Tag Archives: treatment

Psychiatric Refugees? Give me a Break!

By Marvin Ross

For years, we’ve had a small group of very vocal people who call themselves psychiatric survivors — people who have had psychiatric treatment, do not agree with it and consider that they have survived it. Now, thanks to CBC radio, we have someone dubbed a psychiatric refugee — a woman who fled British Columbia for Ontario to escape her involuntary status in a B.C. hospital. And, it was said, she is not the only so-called refugee.

Comparing yourself to people who survived a genocide like the Holocaust or saying that you are comparable to Syrians and others fleeing in leaky, dangerous boats from war is absurd. But what is also absurd is the story that this anonymous person called Sarah by the CBC told. It is just not logical but it is being used to justify the Charter challenge to the B.C. Mental Health Act that I suggested was misguided.

People deserve to know and to understand what the Mental Health Act is about. They deserve to know the processes that are in place to commit someone against their will and to treat them. And they need to know the safeguards that are in place to prevent excesses and protect the rights of the individual. These are never explained.

First, I encourage you to listen to the interview. To begin with, Sarah said that she went to the emergency at a hospital with her mother because of troubling life events and she wanted help. She was admitted, she said, voluntarily but then her status was changed to involuntary.

Now, for her to have been declared involuntary, she would have had to have satisfied all four of these criteria (page 18 of the guide):

  • Is suffering from a mental disorder that seriously impairs her ability to react appropriately to her environment or to associate with others;
  • Requires psychiatric treatment in or through a designated facility;
  • Requires care, supervision and control in or through a designated facility to prevent her substantial mental or physical deterioration or for her own protection or the protection of others; and
  • Is not suitable as a voluntary patient.

If she was involuntary, a licensed physician must have assessed her and certified that she met the criteria. Then, another independent physician conducted an examination with the same criteria to extend the stay beyond 48 hours.

( See form 4 where the reasons for the involuntary decision must be listed.)

At the end of one month, she would be examined again to determine if she still met the involuntary admission criteria and the proper form would be filled out to extend her stay a further month (page 20 of the guide). If she no longer needed to be involuntary during this period, the doctor can cancel it and she can always appeal her status to a review board at any time.

Once a patient has been deemed involuntary, they are given a form 5 (consent to treatment) (page 173), which explains to them what treatment is being given. Note that Sarah told the CBC that no one ever discussed treatment with her. They had to.

In addition, Sarah’s rights would have been explained to her and she would be given a form 13 to sign (page 182). She did say she had to sign something but she was not sure what it was. The person having her sign would have told her that she had a right to a lawyer, that she would be regularly examined by a doctor to ensure she was being held appropriately, informed that she could apply to a review board to assess her capacity, go to court to challenge the doctor’s decision and/or request a second opinion from a different doctor.

Next, she would be given a form 15 (page 186) to fill out so that she could nominate a near relative to be informed of her status. She did say that her mother went to the emergency with her so I have to ask where her mother was in all this. Surely she would have been liaising with the hospital staff over diagnoses and treatments. While her mother would have no authority under the act, most doctors do encourage family participation. During the CBC interview, Sarah said that she wished her mother could be involved in her treatment and there is nothing in the act that says she can’t be.

Sarah told the CBC that she absconded during a smoke break and that a form 21 (page 193) had been filled out. That form obligates a peace officer to return her to hospital. Sarah said she went to police in Calgary and told them, and that they called her psychiatrist but they did not hold her for return. The form 21 is only valid within British Columbia, but if 60 days had expired, it would not be valid and she would be deemed discharged.

There are so many holes in what she told the CBC that cast doubt on all she said. It is important for people to understand, particularly in light of the court challenge, what protections there are for an individual who is involuntary. This is not something that anyone takes lightly and is done for the best interest of the patient and for society.

The infamous Vince Li, who beheaded Tim McLean on a Greyhound bus, was initially picked up by Toronto Police in 2004 and taken to hospital. He left hospital against medical advice as there was no mechanism with which to keep him.

Imagine what would have happened if he had been treated initially? Tim McLean would be alive, his family would not have suffered the pain and anguish they did, and the first Mountie on scene might not have developed severe PTSD and eventually taken his own life.

As for Vince Li, he has done so well on treatment that he is now living in a halfway house. I can only guess at the pain he must feel knowing what he did while psychotic and that he would not likely have done if he had been properly treated at the outset.

Vancouver resident Erin Hawkes has written extensively on how the so-called forced treatment had saved her life. She has written in the National Post, numerous times in the Huffington Post and in the Tyee.

The CBC should interview her as well on the court challenge and they should do better fact-checking. If the plaintiffs in this Charter challenge call Sarah as a witness, we will see how well her story holds up to cross-examination.

Note: this first appeared in the Huffington Post on September 26. One person criticized me for attacking mothers which is not what I intended. I pointed out that Sarah’s mother has gone to the ER with her and I likely had input. When I asked where she was, it was a comment directed towards Sarah who said that she wished her mother could have been involved and I suspect she was. I realize that not all doctors and mental health staff are open to families but enough are. My own experience as a family member is that I have always been involved.

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Why I’ve Been Prescribing Psychiatric Medication For 47+ Years

David Laing Dawson

By Dr David Laing Dawson

In 1968 the police brought a very tall man to the emergency department of a large urban hospital. I quickly learned the man had two PhD’s, one in literature and one in Library Sciences and he was employed as the chief librarian of an important Canadian Library. He was also manic. He could not sit still; he could not stop talking. What spewed from his mouth was a fascinating, pressured, endless run-on sentence of literary quotations, interpretations, criticisms, philosophical observations, and trivia.

The emergency department was designed as an oval, so it was possible to walk the corridor in a continuous circle of approximately 200 feet. This we did. I kept pace as he strode, talked, ranted, and raved, around and around that oval. I carried with me a glass of water and a pocket of tablets in my little white intern’s jacket. Every second or third circuit when he paused briefly to catch his breath I offered him a tablet and a sip of water. He accepted this, swallowed the tablet and continued his journey. I tried to remember some of what he said. I wish I had had a tape recorder handy. His observations roamed over much of English Literature and the history of western thought, in fragments, non sequiturs, creative associations and rhyming couplets.

The tablets in my pocket each contained 100 mg of Chlorpromazine. At four hundred milligrams he slowed at little. By the time I had given him 600 mg he was able to pause. And finally, at perhaps 800 mg and the passage of the better part of an hour, he could sit. The pressure in his speech diminished. He could now absorb his environment. I could now speak a little and he could now hear me.

In 1970 a dishevelled, tall bearded man was brought to a hospital by his family. They had found him, after months of searching, standing outside the Vancouver library in the rain. He had been sleeping rough; he was malnourished; he was not speaking. He was also a lawyer who had disappeared from his office practice, and his family, after announcing he was running for parliament, emptying his bank account, and then being briefly arrested for causing a disturbance. Now he was homeless, depressed, not communicating.

With clean clothes, a soft bed, good food, friendly nurses, and my anti-depressant medication, he was soon talking, more animated. But then he swung into a manic state: over-talking, grandiose, agitated, irritable, demanding. He wouldn’t sit in my office. He stood, paced, demanded I let him leave, ranted invective at my profession, my interpretations of reality, refused my pills. He stood and paced. I sat and listened. He didn’t leave, though the doors were never locked. His family let him know he needed to stay and accept treatment. The law society told him they would not reinstate him without treatment and a doctor’s note. Eventually he sat. Eventually we talked. He accepted my pills, my mood stabilizing medication, lithium. Eventually he was reunited with his family. Eventually he got his licence back. He became an outpatient. He re-established his practice, stayed on his medication, and asked me if I would like to play squash with him.

In 1978 parents brought a young man to see me. He was mute. He had stopped talking altogether. I had a white board in my office, and pads and pencils. The young man was willing to sit and respond to questions by writing out his answers. I found he dare not speak because if he did some tragic event would occur in the world. People would die. He knew this because it had happened. He had become angry, and had taken the Lord’s name in vain, and an earthquake had killed hundreds of people in the Middle East. He agreed to return to live with his parents, to eat and shower and sleep, and to swallow before bed each night the small tablet of Perphenazine I prescribed, and come to see me weekly. He came each week, and each week for an hour he wrote his answers on my white board, and when he tired of that, on the pad of paper I gave him. On his ninth visit I handed him the pad of paper. He put it aside and said, “We don’t need that anymore.”

On a lovely Sunday morning in June of 2008 my wife and I went for a walk. On the journey back I pondered ways to spend a leisurely afternoon. But then we found a frantic woman waiting for us in our parking lot. “John is psychotic again,” she said. John is her brother. An hour later I was in their father’s house. John was on the back porch smoking and pacing. I joined him there. He was agitated, mumbling half sentences in a semi-coherent fashion, some to himself, some to me. Changeable moods swept across him. His eyes would light up and he would tell himself and me that he was Jesus, and he had a mission to save the world, and that I would be forgiven, and then his mood would quickly darken, and he was evil, perhaps the devil himself, and that he should be punished, that he should destroy himself, and then just as quickly back to Jesus. I offered him a wafer of Zydis, a rapidly dissolving form of Olanzapine. He ignored this. His moods and thoughts continued to shift from Jesus to the devil, from good to evil, from a mission to save the world, to the need to destroy himself. I offered the wafer again, and this time he took it and let it dissolve in his mouth. A half hour later he was able to come into the house, and sit, and to sit quietly, and sip tea, and then to speak more rationally. Over the next few hours he became more coherent, better able to focus on the reality at hand. He would stay this night at his father’s, take another Zydis before bed, and they would come and see me in the morning.

It is now 2015. I am astonished to learn that there are people today, even some mental health professionals, who do not believe in the existence of mental illness, nor of the efficacy of psychiatric medications. I suspect that the closest brush they have had with insanity and pharmaceuticals is reading Jack Kerouac and William Burroughs in college, and the only knowledge they have of mental illness, and of the fate of the mentally ill before these medications were developed, has come from Hollywood, or the episode of Murdoch Mysteries I watched last night.

On Mental Illness – Let’s Not Wring Our Hands But Actually Do Something

David Laing DawsonBy Dr David Laing Dawson

The last few days, thanks to our local newspaper and the television, I have been bombarded with mental health news. This could be a good thing. Heightened awareness, increased sensitivity, decreased stigma, having a public conversation about it, making politicians and lawmakers aware.

But it has almost all been over-inclusive wringing of hands, bemoaning the state of the nation, the suicidality of our youth, the stresses of modern life, the bad behavior and instability of our classrooms, the internet vulnerability of our children, the dramatically increased use of marijuana which is now, they say, ten times more powerful than the stuff we toked in the 60’s while singing “Puff the Magic Dragon.”

As is so often the case these days the words and phrases “mental health”, “mental health issues”, “addictions”, “behavioural issues”, “stress”, “anxiety”, “mental illness”, “addiction issues”, are used interchangeably.

The most egregious of these misnomers often comes in the form of “He is known to suffer from mental health.”

Am I too concerned with semantics here? I don’t think so. Because I think all this fraught hand wringing, vague euphemisms, contradictory word usage, broad generalizations, and statistically implied causal relationships can only lead to two kinds of unhelpful responses:

  1. The news itself, defined so broadly, so all inclusively, so vaguely, and with such a sense of urgency, becomes just another stress to bear.
  2. Money is found, a program is announced, some general response that will allow the politicians to appear to be doing something to “solve the problem” and boast in the legislature or town council, while knowing it will do nothing to help specific individuals who actually suffer from specific mental illnesses.

At least response number two will help alleviate the damage of response number one. But response number two is all too often some general manipulation of optics, some appearance of action to “eliminate crime”, or to provide a telephone number to call for those who are stressed or “experiencing suicidal thoughts.”

Okay. There are social, political, and economic factors that contribute to mental illness and disability. And we could and should gradually ameliorate these through social and political programs that reduce poverty (minimum wage, disability pension, and social assistance increases), increase the availability of affordable housing, make day care more affordable and accessible, ensure we have an educated population, help youth transition from childhood to full independence (support, training, internships, money management programs), stop sending young men and women to war and trauma, ensure some of the profits from alcohol and gambling go to alleviate the damage done by alcohol and gambling, fund and evaluate specific targeted programs to reduce the social cost of addictions, and to counter the misogynist messages our young men are now acquiring through social media, pervasively available pornography, and hateful song lyrics.

But there are a number of specifically identifiable and specifically treatable mental illnesses that we could target in a far more specific and effective way. These are:

Anxiety Disorder

Obsessive Compulsive Disorder

Depression

Bi-Polar Disorder

Schizophrenia.

These specific disorders (not withstanding the researchers’ and clinicians’ ongoing search for more clarity, specificity, and causality) can be very specific causes of disability, distress, failure, and suicide.

But we can identify them; we have the tools to detect them; and we have the tools to treat them. And doing this, providing funds and creating programs to do this, would be far more effective than hand wringing.

Take suicide for instance. There are a large number of social factors (loss, divorce, alcoholism, poverty, unemployment, debilitating illness, aging, trauma) that increase the risk of suicide. Some of these we can do nothing about. We can chip away at others through legislation and social programs.

But there are some specific causes of suicide (actual suicide, not threats and thoughts) for which we do have the tools to detect, intervene, and treat.  And these are the mental illnesses listed above.

(I think I must point out here that the proliferation of hot lines, crisis lines, help lines, phone numbers to call over the past twenty years, has NOT changed the actual completed suicide rate in any jurisdiction I know of.  But there have been studies demonstrating that helping and teaching family doctors in the detection and treatment of depression has lowered the rate of actual suicide.)

So what we should focus on are specific programs for early detection and comprehensive treatment of the mental illnesses listed above. Or better targeted funding for the services that do that now, and the linkages between them.  These linkages are crucial in order to move from suspicion, to detection, through assessment, to expert treatment: Parent and teacher to counselor and social worker to family doctor and pediatrician to mental health program with psychologists and psychiatrists.

Editor’s Note Dr David Laing Dawson has been practicing psychiatry for many years. He is a former professor of psychiatry in the Faculty of Health Sciences at McMaster University in Hamilton, ON and the former chief of psychiatry  at the Hamilton Psychiatric Hospital. He is the author of Schizophrenia in Focus, Relationship Management of the Borderline Patient and The Adolescent Owner’s Manual. He has also written and directed a number of films on mental illness.

About That Ladder of Scientific Progress – Reminscences of a Psychiatrist

By Dr David Laing Dawson

stone of madnessIn 1971, before my own son was born, a seventeen year old boy left his family home in Ontario, and traveled to the southern United States with his guitar and little else. This young man, Derek, dressed in a robe and sought out an audience for his message of peace and love. He was hospitalized there, his parents contacted, and they drove down to bring him home. Back in Ontario they brought him to the new Community Psychiatry Program at the Medical Center. This was the Thursday before the Easter Holiday weekend. The young man, fully alert and full of energy, was convinced that he had been appointed by God to deliver these messages. But he didn’t want my medication, and he did not want to be admitted to hospital. His parents agreed to take him home and bring him back for a second visit the following week.

This family went to church on Easter Sunday, and to everybody’s dismay, the young man jumped to his feet, interrupted the Priest, and began a loud, rambling sermon of his own. An ambulance was called and he was taken to hospital. His response to medication was good, and when well, he proved to be a bright, engaging, sensitive, smart young man, capable of succeeding in College and life. But he did not like taking the medication. He preferred, quite understandably, the sensation of invulnerability, of energy, of warmth and possibility, of certainty, that accompanies a state of hypomania and delusions of grandeur. He remained my patient for five years, and I struggled with him to find a pharmacology that would keep him sane without taking away his enthusiasm. He often stopped the pills, became ill, and then reluctantly agreed to try again.

After five years I moved to head a different clinic in another part of town, and then out of town, and then five years later, back to town. I had lost track of Derek, and now my own son was that age, seventeen, and I was driving him to something. I think it was October and the leaves were changing on Aberdeen, a wide road of old and stately houses, some of which had been converted to group homes. We slowed at a busy corner, and on that corner a bearded man with unruly hair and disheveled clothing stood, paced, gesticulated and shouted at imagined specters or people in the street, in the clouds, and in the trees. It was unmistakably Derek, now in his mid 30’s.

“Shit.” I said.

“What’s wrong?” asked my son.

“That man,” I explained. “He was my patient years ago, when he was your age.”

He looked at the psychotic man raving at invisible targets. “Dad,” he said, “It’s not your fault.”

Ahh, yes. I remember that moment because of the heart-warming display of empathy and understanding coming from my teenage son.

But really, we did fail Derek, didn’t we?