Western Standard - April 20, 2023


Deinstitutionalization puts people on the streets


Episode Stats

Length

5 minutes

Words per Minute

186.67044

Word Count

1,097

Sentence Count

58


Summary

In this episode, I talk about the devastating consequences of the long-term trend of deinstitutionalization for people suffering from mental illness, and how we need to decouple mental health services from general hospitals and focus on more specialized facilities.


Transcript

00:00:00.000 I've written several times already on the consequences of well-meaning but misguided.
00:00:05.200 It's a long trend of deinstitutionalization for people suffering from mental illness.
00:00:09.740 Now, my family, unfortunately, just got to experience the outcome of that trend directly.
00:00:14.740 Recently, a close family member of mine experienced a sudden and severe mental breakdown.
00:00:20.360 And while he thankfully wasn't threatening to harm himself or others, he was in a state of agitation and paranoia so serious he couldn't be safely managed within a family household, though he tried.
00:00:29.020 He wasn't capable of taking care of himself, and we couldn't keep him contained, so the decision was made to take him in for professional help and evaluation.
00:00:37.500 This wasn't a situation, though, where you could just schedule an appointment and wait a few weeks to see a counsellor or a psychiatrist.
00:00:42.900 It was acute, and we needed immediate help for him.
00:00:46.480 So our family member was taken to one of Calgary's hospitals, and we began through the emergency department.
00:00:51.500 And just so you know, that's the only way to check somebody in during such an episode.
00:00:55.240 As with pretty much all the emergency departments across Canada, it was busy, they were harried, and they were backed up with admissions.
00:01:01.780 It took over nine hours of waiting before a temporary bed could be found, and he was stuck in that temporary bed for another day until a bed could be found in the mental health unit for some better assessment and to seek treatment options.
00:01:14.020 Now, it's just typical in our healthcare system.
00:01:15.600 The medical professionals are fantastic.
00:01:17.680 I mean, all the way from the people cleaning the rooms to the nurses to the doctors.
00:01:20.580 They're hardworking and patient people, and they're doing a hell of a tough job.
00:01:24.340 The problem is getting through the queue to get to them.
00:01:27.260 The triage area of a hospital is by nature a chaotic and high-stress environment.
00:01:32.260 It's unfair and unhealthy to keep somebody in a serious state of mental health distress in such an environment.
00:01:38.520 And it doesn't do those waiting for physical medical help any favours, either being seated next to a paranoid, delusional person for hours.
00:01:44.540 That's all the options we have right now, though.
00:01:46.540 Canada's monopolized public healthcare model has evolved into a very hospital-centric model.
00:01:52.120 We pack every type of specialty, treatment, and procedure into overcrowded and often poorly managed general hospitals,
00:01:58.700 when many of these services could and should be provided in specialized facilities outside of the hospital.
00:02:04.060 Now, one of those specialized services is acute mental health treatment.
00:02:07.400 Calgary has a population or metropolitan population of 1.5 million people,
00:02:11.420 yet it doesn't have a single generalized psychiatric hospital.
00:02:14.660 Major hospitals, they all have wards dedicated to secured mental health treatment.
00:02:19.940 And there's a forensic psychiatric facility for the criminally insane up by our prison,
00:02:24.720 but there's no specialized facility for just general patients,
00:02:27.680 even though so many people get touched by mental health issues.
00:02:30.780 We recognize that pediatric healthcare is so specialized, we build children's hospitals,
00:02:35.100 yet we can't accept the need for psychiatric hospitals.
00:02:39.120 Psychiatric hospitals, they boomed in North America at the turn of the 19th century,
00:02:42.420 when it was noted that a large segment of inmates in the prison system were suffering from mental health disorders.
00:02:47.980 Facilities were built to humanely house and treat people with psychiatric disorders,
00:02:51.780 and initially that's what they did.
00:02:53.700 Unfortunately, the facilities became dumping grounds for people the state didn't want to deal with over time,
00:02:57.980 and funding began to run short.
00:03:00.140 Conditions became inhumane and abuse was rife,
00:03:02.700 and by the 1950s, half a million Americans were secured in mental hospitals.
00:03:06.040 Canada had tens of thousands secured as well, and the conditions became unacceptable.
00:03:10.880 That began the trend for deinstitutionalization through the 60s,
00:03:14.180 and in North America, mental hospitals began reducing the size and closing altogether.
00:03:18.600 But no new facilities were built, and the remaining ones were often outdated and poorly maintained.
00:03:23.700 So as people were turned out into the communities with well wishes,
00:03:26.140 they often didn't have much support, and we're seeing the consequences of that today.
00:03:29.400 It's estimated that 25% of the homeless you see on the streets are suffering from mental health disorders,
00:03:34.780 and as much as 15% of the inmates in prisons.
00:03:37.340 While we don't like the idea of securing the mentally ill long-term in hospitals,
00:03:41.060 can we keep pretending they're better off in the streets or in jail?
00:03:43.980 We've de-stigmatized a lot of mental health disorders, depression, things like that, and we should.
00:03:49.280 It's time to de-stigmatize mental health hospitals.
00:03:51.920 Extended-stay mental health facilities,
00:03:54.220 they don't need to be inhumane and nasty and odious as they used to be.
00:03:57.600 I assure you, the current wards and existing hospitals are not good spots for people to reside long-term.
00:04:03.040 Our health care system needs a lot of reforms.
00:04:05.500 One big one, though, would be to decouple mental health wards from general hospitals
00:04:09.380 and build facilities that can provide comprehensive mental health care services,
00:04:13.820 from admission to evaluation to day treatment, and yes, possibly secure treatment if need be.
00:04:19.760 Specialized facilities can offer much more effective treatment and take the pressure off of the hospitals.
00:04:24.740 Committing somebody is and should always be a last resort.
00:04:27.600 But we need to have that option available at need, and quickly at times,
00:04:30.500 even if we don't like to think or talk about it.
00:04:32.580 I understand we want to respect people's dignity,
00:04:35.260 but there's not much dignity remaining when a person's on the streets, in jail,
00:04:38.200 or possibly even dead for lack of mental health treatment facilities.
00:04:41.480 Had my family member not had the family support he had,
00:04:43.640 I'm certain he'd be facing one of those fates right now.
00:04:45.780 So again, guys, it's time for some frank talk and treating the people who are suffering from mental illness
00:04:51.540 as the illness it is, and the illness that needs specialized, separate treatment,
00:04:56.160 because they're falling through the cracks.
00:04:58.040 And it's not like we aren't paying for it anyway.
00:04:59.700 We pay for it.
00:05:00.460 It's just that we're paying for it through our prisons, through our regular hospitals,
00:05:03.760 hospitals, and again, in homeless supports.
00:05:06.320 So either way, we're still hoping for the best for my family member.
00:05:09.440 He's still incarcerated in there right now, and many other families are dealing with this.
00:05:13.560 I just wanted to get that out there and remind people.
00:05:15.880 Health care reform comes with a lot of other aspects beyond just the physiological area of it.
00:05:22.620 Health care reform comes with a lot of mental health care reform.