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Treating Mental Illness Will Prevent Future Tragedies

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Reaction to a tragedy in Victoria, B.C. exemplifies the disconnect that exists in our views of adequate care for those with serious mental illness. Alex Conte, a 21-year-old Sooke, B.C. man was found not criminally responsible for killing his mother due to his mental illness.

According to press reports, Conte was convinced that there was some sort of evil being inside his mother and so he killed her with an axe and a knife. B.C. Supreme Court Justice Malcolm Macaulay described the event as "ghastly and bizarre." He went on to say that, "He (Conte) did not think his mother was human at the time."

According to his lawyer, William Heflin, Conte had exhibited previous violent behaviour and had seen a doctor a few days before the murder. He was given a prescription and sent off with no support. Heflin believes that this tragedy could have been prevented had the system been better equipped to deal with the offender. After the trial, he said, "The obvious holes in the system are that when you have a violent offender who's clearly psychotic, the initial thing you should be doing is holding him, assessing him and then trying to stabilize him, rather than just shooing him off home." A psychiatrist at the trial testified that he is schizophrenic.

Heflin went on to point out to the Victoria Times Colonist that, "At the present time, we have people wandering the streets with mental disorders, and they're being preyed upon by the worst elements of our society."

Of course, those of us who are concerned for treatment of the most serious of mental illnesses know this. I can only wonder how those who proclaim that the mentally ill are more likely to be victims of violence rather than perpetrators of violence account for incidents like this. What they often fail to comprehend is that this statement that the mentally ill are less violent than others is true for those who are treated but not for those who are untreated. Appropriate treatment is key.

Research has shown that homicides during a first episode untreated psychosis was 1.59 per 1,000 patients. For those receiving treatment, it was only 0.11 homicides per 1,000 patients. And for those who say that the violence is caused by the prescribed drugs these people are given, it should be noted that the higher homicide rate is for those who are not on prescribed drugs while the lower rate is for those who are.

As CBS News reported on Jan. 31 and now in a Huffington Post article, about 95 per cent of violence is committed by those with no mental illness. But, those with schizophrenia are 2-4 times as likely to commit violent acts. This tendency towards violence is decreased by treatment. These facts are not acknowledged by many in the mental health field who insist on repeating their mantra that the mentally ill are less violent than others. In fact, last year I criticized the Mental Health Commission of Canada for its efforts to convince the media to stop reporting on violent acts committed by those with mental illness rather than focusing on getting treatment for those who are untreated.

In this most recent British Columbia preventable tragedy, a spokesperson for the Vancouver Island Health Authority, Sarah Plank, told the Victoria Times Colonist that a "broad range" of services are offered in the area of mental health and addictions, including crisis response, psychotherapy and housing. The Vancouver Island Crisis Line is available 24/7 for support with mental-health concerns. She went on to say that VIHA spent $108 million on mental health and addictions programs in 2012 -- funding that has gone up 20 per cent in the past five years.

But, psychotherapy and housing are not going to help someone who is psychotic and not treated and neither is a crisis line unless it can ensure hospitalization and adequate treatment. That is particularly so for those who do not even understand that they are ill as is often the case in severe mental illness (anasognosia). And, in those cases, some form of Community Treatment Order is needed to ensure compliance with treatment. NBC in Buffalo interviewed the man with schizophrenia who pushed Kendra Webdale in front of a subway train and Kendra's parents. This is the tragic event that led to the effective Kendra's Law in New York State (a form of Community Treatment Orders). It is very informative and very moving and should be seen by all.

As for funding, it may have gone up as Ms. Plank said but what was the money spent on? How much went to ensuring proper treatment and resources for the sickest? That is crucial as spending significant money on addictions or on services for those with "mental-health concerns" as she described it does not help the sickest of the sick.

This question of allocation of resources is not unique to Vancouver Island. Most, if not all, jurisdictions do not allocate sufficient funds to those with the most serious mental illnesses and they need to in order to prevent these tragedies. According to the Canadian Alliance on Mental Illness and Mental Health, the downsizing of institutional care was not matched with a complementary upsizing of community-based services, resulting in significant gaps of service for those with severe illness.

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