A Second Class System of Care

In an article posted to the London Free Press I was interviewed, along with Chris Moss, about the way mental health crises are handled in London and about a formal complaint my wife and I have with the way mental health crisis calls are handled by our current system. For our family there were two calls on two different dates that we felt were not handled appropriately. Underlying the whole of the mental health system is the fact that it is demonstrable that mental illness is not taken seriously as a medical issue in our country, province, or country. As a matter of fact, Canada is still the only G7 country to not have a national mental health policy. All of this despite the fact that more than 25% of our population, actually more, will at some point in their lives experience a mental illness. Given all this i offer this post, along with previous posts, in order to expand upon the great reporting Jen O’Brien did with her article in the London Free Press.

Our family has been dealing with the fractured mental health system for more than 15 years. Our complaint arose from two calls our family made to the Mental Health Crisis Line and the disappointing service we received. Our calls to this service, specifically created to deal with people having a mental health crisis, were deeply concerning on a number of levels. The reasons for our formal complaint are as follows:

When we called we asked for help and were told to call 911 or go to the hospital. When asked which hospital we were told the one closest to us;

When we called the first time, we were not asked if we would like the mobile mental health crisis team from CMHA to respond;

We were not asked about any diagnosis or existing care;

When during our second call we asked for the mobile crisis team, instead of confirming that they were coming, we were asked to call back to confirm their availability;

We were not informed that those responding to the calls to the crisis line were volunteers; and

It was up to us, those who were in crisis, to call back to the line for updates or to see when the mobile crisis team was available.

Let me unpack the reasons why the six points above are important and why they constitute a second class approach to a medical crisis that no other medical emergency has to deal with.

Why was it a problem to call 911 or go to the hospital? In terms of calling 911, the response would have likely been the police coming to our home. Police are, sadly, often burdened with mental health emergencies and this not only creates a clear stigma with mental health but also creates increased costs and time for policing. The police are not called when someone breaks their arm but in many cases of mental illness crisis, again a medical crisis, they are called to respond. In the case of going to the hospital the problem is that hospital emergency rooms are often ill-equipped to deal with mental illness and you often have to present with very specific and narrowly defined problems in order to get immediate treatment. The problem with being told to go to the closest hospital is we would go to University Hospital. Yet most of the mental health hospital crisis work is done at Victoria Hospital. In both the case of 911 and the referral to go to the hospital, it underscored for our family a lack of understanding of the resources, care path, and mental health system in London that someone in a mental health crisis requires in our city. The result is that the person in crisis could be sent to places where they would be sent to other places to get the care they need. In other words, the management of the crisis is left to those who are in crisis. This is not the case with any other medical crisis.

The mobile mental health crisis team can come to your home? Yes, and during our first call, this was not offered. BUT there are only two people working on that team at anytime for the entire city of 360,000. So the result could be, and was for us the second time we called, that we had to call back to see if the mobile team was free. Again the management of the crisis is left to those who are in crisis unlike any other medical crisis.

Why should you have been asked about any diagnosis or existing care? In any medical crisis you are asked do you have any pre-existing medical condition? Are you allergic to anything? Who is your family doctor? In the case of mental health crisis we were not asked about any existing diagnosis nor were we asked about any existing care. This information can be of critical importance for the responding crisis team and be useful for the person handling the call in order to understand the need for support and directing the caller to that appropriate support. In our case these questions were not asked. Again it speaks to the difference in care and triage mental health crisis get as opposed to other medical crisis.

Why was it a problem for you to call back to see if the crisis team was available? In any other emergency call for medical aid you would never have to call back. it would be inconceivable to Londoners to be told by a 911 operator, “Sorry but we’re busy right, now can you call back in an hour?” They would stay on the phone with you until help arrived. If they became disconnected they would call you back immediately. In the case of mental health crisis, again a medical crisis, you are expected to call back to see if the help you need is available. for a third time I point out that he management of the crisis is left to those who are in crisis unlike any other medical crisis.

Why is it a problem for volunteers to take these calls? There is no doubt in my mind that the volunteers who stand by the phones at the mental health crisis line are fantastic people who are there to selflessly give service to their community. They receive more than 30 hours of training before they are allowed to be on a call. But let me ask this. Would you be comfortable if a volunteer was handling your 911 call? Would you be comfortable if a volunteer handled the calls to Telehealth? I suspect the answer would be no. The reason being is that when a professional is answering those calls, they have a number of years of training, an understanding of trauma informed care, and an understanding of the system and the needs of the person calling. In the case of the mental health crisis line the same standard of care is not applied to those with a mental health crisis, despite the fact that we are dealing with a medical emergency. Also, the standard of care we expect from a professional is different from the standard of care we receive from a volunteer. So why is there a different standard of care for mental illness as opposed to a broken arm or an insulin issue or a heart attack? The consequences can be equally as life threatening.

The management of the crisis is left to those who are in crisis unlike any other medical crisis. If there was any one thing that showed the prejudice in care that those with a mental illness receive that every other medical condition does not it is this: If you have a broken arm and go to emergency you are immediately assessed and a treatment path is established. If you have a heart attack you are immediately assessed and a treatment path is established. If you have a fever and go to a walk in clinic you will be seen and a treatment path is established. In the case of metal illness none of this is the case. For mental illness you are expected to navigate the treatment care path yourself. You arrive at a hospital that may or may not have a psychiatrist on call and are more than likely going to be asked to call a community mental health agency the next day. If you require a diagnosis for a mental health issue you will likely wait a year to 18 months. If you require support from a community agency it is up to you to make the appointments and to arrive and to fill out the required paper work. You may have to do this at multiple agencies and fill out the same kinds of forms over and over again. You will also likely wait weeks or months for care at these agencies. Let us imagine a cancer patient who arrived, had to wait a year for diagnosis, and had to find their own care within the hospital system and community. You might not survive and the community would scream in outrage. Yet with mental illness, where suicide is the leading cause of non-accidental death, this is exactly what happens. Mental health is prejudiced against in the level care. Yet I hear very little community outrage.

This week we met with the London Distress Centre, CMHA, a representative of the LIHN, and others to discuss our complaint. We were met with an openness and empathy that was really wonderful. We felt our complaint was well heard, questions were thoughtfully asked, we were given full licence to speak directly to the issues, and were told that our complaint would lead to changes. This was handled by the leadership of these organizations very well and my wife and I are thankful.

The problem that our complaint and the article in the Free Press illustrates however is not that volunteers are horrible, or that the London Distress Centre is horrible, or that we were treated shabbily but that our system of mental health response and care is fundamentally broken. The jurisdiction of care is split between multiple provincial ministries, the funding for mental health care is a failure, and the response to the growing epidemic of mental health issues in communities is so far below what other medical conditions receives that is in fact a demonstrable prejudice against those who have a mental illness.

it would be easy to point to the current Liberal government and scream my frustration and blame them for where we are. But in fact the Liberals, NDP, and Conservatives are all equally culpable in the lack of thought and resources our current mental health system has. I was one of the first people to speak to the multi-party Select Committee on Mental Health and Addiction at Queen’s Park. Subsequently, the committee made recommendations that have not been acted upon. I would rather see all three parties now come together and enact those recommendations rather than what will happen. A series of finger pointing and blame gaming between the parties that will be full of sound and fury signifying nothing. Because that will be exactly the result if all three parties don’t work together. NOTHING.

Locally CMHA is still waiting for the funding to be released for a Mental Health Crisis Centre where an individual in crisis can refer themselves and be seen and stay if needed, Why hasn’t this been completed yet? Because the funding has not been released by the Ministry of Health. Why given the need? Thats’ a great question that needs an answer.

Locally our Municipal Council has talked about reducing barriers for the vulnerable as a part of their strategic plan. They could put pressure on the Ministry to help get this crisis centre done so that a serious barrier can be removed. They need to  inform themselves about the complex mess that is our local mental health system.

The final responsibility though resides with each and every citizen. The citizens are caring people and show it many times and in many ways. But when it comes to action on one of the leading medical issues facing us today, we are largely silent and the costs, both in terms of wasted resources and human suffering, is immense. So I appeal to you on behalf of the thousands that have a mental illness. Stand up and demand a change. Call your councillor, MPP, and MP and say that you expect action to finally create an equitable system of care. If you belong to a political party bring it up to your riding association and candidate. if you are a ward resident make it a priority for your Councillor and our Mayor.

Some of us have been in this fight for a long, long time and we’re getting a little tired. We need your help now to change the inequality of care that those we love get. Without you nothing will change and across our country, province, and city hundreds of thousands will continue to suffer being treated with second class care.

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