In his column of Feb. 2, “No justice for the mentally ill caught in the cracks,” Jack Knox quotes Dr. Shabehram Lohrasbe as referring to sick people being spun through a revolving door or not getting treatment until it is too late.
Knox continues: “People used to be treated in mental hospitals” and, “so now those afflicted with serious mental disorders are left to wander the street, lonely and isolated, often turning to self-medication.” He goes on to mention the mentally ill as being the prime prey for the drug trade and says: “We seem to have resigned ourselves to being a society that, having once abandoned people in institutions, now abandons them to the street or to family members who love but are occasionally incapable of caring for them.”
Finally, he quotes Lohrasbe as saying: “What we want for people with major mental illness is safe accommodation with tight supervision, particularly when it comes to drug use.”
My first 10 years as a psychiatrist began in 1961 in what was at one time among the largest of mental hospitals in England. Good things were happening there, some of which were better than our services today. However, there were too many bad things, which led me to instigate the grounds for and to become the chief government witness at the 1971 Payne inquiry, which uncovered evidence of patient neglect, fraud and maladministration.
Naturally, at that time, I was all for the promotion of de-institutionalization in the treatment of the mentally ill, and for the development of community services. I spent 26 years as a psychiatrist in Regina as head of the department of psychiatry before relocating to Victoria in 1997.
To a large extent, Saskatchewan was fulfilling many of the expected concepts of community care for the mentally ill, although there were still some cracks in the system.
Unfortunately, my experience in Victoria has been in keeping with the comments of Lohrasbe and Knox about the care of the mentally ill in B.C. We have come full circle, with a need to look at the possibility of some degree of asylum or refuge, in addition to providing prompt and adequate treatment for the most unfortunate constituents in our society, those with mental illness or addiction problems.
We can no longer tolerate patients having to wait for days in the psychiatric emergency service for an in-patient bed. Patients should not be blocking beds in the acute unit because of a lack of alternative placement, and psychotic persons must not be wandering our streets to become prey to drug traffickers.
We need more front-line workers instead of a burgeoning bureaucracy and unconscionable growth of administrative empires in health authorities, which are contributing to the crippling health-care costs across Canada.
Maybe we could look at providing several small facilities, such as the Seven Oaks Tertiary Mental Health Facility, for the additional treatment and care of a whole range of mental-health problems. Seven Oaks provides services for adults with severe and persistent mental illness who require a high level of professional support. The facility has 38 in-patient beds and an intensive case-management service that follows a further 25 patients in the community.
Similar-sized facilities might be developed for those whose mental illness is complicated by street drugs, for the rehabilitation of substance abusers, for chronic but less severe mental illness and for those suffering varying degrees of brain damage complicated by mental-health issues. Let us not neglect these vulnerable people, as they could be our parent, partner, sibling or child.
In replacing institutional care with community care, we have thrown out the baby with the bathwater, and now we have to resuscitate it before it is too late.
Dr. Andre Masters is consultant psychiatrist with General Psychiatry, Mood Disorders and Intake Services, Victoria Mental Health Centre.
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