Tag Archives: Centre for Addiction and Mental Health

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.

The Mentally Ill in Prison – A Reply to the Centre For Addiction and Mental Health

newer meBy Marvin Ross

The chief of forensic psychiatry at Toronto’s Centre for Addiction and Mental Health (CAMH) , Dr Sandy Simpson, gave his explanation as to why so many people with mental illness are in the correctional system in a blog earlier in December. I learned of it because a number of people contacted me upset by what he had to say.

He gave three main reasons for this phenomenon which you can read for yourselves. His first reason is the one that people found the most upsetting as he claims that “broken families, poverty, substance abuse in the home, physical and emotional abuse experience” are “problems that increase the risk of suffering a serious mental illness. Therefore people with problems of criminal behaviour may well also have problems of mental illness, but the illness is not the cause of their criminality.”

This sounded like family blaming to those who contacted me and it does. I asked him on Twitter if he was suggesting that mental illness is caused by bad families? And I added, “Your point 1. MI in jail because of lack of services and beds”. His Twitter reply was “Agreed to last point esp in US. Family one of many relevant factors for crime generally Family problems often social context driven”. I then asked if he thought that serious mental illnesses were caused by families and he replied “no” but he did not reply to my tweet that his blog could be taken the wrong way.

His suggestion that the lack of beds might be a problem but that it is worse in the US is an interesting comment. That may be the case but so what? Is our negligence mitigated because someone else might be even more negligent? Imagine an accused murderer saying to the judge, “but your honour, I only murdered one person. Joe Blow murdered three people”.

Now Doc Simpson works at CAMH and CAMH is notorious in my mind for refusing a court order to treat a mentally ill patient. In fact, they won a legal battle that prevents judges from ordering mentally ill offenders to be taken to a hospital for treatment. In 2010, Toronto judge Mary Hogan, was faced with a schizophrenic defendant before her on a minor offence. She ordered CAMH to stabilize him as she knew that the standard policy was that these individuals were rerouted to jail rather than hospital.

CAMH left him in the hall because they had no beds and initiated legal proceedings to prevent such orders. They won. Can anyone imagine refusing treatment to someone injured in a traumatic car crash because the hospital is busy? It would not happen.

Lack of adequate mental health services and beds is the main reason that so many with mental illness are in jail. According to a thesis submitted in 2011 to the University of Manitoba by Richard Mahé, it has been known since the 1970’s that the lack of community resources resulted in the criminal justice system replacing the psychiatric hospital. The Canadian Institute for Health Information reported that the shortage of psychiatric hospital beds is resulting in people being squeezed out of hospital too early.

This closing of beds was decried by the Schizophrenia Society of Canada. And the Public Health Agency of Canada pointed out that “the rise in the proportion of prison inmates with mental illness suggests that some have exchanged the psychiatric ward for the prison ward.”

Howard Sapers, the investigator for Corrections Canada, told the Tyee that “We’ve seen a big increase in the number of men and women being sent to federal penitentiaries with a mental health issue and many of them end up with diagnosed mental illnesses such as schizophrenia.” And, he added, it is difficult to even find qualified staff willing to work in the prison system.

In fact, a state of the art infirmary and 26 bed mental health unit in the Toronto South Detention Centre has never opened due to a staff shortage. Inmates are being held in solitary confinement instead. Andre Morin, Ontario’s Ombudsman, has threatened to intervene if the situation is not rectified.

So, Dr Simpson, there is a lot to talk about on the subject of mentally ill in jail that is a lot more crucial than speculating on the adequacy of families. And we have a lot of work to do to rectify that sad reality.