I see him everyday, standing out in the street in the heat or the cold fighting ghosts in his head. He's a war vet living the trauma of war a half century after the struggle has become part of forgotten history. Too alone, too marginalized he fights his battles alone on the streets while a busy city pushes past without even noticing.
All too often in Canada, the street or the emergency ward has become the place where those with severe mental illnesses end up. Those with mental illnesses make up a disturbing percentage of the homeless. Occasionally, one of them will make the headlines in a lurid fashion such as the tragic tale of Richard Kachkar who, in a psychotic state, ran out from a shelter on a January morning in his bare feet and jumped into a snowplow. The young police officer that tried to stop him was killed. A life was lost and a family devastated.
Stories like "Cop Killer" Kachkar or "Psycho Killer" Vince Li make the public feel they have reason to fear the mentally ill. Yet the mentally ill are four times more likely to be victims of violence then perpetrators. Mental illness comes in so many forms and degrees of severity, but life on the streets, marked by violence, fear, chaos and uncertainty, only exacerbates this.
It is estimated that 20% of Canadians will experience a mental illness in their lifetime, from depression to schizophrenia. Those who lose their jobs and relationships can easily end up on the streets. But with little access to psychologists, therapy, medication or support they face a tough life of poverty and substandard care. Little wonder that some self-medicate with drugs or alcohol.
Some of the more damaged people have been dumped on the street in the wake "de-institutionalism"-- that mercenary buzzword for cash-strapped governments of the 1990s. The group homes and institutions were shut down and long-term care patients were put onto the street. Many did not have the access or even the capacity to access outpatient care. Suffering from severe mental illness that they could not possibly manage their illness without intensive, long-term, round-the-clock support.
I work with homeless people on a daily basis and have watched the fruitless yet very expensive merry-go-round system of dealing with the mentally ill on the streets. When there is the crisis, it is the police who have to assume the role as the first responders for mental illness. They try and talk the person through the crisis and then bring them to emergency ward where they spend a few hours before being inevitably discharged back on the streets, only to find themselves in trouble the following week, or the week after, back in the cruiser and into the Emergency ward.
There are ways of handling these situations that could have much better impact at much more reasonable social costs. The question is, whether or not there is the political will to develop street-smart responses.
The first step would be to develop a comprehensive mental health care system that creates room for the homeless. The second step would be to strengthen the street level response where social workers work on the streets building relationships with the homeless and marginalized population. Personal relationships are a necessity in defusing crisis and preventing a person at risk from careening between one emergency service to another.
The next step is changing the approach of medical intervention. The reality is that many clients simply do not have the capacity to access services in the hospitals and instead, medical services would be better served going to the clients. Then, of course, there is the need for supportive housing. But to do this, governments have to increase front line funding so that the poor, vulnerable and the desperately ill can access these services.
Mental illness shouldn't be a burden. If they had treatment and support, many could find stability and a life of dignity. It would also come at much less cost to our social, medical and judicial system than in the dog-eat-dog world of street life.
But instead of the proactive response, society has opted for the reactive response -- to criminalize and demonize mental illness. Small agencies are left to cope with clients who require far more care than they can provide through piece-meal support.
Mental illness can be frustratingly complex and difficult to manage, but that doesn't excuse the failed system we currently have in place. There is something fundamentally wrong when people with such needs are simply abandoned. Which brings me back to the veteran I mentioned at the beginning of the article. He paid his duty to society at the cost of his own mental well-being. Doesn't he deserve back up? Does he deserve to be left out on the street living the nightmare of a war most Canadians forgot long ago? Everyday he battles his demons through his imaginary thickets of bamboo trees, but there is no backup for him. It shouldn't be this way.
