The orphans of medicare
Jennifer Clark has been living for two years in a stark room
in Victoria's Royal Jubilee Hospital. In fact, patients with mental illness
— unwanted and forgotten — account for an astounding one-third of all
From Tuesday's Globe and Mail
Jennifer and her husband Rhys Clark in her room at the
Royal Jubilee Hospital May 17, 2008. (John Lehmann/The Globe and Mail)
June 23, 2008 at 10:34 PM EDT
— Jennifer Clark was brought to the emergency room at Victoria's Royal
Jubilee Hospital after a gas-station clerk found her wandering around in
circles, dazed and disoriented and pulling out her hair.
Ms. Clark, a
hairdresser who suffers from bipolar disorder and paranoia, had been to the
emergency room earlier and was discharged. She walked out the front door and
roamed the streets for 11 hours before the clerk called for help. She was
admitted to hospital that night, June 30, 2006, and has been there ever
since – a staggering two years living in a stark room that she shares with a
rotating cast of three other psychiatric patients.
“Everybody agrees that hospital is not the place for Jennifer,” her
husband, Rhys Clark, said in an interview. “But nobody can do anything about
it. It's exasperating.”
Ms. Clark's story reflects a sad reality: Patients with mental-health
problems remain the orphans of medicare – unwanted and forgotten.
One in every 11 visits to ER is for a mental-health issue. So is one in every
seven hospital admissions, and, because these patients stay much longer, they
account for an astounding one-third of all hospital time.
Like Ms. Clark, they can wait years for a bed in a long-term care facility or
a spot in supportive housing, so they end up as detested “bed blockers” or
sometimes on the streets. In the community, family doctors do the bulk of
treatment by default, but they are rarely equipped to deal with the complexity
of care required by patients with severe depression, bipolar disorder or
schizophrenia. Often, they just prescribe drugs.
In fact, Canadians are among the biggest consumers of psychotherapeutic drugs
in the world: They picked up 53 million prescriptions for them last year, with a
value of $2.2-billion, according to IMS Health Canada, a private firm that
tracks prescription drug sales. In addition, direct-treatment costs for those
suffering mental-health problems exceed $5-billion annually, according to a
study by the Centre for Addiction and Mental Health in Toronto; the overall
economic impact of mental illnesses is 10 times that amount.
Yet there is no national strategy for dealing with mental illness.
“The system is in chaos,” said Donald Milliken, former president of the
Canadian Psychiatric Association and a practitioner with nearly 40 years of
experience. He said patients such as Ms. Clark are getting good care but not
appropriate care. The fundamental trouble is not necessarily a lack of money or
a shortage of beds but a lack of organization.
“If you take the same amount we spend on ad hoc care and spend it on
organized care,” he said, “the care and the outcomes would be better.”
Asylums phased out
When it comes to care, mental health has always been the poor cousin of
physical health. This is partly due to a legislative anomaly: Half a century
ago, when medicare was created and Ottawa started funding hospitals, asylums for
psychiatric patients were excluded.
Those suffering from severe, persistent mental illness were warehoused in
institutions paid for solely by the province. Then came the civil-rights
movement, coupled with the advent of effective drug treatments, which led to
policies of massive deinstitutionalization. Dr. Milliken recalls his experience
as a medical resident in 1970: “They gave me the keys to a ward and said, ‘There
are 100 patients in there. Discharge 50.' ”
The number of long-term psychiatric beds in Canada plummeted from a high of
close to 60,000 in the 1950s to just over 6,000 today. That, in itself, was not
a problem. But mental illness did not miraculously disappear and governments did
not invest in community supports for sufferers.
What many patients need is stability – a place to live, a basic income,
assistance with daily activities, monitoring of their medication. When these are
not available, illness can flare up and hospital visits follow.
“Hospitals are just trying to ‘deal' with this – and I use that word in its
most Spartan sense,” said Pamela Fralick, executive director of the Canadian
Healthcare Association. She said health-care professionals are compassionate
people, but “these are cuts that can't be sutured in hospitals.” Also, while
most people recover from bouts of mental illness, a minority of cases are simply
Ms. Clark, 52, has been admitted to hospital 36 times during the past 29
years, often for months at a stretch. Her current stay alone has cost the
health-care system close to $1-million.
But three decades of dealing with her illness – including episodes of mania,
severe depression, paranoia and suicide attempts – have cost her family much
more, emotionally if not financially.
“It's hard sometimes, I won't deny that,” Mr. Clark said. “The reason I hang
in there is because my mother brought me up right. When I said my vows – ‘in
sickness and in health' – I meant it.”
While the public face of mental illness is often the homeless street person
who rants aloud, the reality is that most people with psychiatric problems are
hidden in plain sight. They work and raise families but, in times of crisis,
depend on their families for support. Home care is virtually unavailable to
mental-health patients. It can take months just to get an appointment with a
psychologist or psychiatrist, and waits are particularly long for children.
“There is an inordinate burden on family caregivers – they just don't have
adequate support,” said John Service, a psychologist and executive director of
the Mental Health Commission of Canada.
Stigma and discrimination are also commonplace, even among health
professionals. As a result, people with physical illnesses often get far better
and quicker services than those with mental illnesses, Dr. Service said. It is
not unusual for someone with severe depression to wait 24 to 72 hours for care
in an emergency room – yet these numbers provoke little outrage in the
A big bright oasis
Royal Jubilee has tried to tackle this bedevilling problem by creating an
emergency room strictly for mental-health patients.
The Archie Courtnall Centre – named after the father of former National
Hockey League stars Russ and Geoff Courtnall who suffered from bipolar disorder
and committed suicide – is an oasis. “If a facility like ACC had been available
in my father's time in need, there is no doubt he would be alive today,” said
Bruce Courtnall, an investment adviser at CIBC Wood Gundy and a spokesman for
The centre is a big bright place with a dozen La-Z-Boy chairs and four
short-stay beds where psychotic or suicidal patients can remain until a crisis
passes. “This is a safe place, where patients get treated with respect,” said
Rivian Weinerman, the site chief for psychiatry.
In particular, there is more privacy than in the general ER waiting room,
where a person weeping uncontrollably, muttering loudly about conspiracies,
going through withdrawal, or wearing leg irons and handcuffs is bound to draw a
lot of unwanted attention.
Tellingly, about three in every four patients treated in psychiatric
emergency have some sort of substance-abuse problem. Many people with
mental-health issues turn to alcohol and drugs to chase away their demons. Some
drugs, such as crystal meth or crack cocaine, can also trigger psychotic
Dr. Weinerman stresses that most psychiatric patients control their illnesses
with medication and counselling, but they retreat to hospital when there is an
upheaval – either an internal breakdown in brain chemistry or an external
collapse such as a relationship crumbling.
So, in addition to the psychiatrists and psychiatric nurses, the Archie
Courtnall Centre also has a staff social worker who plays a crucial role in
trying to stop the revolving-door syndrome.
“I do the practical stuff,” said Paul McNamara, a former health-care manager
who decided to return to the front lines. “Once you're medically stable, I ask:
‘How can I help?' ”
On a typical day, he will make calls to ensure a patient's pet is fed, set up
counselling for a family whose son has attempted suicide, negotiate with a
landlord about the return of a tenant who has the occasional bout of psychosis,
and find a bed in detox.
“This is real. What we do here makes a difference,” Mr. McNamara said.
He said people who show up at the hospital emergency room come from across
the social spectrum and they all need the same thing – “a place to go when
things fall apart.” There is some evidence that a dedicated psychiatric ER such
as Archie Courtnall does reduce return visits and admissions to hospital. But
Dr. Weinerman says the success of mental-health care cannot be measured in mere
“This is not a money-saving business we're in, it's a life-saving business,”
she said. “And what troubles me is that there's a ton of people out there who
haven't reached our doors.”
Congratulations Andre on a great article.
Canada has a "taboo" on the subject of mental health. Our federal and provincial
governments turn a blind eye as the mentally ill and their relatives simply
don't buy votes, such is the corrupt nature of Canada period.
Canada has a very simple minded attitude of "it wont happen to me" or "its none
of my business" or "they must have done something to get it" or, they are
contagious and by ignoring it we wont see it and it will go away. Thats a
summary of the Canadian Governments attitude to mental illness.
The reality is mental illness is filling our courts, either by litigants or out
of control judges and yes, some judges are very obviously suffering from a
mental health problem and or a severe personality disorder that would not get
past first base of a triangulation employment interview for say CSIS , the RCMP,
any major police force, or for most airlines as a pilot.
Mental health is costing Canada billions of dollars, it overwhelms our legal
The Merk manual defines "endless legal litigation" a symptom of a mental
illness. Unfortunately, society fails to realize that not only do the litigants
suffer mental health problems but so do our judiciary.
Take any large legal community, its riddled with brilliant highly intelligent
lawyers who can no longer function as lawyers or can only do so under very
limited capacities or duties due to diagnosed and treated mental health
When our Canadian Government deals with the problem of mental health in our
judiciary, such as by introducing employment screening, it may just start
solving the one of the causal problems of endless litigation that clogs our
- Posted 23/06/08 at 10:47 PM EDT
When will the Attorney General deal with the well known and
obvious problem of judges who dispense "justice"while suffering a very obvious
mental health problem and or equally disturbing
"personality disorder" whose major symptom is a "a lack of empathy or
compassion" or "extreme anger".
Those two characteristics are typical of those who kill and torture for very
little in the way of reasoning. Take every major psychopath in recorded history,
they too have a lot in common with the underbelly of judicial personalities in
Ontario that sicken society not to mention destroy what it jokingly called "the
rule of law".
Ottawa Superior Court has a couple of them. Start with Justice Catherine Aitken,
known for her decisions that leave newbi lawyers standing with they jaws open in
shock at her decisions. Known as a "fembox" judge she has been leaving a trail
of destruction for years. Every lawyer in Ottawa knows about it as do all the
other 'sane" judges.
Then we move on to those judges like Dennis Power and Aland Sheffield who suffer
what can only be called "severe personality disorders" who demonstrate "court
rage", yes, its like road rage, except instead of killing another innocent
motorists, they leave a trail of very callously and carefully destroyed lives by
flagrantly abusing their judicial powers to ensure that those litigants who
"piss em off" never get to set foot in a court room again probably because they
suffered an accident at birth and were born with testicles. Yes, the judges who
hate men the most are actually male. Corrupt? thats an inappropriate polite term
for these examples of the underbelly of the Judiciary www.OttawaMensCentre.com
- Posted 23/06/08 at 11:01 PM EDT
At the Ottawa Court House, we are seeing incredible security and
rightly so, why? because the accused is charged, yes charged, not convicted of
the the most vilified crime in history of plotting to kill thousands of INNOCENT
In the same court house, we have judges who also commit crimes against society
that rival the most vile in society. Just how do they do it?
Take Justice Dennis Power and Alan Sheffield for example, They pick on the most
vulnerable in society, male self represented litigants who suffer the double
indignity and disadvantage of being born with testicles and, heaven forbid,
doing an injustice to the legal profession by not paying a lawyer tens of
thousands of dollars (not that they don't deserve it).
These insults to justice routinely "strike pleadings" and issue "vexatious
litigant orders' thats right, they ensure that anyone they don't like never gets
to set foot in a court room AGAIN!
Can you imagine a doctor poisoning the sick? or a pilot throwing his passengers
out at 30,000 feet? Well take a close look at the most despicable examples of
the Judiciary Denis Power and Alan Sheffield.
The word from Judges Chambers is that these two judges are rapidly burning their
bridges and running out of rich and powerful friends who are not disgusted by
their increasingly draconian decisions to exact vengeance against anyone who
"pisses me off".
One of the biggest problems in the judiciary is you never know who you can
actually trust. Those entrusted with the supervisory role are powerless to act,
they find it easier to "go with the flow" that is turn a blind eye to the
injustices and actually "go along with it" and become co conspirators to what
can only be called "obstruction of justice by the judiciary". The same judges
are experts at turning on the charm and convincing all around that the sun
shines out of their rear which we all know is a legal and practical
- Posted 23/06/08 at 11:24 PM EDT