he’s referring to patient-led and directed treatment. It encourages patients to choose what they think works best for them. It seems an increasingly popular cultural norm to reject the medical model in favour of holistic, social, and spiritually based models, AKA the anti-psychiatry movement.

I would argue that the person-centred recovery-oriented model of treatment has helped drive positive change in mental health services. It would depend on who you ask, I suppose? It also very much depends on whether the individual with psychotic illness has a “lack of insight”, because in that instance, treatment is almost always refused. “Lack of insight” is the inability for an individual to understand that they are ill. “It is estimated that 50-90% of patients with schizophrenia and 40% of patients with bipolar disorder demonstrate anosognosia or severe lack of insight.” It is caused by cognitive damage in the frontal parietal lobe and for some, it is a feature of their illness.

Ask any family member with a loved one who is severely mentally ill, has lack of insight and remains untreated, how much they like the “person centred recovery-orientated model of treatment” and I’m pretty sure you’ll end up with a very different answer.

It used to be the case that those who met the criteria of a province’s mental health legislation and who were a threat to self or others would be involuntarily hospitalized, and in some provinces, treated. This was done to keep the individual or others safe until such time that they could attain stability and be released.

In today’s climate of reduced psychiatric inpatient treatment beds, individuals who meet those criteria are not guaranteed to be involuntarily admitted if there isn’t a bed to put them in. Only the sickest get care. This leads to those who are still significantly ill being released into homelessness. Increased rates of incarceration as a direct result of not being able to “choose care” due to illness and lack of insight is also a very real consequence of the person-centered recovery orientated model of care. Still a fan?

As for peer support? What Chris neglects to mention, is far more relevant than what he does mention. Like the fact that the peer support networks for individuals with mental illnesses he’s referring to have no formalized training for severe mental illnesses (SMIs) like schizophrenia, bipolar disorder, or major depressive disorder. Although Peer Supporters need to be in recovery from a mental illness themselves to be peer supporters, there -are no mechanisms in place to keep them safe in the event they are triggered on one of their many calls. Additionally, there is no way of knowing if a peer supporter who may have had a negative experience in their own mental health treatment may let that colour their own biases and responses about medication and hospitalization to those who may really need that type of support.

Of course, peer support is not inherently all good or all bad. Like most things in life – it depends on the context. Peer supporters can be embedded in ACT teams (assertive community treatment) where they work alongside mental health professionals in a team environment. In this environment their assistance and experience can be invaluable. More than that, peer supporters have the potential of being a fantastic support and resource within the mental health system – IF they have current and relevant training on psychotic illnesses.

I agree with Chris’ thoughts on early psychosis treatment, IE: “the earlier you identify early psychosis, and the earlier you intervene and provide treatment, the less likely the individual will develop full-blown schizophrenia. The result is you have better outcomes because if you can prevent future psychotic breaks, there will be less damage to the brain and its functions.” But again, this message is delivered in a way that provides the reader with only part of the picture, and that is my main problem with it.

For instance, does it matter that we increase our access to, or numbers of early intervention spaces if people are not going to choose care? Remember a little something called the “person centred recovery orientated model of treatment” and “lack of insight”?

Also, since teenagers are the demographic most likely to suffer from early psychosis there is the “mature minor” designation most provinces have in place that must be taken into consideration. Each province has different criteria but here in Nova Scotia, a mature minor is deemed as: “a minor who can understand and appreciate the nature and consequences of his/her decision and its alternatives is able to give a valid consent regardless of age. In most cases, children entitled to make personal decisions in Nova Scotia will have reached adolescence. As, in Nova Scotia there is no set age a child must reach before he/she is able to provide consent for treatment, assessment or release of information, the psychologist must thus determine, on a case-by-case basis, whether a child is capable of making decisions in his/her best interest.”

This means a young teenager who may present to a family DR or ER physician (who may not be well versed in treating or diagnosing mental illness, AND who may miss key indicators that signify them), can potentially, if they meet the mature minor criteria, refuse treatment or to share any medical information with their parents.

This, I might add, can happen at times when it is crucial for early intervention and treatment. Delaying, or not treating can mean chronic severe mental illness down the road that is medication resistant. How would you like “person centred recovery orientated model of treatment”, if it were your teen presenting to an ER, meeting the criteria of a mature minor, having undetected “lack of awareness” (doesn’t believe they are ill or need treatment), refusing treatment and who insists that their parents not be notified? Not so much now, I’m guessing.

Fast forward ten years and you may have a loved one with a severely entrenched chronic mental illness that they are unaware of (lack of insight) and that wreaks havoc within their own life and the lives of everyone who loves them. It continues to be a sad reality for many families – mine included, because it is very avoidable, with early access to treatment and care.

Schizophrenia and Violence

By Dr. David Laing Dawson

Though it is true, and has been repeated many times, that people suffering from psychotic illnesses are far more likely to be the victims of crime than the perpetrators, there is a particular kind of violent crime that is usually the product of a psychotic illness. These violent crimes make the headlines because they are shocking and unfathomable. Vince Li kills and cuts up a fellow passenger on a Grey Hound bus. Abdulla Shaikh shoots and kills three different men, strangers to him, in three locations. Kevin Webster kills his mother with an axe while she is sleeping. The month before Moirin (Kevin’s mother) was killed, Kevin was discharged from a treatment program and sent to a shelter.

These three men suffered from schizophrenia. They each had been released from hospital.

When such murders occur it is usually reported that the Police have yet to determine a “motive”.

But such crimes are always the logical consequence of delusional thinking, sometimes compounded by command hallucinations (voices insisting the act be carried out).

The victim is usually a family member. The brutal murder of a mother is often the product of a schizophrenic delusion that mother has been replaced by an evil entity, or is possessed by an evil entity, and the only way to save mother and oneself is to kill this replacement.

Compounding the tragedy of these and similar murders is the fact that we have very effective treatment for schizophrenia. The violent acts mentioned above are the result of either not receiving treatment or stopping the prescribed medication. In most cases the person has been hospitalized recently, and in the past, involuntarily. That is, they have been seen and diagnosed as having a mental illness and presenting a risk to self or others. They have refused treatment or have stopped taking their medication once released from hospital.

We also know that when someone suffering from schizophrenia relapses (having stopped treatment), the same symptoms return, including the same delusion. Even years after the first episode.

As a society we struggle and argue about all possible ways of reducing violence: gun control, longer prison sentences, shorter prison sentences, mental health intervention, housing, security, tighter drug laws, decriminalization of addiction, safe injection sites, education, more police, less police……..

But the one type of violent crime for which we do have a specific and demonstrated prevention is that which is the consequence of psychotic illness.

One component of this prevention can be achieved by retaining involuntary treatment with involuntary admission for mental illness. This ensures that when a psychotic person presents a risk to self or others, treatment of the psychotic illness is started right away.

A second component is the use of community treatment orders to ensure treatment is continued upon leaving the hospital.

A third component (and one that could have prevented the murders listed in the first paragraph) is the use of weekly or biweekly long acting injectable antipsychotic medication.