12/08/2013 05:00 EST | Updated 02/06/2014 05:59 EST

Death highlights battle to help mentally ill who decline shelter in Nova Scotia

KENTVILLE, N.S. - When Doug Greene heard his homeless friend had died in a burning bus shelter in a small town in Nova Scotia's Annapolis Valley, it reminded him of his own vulnerability.

"It could be me," said the resident of Kentville about the nighttime death of Harley Lawrence in Berwick on Oct. 23.

"It's just that simple."

Greene, 48, said his own depression and alcoholism caused him to resist seeking shelter and treatment in the past.

He joins other Nova Scotians, from the province's health minister to street outreach workers, who say Lawrence's death — deemed suspicious by police — has left them wondering how to bring people in from the cold when they're suffering from mental illnesses and addictions.

"I know there's help there but unfortunately due to mental illness I really don't want to go," said Greene, his hand clasping a cup of steaming coffee provided at a drop-in centre.

"Sometimes being by yourself and being isolated is better than having everybody else know."

Greene says he is living in a rooming house, but he once slept outdoors in rural Nova Scotia. He became friends with Lawrence a few years ago, he says, and saw him sleeping under stairwells.

Lawrence's brother Ronald says Harley was never formally diagnosed with a mental illness, but in his mid-20s he became increasingly reserved and paranoid, would drift from town to town and refused contact and help from his brothers and sisters when they approached him.

Chaplain John Andrew, the director of the Open Arms emergency shelter in Kentville, says Lawrence's case shows the need for street outreach workers in rural areas and highlights the lack of low-rent rooming houses and apartments.

He also says the province's Involuntary Psychiatric Treatment Act should be altered to give families, police and mental health staff more say on identifying and sending a person to receive psychiatric care when sleeping outdoors becomes dangerous.

Andrew estimates he's dealing with six to 12 people in the eastern part of the Annapolis Valley who are homeless and are unwilling or unable to seek shelter due to their deteriorating mental health.

"We are powerless to make any decision on their behalf," he said.

"I have a problem with that because we make decisions on behalf of our children, we make decisions on behalf of our elderly family and friends when they become incapacitated."

The act requires a person to be "likely to suffer serious physical impairment or serious mental deterioration or illness," and have recently posed a serious harm to themselves or others before being involuntarily committed to care by a psychiatrist.

Andrew says in practice this often means severely mentally ill homeless people have to either commit crimes or become physically injured before they're taken by police and paramedics for assessment.

Greene says he would have been angry about such an intervention, but adds: "I would have realized after some time it would have been the best thing to happen to me."

The Canadian Alliance to End Homelessness, a national advocacy organization, has said the number of homeless Canadians ranges between a federal estimate of 150,000 people up to one million, depending on how the condition is defined.

Sam Tsemberis, a homelessness adviser to a federally funded research group, said estimates on the percentage of homeless people with some form of mental illnesses range from 30 to 50 per cent, and those who live on the street are more likely to experience addictions and illnesses.

Health Minister Leo Glavine, who represents the riding where Lawrence died, said the death has heightened his awareness of the need to help people who are living on the street and suffering from mental illness.

He's reviewing about 100 recommendations from a two-member panel on involuntary treatment and expects this will lead to an "overhaul" of the act.

"We need to find a mechanism and a means and a directive within the act that is more open to a stronger community supportive approach," he said in an interview.

But Tsemberis says the existing wording on involuntary treatment is adequate in Nova Scotia, and Lawrence's story is the "tip of the iceberg" that reveals a need for deeper fixes.

EJ Davis, a street outreach worker in Halifax, said offering housing without strings attached, and then providing mental health treatment and support in their own home, is the way forward.

The 42-year-old outreach worker said the "housing first" approach begins with outreach workers like himself being available when a person will take help.

"That's the key, being that annoying face every day saying, 'How's it going? How's it going? How's it going?' " he said.

But the lack of housing available to people when they're ready to take it is a problem, he said.

"It would be great if we were in the place where I had the resources to walk up to someone and say, 'Look, do you want an apartment?' "

As he does his usual rounds, Davis pauses and chats with Jason Kearnes, a 41-year-old who said he is living with mental illness. Kearnes said a team of street outreach workers including Davis helped him move into a room.

"If I'm hearing voices and I'm not on my medication, I don't want to be anywhere near a shelter," said Kearnes, adding he's grateful to have a place to stay on his own.

He said he is still battling alcoholism and has been looking for a psychiatrist to help adjust his medications.

While Ronald Lawrence says he appreciates the push to find ways to avoid further tragedies, he also says there's no single nor simple solution.

Lawrence says it's hard to know if involuntary treatment, an apartment or a persistent street worker would have saved his brother's life.

"It might help, it might not," he said. "He might have disappeared again, as he did over the years. It's a catch-22. ... But it's worth a try. Anything is worth a try."