Ontario’s mental-health system needs to be fixed now

Posted on September 4, 2010 in Health Debates

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TheGlobeandMail.com – Life/Health/Second Opinion – Implementing the recommendations of a legislature committee would launch a new era of compassion, care and safety
Published  Sep. 01, 2010.  Last updated on Thursday, Sep. 02, 2010.   Andre Picard

What a cruel juxtaposition of events.

Last Thursday, a committee of the Ontario Legislature released a hard-hitting report on the need to fundamentally transform the province’s mental-health and addictions system.

Then, on Sunday, as if to underscore the urgency of implementing their recommendations, Toronto Police shot to death 25-year-old Reyal Jensen Jardine-Douglas. The shooting is still under investigation, but his “crime” seems to have been to suffer from mental illness.

The scenario is depressingly familiar: Young man has a psychotic episode, police are called (usually by a concerned family member), the agitated individual (screaming threats and sometimes brandishing a weapon) refuses to obey police orders. Bullets fly. Another “crazy” person dies. Then we are all left to wonder why.

Invariably, police and families are put in this untenable situation because the sick individual was untreated. The shooter, the ill person and the grieving family are all victims – of a broken system.

Mr. Jardine-Douglas is a case in point. Suffering from severe paranoia, he was taken to the family doctor on Aug. 27. His condition worsened so, the next day, his family took him to a hospital, where he was turned away because no psychiatrist was available. Help was sought at a second hospital, but the man refused treatment (not unusual for people with severe mental illness) and fled. Police were called because the family feared for his life. Not long after, Mr. Jardine-Douglas was making a scene on a city bus, then he was shot. He is dead because he didn’t get timely, appropriate care.

“We are convinced that a radical transformation of mental-health and addictions care is necessary if Ontarians are to get the care they need and deserve,” the committee headed by MPP Kevin Flynn wrote in a report tabled a few days earlier.

The MPPs heard many heart-wrenching stories about families’ inability to get care for their loved ones in a byzantine system, and about the frustrations of caregivers who have one hand tied behind their backs by senseless laws. To their credit, the politicians proposed some sensible, no-nonsense solutions.

First and foremost, they called for the creation of a new umbrella organization, Mental Health and Addictions Ontario.

Hold on, you might say, the last thing we need is more bureaucracy. But the single biggest problem with the mental-health system is that there is no system, only a muddled patchwork of services.

MHAO would be modelled on Cancer Care Ontario, which has been revolutionary by organizing cancer care in the province. Mental health needs the same medicine.

Currently, getting medical treatment, particularly for acute problems such as psychotic episodes, is nearly impossible. Emergency-room protocols are uneven at best; 24/7 mobile crisis-intervention teams work marvellously, but they are few and far between. There is an acute lack of treatment beds, particularly in psychiatric hospitals. While these institutions have fallen out of favour, they are essential for the sickest of the sick.

Most people suffering from mental illness live in the community, but getting appropriate care in the real world is dizzyingly complex. They need housing as much as medication and they need income as much as counselling, but our social welfare system operates in silos.

Mental-health and addiction services are funded or provided by 10 different provincial ministries. Community care is delivered by 440 children’s mental-health agencies, 330 adult mental-health agencies, 150 substance-abuse treatment groups and 50 problem-gambling centres. There are many well-meaning programs, but there is no co-ordination and little collaboration.

The lack of leadership and accountability is disturbing, and sometimes deadly.

The legislature committee pointed out, quite astutely, that while mental illness and addictions are medical conditions, they have become criminalized to a troubling degree. More than one-third of people in custody in Ontario suffer from a diagnosed mental illness and substance abuse is a factor in half of all criminal offences.

“Far too many Ontarians experience their first contact with the mental-health system through the justice system,” the MPPs wrote.

Police need to be better trained to deal with people suffering from mental illness and these sick individuals need to be sentenced to care, not jail.

One of the most compelling aspects of the report – and one that will probably prove to be the most controversial – is the call to broaden the criteria for involuntary admission (and, by extension, limit the right of severely mentally ill people to refuse treatment.) “The right to autonomy must be balanced by the right to be well,” the committee wrote.

It is a travesty that families have trouble getting care for family members who are clearly very ill, yet refuse treatment or are too quickly discharged.

This is not freedom, it’s a death sentence.

Similarly, privacy laws create perverse situations where families are emotionally and financially invested in caring for a loved one but are denied even the most basic information about their condition.

The recommendations made by the all-party committee are not new, but they are stated plainly, concisely and with an appropriate sense of urgency. Given the unanimity, there should not be a moment’s hesitation to act.

As the MPPs said succinctly in the report’s conclusion: “The necessary changes have yet to be made and individuals continue to suffer.”

Implementing the recommendations would launch a new era of compassion, care and safety for mentally ill people and their families. Inaction will leave us all with blood on our hands.

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