A Dose Of Reality Is Needed For Mental Health Week

By Marvin Ross and 1st published in Huffington Post May 11, 2016

In Canada, the first week in May is designated “Mental Health Week,” and according to the Canadian Mental Health Association, the purpose is “to encourage people from all walks of life to learn, talk, reflect and engage with others on all issues relating to mental health”. We are encouraged to #getloud for mental health.

In the US, the entire month of May is devoted to “mental health”.

However, I have to say that I am perplexed about the reason we “celebrate” mental health in both Canada and the US. I assume we are celebrating, but I’m not really sure what we are celebrating or what we are doing.

What is not “celebrated” is our abysmal record on providing treatment and resources to those who suffer from serious mental illnesses like schizophrenia, bipolar disorder, severe depression and other illnesses. And note, I said illness not health. There is a difference. A poster circulating on the internet expresses the problem extremely well. It says:

Saying “Mental Health” for schizophrenia is like saying “Physical Health” for cancer

You can substitute serious mental illness for schizophrenia above.

Justin Trudeau had this to say at the start of the week, “Let us use our voices this week to help change the way society views mental health issues and those living with them. Now is the time to GET LOUD for mental health.”

And of course, he uses the word issue as in mental health issues. Hamilton psychiatrist and fellow blogger on Mind You, Dr. David Laing Dawson, discussed the use of the word issue in one of his blogs and commented that “by calling mental illness an issue we are placating the deniers of mental illness and we are reducing it to an abstraction, a topic for discussion and debate, rather than a reality in our midst….”

And he ended his blog by stating “But let’s stop with the “issue” when we are naming or describing a painful reality.”

The painful reality of mental illness in both the US and Canada is that we do not have enough resources like hospital beds, community treatment, housing, etc to provide the proper treatment that is currently available for these who suffer.

Readers of my blogs on Huffington Post know that many of them deal with the inadequate services that those with the most serious mental illnesses receive in Canada. It is hard to pick out one as so many of them deal with this problem. If we were to have a realistic group of people representing the faces of mental illness in Canada, we would have someone who is in solitary confinement in a prison and someone who is homeless.

One of Correction Services Canada’s top priorities is to deal with the mental health needs of its population. They estimate that 38% of incoming prisoners suffer with a mental illness. In his June 2015 report, the Correctional Investigator of Canada, Harold Sapers, found that “mental health issues are two to three times more common in prison than in the general community”.

In Ontario, the Globe and Mail recently analyzed the long-term solitary confinement of prisoners in Ontario and found that 40% were locked away for more than 30 or more straight days. This is twice the limit permitted by the UN in its Nelson Mandela Rules.

The Globe reported that:

On 40 per cent of the files, staff gave mental health or special needs as part of the justification for their prolonged segregation, a figure that seems to clash with provincial policy stating that segregation should never be used for inmates with mental illness until all other housing alternatives have been considered and documented.

In the US, a recent report disclosed that there are 10 times the number of mentally ill in prison than in state psychiatric hospitals. Most of them, the report states, would have been in psychiatric hospitals before they began to be closed. The largest mental hospital in the US is Cook County Jail in Chicago.

And what about homelessness? According to the Centre For Addiction and Mental Health in Toronto, surveys of various Canadian cities put the percentage of homeless who suffer from mental illness at between 23 and 67 per cent. Furthermore, “While mental illness accounts for about 10% of the burden of disease in Ontario, it receives just 7 per cent of health care dollars. Relative to this burden, mental health care in Ontario is underfunded by about $1.5 billion”.

Again, in the US, about one third of the homeless are people who suffer from untreated mental illness

In a 2015 survey done by the Mood Disorders Society of Canada, the top priority for the respondents (91 per cent) was the need to have greater access to professionals. Over one third (38 per cent) said that the wait for diagnosis was over 12 months. In the most recent tragedy that took place in the middle of Mental Health Awareness Week, a 38 year old man was released from Burnaby, BC General Hospital where he had resided for three days due to suicidal thoughts. His mother had asked hospital staff to release him to her care but they did not do that. They gave him a bus ticket and sent him on his own. He committed suicide shortly after.

Clearly, as a society, we need more than simply being aware of mental health once or twice a year. We need a time when we can reflect collectively on how inadequately we treat those amongst us who have a brain illness. And we need to lobby to right that wrong. The money spent on these awareness campaigns could be put to better use providing more services for those who desperately need them.

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5 thoughts on “A Dose Of Reality Is Needed For Mental Health Week

  1. Publicly funded services need to keep in mind that 50 to 90 percent of people with mental illness live with their families. Families are doing most of the work and it would help if publicly funded services respected this fact and chose to work with families instead of keeping them at a distance with unrealistic privacy legislation. Also these services should be evaluated regularly but seldom are. I also believe that we need to revisit the concept of the Assertive Community Treatment Team. These teams are staffed by expensively paid professionals of several disciplines. Often there is a high turnover. Are ACT teams really the right modality for an individual who by virtue of his/her illness has difficulty making relationships with people. Families never know when the ACT team staff will make a visit which adds to their stress. They also do not know the qualifications of the professional. The ‘family/psychiatrist model’ which has proven successful in China appears to be a less expensive, less intrusive, and a more effective alternative to the ACT team. There are always calls for more money to be put into community services, but there also needs to be a little more thought into making these services more effective. Let us truly make our services “patient first”.

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  2. What people believe prevails over the truth.
    SOPHOCLES,

    The most striking thing about Steve was the size and condition of his hands. He was a thin man, bony to the point of emaciation when he was brought into our psychiatric emergency room. The cop who accompanied him had not needed handcuffs, Steve had been walking on the freeway trying to stop cars and “preach” to the occupants. He appeared to be mild mannered, shuffling as he walked with his head slightly cocked to the side as though he were listening intently to something. He wore tattered clothes with no shoes on his long thin feet and his tangled brown hair framed a face that was dominated by intense black eyes. His hands, which were loosely clasped upon his chest were very broad with long graceful fingers ending in dirt encrusted nails. Though they were dark with dirt, those hands looked incredibly strong and sinewy for such a tiny man. Those hands had seen hard work, I thought as I began an evaluation hampered by Steve’s lack of any paperwork and his inability to give any history other than he needed to “feed the birds” When he said this his attention was completely on my eyes, looking for some sign of understanding. I offered “Yes, they need their food” and he smiled. In the background the screams and cries of other patients brought me back to the question of where the birds were, but there was no answer to this. Somehow I knew that Steve had worked with animals and that he needed to be back wherever it was that he was comfortable and accepted.
    After an hour during which Steve listened to my questions and nodded mostly no to anything that could direct me to family, medications, living situations, jobs, education, funding, I knew that I had yet one more vulnerable victim of mental illness challenged by State budget cuts, lack of county resources, Federal neglect, societal marginalization and cultural stigmatization. When I gave Steve a turkey sandwich he carefully separated the bread from the mixture and put it aside. “To feed the birds” he whispered and I wrapped up 2 more sandwiches for him to take on the bus ride down to south Los Angeles to the only shelter open during the warm months in Southern California. It was a hell hole of desperate, sick single men who moved like shadows through the underworld of the county. Without identification, without a history of alcohol or drug abuse, lacking funding and with no signs of homicidal or suicidal ideation there was no other place for him to go. The downtown shelter opened at 5 pm for one hour to admit people for the night and so I had to get him on the bus quickly. He followed me around the emergency room while I readied him for the trip and I could hear him softly making clucking noises as though he was calling chickens.
    Steve was one of hundreds of mentally ill individuals brought into the Emergency Room after the abrupt closing of Camarillo State Hospital; the largest state hospital west of the Mississippi. This institution housed more than 7000 individuals; mentally ill and “retarded” as they were known at that time from the 1930’s until 1997. Set in the rolling hills of pastoral Ventura county Los Angeles it held a mixed population who remained there for many years. Camarillo also had farms, pools and workshops that helped many to develop skills, to work as part of teams and to develop skills that would, in the end, never be used.
    The hospital grew all its own food; there was a dairy and strawberry fields and chickens and cows. The patients worked the fields. Camarillo even had its own soda. It was state soda. In 1932, the State of California purchased 1,760 acres (710 ha) of the Lewis ranch, located three miles south of the city of Camarillo, and established the Camarillo State Mental Hospital. Camarillo State Hospital was in use from 1936 to 1997. During the 1950s and 1960s, especially, the hospital was at the forefront of treating illnesses previously thought to be untreatable, for instance, developing drug and therapy procedures for schizophrenia. Programs initiated at Camarillo helped patients formerly relegated to institutions to leave the hospital and move to less restrictive group homes or become (at least nearly) independent. The hospital continued to be a leader in the research of drugs and therapies in subsequent years. They also had one of the first units of any hospital to deal with autism. A dairy was built adjacent to the hospital for the patients to grow vegetables and work with the animals as a form of therapy.
    This state hospital was “home” to many mentally ill individuals who had no families and a significant number of them , when released, wanted to return to their “jobs” and the dorms that were so familiar to them. They created a song
    Cama-ree-yo here we come, right back where we started from, Cama-ree-yo U.S.A. Hey!”
    They lived and died at this State Hospital and those who died without relatives to claim them were buried in nearby cemeteries in unmarked graves.
    Closing Camarillo was a death sentence for many mentally ill individuals because the Community Mental Health System was unprepared for them and shelters and transitional programs were scarce, they were restrictive in terms of policies and rules and they had long wait lists. The Southern California jails and Emergency Rooms were inundated with hundreds of traumatized people. I encountered many of them during my work in the Jails in downtown Los Angeles and will introduce one of them below.
    The N.Y. Times recently published an opinion piece calling for the establishment of high quality, ethically administered psychiatric asylums would provide the seriously mentally ill with a place to stabilize and recover.
    To give these people the care they deserve, we need to bring back psychiatric asylums. Not the dismal institutions that were shuttered in the past, or settings of gothic fiction, but asylums based on the true meaning of the word: places of sanctuary and safety for vulnerable people. The current system too often fails to protect and care for individuals who have serious mental illness in the appropriate place and at the appropriate time. The Supreme Court was right to have ruled in the 1999 Olmstead decision that individuals with physical or mental disabilities should be provided treatment in the least restrictive setting. But the court also warned that people who need more support, in therapeutic institutional settings, should continue to receive it.
    The few state hospitals that remain, though, have months-long wait lists, and private psychiatric facilities cost tens of thousands of dollars per month. The dramatic decline in psychiatric beds has been well documented

    “Get ready for a flood of homeless patients”
    The staff in my county Psychiatric Emergency room were aware of the true reason that Camarillo was closed and this was the States refusal to fund institutions such as Camarillo when the budget was being diverted into useless projects and the wallets of contractors and builders who had the right contacts and were being paid monstrous amounts of money for roads leading nowhere and unfinished bridges. The politically and economically unattractive population of the chronically mentally ill had few supportive arms to hold it up to the attention of greedy and power-hungry individuals. The “cover ups” and lies were abundant and most prevalent was the statement that community services were the best, most efficient, least restrictive strategy for helping the chronically mentally ill….even though at the time and now this community system is not adequate, or accessible for many who are chronically/critically ill, homeless and without resources.
    This author’s staff in the Psychiatric Emergency Room were “aware” that they would come and also “aware’ that we had no resources for them. There were few, if any, available shelters or transitional facilities and community mental health had just been set up (was in it’s infancy with terrible problems; no staff, no protocol, etc.) Patients were “referred” to wait lists for programs, for mental health appointments and given no meds when they left. No families around, no transportation and no supports. Many roamed and were incarcerated for trespassing, and other minor offenses. One of them who wound up in the LA Jail several years later became the “poster boy” for the new mental health program in the jail system. As a result of the correctional system’s lack of any mental health program this man was released in a fully delusional state, in the middle of the night and tried to commit suicide by having his legs amputated by a train at Union Station. Due to this case the jail is still under Federal scrutiny to date with the Chief Sheriff indicted for obstructing the investigation. With the jails overflowing with mentally ill inmates the need for long term and comprehensive transitional programs is urgent…..but, once again, a truth is hiding behind rhetoric that is promoting community services as evidence-based strategies for recovery. And the words recovery, wellness and behavioral health are ringing the alarm bells and echoing down the deserted halls of Camarillo.
    The nightmare begins again
    Below is an urgent letter from the director of House of Refuge in Arizona, a wonderful transitional program that will close it’s doors due to cuts.
    Dear Friends
    ALERT!! HUD to cut funding for transitional housing. This faith-based nonprofit that houses 81 families in Mesa, AZ is in danger of closing their doors to fami…
    On May 2nd, 50% of the transitional housing programs in the United States were notified they would no longer receive funding through the Department of Housing and Urban Development (HUD). House of Refuge was one of those agencies. To escalate the problem, House of Refuge was also notified that this defunding would take place retroactively as of February 1, 2016, the beginning of their HUD grant fiscal year. The loss of this funding compounded with a lack of affordable housing will potentially put the 81 homeless families (94 adults, 125 children, 88% single female head of household) we currently serve into unsafe, unstable, living situations post separation from programming.
    House of Refuge has served homeless Arizona families since October 1996. In that time we have assisted over 7,000 individuals out of their homeless cycles and averaged a 90% success rate of moving families into permanent housing.
    House of Refuge also understands the importance of running a fiscally sound non-profit. We knew the importance of having a 6 month cash reserve for emergency changes in funding and cash flow. However, with the retroactive decision of February 1, three months of those reserves were used prior to the May 2nd notification. The remaining 3 months cash reserves will not give the House of Refuge staff enough time to move families through the local housing wait lists and into acceptable alternate housing.

    On behalf of these families I am asking that you contact one, or all, of the following officials and request that they lend their power and influence to intervene in this unprecedented, insanely catastrophic, inhumane decision by HUD–
    Funding cuts could leave 100-plus East Valley families homeless Last week’s cuts reflect a national shift away from intermediate housing options in favor of directly placing homeless people in permanent housing, a strategy HUD officials say is cheaper and more effective. Local transitional-housing organizations say they were aware of the trend but expected reductions to happen gradually.
    Mandi Boyster, with her 5-day -old baby girl, Shyloe, lives in one of the units at House of Refuge in East Mesa. Several Valley transitional-housing providers recently found out they were losing the annual HUD grants that keep them operating. They say they might have to evict residents as a result They will have to evict residents if they cannot identify alternative funding sources
    Transitional-housing agencies throughout the Valley are scrambling to keep their doors open after the federal Department of Housing and Urban Development eliminated their grant funding last week.
    Nearly 200 families could be forced to leave their temporary homes within months if the seven affected agencies can’t find millions of dollars in new funding. The providers for years have relied on the HUD grants to cover expenses for daily operations.
    Transitional-housing organizations aim to bridge homelessness and permanent housing by giving individuals or families stable interim homes while equipping them with the skills to live independently. They provide apartments or other housing units at little to no cost as residents receive services such as job training, parenting classes, counseling, substance-abuse treatment and domestic-violence assistance.

    In Los Angeles, the transitional programs that face closure are the most useful resources that this author and other social workers/discharge planners have. There are 18 Transitional shelters in or near Los Angeles, CA that face closure. Here are several excellent programs.
    Help is On The Way Help Is On The Way provides accommodations for transitional living, mental health housing, and sober living in LA. This environment fosters opportunities to participate in menu planning and food preparation, develop and experience positive relationships, receive as

    Languille Emergency shelter, located at 267 N. Belmont Ave., Los Angeles, provides a temporary home for 30 women who are taking the first crucial step out of homelessness toward a life of dignity and self-sufficiency. The women who come through the doors of Languille have lived on the streets or in jail.

    Lamp Inc Transitional Housing
    Lamp Community’s mission is to provide the resources and a safe, accessible environment in which homeless men and women living with chronic mental illness can work toward
    and gain more control of their lives. Los Angeles County is home to at least 91,000

    Union Rescue Mission Los Angeles
    Los Angeles, CA 90013
    (213) 347-6300
    Transitional Housing

    Good Sheppard Los Angeles, CA 90059
    213 235-1460 Transitional Housing
    Higher Goals Inc. Los Angeles
    Los Angeles, CA 90044
    (323)755-9702
    Transitional Housing
    Center For The Pacific Asian Family Los Angeles
    Los Angeles, CA 90036

    Transitional Housing, Non Profit Organization

    A Voice From Behind the Bars
    After Camarillo closed this author worked in the Los Angeles Jail as a mental health evaluator (part of a new 2 person team put in place by Federal Investigators). Many jail inmates were

    ________________________________________
    in Camarillo prior to its closing. There remains an urgent need for Transitional Programs and State beds for the chronically mentally ill inmates who are released to the streets of downtown Los Angeles but the beds and programs have been cut and now are being further starved for funds. On one occasion, as I stood inside of a crowded mental health dorm I heard my name being yelled and found a man who had cycled into the Emergency room many times and was well known to me. He had a troubling delusion that caused him to roam the streets at all hours seeking a plastic surgeon or someone else to cut off his nose. This troubled soul believed that his nose grew at night and that it threatened to turn him into a monster. Along with other psychotic symptoms, this delusion propelled him into the streets to “walk off” his unbearable anxiety and to look for someone to verify that his nose was growing. Unfortunately he carried a knife in case someone was willing to cut his nose down to size and his family could not check his pockets when he left home in the middle of the night. Usually, after accosting a number of people and showing the knife the police would pick him up and if the Emergency Room was crowded they booked him into jail.
    When this individual was at Camarillo (during his adolescence) there were 2 protocols that enabled him to survive with his delusion; walking the grounds when he became anxious and playing his guitar loudly. The staff were able to accommodate him and his quality of life improved greatly. When the hospital closed he went back to his elderly parents and predictably deteriorated.
    There were 2 options that would have worked for this man; long term care in a psychiatric facility where daily strategies might help to reduce his fears and help him to manage his overwhelming anxiety and a transitional program where comprehensive services for 6 or 7 months could also affect similar results. None of these resources were available. There were no State beds and the 1 program that had a bed was very restrictive in terms of their residents staying inside at night.
    There are several fables that have been spouted to rationalize the amputation of long term, comprehensive mental illness services either via hospitalization or transitional programs. The honest and prevailing truth is that political and economic conditions are at the base of this deadly surgery.
    Below is a fable from HUD that describes the role of the State Hospital within an imaginary continuum of care.
    State hospitals also operate within service areas featuring varying levels and types of community-based services. These include residential programs, which can range from intensively staffed, highly restrictive group homes to programs in which people live independently or with their families, assisted by support from outreach workers and case managers. Many systems also feature day treatment, employment, and clubhouse programs as well as case management and other services designed to promote successful integration into the community for their clients. Systems vary widely, however, in the levels and types of services they maintain, and this variability affects the breadth of clientele they can support in the community. The state hospital’s niche within its service area’s continuum of care has thus been heavily influenced by the availability and scope of the community-based services operating in its area, as well as by the availability and accessibility of alternative inpatient providers.

    “What people believe prevails over the truth”. Belief systems are very formidable and withstand almost all challenges. If you can be convinced or coerced into believing in something or someone that belief will drive your behavior, shape your attitudes and define your values. We have recently seen the debunking of many scientific studies where the data, the methods and researchers corrupted the research and presented it as scientifically valid. We have heard the voices of those striving for political power who are now desperate to have us believe in their promises. The truth can be painful, frightening and frustrating but it “trumps” the lies and the half-truths that we are being given in terms of programs and policies that effect our mentally ill loved ones.
    Beliefs are sacred and valuable and must be reserved for things and people who have proven to be trustworthy and who follow a moral code. From what this author has seen and experienced, the critically and chronically mentally ill do recognize people in whom they can believe and people who speak the truth. Although the expression of their trust may not be conventional..it is there and the advocates and families who are honest and consistent with their care are the ones that they tend to return to. As Steve followed me around in the Emergency Room (and many others have done the same) I am reminded that they deserve to be within the circle of honest people who work on their behalf.

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    1. Absolutely, but many of the budget cutters and the policy people do not or won’t appreciate what a person with a serious mental illness is up against. Allowing people trapped in a mental illnesses ( out of touch with reality) with no useful services is outrageous. But it will continue. useless programs continue . useful programs barely exist

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  3. Critics of psychiatry aren’t “mental illness deniers”. We’re saying that the cruel families, doctors, etc. are the sick ones.

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