Category Archives: Mental Health

Day Three – Left To Our Own Devices

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In the town where I live, I am often very lonely. I don’t have a lot of friends here and don’t see the ones I do have very often. There are some very concrete reasons for my absenting myself from friends and why I am often lonely. This town encourages loneliness, and many, many, many people have told me how difficult they find it making friends here. But this loneliness is not only about my town but also about your town ans the fact that loneliness not only happens here but happens everywhere in such massive numbers that I think it will effect our near and long term future.

I am sure you’ve read about the plague of loneliness that has gripped the western world. I am sure you’re aware of how exasperated that is with the arrival of this virus. It further strips people of any connections they have to other people, and the result is more isolation without any hope of connections to other people. I had read somewhere recently that there has been a huge increase over the last 5 years to help lines and that the volunteers who work those lines have regulars who call every day because that is the only connection to the world they have. Did you know that loneliness can lead to an increase of 30% in early death? I didn’t, but it makes sense to me. So those people who are calling helplines as their only source of social connection are more likely to die because of how alone in the world they are. Doesn’t that break your heart?

In Japan, the lonely and self-isolating are called Hikikomori. Japan has an official number of 1.15 million Hikikomori but experts tell us that this number is more likely 10 million. These people purposely withdraw from society. They are so hurt or bewildered by the world around them that they withdraw from all contact. Shutting themselves up in their apartments, never leaving. Many times they only come out when neighbours complain of smells and authorities investigate finding these poor individuals have died. I think I understand some of the reasons people become Hikikomori. The depths of their pain and hurt must be so extreme that they would rather not see anyone. Ever.

Why I am sharing all this with you? Well because I don’t think about this issue very often and am sure many of you never give it much thought either. More importantly, I want you to consider how we got to the point where people have to call helplines in order not to feel lonely. How did it come to pass that there is such an epidemic of loneliness that it is reported in the planets major newspapers as a substantial public health issue..

I believe that this global loneliness is also linked with the rise in bullying, loss of civility, our inability to see past our own point of view, and growing seeming indifference to one another. We humans are changing friends. We seem to be more lonely, less able to see opportunities for understanding and collaboration, and hardened and indifferent to the suffering that is growing around us.

I am not sure we can change the course we are on, and I would like to leave you with a typically hopeful ending to this kind of blog, but I am not sure I can. I know I am lonely, and I know you are likely alone as well. Both of us knowing this, we don’t seem to be able to connect and change the course of that isolation. So will we become a world of Hikikomori? This may be how many people end up. Unable to cope with the shattered world around them. I hope not, but I am unsure if we collectively have a heart big enough to overcome this and the rest of our problems.

I will look out my window, watch, and see what happens.

Throwing Birds

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I have been struggling for some time now to articulate my growing alarm in how we come to grips with the bewildering way we work on mental health. In London Ontario mental illness has increased 132% since 2003 and the question I have to ask is why was there an increase given the attention mental health has received? Today is Bell Lets Talk and this is a laudable effort by Bell Media to create conversations and awareness around mental illness. Yet I would argue that there has been no significant change in how we address the causes, or in the the access to care, for those with a mental illness. So I have to ask “Do we know what we are doing?”

I believe, deeply , that this is not the fault of organizations like CMHA, CAMH, Vanier, Ways, Family Service Thames Valley, or any other agency locally or provincial.These agencies act on the priorities of funders such as governments and foundations.They make the best case they can for funding services largely based upon how funders believe we should be addressing this issue. Yet we don’t really seem to be making any progress on moving the needle significantly on mental health so my next question is “ Do funders understand where we should be focusing our efforts?”

Let me also make you aware that other issues come into play when we speak of mental illness. Poverty is the greatest cause of mental illness and my friend Abe Oudshoorn laid out a compelling case about this and how we discuss mental health. Take some time to read Abe’s important blog on this.

I believe that in order to make significant progress on creating the conditions for recovery we have to address three main areas. The first is obvious and that is funding. In mental health, funding is significantly lower than for other health issues and if you are a child or youth the funding is even lower. In any issue in which the most vulnerable are supported, funding is the gas in the tank to power the motor toward a sustainable system of care.

All too often the discussion of funding conditions for sustainable recovery are drowned out in the media and online by cries of taxes being to high. As a matter of fact this issues, and others, cannot be heard over the hue and cry of MY TAXES ARE TO HIGH. The result is that politicians, especially during elections, are fully engaged in the dance politic and issues of poverty and mental health are left on the side hoping someone will ask them to dance. This is our fault fellow citizens. The narrative we create is about our money when perhaps it should be about compassion and care. If we collectively change the tune then perhaps issues of care for the most vulnerable will be asked to the dance .

The second area is all about the funders themselves. From the Federal, Provincial, and Municipal governments the narrative is more about accountability than it is about quality and efficacy of care. The same is true of foundations and other funders locally, provincially, and nationally. Rather than ensuring the way we are addressing issues of wellness are responsive, effective, and adaptable , we end up with a system that adheres strictly to the regimes of outputs and outcomes. There is very little opportunity to sustainably test new approaches and implement them in our systems. Rather there is an endless series of pilots and initiatives that are rolled out with a lot of fanfare but usually end up being shelved and never implemented. So unless we the citizens, and the funders who we support, frankly get revolutionary about the criteria for funding and reporting then there will be no change.

The third and final area is planning. I believe the way we now plan how to respond to mental health, or any other social issue, is so woefully inadequate that we end up with a patch work system of care that has become a culture of fractured intentions rather than a meaningful eco-system approach. Each of the players on this field, from funders to agencies, have their own mission and vision combined with a mountain of strategic plans surrounded by a public that is worried about their own individual economic well-being, that leaves an ever-increasing number of people stranded and ill. In his smart book Social Labs: A Revolution, Zaid Hassan described how we think planning works and what actually is happening when we do. Said makes the point that we live in a complex adaptive environment with massive interconnected systems that continually create ruptures in our societies. We only need look to economic train wreck of 2008 or the current value of the looney for examples of complex systems creating local ruptures. In the example on planning he points to this analogy: Imagine you throw a rock. You can pretty reasonably guess where that rock will land. You can plot its trajectory and understand the impact it will make when it hits the ground. This is how we do planning today. We create plans that say by X date we will have done X things with X number of people. But now imagine instead of throwing a rock you throw a bird. Can you reasonably plot it’s trajectory? Can you make a reasonable guess where it will land? Can you make a reasoned guess as to the impact it will make? No you cannot. You will have no idea where that bird will fly or the path it will take. So why, when we are dealing with complex macro economic forces, complex societal forces, complex interdependent systems, and the most complex of all – human beings in crisis, do we make plans based on throwing rocks when in fact we are throwing birds? Governments, funders, and agencies need to think about this seriously and invite us citizens in to come up with a different approach. There is a way to do this.

SO on this, Bell Lets Talk Day 2016, what should we be talking about? Abe did a great job of speaking to the issues of poverty and mental health, but we also need to be talking about the system and methods we create to sustainably and effectively MOVE THE NEEDLE. Right now we are not and the results, unless we are willing to make a meaningful effort, will be even more tragic than they are today.

A Second Class System of Care

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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.

A Broken System of Care That We Don’t Want to Fix – Mental Health

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So a young woman kills herself because she can not get the mental health care she needs. If you think this is a new story then think again. This is not a new story at all. This is a story i have seen personally play out many times. I’ve seen it play out in deaths, I’ve seen it play out in broken families, i’ve seen it play out in children not getting the care they need, and i am sick of it. Really, really sick of it.

I know so many good hearted people who work in the mental health system who try hard every day to make a difference for those who have these illnesses. They put in unbelievable hours and deal with an encyclopedia of tragedy and woe that those who suffer with mental illness endure but in the end it does not matter. enough.

It doesn’t matter because despite public campaigns about stigma, despite videos of celebrities who speak up about their struggles, despite more than 1,000 people filling a breakfast here in London about mental health it doesn’t matter in the end. Why? Because despite all this pressure and all this public talk we, the citizens of this country, province, city, do not care enough to make sure that our political parties fund mental health and make sure that services are delivered not just well, but brilliantly.

Many speak about the stigma of mental health but it’s not stigma. No, stigma is much too polite a word for what is really happening here. The word we should be using is prejudice. Our system that we empower, our workplaces where we serve, our hospitals and schools where we learn, are prejudiced against those with mental illness. If you went to the emergency room with a broken arm then you would be treated immediately. If you had diabetes then you would have a system of care around you that would ensure you did not die. If you had cancer then you would have an inspiring system of medical and psychological support while you battled through this affliction and at the end you would get to ring a bell. There is no bell for mental illness. There is no support at the ER, no coordinated handoff between community and hospital care, and we deal with mental illness though the police being called. There is no other word for this but prejudice.

In the end friends, every one of us is culpable in the death of this young woman, Jenepher Watt. We chose not to pay for the care that she and hundreds of thousands need in order to give them a chance at the life they deserve.  The child and youth mental health system is brokenly divided between the health, social service,  education, and often justice system. The adult system is broken between the health,  community, and justice system.  There is turf protecting, there is risk avoidance, there is a failure on all of our parts to point to the issues. And the largest failure is that we choose, WE CHOOSE, not to insist this fractured system be fixed and properly funded. 

If I sound angry friends, then I am sorry but I am angry. I am so angry that I feel helpless. I am angry that the NDP and the Conservatives will use this as fodder for their own political ends. I am angry that the Liberals have not fixed this system yet. And I am angry at myself because I haven’t managed to do enough to change it and convince the rest of you to stop talking and do something about it. It’s time for Canada to stop being the only country in the G8 with out a national policy on mental health.

I have seen this story play out in my family, my friends, my community, and I sick of it. I am sick of seeing deaths and wasted lives. I am sick of seeing dedicated workers not know what to do. I am sick of our collective indifference to this pandemic of illness in our communities. And yet I am still stubborn enough, or foolish enough, to think that if we choose to, then this would all change and we would not have any more Jeniphers to mourn. Instead, we would all be celebrating their and our lives. But we choose not to make that happen. Maybe it’s time to change our minds and make something happen. Please, I am begging you,  MAKE SOMETHING HAPPEN. MAKE SOMETHING HAPPEN. CHANGE THIS BROKEN SYSTEM. Write your MPP’s and MP’s and City Councillors and demand that this has to change and they have to cooperate to do it.

Federal 

Mister of Health – Federal Government

The Honourable Rona Ambrose, P.C., M.P.

Send Comments here – http://www.hc-sc.gc.ca/contact/ahc-asc/minist-eng.php

MP London North Centre

Susan Truppe

Email – susan.Truppe@parl.gc.ca

MP London West

Ed Holder

Email – ed.holder.c1@parl.gc.ca

MP London Fanshawe

Irene Mathyssen

irene.mathyssen@parl.gc.ca

Provincial

Minister of Health – Ontario

Hon. Dr. Eric Hoskins

Send comments here – http://www.health.gov.on.ca/en/common/default.aspx

Deb Matthews

Minister Responsible for the Poverty Reduction Strategy

Deputy Premier

President of the Treasury Board

MPP London North Centre

dmatthews.mpp@liberal.ola.org

Peggy Sattler

MPP  – London West

psattler-qp@ndp.on.ca

Teresa Armstong

MPP – London Fanshawe

tarmstrong-qp@ndp.on.ca

Local 

London City Council

https://www.london.ca/city-hall/city-council/Pages/default.aspx

Out of Sight – Out of Mind: Homelessness and Mental Health

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There have been a number of tragedies stemming from the terrible death of David MacPherson in the fire at the unregulated group home last week. The tragedy that someone would run a home like this this is not be accredited; the tragedy that there are so many in London that need this assistance and have no where else to go; the tragedy of there being no way for these people who found each other to stay together; and the list goes on and on and on and on. But in all our hand wringing and calls for of blame and change we might want to take a minute and pause.

Already the blame is starting to roll out thick and fast, and in collective righteous indignation we will ask how could the fire department, mental health advocates, hospitals, police, city, government allow this to happen? We will insist that there needs to be an investigation and that there must be change! The public will demand that this never happen again! The public will want someone to pay for this tragedy! The public will want that someone to make sure that David MacPherson’s death was not in vain! The public will want some good to come from this! 

Also, quietly in the background, in meetings behind closed doors, the hospitals will be talking to community mental health agencies and asking them not to aggravate the situation , the LHIN will be asking the hospitals to keep things calm, the endless and unfeeling machinery of turf protection and blame dodging will continue unabated and the result will be exactly nothing.

But perhaps the public, you, me, us, might want to take a good long look in the mirror, and understand our culpability in this and thousands of other deaths like David’s. In the end, after all the finger pointing and indignant outrage by politicians and media, by well intentioned but completely uniformed community and media leaders, we can sit down and talk about the heart of this matter.

The fact is that this death, and thousands of other deaths, happen because we are too cheap to pay for services for someone like David MacPherson. An organization like People Helping People would never need to exist if we decided that it was important that people are not left homeless. Their leader, Mr. Charles, would never be needed if we thought that mental health services were important. The landlord would have already been charged and prosecuted if we thought it was important that the fire department had the heft it needed to charge him.But we’d rather low taxes and not to think about it to much.

We don’t care enough to fix the issues of homelessness, mental health and addictions in our city, province, or country. We are so much more concerned with watching politicians point fingers, talk show radio hosts offer overly simplistic one liners, and with hoping that it will all go away soon. And there is the nub of the issue friends. Really, we want it all to go away. We want the people on Dundas and Richmond and the people in Old East Village to be out of sight. Because if they’re out of sight then they’re out of mind and we don’t want to think about this anymore. Despite protestations to the contrary, we don’t want to pay for the care that will create a home so they can get the treatment that will stop a death like David MacPherson’s. We will feel bad, but in the end David’s death is the price of keeping taxes low and that’s too bad but that’s the way it is.

Some will say “but times are tough and we can’t afford great services” but this argument has a hollow ring to it. We’ve been cutting services for the last 20 years and the majority of that time the economy has been fine so it makes little sense. Some will say it’s the fault of the heartless conservatives or the spend and tax liberals but we put them there and they respond to what we want so that argument rings hollow as well so deaths happen and we look away.

This week we opened a really outstanding mental health hospital in London and that’s a good thing. It’s taken 23 years to build and because of that it has now cost $1 billion dollars, but I am glad it’s here. However, for $1 million dollars we could create more emergency shelter beds, for $7 million we could build some affordable housing, and for $20 million there would a lot fewer David MacPherson’s this year and next. This seems small next to $1 billion, But we won’t pay it because we have been sold the mantra that taxes are bad for more than 30 years and so there’ll be more David’s and more groups like People Helping People and more predatory landlords taking advantage and the end result will be more preventable deaths and more homelessness and more blame and…. well you get the idea.

Nothing will change and nothing good will come from David MacPherson’s death because we don’t care enough to pay the taxes to make sure it doesn’t happen again. That’s the truth. But don’t worry about it. Once the media storm passes things will go back to normal and then you won’t have to think about it. It will be out of sigh and out of mind.

Sensationalism, mental illness, and the London Free Press

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It was with alarm that I became aware of an article by London Free Press reporter Jonathon Sher about Bethesda House, LHSC, and mental illness where Mr. Sher made some broad assumptions about not only those who have a mental illness, but about how we, as citizens of London should feel about them and the places where they are treated. The fact is that 1 in 5 of us has, or will have in the course of our lives, a mental illness. My personal  experience has been documented in other posts here, here, and here. I also have direct experience with advocating at all levels for the need for increased support for those with a mental illness.

Our own parliament defines mental health as:“Mental health is defined as the capacity to feel, think and act in ways that enhance one’s ability to enjoy life and deal with challenges.” 

Mental illness is defined by the Public Health Agency of Canada as: “Mental illnesses are characterized by alterations in thinking, mood or behaviour associated with significant distress and impaired functioning.”

The Canadian Psychiatric Association quite rightly points our the dangers of how we define mental illness saying, “Mental illness and mental disorder are not easy to define. Misunderstandings lead to misuse and abuse of the terms, reinforce myths, and even prevent people from getting help when it is really needed.

The media has shaped many of the ways we think of people with mental illness through movies and TV like Psycho, American and Dexter, watching the real-life drama of Charlie Sheen and Bi-Polar/Bi-winning, or the sensational news stories of murderous rampages. We often don’t think  of people with mental health issues as having a medical and treatable illness. Mental illness makes many people very uncomfortable and since it is an “invisible” illness, it’s hard for us to understand the circumstances of a person with a mental illness in the same way we might if a person had cancer or a serious physical disability.

In the article published by the Free Press, of which there are two versions (version one and version two), there is an implication that some possibly dangerous people will be moving into the recently acquired Bethesda House and that the public need to be informed. The title of the article on May 15th was “London Health Sciences Centre’s secret: Program for psychotic disorders could move to former Bethesda Centre” and it opened with the following sentence, “London’s largest hospital is considering moving a program for adolescents and young adults with schizophrenia and other psychotic disorders into a residential neighbourhood.“ The headline and first sentence are written in a way as to sensationalize this issue by implying that LHSC intentionally kept the move a “secret” because they feared the community’s response. Mr. Sher is perpetuating a stereotype that people with mental illnesses should be feared.  

Emphasizing  this point at the end of the first sentence Sher says, “a possibility officials didn’t acknowledge until pressed repeatedly by The Free Press.”  So not only is a threat moving into residential neighbourhoods, but it’s being hidden by our local hospital. The article goes on to say, “London Health Sciences Centre announced Wednesday what appeared to be unambiguous good news for the London neighbourhood tucked behind the Children’s Museum .“ So now we not only is there danger and a cover up, but Mr. Sher has made sure to let us know that it will be close to a children’s play facility. All of this in the first 57 words of his article. 

The article goes on to to explain that at first it was supposed to be only an eating disorders program moving to Bethesda but, “It was only after The Free Press insisted on a response that the head of the hospital acknowledged Thursday that PEPP might be moved.” What is PEPP? PEPP stands for the Prevention and Early Intervention Program for Psychoses which, according to the website for the program is, “a community-focused mental health program which provides prompt assessment and comprehensive, phase-specific medical and psychosocial treatment for individuals experiencing their first episode of psychosis. The program is structured around a modified assertive case management model. The intensity of the treatment is guided by the patient’s needs, the family’s needs and the stage of illness.” This program is designed to provide an early intervention to help teens and young adults in preventing serious mental illness. I worry however that these young people may stay away after the way these articles have framed them as a potential danger. Young adults are self-conscious enough about how they are viewed and as a result of these articles they may never go to PEPP to get the help they need.

The article, with help from an anonymous source inside the PEPP program, goes on to say  “We all find it odd that our clinic (PEPP) was left off of the letter. I think residents in the area should know just what kind of clinic is moving into their area,” and further states “There’s such a stigma in mental health and not including PEPP on the announcement isn’t helping matters,” a staff member wrote in an e-mail to The Free Press.”   What is troubling here is the seemingly incongruous statements of “I think area residents should know just what kind of clinic is moving into the area” and then to discuss stigma “There’s such a stigma in mental health and not including PEPP on the announcement isn’t helping matters.” So we have a statement that residents should be warned and then a statement about the stigma for those with mental illnesses. A warning on the one hand and then the pointing to the damage of stigma on the other. 

The second article, which uses the same website address as the first, is headlined with “Neighbours cry foul at LHSC’s handling of possible move of psychoses program to residential area“ and again starts with the alarmist opening sentence, “A London hospital might move a program for those with schizophrenia and other psychoses into a residential neighbourhood.”  Very much like the first article, Mr.Sher has linked mental illness with the inference of danger moving into a residential neighbourhood. Much of the next several paragraphs are the same as the first article then we have the response from neighbours, “The lack of disclosure upset neighbours, who received notices from the hospital that made no mention of the psychoses program.” Again the inference of some cover up of danger by not sharing this information with the neighbours. 

Both articles imply that mental illness is dangerous and the hospital is trying to cover up the move of PEPP and at the end of each article, the following poll appears. “Would you be upset if a program for people with psychotic disorders moved into your neighbourhood? “ I’m not sure The London Free Press could be any less ambiguous about the linking of those with a mental illness to causing disruption and danger to a neighbourhood. This insensitivity to those with mental illness leads to increased stigma and prejudice and is being amplified by the very large reach of our local newspaper.

I have no argument that LHSC should have been much more thoughtful about the potential move of these programs. They seem to have dropped the ball and it also seems to me that in this case there are some employees with an axe to grind about the program’s move and because they had that axe to grind they contacted The London Free Press. Fair enough, and so they should, but to then create the kind of connections the article did between implied danger and young adults with serious mental health issues is sensational, insensitive and unfeeling. If a diabetes program were to move into the neighbourhood would Mr. Sher be as compelled to shine the light of journalism on this issue? If the hospital hid plans to move a geriatric specialist  into the neighbourhood should we not also be worried?  All those old people are coming from somewhere and they’re coming to your neighbourhood! No, of course not, but in these articles this medical and physical illness is being ostracized for reasons I am having trouble understanding.

The lives of people with mental illnesses are hard enough without articles like these coming out and re-instilling false fears. We don’t need to be worried about the mentally ill living amongst us for indeed they already are and have always done so. Mr. Sher’s article has made it just that much harder for people with a mental illness, including those I love, to be accepted for who they are. I’m not sure why Mr. Sher reported this story with this slant but perhaps next time he covers mental health he could be a little less cavalier about linking mental illness with danger and perhaps a little more thoughtful about the impact this kind of writing has on our fellow Londoners with a mental illness. We could all learn a lesson here and exposing stigma and prejudice about mental illness is not only for Mental Health Day, in my house and in our community, it should be everyday. 

Our newspaper should better serve our community and not resort to this kind of sensational reporting. Most of the time it does this, but in the case of these two articles there is a lot of room for improvement. I hope that happens and I hope Mr. Sher pauses next time before increasing the prejudice and stigma of mental illness by linking it to cover ups and implied danger. Those with a mental illness and their families have enough of a burden already without the added weight of this kind of sensational reporting.

Here’s what you can do – Show Up

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The Citizens Panel

In my last post I asked where was everyone and many of you answered. I am deeply grateful for this. Some of you asked where you can show up and help and I have a suggestion for you that I hope and pray you’ll take me up on.  I’m involved with some amazing people, Rev. Kevin Dixon of St. Paul’s Cathedral, Sue Wilson of the Sisters of St. Joseph, James Shelley, co-ordinator of the City Symposium, and Eric Shepperd, and Glen Pearson, on a citizens panel trying to make some concrete suggestions for the thousands of people who are on Ontario Works and Ontario Disability Support Payments (ODSP). Our province, Ontario, is in the middle of a review of these services (called SARC for Social Assistance Review Committee) and as a part of this you have an opportunity here in London to speak to some very specific points in order improve the lives of the most vulnerable in the places where we live.

In London a review was held with agencies and people with lived experience currently using the OW/ODSP system. Some of the thoughts that came out of this were: “Londoners expressed interest in simplified social assistance rules. While they want consistency, they also want workers to be able to respond to their individual needs. They want a program that better provides enough income to meet the cost of living particularly for food and shelter and they want a program that includes transportation as a basic benefit. They want a program that allows people to keep more of the income they earn from working and want a program that does not require that assets virtually be depleted as a condition of eligibility. Having access to adequate housing is fundamental.”Click here to read the entire report form the London meeting.

Let me give a little background so you have something to go on. Currently if you are on Ontario Works you get about $582.00/month to live on. In London the Low Income Cut off measure ( the poverty line) is a little more than $1500/month. So if you’re making a little more than $1500/month you have enough to pay your rent, get groceries, buy your clothing, ride the bus, and generally squeak by. But remember if you’re on OW you’re only getting about  582/month. That’s a difference of more than $800/month.

(Graph supplied by James Shelly)

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Low income cut of vs OW vs ODSP

Also if you’re on OW or ODSP and you make a little extra cash, say you get a part-time job or 10 hours of work from a temporary employment agency, that gets clawed back from what you receive every month. So if you make an extra $100 that month 50.00 will be taken off of your OW cheque. So if I get paid $10.50/hr. for 10 hrs. that equals $105.00. But half of that, 52.50, will be deducted from my 582/month. So we end up with 529.00 for your OW cheque . So really I get paid $5.25 for every hour that I work while on Ontario Works.

I don’t know many people who would work for $5.25/hr. If I wanted to make 10 hours’ worth of pay I would have to work for 20 hrs on OW. Now some of you may think that this is a good deal, that we’re giving them money anyways so they should be grateful for what they get. But think about this for a second:

  1. The economy is really bad right now
  2. Part time work is becoming the norm
  3. 1 in 5 children live in poverty in London
  4. Would you work for 5.25/hr.?

Add to this, and I have seen this first hand, that you’re OW benefits may get cut off until OW verifies your income and we have a serious disincentive for anyone to try to make a little extra money.

At the City Symposium event on Dec. 13th we are going to be talking about the income gap that is growing ever wider in our country. We’re going to use this talk to then gather people around and offer recommendations to the City of London on this Social Assistance Review Process. The City will then take these recommendations and adopt them and send them on to the Provincial Government as well as the Federal Government. We will meet twice in January to do this.

So in my last post I asked you where you all were. In this post I am asking you all to show up on Dec.13th at the Wolf Performance Hall at the Central Library in Downtown London and to make a difference. You will hear about the growing income gap and then WE NEED YOU TO SHOW UP IN JANUARY  to input on improving the lives of our cities most vulnerable in a tangible, practical way.  I am begging you to make a difference. So tell your church leaders, your service clubs, your neighbours, your friends, your boss and coworkers, to show up, to make a difference, to be a part of something important.  I don’t think I’m asking too much. I just want you to change the world. Who’s in?

City Symposium 5 – Income Gap

Additional resources to understand the issue

What will we do? World Mental Health and World Homelessness Day

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I’ve been meaning to write the follow-up to my posts on mental health and the issues that surround it for some time now. But what with our Ontario Provincial Election and the demands of work, school, family and my to many projects the time just seemed to slip by. But today is World Mental Health Day and it’s World Homelessness Day and here in Canada its Thanks Giving so it’s apropos that I offer my solutions to what is often a black hole of issues.

First though a couple of things you need to realise about homelessness here in London Ontario and by extension the province, the country and the world. There are often 2000 people per night that sleep on the streets or in the limited shelters in our forested city. That’s a lot of folks with no family to celebrate this holiday with nor enjoy that holiday staple the turkey dinner and they live on the street. If this makes you feel bad good. I think we all have a collective shame to bear that we allow this to happen in community in which we live

The Cost of Poverty according to the Ontario Association of Food Banks is “The report finds that the economic cost of poverty in Ontario comes to $32 to $38 billion per year “ and with child poverty “If child poverty were eliminated, the extra income tax revenues nationally would be between $3.1 billion and $3.8 billion, while for Ontario, the additional (federal and provincial) taxes would amount to $1.3 billion to $1.6 billion.  The total economic cost (private and social) of child poverty Ontario is $4.6 to 5.9 billion annually.”  The London Free Press Reported recently about the London Food Bank  “As the food bank marks its 25th anniversary this month, use has gone up, not down. It has had an almost 10-fold increase in client families, to more than 3,200 a month. And still Londoners go hungry, are homeless and are unemployed.”

The Cost of Mental health is .  “$51 billion is the estimated cost of mental illness to the Canadian economy in terms of health care and lost productivity” and in Ontario “$34 billion is the cost of mental illness and addictions to the Ontario economy” according to the Centre for Addictions, and Mental Health(CAMH)

What you need to realize friends is that Mental Health, Poverty , and Homelessness are all deeply interrelated. But what can we do as ordinary citizens to change what seems to be an insurmountable problem? We can choose to act with a political and community minded will to ensure our governments address these as some of our highest priorities.

I can here you thinking “ Sure you keep talking about these issues but what are you offering as a solution?” Well I’m glad you asked. I suggest first that as a province and a country we need to stop talking about tax cuts and start talk about paying for the community, Province, and Country in which we want to live. This means that if I have to pay an extra $400/year in taxes to solve these issues then I’m willing to do that as the cost to making where I live a better place for everyone.

I also believe that we need to integrate our approach across disciplines. There can be no separation of church and state between health care, education, community and social services, police and justice, and the public. So on the issue of homelessness, poverty, and mental health there is a unified approach to taking action across the board that is driven by research and not politics.

A fairly straight forward thing that could happen immediately to help almost 53,000 people in London is to increase Ontario Works and ODSP (disability) payments to 10% above the low-income cut off line. At the same time we need to create a transition from OW to work. This means rather than claw back benefits when a family earns some money we allow them to keep it and once they have regular full-time employment then we allow them to keep their benefits for 6 months. This would ease the transition and ensure economic stability for that family.  With the current system this is impossible so families and individuals feel they cannot leave Ontario Works. I have seen this hundreds and hundreds of times in the past 4 years.  Our system actively discourages people from moving forward because it does not allow them to build an economic cushion. You are either on OW or your off.

This chart gives you an idea of the gap between what OW and ODSP pay and what the Low Income Cut Off mark is . This comes from Children’s Mental Health Ontario:

You can see that we have a long way to go but if we do decide to cover this distance and take on something that is important for the economic, health, and generational benefit of our community then we will be pulling down the huge economic and human cost of these underfunded and often ignored area.

In the end we can either deal with these issues honestly and with maturity or keep playing the tax cut shell game we have been for to many years. We as corporations, businesses, public institutions, governments, and most importantly citizens must decide how our communities will prioritize our efforts. I propose the priority is Poverty, Homelessness, and Mental Health, so that we have a community for all not just some.

5 MOMS AND THEIR KIDS LEFT BEHIND

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So what you may not know is that when it comes to any mental health issue affecting a child or a youth that the system is divided into three non-cooperative spheres. There are The Hospitals, The Schools, and The Mental Health Agencies in the community.  Now each of these is funded by three separate systems as well.  The Ministry of Health, The Ministry of Education, and Ministry of Child and Youth Services. Why is any of this important? Because for the last week I have been trying to get help to 5 different families all with children with extreme symptoms all of whom cannot get the help they need and these systems are not working together to solve these extreme issues.

So let’s imagine you are a mom with a child, say between 6 and 8, who is continually so out of control that he or she has completely trashed their room and you have a number of bruises and knocks and in some cases broken bones. Let’s also imagine that the child’s room has had to have all toys, furniture, closet doors, and lamps removed because when this child flies into a rage they hurl these things around. Also the child’s room has had the walls boarded up because the child has punched holes into. Let’s further imagine that the windows have been boarded up because the child has tried to hurl themselves through the window. Also this child has lashed out at siblings, parents, teachers, workers, hospital staff and relatives. Now as a parent you have had this child hospitalized, you have called the various crisis intake lines, you have gone through the various agencies and have applied for respite and counselling and …well you get the idea. Now given these above circumstances you would think that these three systems would do everything they could to support these moms and dads and get this child stabilized and the family some relief. Think again friends think again.

What happens instead is that first you’re parenting skills are called into question and you’re immediately but into a position of justifying that you are not the cause. This will often happen previous to any treatment. But it gets better folks. So again we’ll imagine that things are so bad that your child, or the police in many cases, is taken to the Emergency Room. You arrive hoping that you’ll get relief and support but sadly that is not often the case. The ER staff, who are heavily overworked, are usually under trained when it comes to child and youth psychiatric issues. So you tell your story and you wait to be seen by a resident in psychiatry and then you’re assessed and if you’re lucky you’ll get an admit. BUT if your child is exhibiting externalizing behaviour, like hitting or biting or is violent, you won’t get that admit even if your child is tied to the bed during the consult. Why? Because if your child is exhibiting these symptoms the hospital is not equipped to deal with it. So you’re back out on the street again and asked to go to a local community agency. Literally given a list of numbers to call and asked to do it yourself.

So now you’re off to the local child and youth mental health agency. You arrive hoping for immediate relief to find you must fill in forms, tel your story again, and then you wait and wait and wait. Often this wait can be from 4 months to 2 years and during all this your child is still in crisis and therefore so is the family.

Meanwhile your child is at school. At the school there are usually 2 paths. Path one is where you will be called at work, as in my case daily for months, to pick up the child. Path two is that you will go through a process to get your child the educational supports they need including educational assistants, specialized program modification, and additional psycho-educational supports. This will take months and months and will often result in a reduction of time for your child in school. In the case of my daughter she went for half a day for a year.

So now your child is attending half a day of school during which you’re still going through assessment and intake with the mental health agency and may have had as many as 6 hospital visits within a 4 month period because your beautiful child is in a medical crisis. Oh by the way your still trying to keep your job and marriage going during this or if your single and living at or below the poverty line your barely making it through a day and will likely suffer your own health crisis.

So you have finally survived the waiting list and the agency calls. This may go one of two ways as well. The first is that you will be assigned a case manager, that’s someone who coordinates your care, and assigned to programs. Part of this program is that you will take a parenting class while your child goes through a some sort of behaviour modification program. These programs can be highly effective but that is dependent on the illness you’re child has. I’ll get back to diagnosis in a minute.

The second way this can go is that after months of waiting you may be told there is nothing this agency can do for you and you’re sent to another agency. Fortunately in London we have CSCN as a central facilitator of connecting you with one of these agencies but often the wait can be as along there as it is at the agency itself and you may still be told, as my family was, that there is nothing they can do for you. So as I said before your back at square one. So you go to another agency and start again. Meanwhile your child is having even more problems at school and is attending less and you’ve had to visit the hospital several more time.

Now for the Diagnosis. So during this whole adventure you have no formal diagnosis. A diagnosis for your child can take several years and can often change over time. There is a serious shortage of qualified child psychiatrists in Ontario, more than 50% of them in Canada reside in Quebec, and the wait times to be assessed can be horrific.

So you get a diagnosis, you start medications, you finally have an agency working with you , and the school situation is now on track. Sigh of relief. But what if even despite all of this help your child is still having violent outbursts and your home and work life is in a shambles. Well you can try to get your child into a psychiatric facility that specializes in children. Again we are blessed in London with The Child and Parent Resource Institute or CPRI. CPRI has both in and out-patient care and has an outstanding collection of staff with a number of specialities. So you go to CPRI, which by the way serves all of South Western Ontario – a huge population, and try to get admitted.

Well you’re back on a waiting list for the outpatient programs. If you’re lucky enough to get a YURI bed, that’s a short-term emergency assessment inpatient program, you can get a meds review and diagnosis review. But YURI beds are few and far between.  And you’re waiting again. Remember that unlike any other emergency medical issue mental health issues are often about waiting for service and telling you’re story again and again while trying to muddle through.

 

So were now at 1280 word to describe the situation of 5 mothers I have been trying to help in the last 7 day.s They are still not receiving the help they need. These three systems are not talking to each other, there are no emergency beds available, there is no support in the community to help, and they are all on waiting lists or have been told that they can’t get the service they need. Also within the school system they have been expelled, suspended, charged by the police, or been told to go home.

Now I could yell at the people who work in these systems, people like principles, and doctors, and social workers, and teachers, and…well you get the idea. But they are not the problem. I know many dedicated and brilliant people within these systems that have literally changed the lives of many families. No the problem is larger than that. The problem is the whole system and the way it is funded and designed. A successive series of governments have left the child and youth mental health system understaffed, radically underfunded, and siloed in to three separate areas of which only one can be investigated by the provincial ombudsman. Someone once said that if adult mental health was the orphan of the medical system then child and youth mental health is the orphan of the orphan. We are fortunate In Ontario that the Liberal government recently increased funding to child and youth mental health but the real world effect of this, while good, is still way behind the rest of the western world. In fact this government is the first to give any increase in funding at all for the last 13 years. A positive step forward. But in the end this last week there have been 5 moms all with children with serious medical conditions who continue to be in crisis and are not getting the help they need. Oh and by the way…there are as many as 650,000 children with a mental health issue in Ontario alone of which only 1 in 5 are receiving any treatment.

My next post will deal with the transitions. The transitions between Hospitals and Agencies and the transition from youth to adult mental health systems.

Why this is the best fathers day ever

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Many of you know that my beautiful daughter has a mental illness and that her life, as well as that of  my wife and I, has been a struggle for many years. She has Bi-polar disorder. It’s an medical  illness not a choice.

Recently she got in allot of trouble in school. The result is that she is suspended, probably her 8th or 12th time this year, and the police are involved and we’re in the shit. Her school principle has worked hard with us, as has her EA’s and teachers but they have only so much patience and only some of them understand how hard it is to move forward or the context of mental illness and it’s effect on our girl. But because she can’t control her anxiety level and the way she feels when she’s anxious she can be at times violent and verbally abusive. She has little control of her emotional state when stressed.

So if you want to know what this translates to in real life read on.

My daughter never got to be in a school play. My daughter never got invited over to friends houses. My daughter never had friends in school. My daughter talks about ending her life and how no one in the world cares about her when she is in a heightened state.

But this year, her first in high school, she actually has some friends.. As a matter of fact one of her school friends felt so bad for my girl over what recently happened and wanted her to feel better and cared for so much that one of them came across town to give her a “feel better” gift. This is a good thing. This is an amazing thing. This is a new thing.

My wife and I have attended hundreds of meetings since she entered the school system, we have argued, advocated, pushed, cajoled, begged, and have never once stopped trying to make the people in our community understand what our daughter and by extension  others need. We have also spent a huge amount of time advocating for other parents who have as bad and many times worse experiences with their child, school, service providers, because my wife and I made a promise to do everything we could so another parent didn’t have to go through what we did.

In Ontario there are more than 450,000 children and youth who have a diagnosed mental illness. Of this huge group only 1 in 5 are getting any help at all and suicide is the leading cause of non accidental death in Ontario. You can add up cancer, diabetes, car accidents, and everything else together and it does not add up to the number of young people in pain that end their life. We as a province fund helping parents and their children in as small a way as possible.

Today, this 15th fathers day for me, we had to talk to our daughter about how serious things have gotten at school. This isn’t the first time we’ve had this conversation, it’s about the millionth, but this time the police have been involved and the stakes are higher. Our girl freaked out and was terrified. We talked through this, we had to all take a time out, but we came back together to come up with a plan. We’ll try this plan out and it might work or it might not. I hope it does. I always do.

Some of you have tried to be “helpful” and said to me “ well she just needs to be disciplined, your too easy on her.” Some of you have said “ she needs to learn the consequences of her actions and if she ends up in jail well then she’ll learn.” Some of you have said “ have you tried this vitamin or that miracle cure” or once someone suggested putting a collar on her and giving her an electrical shock when she’s “misbehaving”. Many have said that this is behaviour and behaviour needs to be addressed. It’s not behaviour. It’s a symptom. Any of these “suggestions” are the equivalent of saying to someone who is a paraplegic that “ if you wanted to you’d just get up and walk”. But because it’s a mental illness well that’s not the same. But it is.

The reason this is the best fathers day though is that fathers day, as every day for a caring dad, is about doing the hard work of raising your child so that they have the options to get to the place where their dreams lead them. For any parent it is never a straight forward process. There are always struggles, hurts, triumphs and worries. But for me is is a privilege.

It is a privilege to be a father. It is a privilege to have my daughter in my life. It is a privilege to struggle with her and to keep trying and trying, especially when things are hard and especially when were in the shit.

This is my best fathers day ever because I get to be a father to my daughter.