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

Summaries generated with gmurro/bart-large-finetuned-filtered-spotify-podcast-summ .

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

Transcript generated with Whisper (turbo).
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.