Monthly Archives: October 2022

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.