B.C.’s mental-health system has become, for strange reasons, out of control.
That’s the most common concern expressed in the huge response the Vancouver Sun received to an article about my father, who had schizophrenia, which concluded he would very likely not have survived B.C.’s current mental-health system.
A Second World War ambulance driver who had a psychotic breakdown when he was 27, Harold Todd spent almost two decades in the now-defunct Riverview Hospital before being transferred to a non-profit Vancouver boarding home offering basic support, where he lived a modest life for 25 years until he died in 1999.
A flood of anguish-filled comments and correspondence came in, flowing from family members of mentally ill people, psychiatric nurses, politicians and medical ethicists. Some offered support for a re-imagined Riverview and the benefits of boarding homes, most of which have been dismantled. Some were frustrated policy-makers seem held back by the fear of appearing “paternalistic.”
Most recounted heart-breaking family tragedies, about how they felt both them and the so-called “system” suffered defeat in trying to care for struggling dads and moms, brothers and sisters, aunts and uncles. So many people with mental-health problems – often sensitive and gifted, who loved to play chess or tennis or discuss philosophy – succumbed to addiction, crime, homelessness or suicide.
System failure
I wish I could include the family stories of every correspondent.
Sydney Foran was just one of scores who wrote eloquently, including about growing up in the same tree-lined Kitsilano neighbourhood where my father lived in a supportive boarding house, whose residents were accepted by the community.
Suffice to say, Foran’s brother, Don, was not as “fortunate” as my father in his battle with mental difficulties. The short version of the life of Don, an actor, is he ended up alone in the Downtown Eastside, where he recently died of complications from addiction.
“I now live in the West End and see ‘Don’ on the street all the time,” Foran says. “I see people like him with mental illness and/or addiction, struggling to survive every day. I cannot tell you how broken my heart is for all those who will die, alone, cold and in pain, feeling unloved.”
Hospital discharges to nowhere
Many were appalled at the wretched state of Vancouver’s 7,500 SRO, or single-room occupancy, units where the majority of mentally ill and addicted end up.
Recently retired psychiatric nurse Maureen Roper said she is one of the majority working in B.C. hospitals who are constantly “saddened to see all the vulnerable clients discharged into SROs after a good admission to hospital to stabilize them.”
Elected officials: ‘Things are so much worse’
Nanaimo Mayor Leonard Krog, who this week had to deal with a shooting inside an encampment in his city, said, “Things are so much worse than in your father’s time.” Nanaimo has almost 900 homeless people — more per capita than anywhere in Canada — and prosecutors tell Krog 80 per cent of those involved in criminal activity have mental health or addiction issues. Usually both.
Conservative MP Tako Van Popta (Langley-Abbotsford) raised the story of my father in the House of Commons in debate over Bill 39. Van Popa argued for improving housing and other services for mentally ill people, rather than the Liberal government paving the way for them to be euthanized through MAID.
Defending boarding homes
It was amazing how many people recounted positive experiences with boarding houses, most of which are gone.
Lenore Rowntree, who is involved in advocacy, is grateful for one of the rare boarding homes that still exists in Vancouver, in this case for mentally ill women. It remains open mostly out of the sheer goodwill of the owner. Rowntree’s sister has been there 15 years. But it’s impossible for new folks to get in.
Steve Jackson, a retired editor, grew up in a Vancouver boarding home run by his mother.
“My mother and I would watch TV with residents and sometimes play cards or board games with them. At Christmas she gave everyone a small gift, followed by a turkey dinner and homemade Christmas pudding. She hired workers to keep the place clean, do laundry, help with food preparation and the routine job of handing out medications — at 10 a.m. daily — to the 18 or so patients.”
That system seemed to work, but it’s mostly been abandoned.
Developer Michael Audain, chair of Polygon Homes, believes there is a lot to be said for boarding-style homes, after witnessing them in a variety of countries.
“I learnt in England that the best accommodation for people who are not ready for completely independent living is a group home of some kind, or a covey of say 10 to 12 small apartments in which a resident manager keeps an eye on the residents, lending a hand for shopping and other chores. And, importantly, ensuring they take their meds.”
Anxiety about ‘paternalism’ caused setback
Many readers supported the worries of frontline Downtown Eastside psychiatrist Bill MacEwan, who said too many officials responsible for mentally ill people decided that boarding homes like Capa Lodge, which offered my father three meals a day, were “paternalistic.”
The officials phased out Riverview, as well as smaller intermediate-care facilities, by arguing mentally ill people should have independence. Former provincial NDP cabinet minister Tom Perry experienced the push in the 1990s to de-institutionalization, which was largely spurred by an over-reaction to the movie, One Flew Over the Cuckoo’s Nest, in which Jack Nicholson plays a mental patient rebelling against a sadistic psychiatric nurse.
Reformers, Perry said, seemed “ignorant of how chaotic life can be for people with severe mental illness.”
Walter Glannon, a professor who has served as a medical ethicist for B.C. hospitals, was one of many concerned about how the tragedy in mental-health care in North America grew out of the 1970s anti-psychiatry movement.
“Claiming that the very idea of institutionalization was paternalistic and violated patients’ autonomy, advocates of this movement argued that moving patients out of mental hospitals was in their best interests. In many cases, this clearly has been false. The disease often takes away their autonomy.”