10/21/2013 12:29 EDT | Updated 01/23/2014 06:58 EST

Having Police Shoot the Mentally Ill is Cost Effective But Absurd

Some interesting testimony is being provided at the latest inquest into three police shootings of mentally ill people in Toronto which vividly portrays the absurd way we treat mental illness. This inquest and its circumstances could be from anywhere in North America as our treatment of the severely mentally ill is the same throughout North America.

Dr. Mara Goldstein is a psychiatrist at St Michael's Hospital in downtown Toronto. She told the inquest that hospitals have a right to refuse admission even when a person is requesting it and that it is becoming more difficult to gain access to an in-patient psychiatric facility. She added that "the demands for admission are far greater than supply, and over the past several years there's been an increase in outpatient services in an attempt to keep people in the community,"

Presumably, many of those who cannot get admission are ones who really need it but what would most people say if she was talking about cancer? Sorry you have cancer but we just don't have the resources to treat you.

According to the Toronto Star, "the inquest has heard that when someone is advancing with a sharp weapon, their mental state is not considered. In use-of-force training, officers are taught to yell a command such as "Drop the knife!" and draw their firearm -- regardless of the person's psychological condition."

So, when someone is severely troubled, delusional, and potentially violent and we have no beds for them in our hospitals, they may get to deal with the police who are likely to shoot them. Not exactly a humanitarian way of dealing with the seriously mentally ill but one that is likely cost effective.

And that is the crux of the problem which our legislators and policy makers ignore although the police don't. We are not providing appropriate care and resources to the seriously mentally ill and we need to.

The Canadian Medical Association Journal carried a news item in its Oct. 9 issue on how the police are calling for more mental health services. That news article began with "Across Canada, police are bearing the brunt of broken mental health care systems and are calling for increased funding for mental health and social services." Interesting that it is the police who are asking for this and not the docs. That says a lot.

The police argue, the article states that they should not be the front line of mental health services and that, as an example, 21 per cent of calls to police in Vancouver result from mental illness and that in Toronto in 2011, 8500 people were detained under the Mental Health Act. Vancouver chief Jim Chu stated that "We're encountering people that should be institutionalized," and. "We deal with them and they're back on the street a day later, and then we deal with them and they're back on the street two days later."

The police have a very difficult job and while I may have been critical of some of their actions, I've also said that they tend to be the most compassionate when dealing with the mentally ill compared to many of the professionals who are paid to be involved with them. I've observed this myself on a number of occasions and quite a few family members have said the same.

An example of the almost impossible task of finding psychiatric care in Canada is that of the Gibson family in Victoria, BC. John is a water resources scientist and University of Victoria professor. He suffered from severe psychosis and became mentally ill during the fall of 2011. His wife, Marion, has written a book called Unfaithful-Mind which outlines the problems they faced and she has been interviewed on radio and given a presentation in Victoria.

Although John suffered a major psychotic break, lived in a chaotic delusional state for months, spent time in hospital, was released, was prescribed an assortment of medications and dealt with unwanted side effects, all this was done without the specialized care of a psychiatrist or any substantial follow-up. He currently lives without a diagnosis or any real explanation or understanding of his illness. The family has received little to no support or education from any mental health services. Any information about mental illness, delusions, hallucinations, psychosis and the various medications was acquired through their own prowess and research.

The family was fortunate in that they had a family doctor who is knowledgeable about mental illness and John has made a remarkable recovery, is taking medications and is back at work but he is still without a psychiatrist. It is unfathomable that someone, especially in a provincial capital in Canada in the 21st century, cannot get the care of a medical specialist.

In this case, there was a reasonably positive outcome. But most people who develop a psychotic illness and schizophrenia are normally much younger. The typical age of onset for males is 18-25 (a bit older for females). At that age, they have not developed the social and educational skills of someone like John who is in his 40s, married with children and who has has an education and a career.

Most who develop psychosis will only get brief and inadequate hospitalization and follow up without ongoing rehabilitation supports. They will likely not have a consistent psychiatrist to monitor their care and they will often continue in and out of psychosis. Many will end up homeless, in despair, or in the criminal justice system. And some will be shot.

A sad state of affairs for a prosperous and supposedly caring, compassionate society.

Facts About Mental Health in Canada