I was very dismayed when I read the Canadian Mental Health Commission's draft document. If they proceed with their fuzzy thinking, even more of the seriously mentally ill will end up in jails, prisons, or on the streets. Dorothea Dix rescued the mentally ill from the streets over a century ago, and now we are about to let those afflicted by serious brain diseases (Schizophrenia and Manic depression) live in squalor again.  We now have better treatments, but so many are not able to benefit from them. There will be a new generation of chronically mentally ill, because they do not get treatment in a timely fashion. There are very few inpatient beds. The Commission simply fails to understand that people who are seriously psychotically ill do not access treatment because they are not able to appreciate that they are ill. The Commission seems to feel that stigma is why they do not access treatment. That is wrong. The truth is that people who are trapped by their illness do not have insight. Stigma is a problem, but it is not the biggest problem. The Commission must tell the truth about why the seriously psychotically ill remain ill and untreated. Stigma will be less of a problem when those most seriously affected return to better functioning. 

 

Toward Recovery & Well-being

 

A Framework for a Mental Health Strategy for Canada

 

Mental Health Commission of Canada January 2009

 My review of Commision's draft document April 19 2009

 Patricia Forsdyke

                       

Introduction

I have recently read the draft report and find it to be both distressing and disappointing. The document does not prioritize and it often misspeaks and accepts its own myths. It does not seem to have been advertised outside the commission site, and I know that many individuals have had a great deal of difficulty with using the site via passwords. My late submission will be sent to my MPP and MP. As for the workbook, the questions are loaded and somewhat biased. Is the commission trying to affirm what it already believes? It is a make work job.

N.B. I speak for many families who are too burned out with the burden of care to respond to this draft. I also speak for many who are diagnosed with a major mental illness, who feel that their illness has little to do with how they were reared, or what society has enacted upon them. Relatives often feel that, had their loved one been given proper medical care at the right time, their need for their own respite might have been much less necessary. They believe that outcomes would have been better if there had been prompt professional care, and that their ill  relatives would also need less from social services, of the kind the commission prescribes, had their relative received medical treatment in a  timely fashion, thus preventing more long term extensive care requirements. Extensive supportive services have often become necessary because the health care system fails them and their relatives. They need prompt medical attention and access to the best possible medication.

Schizophrenia and Bipolar 1 Manic Depression and obsessive compulsive disorder should be considered no-fault conditions and dealt with accordingly. There is barely anything about medical treatment or the shortage of safe hospital beds in the document. These illnesses cannot be prevented because we do not  know enough about the failed chemistry that goes into them.

Society has a lot to answer for, but it is not responsible for a person’s inherited biochemistry. A genetic predisposition should be considered a no-fault condition and given the healthcare dollars it deserves. The draft does not clearly and unambiguously distinguish schizophrenia and bipolar-one from those conditions that are a result of societal ills (e.g. trauma in the form of war, rape, sexual abuse, or discriminatory cultural practices). Stress does not cause insanity. If it did we should see people who have undergone amazing trauma totally psychotic. I have observed so many families challenged to the limit and undergoing amazing strain, but they have not gone mad. The collateral damage to them is often high blood pressure. Clearly one cannot ignore problems that are caused by society, but one must not think that it is OK to talk about the two groups as if they were the one.  

MY QUESTIONS:

1. Where is there any mention of the shortage of serious and qualified health care professionals, or the serious shortage of inpatient care?

2. Why  does the draft not distinguish (in fact it blurs the lines) between societal ills, which  deliver  profound unhappiness and ill health, from the three percent who are afflicted with  major biochemical conditions to which they are prone?

3. Why is the report so heavily weighted  towards the wellness movement, while ignoring medical illnesses? It talks of “mental health issues” instead of “mental illness.”

4. Why does the Commission ignore the fact that most people trapped by a psychosis are clearly not capable of making an informed choice? The Commission talks of a choice that cannot be made!

Particularly distressing is that the Commission does not show any understanding of the fact that, where a psychosis is concerned, it is not a matter of choice of treatment for their life-threatening illnesses, but a matter of medical action (treatment) – just as for a heart attack. Finding the right medication  and giving it fast is of utmost importance. One medication does not fit all. This means the service of an expert physician to come up with the most efficacious medication for a particular individual. This takes time. Close monitoring is essential. This is often best done in hospital in order to keep patients safe while starting on these powerful drugs.

5. Why did the report go on about the recovery movement in relation to the 3 percent (Schizophrenia and Bipolar 1) when it really should be talking about more precise things like stabilization and rehabilitation and the usual need for more medical care?            

“Recovery” has become a cunning weasel word! You say much about recovery in the draft but your dialogue leads nowhere, and it ignores those most in need of medical services. The “recovery movement” is all hype! For example, one does not accuse patients who have Diabetes type 1 of having their disease because there is a lifestyle problem, or say that it can be prevented by lifestyle management. Nor do we go on about “recovery.” We and they talk of stabilization and managing their illness with insulin in order to prevent further complications such as blindness, cardio-vascular problems and  peripheral neuritis. Like the major mental illnesses it is a no-fault illness, and when patients are in a crisis we give them either glucose or insulin.

6. First episode events and untreated psychoses are not mentioned at all. Why is stabilizing treatment not mentioned?

Pre-validated consent (Ulysses Clause) mentioned briefly in the Commission’s draft, at best can only be used after the first episode. When the first episode presents, there is no Ulysses Clause in place. The draft document does not prioritize and it often misspeaks. It ignores the fact that many acutely psychotic people have no insight that they are ill, and therefore refuse life-saving treatment.

7. Why is there no recognition that these are life-long illnesses?

Talk of not needing medication for bipolar 1 or Schizophrenia is very dangerous. It is implied in the document that these groups will not need medication for the rest of their lives. This is nonsense. For some individuals failure to take medication will greatly increase their risk for suicide (10-15% lifelong risk) and risk their harming others, usually their family.   

8. Why does the draft not acknowledge that there has been an increase in prison occupancy and a growth in forensics? 

There is absolutely nothing to reflect the fact that the only growth area in inpatient care is in forensics. Much of the growth in forensics could have been prevented had medical services been delivered in a timely fashion. Downsizing of hospitals has created enormous misery for those afflicted with serious mental illness. Families have not been listened to.

9. Why does the document not refer to failed mental health legislation?

The document speaks about choice without ever mentioning that people who are actively psychotic often have no insight and are trapped by their illnesses. They are allowed to avoid essential medical care to their personal detriment. Lack of insight and adversarial mental health legislation results in treatment-delays to everyone’s detriment.  

10. Why do I challenge some of the premises that exist in the Commission’s draft document? 

Because someone MUST. The draft is seriously flawed. There should be an appreciation that the subject of social determinants of health and well-being is in quite another category from the subject of those who suffer from serious mental illness (3 percent). The report over-uses the word “issues” and under-uses the word “illness.” And when it does use “illness” it underplays “treatment” and gets into “choice.”

11. When is the commission going to tell the truth that an untreated psychosis can be very dangerous for society, the family and the person with the illness?

When are the commission and its committees going to understand that a person that is psychotic cannot make reasonable choices while trapped by a psychosis? When will planners show any understanding that medical treatment is the first line of defence against further deterioration that is essential for future autonomy after stabilization. Poor life style follows the onslaught of these illnesses when they are left untreated. The cart is clearly before the horse in that it is implied that if one worked on societal ills, cultural biases, poverty, and providing everyone with a job, everything would be well.  

12. Stigma needs to be given its due, but why has it been given so much emphasis?

It has become an albatross! It is repeated throughout the document. There is overkill…. why ? The best stigma buster I know for major mental illness is treatment. One beheading on a bus from lack of responsible access to appropriate treatment impatient care does more to create discrimination than anything else! What is more, psychotic street people are often very frightening and that also creates stigma. What are you going to do about street people?

13. Why is prevention overplayed?   

There is no evidence that Schizophrenia or Bipolar 1 can be prevented. Though their biology is somewhat better understood, much more basic science is needed to further untangle the nature of these devastating brain diseases. These illnesses run in families where there is genetic loading and the most important strategy to manage these brain diseases is treatment. Treatments are better than they were, but too few receive them, particularly those in the three percent group. The health care system is under-funded in this area of medicine. There is a bias against hospitals and against medication in the document. It is hidden, but it is there!

14. Why is their so much pressure on individuals who are seriously mentally ill to have paid work?  

Some people are better not to be forced to work. Take, for example, a woman of fifty who graduated from a good university who developed SZ in her early twenties. She married and had a child. Her illness presented at this stage and sadly she was not properly diagnosed and time was wasted. She is fairly well maintained on high, but essential, doses of neuroleptics. She finds daily coping hard, but has managed for the last fifteen years to educate professionals in a clinical program. She also educates high school and college students. She often says: “I experience double discrimination when people in the social system tell me that I should be in the work force. I know that I can’t and would relapse.” This person is very giving and demands little. I tell her that she is working by managing her illness as best she can. She is very wise. Her son has grown up with a very loving mother despite her major mental illness. She was widowed two years ago.

CONCLUSION

I challenge some of the premises that exist in the Commission’s draft document. There should be an appreciation that social determinants of health and well-being are in quite another category from that of those who suffer from serious mental illness (3 percent). The report over-uses the word “issues,” “stigma” and “wellness” and under-uses the words “illness” and “diagnoses.” When the document does use “illness” it underplays treatment and gets into choice.

As for the eight goals, they are like apple pie and motherhood, and they do not separate out biological predispositions for serious illnesses from socially-caused troubles. I am afraid the one-size-fits-all approach will fail and further discriminate against the former group. Individuals who can ask for help will maybe benefit from the report, but those who are afflicted with brain diseases will continue to be ignored or slip into unsuitable places (prisons or the street).  Many more will succumb to HIV, hepatitis C, TB, etc., as a direct result of flawed policies. Serious mental illnesses are very clearly physical illnesses and should be treated as such. The two groups have different starting points. It is folly to think otherwise. People with Schizophrenia and Bipolar one will clearly be disadvantaged if policies follow from the Commission’s flawed Draft document. The Mental Health Acts are failing the seriously mentally and the commission should address this.

With respect to Goal 8, I would say that all the politically-correct thinking in the draft report will ensure is that the three percent really needing top notch service will remain in the shadows, but anyone with mental “troubles” will be able to get what they ask for. Rome has been burning for those with serious mental illness and we should not have to wait another ten years for the mess to be turned around. In the meantime we shall see more homeless and more ending up in prison.

Reference

When There are Almost No State Beds Left? by Lamb et al. (Click Here). For further list of readings see my Presentation to the Ontario Select Committee (click below).


Go to: Presentation to Ontario Select Committee on Mental Health and Addictions Click Here

Back to: Schizophrenia Page (Click Here)

Back to: Home-Page  (Click Here)


This page was established by Patricia Forsdyke in May 2009 and was last edited 19 Sep 2010