Guest Blog Parents Live By The Reality Model. Its Time The Mental Health System Did Too.

By Kathy Mochnacki

Recently, I was woken from sleep by a phone call. It was my son calling from his supportive housing residence. He could not locate his identification cards and was yelling at me in a loud voice asking where they were. I knew that he needed the ID to open up a bank account the next day and referred him to the program administrator who had kept his ID in a safe place. I checked with the program administrator next day, who said that he had called her and his tone had been quite reasonable. As a rational person, I recognized that the loud angry voice that I had experienced came from the heightened anxiety that he felt because he feared that he may have lost items which were vital to him performing the necessary step of opening up a bank account. As a mother caring for a son with a serious mental illness, it has been a common experience to be the brunt of such outbursts over the years. I do understand, however, that my son’s outbursts of anger come from a place of intense anxiety.

But here is the problem. There are so many professionals in our current mental health system, who are about my son’s age, but do not have a serious mental illness, whose method of communication is also distressing. For example, a male nurse at a local Emergency Ward, in response to my inquiries asked “How old Is your son, Mrs. Mochnacki?” I guess he thought I was being an overprotective mother. His sarcasm came from a place of ignorance, as he was unaware, and did not bother to find out, that my son’s diagnosis involved memory problems and other challenges. The same hospital gave me exemplary service when I was treated for breast cancer. Perhaps their cancer care department could educate some in the psychiatric department about how to appropriately treat patients and their families.

Often our difficulties are with bureaucrats whose heightened sense of self -importance, an unattractive quality coupled with an unacceptable ignorance of the symptoms of mental illness, makes for disaster. A case in point is the “Senior Director of Transformation and Strategy” who established the vision, mandate, and principles for the development of a Mental Health and Addictions Crisis Hub while “securing government approval for a ‘transformational’ model that introduces coordinated, wrap-around care, with seamless transfers, and integrated services”.

Problem is that many people with serious mental illness will not use this Hub as they have the symptom of anosognosia which means that the person does not have insight that they are ill. Anosognosia or lack of insight is the principal reason those with schizophrenia and bipolar disorder do not take their medication and do not seek care. The opportunity was there for this individual to find out about this symptom, as I sat on a Council which he headed for three years, but he chose not to find out. Another bureaucrat from the same Council told me that the College of Physicians and Surgeons of Ontario (CPSO), a regulatory body, would have to determine that anosognosia was a symptom of serious mental illness! It is not CPSOs function to determine symptoms of diseases.

It may be time for some mental health professionals to look in the mirror and acquire some insight of their own. Recently an Ontario Health Team was challenged to find family representatives for their leadership council and had learned that family caregivers, in past councils, had felt condescended to. After becoming aware of this fact, they then issued a recruitment flyer to solicit applications for positions for family caregivers that had been created on their Leadership Team. The flyer stated that successful applicants will be “matched with a point person/ mentor to successfully support you in your role”. Why do we need support? We are articulate adults who have valuable information to share and have done this for years as numerous government policy papers will attest to. Is not the shoe on the wrong foot? Should it not be the professionals who need to learn how to listen? By indicating that we are the ones needing support is just another example of condescension. Positive change will not happen when families are kept in the stepdown position.

Recently, I complained to the local consumer survivor organization about the wording of a terms of reference of one of their programs. It said “we do not define force and coercion as help”. I asked whether this was a reference to involuntary treatment and explained that many of the families that I knew had depended upon this policy to get needed help for their loved one. The executive director wrote back and did say that involuntary treatment had worked for some but a later letter from the Board of Directors refused to change the wording even though the threat of the availability of involuntary hospitalization traumatizes families of those with serious mental illness who must rely on it to protect the rights of their loved ones to attain wellness and be alive.

In answer to my first email of complaint, the executive director states: “The Peer Support movement ………was founded on the need for Consumer/Survivors to advocate for rights protections and positive change in the healthcare system and beyond, as historically, people with ‘serious mental illness’ often had their rights stripped from them. The pioneers of the consumer survivor movement have been advocating for positive mental health care reform for decades, and thankfully we at least now have the system using the language and philosophy of ‘recovery’ and recognizing and embracing the value of Peer Support for example, rather than the antiquated belief that people with lived experience all have a life-long condition which must be treated ‘professionally’ and clinically and that medication for all of us, is non-negotiable. That’s simply not the evidence, and as a result the system has seen positive changes, moving away from this and bringing in more holistic and diverse views and understandings.”

Recently, emergency services were called to one of their programs. According to an eye witnesses, this is a common occurrence. A woman in psychiatric distress was strapped screaming to a gurney and taken to hospital. Where is the human dignity in this? Is this a good example of the effectiveness of “Peer Support”? This sad spectacle of human suffering fuels stigma and public anger against all of us including families who are supporting a loved one with a serious mental illness. The crisis that this poor woman experienced may have been prevented if she had access to “antiquated” treatment and the availability of medication.

The consumer survivor movement speaks for an articulate vocal minority blinded by a philosophy which sadly impacts upon us all with such profound negative consequences.

One of the popular messages coming from the mental health system is the call for “parity”, as people in the mental health system demand equal funding for mental health care; equal, that is, with physical health care. But what they have not appreciated is the fact that physical health care involves physical health literacy. There is an acceptance that there are many physical illnesses each with their own set of symptoms. In contrast, the mental health field does not have this quality as we hear references to the euphemistic “mental health issues” but little reference to terms such as “schizophrenia”, bipolar disorder, or major depressive illness to name a few of the mental illnesses. Too many employees of mental health agencies have no training in mental illness and this can be a risk factor which causes hurtful judgements, and fuels systemic attitudinal barriers. Families are often blamed for their loved one’s mental illness as some of these employees have had educations influenced by psycho dynamic theory which puts emphasis on early childhood experiences.

Change comes from the ground up. Professionals could serve us better if they took the time to appreciate the challenges which our loved ones have faced. My son, who for most of his childhood suffered from undiagnosed Asperger’s Syndrome. That is a disorder which involves a deficit in understanding social cues, so he experiences intense anxiety. One time in Grade 3, he was with his twin brother in an exercise about social skills. He was asked who his best friend was in front of all the other classes in the gymnasium where this exercise was held. He finally blurted out that his best friend was his twin brother who was sitting beside him. The presiding teachers were not happy with his response and chided him to come up with another answer. After a while of this taunting in front of all the other children, he finally blurted out “F—Off”.

I was summoned to a dressing down by the same teachers and my son was given a two week suspension.

Isn’t it time, that we cut with the crap, and start taking mental illness seriously? We need mental health professionals who take the time to find out about the symptoms of the different mental illnesses that makes life so challenging for our family members? Take the time to listen to families and read and follow the recommendations of those myriad of reports that have been gathering dust over the years. The first recommendation of the three decades old Ontario Government Graham Report advises that we “place priority on providing support to individuals and their families who experience serious or prolonged mental illness or impairment”.

I invite mental health professionals to work with families to honour this recommendation.

Kathy Mochnacki is a registered social worker and Chair of the Board of Directors of Home on the Hill Supportive Housing. She is the mother of an adult son with serious mental illness. Home on the Hill can be found at

https://www.homeonthehillsupportivehousing.com/

Something a Little Different for the Lazy Days of Summer

Marvin Ross

Our postings for the past few weeks have been a bit heavy so we thought we would lighten it up with a more personal post about us.

In early June, I received an e-mail from a writer for the Toronto Star who had uncovered a photo of my son and I in their archives from 1984. She loved the photo that was taken for a story the paper did about the book Sorry Daddy A Father’s Guide to Toddlers which followed from Daddy Dearest A First Time Father’s Guide. These were two of four books I did with the brilliant illustrator, David Shaw. She wanted to update the story for Father’s Day which she did and this is what she produced:

https://www.thestar.com/life/together/snapshot/2021/06/20/daddy-dearest-author-marvin-ross-wanted-to-help-first-time-fathers-nearly-30-years-since-this-photo-hes-still-focused-on-being-a-dad.html

That was followed shortly after by a very lengthy profile in the Hamilton Spectator of blogger Dr. David Laing Dawson. David has decided to retire from psychiatry effective the end of July and is leaving Hamilton, Ontario to return to British Columbia where he was born. That explains why he hasn’t written much of late as he is busy winding up his practice and his other activities. He will return.

David, and his wife, Marlaise, have been at the centre of the cultural life of the city since at least 1996. As the profile of them in the local papers said “In some ways they lay the groundwork or at least set an example for what followed in the arts here — the burgeoning of James Street North, the emergence of the Pearl Company and the general cultural “moment” that we’d been experiencing before COVID and arguably are still experiencing, through it, struggle as it is.”

The full profile can be found at:

https://www.thespec.com/news/hamilton-region/opinion/2021/07/08/hamiltons-gallery-on-the-bay-to-close-its-doors-at-the-end-of-summer.html

The UN Fights for the Rights of the Disabled at the Expense of the Mentally Ill

By Marvin Ross

The Convention on the Rights of Persons with Disabilities established by the UN came into force in 2008 and has been signed by 163 countries. The intent was to protect the rights and dignity of the disabled but, in doing so, the Convention limits what signatory states can do to help those with the most serious of mental illnesses. They have done this by banning any involuntary committal or treatment for those who are a danger to themselves or others, banning treatment orders to help those who continually relapse stay out of hospital, and recommend that all regardless of the severity of their mental impairment go to jail rather than into treatment when they commit offences.

The UN Committee wrote: “Committal of individuals to detention in mental health facilities, or imposition of Community Treatment Orders contravene the convention and must be eliminated.” and “In the area of criminal law, recognition of the legal capacity of persons with disabilities requires abolishing a defense based on the negation of criminal responsibility because of the existence of a mental or intellectual disability.”

Canada ratified the Convention but not those provisions. A small number of countries also refused to ratify those provisions including Australia, the Netherlands and Norway. Thus far, the US is one of a very few who have not ratified it.

Both psychiatry and families oppose these mandates. Lancet Psychiatry wrote that these articles threaten to undermine critical rights for persons with mental disabilities, including the enjoyment of the highest attainable standard of health, access to justice, the right to liberty, and the right to life. Stigma and discrimination might also increase.

Dr Paul S Applebaum, writing in Law and Psychiatry, said “Although exemplary in many respects, the convention contains provisions that threaten to disrupt long-standing approaches to mental health law, including civil commitment and guardianship; interfere with efforts to protect people with severe cognitive and emotional impairments; and leave many people with disabilities worse off than before.”

Families of those with serious mental illnesses also object to these provisions. Both the BC Schizophrenia Society and the Saskatchewan Society sent letter to the Prime Minister in 2020 outlining their concerns.

The issue of abolishing Not Criminally Responsible is also troubling. How can someone whose brain is corrupted by serious mental illness form intent? They cannot and intent or mens rea is the basis of criminal law. You cannot convict someone for a crime who had no intent or the mental ability to form intent. Crimes committed by people who are so mentally deficient from psychosis should not be punished but rather treated. The UN Convention, however, would agree with those US States that still have the death penalty and allow people with schizophrenia to be executed.

Despite the history of treating the mentally ill with understanding going back to before 1800, the UN is attempting to reverse this. Prior to 1800, a mentally ill person who committed an offence was turned over to the family for care because the mental illness prevented criminal prosecution. In 1800, the British Parliament passed the Lunatics Act whereby mentally ill persons were detained indefinitely as no treatments existed. This was replaced in 1843 by the M’Naghten rule where an offender can be judged not guilty by reason of insanity and sentenced to treatment in a secure facility. This defence is recognized in countries using British Common Law with the exception of the US states of Idaho, Kansas, Montana, Utah, and Vermont. Those states, however, still use ability to form intent as a criteria. The UN’s regressive policy nullifies history.

Every jurisdiction that allows for involuntary committal has stringent safeguards to prevent abuse. There are limits on how long someone can be detained and, in Ontario at least, patients can have a lawyer and appeal. Regular reviews are mandated to prevent anyone from being forgotten or held longer than they should be.

Canada has just nominated a law professor from the University of Windsor to the convention and sadly it appears that she knows little of mental illness. I have attempted to talk to her about the mental health dictates of the UN and to ask how much she knows of serious mental illness but she has yet to reply to me and the media relations staff at the University have been unable to get her to reply as well. The most vehement opposition to involuntary committal and community treatment orders are lawyers specializing in disability issues so I fear she is in that camp.

And, as I’ve pointed pointed out in my book, the UN is heavily influenced by the Mad in America advocates.

I would encourage Canadian readers of this blog to write to her with your views. You will find her credentials here https://www.uwindsor.ca/law/ljacobs/

I understand that there is pressure being exerted for the US to ratify the Convention so I would suggest that Americans reading this lobby to prevent that or to at least ensure that the negative articles for the mentally ill are not accepted if the US ratifies.

If Germany Could Do it, Why not the Catholic Church

By Marvin Ross

After Nazi Germany was defeated and the full extent of the Holocaust became known, Germany agreed to pay compensation to the victims. In 1951, West German chancellor Konrad Adenauer committed to paying “moral and material indemnity” for the “unspeakable crimes…committed in the name of the German people” during World War II. The following year the government signed a set of reparations agreements with Israel and an umbrella group of advocates known as the Conference on Jewish Material Claims Against Germany, or Claims Conference.

East Germany refused any responsibility but when Germany was reunited in 1990, a new agreement was created to compensate those survivors who received little or nothing before. Compensation was made to all who suffered at the hands of the Nazis and not just the Jewish victims. Germany and its citizens have attempted to atone for the atrocities committed in their name and deserve credit.

But what of the Catholic Church? They, and the other churches involved, need to not only apologize to Indigenous people in Canada but to pay reparations for what they did in the schools they ran. Thus far, the Pope has refused to even apologize let alone to consider payments. Indigenous leaders are planning to visit Rome later this year to ask although I disagree with their doing that. If he is unwilling to do so, it is on him and they should not beg.

In the US, the Jesuits have already set a precedent for retributions. Jesuits were active slave holders who then sold and traded their slaves to pay for the upkeep and building of churches and schools including Georgetown University. In 1838, they sold 272 slaves to a Louisiana plantation to keep the school solvent. They have pledged $100 million to the descendants.

The net worth of the church worldwide is estimated to be in the area of $30 billion based on its ownership of churches, schools, presbyteries, hospitals, nursing homes, offices, tennis courts, and telephone towers. The church is wealthy enough that they do not need tax exempt status nor should we be funding Catholic schools as we do in Ontario. Public funding is particularly odious when a number of Catholic school boards in Ontario have refused to fly the Pride flag.

I do find it a bit odd that people are surprised at the cruelty though. Christians proselytize and attempt to convert anyone who is not a Christian or of their particular denomination. They do so because they consider anyone who is not a Christian to be a heathen or, as the Nazi’s called Jews, Gypsies and other, untermenschen – subhuman. If they refuse to accept the teachings and to remain heathens they deserve whatever punishment they get.

I still remember my shock in elementary school to learn of the slaughter of the South American natives by the Spaniards when, in one instance, a chief dropped the bible he was given. And, of course, we have the cruelty of the Spanish Inquisition put to music by the great Mel Brooks in the History of the World.

Because of the revelations about what went on in residential schools, there is now a movement to rid ourselves of statues and names associated with their implementation. Statues of Sir John A Macdonald (the first Prime Minister) and Egerton Ryerson (who introduced public education) are being defaced and there is a movement to rid the name of Ryerson University because they both proposed residential schools.

You cannot change history and singling out two people to be removed from public visibility does two things. First, it suggests that they were solely responsible which is not true. They represented the prevailing opinion of the day. Secondly, it removes them from visibility so that what they represented is hidden and we do not want to hide what happened. We need to remember it as an example of what should not be done.

It also assumes that no one today would agree with the positions held by Macdonald and Ryerson which is not the case. The abuses of residential schools has been known for ages but ignored. It is only with finding the hidden bodies that we get upset about and our Indigenous citizens are still treated as untermenschen to this day. If we were serious about improving things then the government would have begun to implement the recommendations from the Truth and Reconciliation Report but they have not.

Trudeau said a few years ago that he would rectify the drinking water on reserves and end the boil water advisories. Many reserves still lack proper drinking water. I saw a young Indigenous child interviewed on the news from one of the vigils held on Canada Day. He said if Canada can spend millions putting oil pipelines through reserves, why can they not put a pipeline to a reserve with clean drinking water? Out of the mouths of babes!.

Worship, Truth and Reconciliation – A Canada Day Blog

By Dr David Laing Dawson

Stopped in traffic for a moment I noticed we were sitting beside a Church Office. The signage pointed out this was an Office and not the place of Worship, which was a building at another address. It was the word “worship” that stuck with me.

It is not the matter of believing or not believing in a God, nor the benefits that accrue from gathering in a group and engaging in rituals to mark births and deaths and seasonal change, and listen to someone telling us to try to be good human beings.

It was the word “Worship” that struck a chord. What a strange anachronistic idea that we should “Worship” anything or anybody or any deity, especially an imagined alpha male in the sky, and his human proxies.

I suppose I am paying attention to this because a half dozen Catholic Churches on or near Reserves have been torched this month. And that one word gives the game away. Worship. It is a word of power, of certainty, and of the threat of punishment if not followed. It would be what tribal leaders expected, medieval kings, potentates, dictators, autocrats…unwavering allegiance and ritualistic methods of attesting to unlimited devotion, as well as punishment for any deviation.

And clearly any human organization that demands that level of devotion, kneeling and worshipping, saying the right words, is a cult within which, at least from time to time, terrible abuses will occur.

As bad an idea as it was to develop residential schools for aboriginal children, it was worse to hand management of these schools over to the Catholic Church. But then, at the time, it would have seemed natural, and we were only in the beginning of a journey to separate church and state.

But here we are in the seventh inning of evolution, of developing a method of governance that is inclusive, transparent, and fair to all, and a method of human governance and education that will avert, avoid, deny those human instincts that once may have had survival value but no longer do.

So let us have truth and reconciliation. Let us think hard on the mistakes of the past. But let us also celebrate how far we have come in the, perhaps impossible, pursuit of ways and means of human governance that will be, someday, inclusive, transparent, fair to all, and will also let us, collectively, save the planet.