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Alzheimer's and Schizophrenia: A Tale of Two Diseases

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Who can explain why our society treats those with Alzheimer's disease medically while we increasingly treat those with schizophrenia and other serious mental illnesses in jail?

Alzheimer's disease impacts the elderly while schizophrenia, which begins in late adolescence, initially impacts the young. Among the symptoms of Alzheimer's are delusions, paranoia and impulsive behaviour Symptoms of schizophrenia include hallucinations, delusions, thought disorder and, in many cases, paranoia.

While steps can be taken to slow the progression of Alzheimer's, schizophrenia can be managed in many cases. Its victims can lead productive and positive lives with proper care. The same applies to other serious mental illnesses.

Time Magazine reported that "during the 1800s, long before state-run agencies existed to treat mental illness, families would simply drop their loved ones off at jails or prisons." Florida judge Steve Leifman told Time, "More Americans receive mental health treatment in prisons and jails than hospitals or treatment centers". He added, "It's the one area in civil rights that we've gone backwards on."

Dade County Jail in Miami has half its nine floors for mental health wards which, Leifman said, are more like a warehouse than a health facility. The largest psychiatric facility in the US is Rykers Island, a prison in New York City.

The current battle in Toronto over where people with serious mental illness should be treated should not make Canadians feel proud or feel superior to the U.S. health care system. Some judges in Toronto's mental health court have taken issue with hospital officials for keeping mentally unfit people in jail for weeks because of hospital bed shortages.

Lawyers for a Toronto man with schizophrenia, James Procope, who was kept in jail for 61 days, have filed suit in the Ontario Superior Court to have his criminal charges stayed on the basis that he was subjected to cruel and unusual punishment. Ontario Court Judge Mary Hogan had originally ordered that he be taken to a hospital but there were no beds. Robin Parker, one of his lawyers, stated that "these sick, unfit people remain in jail, in procedural limbo until they are eventually brought to the hospital, but only when the hospital decides they are ready to take them. The hospital seems to be answerable to no one."

Mr Procope's crime was to raise his fist at a coffee shop employee who tried to stop him from taking extra packets of sugar. He was also charged with theft of $21 in merchandise from a nearby store. Police then discovered that he had an outstanding warrant for assault when a security guard tried to stop him from sleeping in a building foyer.

This, unfortunately, is not a unique case. Howard Sapers, the investigator for Corrections Canada said in his latest report on Federal Corrections for 2009-2010 that mental health is one of the most significant concerns in the system. The prevalence of mental illness amongst prisoners is far greater than in the rest of society. In his report for 2005-2006, he stated that the number of prisoners with significant mental health problems had doubled over the previous decade. He wrote, "Offenders with mental illnesses continue to be segregated and punished for displaying symptoms of their illnesses and are not treated adequately according to "professionally accepted standards." "

The term segregation often refers to solitary confinement. In the infamous case of Ashley Smith, this young woman hanged herself in a correction facility while staff looked on. She had bipolar disorder and was initially arrested at the age of 13 for throwing a crab apple at a postal worker. She was arrested again at 15 for breaching probation. She ended up, over the course of a year, being moved to 17 different prisons and being left for months in a bare cell with nothing to do.

The Human Rights Commission of Canada has declared that the treatment of prisoners with mental illness is a "pressing human rights issue" The Canadian Civil Liberties Association along with six other organizations condemned this practice and stated that "our prisons are managing mental illness through prolonged segregation".

If an Alzheimer's patient wanders off and causes a disturbance in public or steals some small item in their demented state, they are not jailed. But we treat those in a psychotic state who commit similar offences differently. Had the system dealing with Ashley Smith realized that her throwing an apple at a postal worker and the escalation of her behaviour from there reflected an illness rather than a crime, the outcome would have been different. At some point on that continuum, she could have been given help and treatment and, today, she might have been alive and contributing to society.

There are many more like her and they deserve better from a civilized society.

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