When I first decided to become a nurse, one of the things I vowed to overcome, (along with the actual fear of the long academic journey ahead), was my fear of confronting the unknown. So it was with a tightness in my chest that I watched a very sad, very broken man on the psychiatric unit where I volunteered -- his hands gripping his chest; grief contorting his face into a grimace so painful that his actual physical and emotional pain had to be far greater than what I was being permitted to witness.
Attempting to conquer my fear of those who lived differently than I did; my fear of the people who approached me on the streets asking for money and cigarettes; the dread I experienced walking by a group of men and women huddled together, presumably to keep warm in minus 40 Celsius Winnipeg weather, but in my eyes seemed much more threatening than they were -- more specifically though, I needed to conquer my fear of those who displayed an emotion that I kept hidden away from the world like a crime I was deeply ashamed of: my own feelings of indescribable grief and loneliness. I forced myself to outright ask this man who had tears rolling down his cheeks, laying in a recliner staring up at the ceiling, what was making him so sad.
He quietly shared that he wasn't quite sure. He remembered standing on the street (this was in January) wearing nothing but his pants, shirt, and socks. The police had pulled up next to him, placed him in the squad car, and drove him to the ER, where he was admitted on the unit where we met. As we continued our conversation, bits and pieces of his life alluded to moments of stark darkness when he shut everything out, including his wife, children, family and friends. Once he was able to scale the jagged wall of his own personal hell, he would celebrate with long endless nights of binge drinking and gambling. Over time, he lost his family, his job and his money. He was evicted from several homes due to his inability to pay his rent and his bills until finally he became broke, alone and homeless.
Several years earlier, he had been gainfully employed, supporting a family, and belonging to a socioeconomic class that did not depend on the handouts of strangers and homeless shelters. After a diagnosis of bipolar II disorder and several weeks of stabilizing treatment, this man was still no further ahead upon his release from the psychiatric unit than when he had been admitted. Although his affliction now had a fancy name and medication, beyond the doors of the establishment, he could only hope for newer clothes and a pair of shoes. He would still be homeless, and in order to overcome this tremendous marginalizing barrier, stable shelter, access to regular meals, and some support systems would be necessary. As a nursing student, I was learning about the determinants of health, and understood that those living on the fringes of society were more likely to suffer from poor physical and mental health; most of their health issues would not have been as severe and numerous if they had a home, rather than living on the streets. According to the Canadian Medical Association Journal, "The health care system often fails to provide adequate treatment for homeless people with mental illness or substance abuse."
It is those living on the streets who, sadly, are the most affected by the stigma associated with mental illness. Stigma is alive and well, yet, for those of us who are fortunate enough to continue working or have a strong support system advocating for us while we too struggle to climb the walls of our own personal hell -- this stigma, even though it is still socially representative of a mass opinion that believes mental illness is in fact simply moments of grave distress rather than actual sickness -- this stigma is nowhere near that which plagues our homeless population. For while mental illness devours the lives of those touched by it and destroys the souls of those wrestling it, to have the luxury and protection of loved ones, food, and shelter, along with easily accessible healthcare and community resources allows for a greater rate of recovery, and diminishes co-morbidities. The marginalization related to low socioeconomic classes prevents steady treatment due to lack of available community resources thus presenting a more rapid and greater rate of symptomatology.
Solving the plight of the ever increasing gap in socioeconomic populations and more specifically decreasing homelessness, and perhaps even seeing its disappearance completely (this will not occur soon however), would be a feat indeed. Mental illness can affect everyone. In Canada, 20 per cent of the population will be afflicted by mental illness. Of those, 30 to 35 per cent are homeless. These are striking statistics that can't be ignored, and yet they will be. Before any social progress can be made, mental illness has to be acknowledged as a real and powerful determinant of health which affects all social classes, but plays a greater role not only in the lives of those who are displaced, but in some cases also contributes to their displacement and state of living, as stated by the Canadian Mental Health Association which says that a supportive environment is key to mental health, but also in managing mental illness. If such an environment is not accessible, mental illness sufferers are more likely to eventually succumb to the stressors of everyday living.
Even going to work can become too heavy a burden to shoulder, and once again as I flog a dead horse, statistics show that the prevalent attitude in the workplace is not one conducive to exposing ones mental illness. According to the Centre for Addiction and Mental Health, over 60 per cent of people would be concerned of their workplace environment if they knew one of their co-workers had a mental illness. The stigma associated with mental illness is such that reaching out for help may prove too difficult and in fact impractical if someone is keeping their mental illness from family and co-workers a secret, and eventually, as described by the gentleman I met while I was volunteering on the psychiatric unit, mental cognisance and resources becomes less and less accessible.
Say what you want, but the stigma associated with mental illness is currently cemented into the collectivity, and our society is unwilling to provide the necessary care and funds to rectify the overwhelming statistics proving so. Sadly, according to the Centre for Addictions and Mental Health, 42 per cent of Canadians acknowledge an uncertainty as to whether they would associate with someone admitting to suffering from a mental illness. Pursuant to this, 55 per cent of Canadians admit they would be unwilling to enter a spousal relationship with someone who has a mental illness. Knowing these statistics, contradicting them by stating that we are doing all that we can to be proactive towards the advancement of mental illness destigmatization in order to actually begin making changes at every demographic level is a farce. Clearly we are nowhere near to solving homelessness. And we are also nowhere near to stamping out mental illness stigma. And yet, acknowledgement that mental illness is a real thing can be an opportunity to unify the growing divide between social classes as we realize that this disease does not discriminate, and its repercussions travel the entire thread of societal marginalization.
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