If we learned that insufficient treatment facilities for multiple sclerosis or brain cancer were forcing 400 people to live destitute on the streets of Victoria, there would be an outcry.
Yet that many victims of schizophrenia, bipolar disorder and other forms of mental illness are among our city’s homeless population and there is no uproar. More than twice that number of mentally ill people live on the streets of Vancouver and this also occasions no surprise.
The truth is, we’ve grown accustomed to the idea. Fifty years ago, the prospect would have shocked us. But now, we more or less accept that serious mental illness and homelessness go hand in hand.
That’s not to say that nothing is being done. According to the Canadian Alliance on Mental Illness and Mental Health, the B.C. government spends more than $600 million annually on services for the homeless. And not-for-profit groups offer vital aid as well.
Yet the hard fact remains that growing numbers of people with serious mental disorders are living on the streets of Canada’s cities. And the situation is not getting better; it is getting worse.
No doubt the cost of treatment plays a role. Schizophrenia usually begins in the late teens or early 20s, and can last a lifetime. Institutional care over long periods is enormously expensive.
Yet patients with severe Alzheimer’s disease often require residential care, sometimes for several years, and somehow that gets paid.
Part of the difficulty might lie with the drugs involved. Anti-psychotic medications often create unpleasant side-effects, like movement disorders and drowsiness. Some victims of mental illness may end up living on the streets because they cannot tolerate the treatment.
But there is another factor, as well. In the 1970s and ’80s, a conscious decision was made to end the wholesale institutionalizing of mentally ill patients.
A new generation of psychologists argued that forcibly committing people to “insane asylums,” as these were called, was a breach of human rights. They assailed the medical profession for acting as jailers instead of caregivers.
Some went even further and disputed the whole idea that mental ailments really are a form of illness. They argued that symptoms like hallucinations and disorganized thinking are simply an alternate way of seeing the world. As one noted, “If you talk to God, you are praying; if God talks to you, you have schizophrenia.”
The more extreme view did not persist. The physical foundations of mental illness are now well established.
But opposition to institutional care, except in extreme circumstances, has become accepted policy. In B.C., the number of psychiatric beds has declined greatly in the last 30 years.
Riverview Hospital in Coquitlam was once the main facility: At its height, it housed 4,630 patients. Today the main building is empty, and only a small number of patients are treated there.
Some new residential centres have been constructed around the province. But the total number of spaces available is only a fraction of the historical capacity.
When this scale-down began, decision-makers promised that alternative treatment options would be developed at the community level. To what extent this was a realistic plan is debatable. Caring for acute mental illness without the concentrated resources of a hospital setting is a major logistical challenge.
Yet the facts speak for themselves. With hundreds of mentally ill people living on the streets of Victoria, the promise of a more humane system has visibly failed.
There is no question of rolling back the clock. Forced commitment as a model of care was a betrayal and a shame.
But some workable approach must be found. And it starts with a basic resolution: Homelessness cannot be accepted as a treatment plan for severe mental illness.
© Copyright 2013