The media reports on former Supreme Court of Canada Justice Frank Iacobucci's 413 page comprehensive report on how Toronto police deal with people in crisis have missed what I consider to be the key. There is so much in the report that it is not surprising but it isn't until page 91 that he states that "the issue of police interactions with people in crisis is not merely one of policing. Its root causes cannot be addressed without tackling the need for more comprehensive care for people with mental illness."
Two pages later, he states that "the high volume of police interactions with people in crisis is in large part a function of the failure of the mental health system to provide adequate community-based treatment for mental illness." Chapter four is devoted to exploring this problem and the Ontario Government and the Ministry of Health and Long Term Care (MOHLTC) come in for considerable criticism.
He points out that Ontario does not have a mental health system as there is no coordinated, comprehensive approach to treating mental health. Rather, there is a patchwork collection of hospitals community treatment organizations and practitioners with often inadequate funding. Toronto (and the Province) he says would benefit from a well coordinated system.
And while he says that the mental health system is not the subject of his review, he adds that it is impossible to address the topic of policing people in a crisis without referring to it. Because of the weakly organized mental health system and the lack of adequate resources coupled with the high volume of police interactions with mentally ill people, the police service is now part of the mental healthcare system.
Many witnesses reported that the health system is based on crisis management rather than being proactive or having an emphasis on prevention. Police often find themselves dealing with disturbed individuals days and even hours after they have been discharged from hospital. On other occasions, they take troubled individuals to the emergency only to have the hospitals find that they cannot admit the individual.
None of this is surprising to those of us who have experience with the system and Iacobucci does cite the deinstitutionalization movement going back to the 1950s and 1960s as a cause. In those two decades, he says, almost 80 per cent of beds in Ontario psychiatric hospitals were closed while the necessary community services were not fully implemented. "Society has still not risen to meet the challenge of providing adequate community mental health supports."
The report states:
One of the most common themes emanating from the submissions of a wide variety of stakeholders from all communities consulted, including those at the highest levels of the healthcare system, was that resources devoted to mental health treatment and community supports, housing supports, outpatient teams, social work, peer support and other resources are inadequate. Several stakeholders directly linked these inadequate supports to the high volume of crisis calls and apprehensions under the Mental Health Act.
One of the themes in my blogs here is that Ontario has had numerous reports on how to improve the system but that they have done very little if anything to reform the system. Some of those reforms as I stated in my advice to the new Minister of Health would cost very little. The Canadian Mental Health Association has put together a chronology of reports, recommendations and plans completed by the government from 1983 to 2011 to improve mental health care. There have been 16 in total and yet Justice Iacobucci finds, in 2014, that Ontario still does not have comprehensive properly funded services.
There is no justification for continued government inaction.
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MYTH: Once you feel better you can stop taking your medication FACT: Almost all patients with psychiatric illness need maintenance treatment for a while, even if they start "feeling better." Masand says this is to prevent relapses and recurrences, similar to diabetes and heart disease patients.
MYTH: Psychiatric illness is a result of bad relationships FACT: All psychiatric illnesses have a genetic component and an environmental component, Masand says. A bad relationship, for example, is only one of several factors.
MYTH: Psychiatric illnesses are due to weak character or inadequate coping skills FACT: Psychiatric illnesses are medical illnesses with several origins like all other illnesses, Masand says. Just because you cry easily or can't cope with personal problems, it doesn't make you weak or more likely to be mentally ill.
MYTH: Depression is just sadness that will go away FACT: Depression is a serious medical illness with morbidity and mortality, Masand says. Not all people show obvious signs of being depressed either. While some seek medication or go to therapy to cope, Masand says others try exercise, yoga or meditation. On the flip side, if someone is often sad or emotional, it doesn't necessarily mean they are depressed.
MYTH: Once you have depression or bipolar disorder, you will never achieve your full potential or live a 'normal' life FACT: Some of the most successful people in various fields have had depression or bipolar disorder, including Isaac Newton, Beethoven, Brad Pitt and Oprah Winfrey, Masand says. People who go through a mental illness may also feel they can't ever get back to a "normal life." This is another myth. Someone with a mental illness can still function, go to work, raise a family or perform any other task.
MYTH: Suicide is not a big problem in our society FACT: You may not know someone who has committed suicide, but this doesn't mean it doesn't happen. In 2009, for example, suicide accounted for 3,890 deaths in Canada among both genders, and according to Statistics Canada, mental illness is the most important risk factor. In the U.S., Masand says suicide was the 10th leading cause of death in 2007.
MYTH: Treatment for psychiatric illness is a cop-out for weak people FACT: Treatment is necessary for psychiatric illnesses like it is for other medical illnesses, such as diabetes and heart disease, Masand says. This myth is also commonly believed because finding help or telling people close to you about your illnesses can also lead to shaming and embarrassment.
MYTH: All patients with schizophrenia are dangerous FACT: If you've ever seen schizophrenia or mental health portrayed in mainstream media, you might just think everyone who is mentally ill is "crazy." Only a small proportion of patients with schizophrenia can be violent and this is usually because they are untreated, Masand says.
MYTH: Talk therapy is just whining FACT: Several types of talk therapy, such as cognitive behavioural therapy, can be just as effective as medication in treating depression and anxiety disorders.
MYTH: Attention deficit hyperactivity disorder (ADHD) is a new way to explain bad behaviour FACT: ADHD is a psychiatric illness with a well-described constellation of symptoms and proven treatments. And while common symptoms of ADHD include difficulty paying attention or procrastination, people may also self-diagnose their children with ADHD because of bad behaviour, according to SheKnows.com
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