THE STANDING SENATE COMMITTEE ON Social Affairs,
Science and Technology
VANCOUVER, Monday, June
The Standing Senate Committee on Social
Affairs, Science and Technology, met this day at 9 a.m. to examine issues
concerning mental health and mental illness.
Senator Michael Kirby (Chairman) in the chair.
The Chairman: Senators,
we are here to continue our discussion of issues related to mental health,
mental illness and addiction.
We have three witnesses, Francesca Allan, Rob
Wipond and Ruth Johnson. Colleagues, in front of you are statements that the
witnesses would like to put forward.
We normally ask each of you to read out your
statements then we have a dialogue and questions.
Mr. Rob Wipond, As an individual: Honourable senators, I have been a researcher/writer on social
issues for 20 years, specializing in mental health.
Mental health care is in a sorry state and could
easily be much better. Your reports show this committee has a strong bias
guiding it and this suggests you will contribute to worsening the situation
rather than improving it.
It is good the committee recognizes the
importance of community supports but I worry about the encouragement for forced
psychiatry and increased psychiatric treatments. Your reports are frequently
factually misleading and omit crucial information, and I am referring to all
three reports, by the way.
Your discussion of forced treatment in the
first report says all legislation must comply with the Canadian Charter of
Rights and Freedoms. In fact, most knowledgeable lawyers argue our Mental
Health Acts do not comply with the Charter. As we speak, several legal teams
are challenging the Mental Health Act of British Columbia.
An Ontario case recently went to the Supreme
Court and the patient won. Why are these very important facts not discussed? Worse,
the report attacks provinces that allow people to refuse treatment.
If psychiatric treatment were effective and relieved
suffering, we would not have the crisis that we have in our health care system.
People would love their meds. Forced psychiatry exists because many people
often do not feel better, or loathe the drugs and their damaging side effects.
Even more prejudicially, the next paragraph
links no problems to jurisdictions where people can never refuse treatment, yet
the problems are obvious and epidemic. Just once, treat a patient against her
will and if you do not alleviate suffering, you have lost that person's trust
and intensified her fears forever. This is a vital issue for virtually all
patients and ex-patients I have interviewed. Many are terrified of the mental
health system. Why do we ignore this fact? Why are we not looking for solutions
to this problem?
The report then highlights this quotation:
Compulsory treatment will usually restore
someone's freedom of thought from a mind-controlling illness.
This is deeply biased Orwellian word twisting. This
entire section is utterly dismissive of the real, extremely controversial
issues surrounding relations of power in our mental health system.
In B.C., patients have virtually no rights and
they seldom regard incarceration and drugging as liberating. Psychiatrists who
do not want to relinquish any power obviously heavily influenced your report
and it is a travesty that you apparently let them block serious questions in
your third report.
Without rectifying that extreme, constantly
threatening power imbalance, our entire system is thoroughly poisoned.
We endorse forced psychiatry based on an
assumption that science can identify mental illness and treat it appropriately.
This assumption is false. There is no established legal or scientific standard
for what constitutes a psychiatric examination for a mental illness.
We hear this theory of biochemical imbalances
and fantasize that psychiatrists in our hospitals examine people's brain
chemistry. They do not. The U.S. Surgeon General admits:
There is no definitive lesion, laboratory test
or abnormality in brain tissue that can identify mental illness.
The Diagnostic and Statistical Manual 'Normal' Disorders concedes the causes of mental illnesses
remain unknown. Psychiatrists exam you any way they
like. Mostly they talk with you and observe behaviour. That is it. The closest
things we have to standardized examinations, which are sometimes used, are
general psychological tests. These tests for depression have questions like:
Which statement best describes how you feel: I
do not feel sad; I feel sad much of the time; I am so sad I can't stand it.
Now, if I ask you right now whether you are
agitated or really agitated, we can call this exchange a lot of things but
rigorously scientific is not one of them. Nevertheless, these types of utterly
subjective error-prone dialogues and observations are the foundation of all
diagnoses of mental illness in Canada and all forced treatment.
The absence of any discussion of this in your
report has enormous ramifications, because if a diagnosis of mental illness is
not based in science, what is it based in?
Let us watch it in action. Your report says:
The benefits of early intervention extend to
numerous mental illnesses and to individuals of all age groups.
Scientific evidence does not support these
fantastic claims. According to the definitive “Early
Intervention for Psychosis (Cochrane Review)” for
example, there were, “insufficient trials to draw any definitive conclusions.” The
few conducted trials found “no difference between intervention and control
The benefit of early intervention is a
controversial hypothesis, and how could we be conclusive when we are not even
sure how to examine people for mental illness? Indeed, the CMHA did an early
intervention study and found “nearly half of the participants received an
Of course, if psychiatrists diagnose
incorrectly 50 per cent of the time, the “corrections” are likely wrong 50 per
cent of the time too. Therefore, this study actually suggested a 75 per cent
error rate in early intervention, which does not beat dice throwing for
Who guided those extraordinarily exaggerated
claims into your report?
Consider how dangerous they are. Suppose we
have a distracted, lethargic boy, and a focused, energetic boy. I say this
distracted, lethargic boy has a biochemical brain imbalance; we must force him
to drink twelve cups of coffee and pop some black beauties and smoke crack
every day and he will be as successful as this other boy. You would laugh me
out of here, would you not? Worse, you would say, first off, how do we decide
if either lethargy or fervour is an illness? We are just holding these children
up to arbitrary social standards. Furthermore, how could anyone seriously
suggest that turning our children into drug addicts is a reasonable solution to
any of their psychological problems? Consider the long-term damage of extended
Ritalin is a damaging, addictive amphetamine,
not unlike cocaine or black beauties, and that is why it is now a common street
drug too. Four months ago, Health Canada banned the attention deficit
amphetamine Adderall, after it killed 14 children.
Many studies have shown that more exposure to
psychiatrists means more diagnosis of psychiatric illnesses. The Diagnostic
and Statistical Manual of Mental Disorders, DSM calls love sickness and computer
addiction mental illnesses. This is what you are setting our children up for
when you advocate early intervention: Stigma, drug addiction, brain damage and
potentially, death. You had better be sure your science is solid, and it is
Your reports broadly support increasing access
to psychiatric treatments without reviewing the most common treatments. Doing
so provides crucial insights into why our mental health care system is in
crisis. Psychiatrists prefer descriptives like “antipsychotics” and “mood
stabilizers”. In lay terms, the most common drug treatments are tranquilizers,
highly addictive sedatives, amphetamines and a variety of drugs with clinical
pharmacologies that state “the mechanism of action is unknown.” Most can be
Studies on these drugs have been on small
groups of people for short periods. More people drop out than experience
meaningful improvement in their condition. Even then, most receive funding from
the biased drug manufacturers. The leading medical journals have spent several
years trying to establish new regulations to make these studies more honest and
The other common treatment is electroconvulsive
therapy; electric shocks to the brain. In the early literature, psychiatrists
stated that its therapeutic action was brain damage; patients forgot their
problems. Nowadays, psychiatrists say the therapeutic action of ECT is unknown
but there are side-effects of memory loss.
When you advocate forced treatment and support earlier
and more psychiatric interventions, you set people up for sedative and
amphetamine addictions, electrical shocks to the brain and poorly understood
brain chemistry experiments.
The Senate committee, like much of the public,
has developed a distorted sense of the efficacy and safety of psychiatric
treatments. We have given psychiatrists supreme authority. Our faith is woven
from wishful thinking, conflicts of interest, and a focus on behaviour control
over genuine healing.
Consider that the B.C. government recently
dismissed environmental concerns and expanded fish farming. Suppose,
hypothetically, every provincial politician worked in the fish farming industry
and also took personal gifts from fish farming companies. Would you say “unimportant,”
“we can still trust our politicians to make a balanced scientific decision
about expanding fish farming.” That is exactly the situation we are in with
psychiatrists and the drug industry.
Meanwhile, independent World Health
Organization studies have consistently shown that outcomes for people diagnosed
with mental illnesses are significantly better in India, Nigeria and other much poorer countries than they are in wealthier nations where drugs are the
widely available first line of treatment. One study concluded:
Being in a developed country was a strong
predictor of not attaining a complete remission from mental illness.
Your report ignores this and exhibits other
cultural biases. It laments, “Aboriginal communities suffer significantly
higher rates of mental illness.”
The Aboriginal liaison for Victoria's
psychiatric hospital put that differently in an interview with me,
Are there Aboriginal people who have a
cultural viewpoint of the world that makes them more susceptible to a mental
That question is not in your report. Ample
research has shown that culture, lifestyle and spiritual difference are crucial
factors in diagnoses and forced treatment. If you start seeing gods and demons
and believe you are approaching a mystical breakthrough, it is not at all
likely that a psychiatrist is going to support your exploration. He is going to
call you “delusional,” probably “schizophrenic” and tranquilize you.
Your report laments that Canada has only four Aboriginal psychiatrists but shows no concern for the lack of traditional Aboriginal
healers in our psychiatric hospitals. That was a major concern of our Aboriginal
liaison and this same issue extends further. Where are the Jungian
psychologists, the transpersonal psychotherapists, the Hindu yoga gurus, the
Buddhist meditation teachers?
If this makes you roll your eyes, or want to,
as it does many psychiatrists that I have interviewed, you exemplify the severe
prejudice in our mental health system.
This is a major issue of belief differences
which your report rarely addresses and it is a primary aspect of the crisis in
our mental health system for many patients.
Your report notes “there is a significant lack
of accountability mechanisms”. Doctors police themselves. I believe only
one modern Canadian psychiatric hospital has ever
undergone a comprehensive independent investigation. That one
investigation found “systemic” abuse of patients' rights, although few of its
recommendations have been implemented.
What proof do the people who hold the power in
our mental health care system have that anything they are doing is truly
helping our society?
What large-scale statistical evidence do they
provide of improved mental health in Canada? What large-scale statistical
evidence do they provide of improved mental health in Canada?
In fact, all the evidence shows everything is
getting worse. Meanwhile, every time things do get worse psychiatrists say they
need tougher mental health laws, earlier interventions, more public outreach,
community treatment orders and on and on. They are putting infants on
antidepressants. As many as one in five kids are on drugs. Five per cent of our
population is addicted to prescription sedatives. Electroshock is increasing. Lobotomies
are performed right here in Vancouver.
Where will it stop and when will we say that maybe
we need to develop a model of mental health care that is not oriented around
drugs and forced treatment.
The Chairman: Thank
you very much.
Ms. Francesca Allan, As an individual: Senators, I am a patient and an ex-patient and I spent about four
years, not necessarily all of that time in the hospital, but perhaps out on a
warrant, still committed, but allowed to live outside the hospital.
I know what I am talking about as far as what it
is like to have a psychiatric label and I just want to get this off my chest
right away: I do not believe in psychiatry, I do not think it has the answer.
I just do not know how you can take a person in
emotional distress, and force that person to do things that he or she very much
does not want to do. In many cases, they force the person to do very dangerous
things. Psychiatry is not interested in making you feel empowered. The crux of
feeling good is feeling that you have some control over your destiny and that
is something that psychiatry just does not do.
I am also involved in litigation against my
former psychiatrist and as part of that, you have to get your medical records
and go through them. One thing just stuck out so much because the people that
wrote this were probably members of the psychiatric nursing team and they said that
I expressed “feelings of powerlessness.” “We explained to her that
electroconvulsive therapy will increase her feelings of power and will make her
feel better.” They do not refer to the therapy as “forced” they call it “without
consent.” I do not know exactly how they worded it but that was the gist of it.
I do not know how dragging me kicking and screaming out of an intensive care
ward to have something done that is just unbelievably invasive is supposed to
empower you, is it just so offensive to me.
I do not believe in involuntary treatment for
anybody. I mean, if I had a friend who was having a real crisis I might say
this person has to be inside, they are in danger outside, but it is a very,
very far cry from saying that somebody has to be restrained, removed from their
social situation, it is a far cry from that to saying we are just going to
start messing with your head.
My biggest problem with psychiatry is that I
have just seen so many horrendous mistakes. I have put down my labels: Schizophrenia,
schizoaffective disorder, clinical depression and borderline personality
disorder. These are not just labels, with each label came six months or a year
of intensive treatment. The hospital that Rob was talking about, they not only
talked about systemic abuse of patients, they were talking about actual abuse
of patients and I do not know what the percentage is but I believe it was over
50 per cent of the females in Riverview were sexually or physically abused. Is
Mr. Wipond: I am
not sure of the statistics.
Ms. Allan: Oh,
sorry. There is just something terribly wrong with that and in the paper that I
gave you — I mean I could talk for days about what is the matter with the
system, I just pulled the few that really speak to me, one of them is the legal
standard for involuntary certification. Whoever wrote the Mental Health Act in B.C.
had their heart in the right place, but the way that it is applied is not
contemplating that statute correctly.
I was a voluntary patient, asked to leave, and
had been certified on that basis without them even having — well, at one time,
they tried to do it over the phone; a nurse just wanted to talk to the doctor and
said. “She is trying to leave, we better certify her.” That is not what the act
meant when it said a “second physician,” which is supposed to be a safeguard,
must examine you.
A huge problem is that people are voluntary
patients and on that basis, 80 percent of patients are voluntary. They are not voluntary
if the threat is to change their status to “involuntary.”
The option of electroconvulsive therapy in
exchange for an early release forced me to sign the consent form; this is not
consent, it is coercion. Many things are “voluntary,” but many things that we
consent to are not voluntary. It is just like if you put a gun to my head and
make me sign over my property to you, that does not equate to consent and that
is virtually what the doctors do to the patients.
Although there is a provision for informed
consent, it is just not done. The psychiatrist that I am involved in litigation
with was quite blatant about saying that he did not believe in informed consent;
it upset the patients, it was not a good thing. I just do not think that decision
is something that the psychiatrist should make. They give us drugs without
information on their side effects.
Another huge problem in the hospital is that they
are looking for ease of management. Like, it is easier when people are drugged,
they are no trouble, and they are just staring at the wall, staring at the TV. That
might be a good thing for the staff. We should not be concerned with what is
good for the staff; we should be concerned with how these patients will get
better and ultimately end up going back to their lives.
I do not know, this just looks like a bunch of
words now but I think that there are some disturbing things, like the TMAP algorithm
thing. Mr. Bush wants everybody screened in Grade 2. It sounds like a joke but
he is quite serious. Pfizer, Eli Lilly and others will do the testing. These
are not disinterested parties. That is just crazy. There are members of the
psychiatric establishment that support psychiatric drugs.
I cannot tell you how profound an impact a
psychiatric label makes on your life. I mean, I lost my job and I lost my means
for getting another job because I had been in the hospital.
As an involuntary mental patient, even outside
of the hospital, you are the lowest of the low. A convicted felon faces fewer
stigmas than we do. I was ill about 15 years ago, then I got better, and then I
was out for 12 years and I did not have any care whatsoever but I was younger
then. I was 20 and I was very selfish and I was just so happy to be out of the
system I just thought, well, every man for himself, I am out, that is it. It
happened again 15 years later, nothing had changed, some things were even
worse, and this time it is just not good enough for me to get out and say I am
done. I have no choice but to see what little I can do about what our society
does to people that are just not getting along.
I think there are many things that need to be
I am involved with the Civil Liberties
Association in Victoria. They are an offshoot of B.C. Civil Liberties and I
sort of hijacked their meetings for a couple of months and made them talk about
this issue. They came up with a Statement of Principles re Mental Health
Treatment, which is now in the hands of B.C. Civil Liberties who will
possibly put together a position paper or join one of these actions as an
When I went to see them, it was a very small
group and some of them I knew from before, so it was very casual and I said, “I
want to have the Mental Health Act repealed.” They told me to forget it and we
started to talk about how to make it better. I defer to their judgment because
they are smart people and have been doing civil liberties for 30 years, most of
them. Anyway, what they came up with is really worth a read. If that, in
conjunction with the current Mental Health Act the way it is, if it was
actually followed, I would not be as happy as I would be if there was no such
thing but I could sleep better. I would be okay with that.
The Chairman: Thank
Ms. Ruth Johnson, As an individual: I would like to speak on preferred housing options for your
consideration, not because I am a public speaker but because I feel so strongly
about the issue.
I am a consumer of mental health services, which
means I am a patient, I am a client, I am a number of labels, I am a peer
support worker for CMHA, and I volunteer three days a week at the psychiatric
ward as a peer support worker. You will find the blue pamphlet in the handouts.
I have been on a committee for the hard to
house for ten years and helped plan five consumer conferences. I sit as a
consumer on the Advisory Council for Mental Health.
I have heard from many people on client issues
and housing. Affordable supported housing is one of the primary needs to
stabilized mental health. The B.C. guidelines practices for mental health agree
with this and go a long way to support individual care. I see it as one of the
biggest government directives in client care and accountability.
The effect of stigma and poverty are still the
hardest to bear. The shelter allowance here is only $325 per month. The
availability of apartments in that price range is almost non-existent and roommates
can provide extra stress. The government must provide additional shelter
Housing limitations directly affect admittance
to and discharge from the psychiatric ward. We need a variety of housing on a
continuum of care from tertiary to boarding homes to block homes and
independent SIL apartments. Both federal and provincial grants need to be
available for this housing.
In summary, I will restate my personal
observation: In my experience, consumers and I get ill when, on top of a mental
illness, we have the additional stress of not having adequate supported
Could you check why $800 million remains
unclaimed from the affordable housing agreement recently released from the 2005
federal budget of Minister Fontana's $1.5 billion he committed a month ago?
I would like to point out what exists for
housing in Nanaimo on Vancouver Island. You will find a graph and in the green
you will see the tertiary care for the most severely ill. Our hospital psychiatric
ward has 24 beds now with eight more to come for a hospital psychiatric ward. That
will bring the total to 32 beds.
There are 20 other 24-hour care beds in Nanaimo. In the yellow you will see the family care homes or boarding homes, two early
psychosis intervention beds, one respite bed and 14 regular beds. The orange
represents all the SIL, supported independent living, houses in Nanaimo. Nanaimo Affordable Housing has 38 beds with staff. B.C. Schizophrenia Society has
18. There are four more beds at Rosehill and 10 in co-op housing. We have nine semi-independent
living houses at this time and they are all apartments located anywhere in the
community. There is now a wait list of about 30 people.
The population of Nanaimo is 76,600 and we have
only 216 beds. There is a women's shelter in town and also a shelter for women
trying to exit the streets and drugs. There is a shelter for transients called
Samaritan House and the Salvation Army is building a new transient shelter that
will have 16 suites for mental health and six crisis beds.
The Vancouver Island Health Authority
philosophy statement uses best practices models of psychosocial rehab housing
for mental health services. We need continuum housing to address the variety of
levels and the needs of support during the acute phase of the illness as well
as the need for permanent housing to the point of independent living.
All housing for the mentally ill and its
corresponding varying levels of support will support psychosocial rehab. The
ultimate goal is for all clients to have safe, affordable housing that meets
their individual needs. Most consumers polled preferred apartments where
clients live in rent-subsidized apartments with interim outreach support. Documents
and reports to support this went directly to Mr. Kirby and are detailed in
three studies. Some clients may need this type of ongoing housing and many stay
in their subsidized units for quite some time.
Adequate housing for people with mental illness
look like this: Units that are clean, no mold, no cockroaches, no rats, quiet,
safe, and close to amenities and support services. We need choice in a variety
of neighbourhoods. Furniture, appliances and household necessities need to be
available. Options for maintaining the same housing arrangements regardless of
the changes in a person’s mental health need to exist. We need to add the maintenance
of these buildings to an ongoing budget. We need money to start up new
Here is the five-year plan study with all the
people in the different forms shown on the graph. This study showed us where to
spend the money for our area and we have to date what I have showed you as the
existing housing. The list includes goals, standards and strategies in the
areas of service accountability, consumer involvement, individualized service
and a recovery focus.
I personally do not believe you ever recover
from a mental illness, you just learn to cope with it. Best practices should
include service accountability with appeals procedures.
The City of Nanaimo study states that the
community is the essence to survival in a town and that affordable, safe,
sustainable housing is the basis for that neighbourhood. The study encourages senior
levels of governments to recommit to supporting non-profit housing. The study
found that wait lists for non-profit housing is increasing. Many homeless live
in Nanaimo and mental illness may or may not be diagnosed.
The study left a suggestion for strategies to seek
solutions for affordable housing for the homeless situation in Nanaimo. The study seeks to ensure that the shelter portion the income assistance program reflects
the actual market range for rental housing for low-income families, people with
disabilities, seniors and single adults.
That concludes my statement so please feel free
to ask me questions about my illness, my wellness and about my experience with
The Chairman: Thank
Let me just work my way backwards and across
the panel with a couple of questions then I have Senator Trenholme Counsell,
Senator Cordy and Senator Cook.
Ruth, you should know that the issue of the
supporting housing problem is a coast-to-coast problem that began after the
federal government withdrew in 1994.
You are the first person to give us a detailed
submission concerning the housing problem. Your written submission, “Draft #2” gives
us details and descriptions that highlight an unbelievable coast-to-coast
Francesca, can I ask you a question about the
statement of principles?
Ms. Allan: Yes.
The Chairman: I
will go through them in detail, but you pointed out that they are now in the
hands of the Victoria Civil Liberties Association.
Ms. Allan: Yes, B.C.,
which is a much larger organization.
The Chairman: I
have never looked at the provincial Mental Health Act, I mean they exist in
every province in varying degrees and I am well aware of the Supreme Court case
you talked about recently but I have not looked at the details of the B.C. act.
I gather the Civil Liberties Association is to
try to get a rewritten or amended version of the B.C. Mental Health Act and
then presumably other provinces would include these kinds of changes. Is that
what they are trying to do?
Ms. Allan: The
major change is they want oversight by civilians and by peers, people who have
been through the system. The best thing that they came up with was the
psychiatric advocate office, which would be there for anybody who had a problem.
If you get in touch with these people, they will, you know, sit with you while
you speak to the review boards when you challenge your certification. We are
not sure if that person will be a lawyer or a social worker, but somebody will
accompany the patient.
The Chairman: You
refer to essentially an ombudsman-type role.
Ms. Allan: Our
government cut our ombudsman. We do not have an ombudsman here anymore. We do? Sorry,
forget it then.
The Chairman: We
have to work out the exact nature of the advocate's office but the idea and the
concept is good.
Ms. Allan: Just
the idea of somebody to be there to make sure that the committee hears what the
patient has to say.
The Chairman: Right.
Again, one of the other ideas along that line is the notion of patients having
a case manager or advocate for the patient rather than a case manager working
for the system.
Ms. Allan: Yeah,
because we have that title now.
The Chairman: The
title is the wrong title but the concept is the same.
Mr. Wipond, we will debate some of your points
eventually, but in your comments, you suggested that this committee has many
Our issues and options paper outlined our
position on the state of mental health in the country. Our positions will be in
our final report that will contain recommendations.
I do not mind any of your comments except
please do not take anything that is in the issues and options paper as a
position that we are likely to end up necessarily taking at the end because
that is not the case.
You held up a couple of studies, one of which I
believe was the CMHC study. We would like a copy of it if you have one.
Mr. Wipond: Yeah,
I have a copy of the executive summary with me, and I will give it to the
The Chairman: When
we are finished, we will pick that up from you, because we would like to see
I understand you are concerned about
psychiatrists. Let me tell you something, by the way, this might not be
evident, but the majority of us around the table have had family members who
have had similar illnesses.
My point is we understand. Many of us would say
many of the things about psychiatrists that you have implied. That is not to
say that psychiatrists are all bad, but to say we understand the limitations of
the profession. That is why I found your comments useful in terms of getting us
somewhere with this problem.
Is British Columbia or any other province
making the needed changes? I assume that because you are a reporter that you
know about these things.
Mr. Wipond: I
see a hodgepodge of little things happening here or there. For example, we
talked about accountability; I believe there is a county in Oregon or Washington that passed legislation requiring more careful monitoring of people after leaving
the hospital to see if patients are recovering from mental illnesses or just
bouncing around in conjunction with the sort of treatments they are getting.
We need an independent measure of success or
failure and that legislation is precedent setting.
The Chairman: We
do that, by the way, for heart patients and cancer patients routinely, just to
give you the perspective.
Mr. Wipond: With
so many things, if we only applied the same standards as we do to physical
illness: accountability, scientific rigour, et cetera, we would have a completely
different ball of wax.
This is a social control sort of movement. We
get these occasional housing movements and initiatives around particular issues
in areas where a compelling person manages to work with the police and the
Right now in Victoria, we have a group of
people looking at the whole problem of emergency interventions, because we had
a couple of people killed recently in emergency intervention situations.
We had a meeting at the hospital where they
showed a Canadian movie about this particular problem. The movie illustrated
how police are becoming therapists out on the street.
I do not know if I am really answering your
questions about solutions. Europe and India have a completely different
approach to mental illness.
The Chairman: Is
Mr. Wipond: It is
The Chairman: It
was the largest mental institution in the province.
Mr. Wipond: Yeah,
and it was not closed for any particular reason other than all the cut-backs
and they shifted everything over to Vancouver General Hospital. It had nothing
to do with that fact that it was a terrible hospital or anything like that, it
was very indicative of most hospitals in the country.
The Chairman: Well,
it was a hundred-plus years old.
Mr. Wipond: Oh,
as a facility, yes.
The Chairman: Is
there a study to see what has happened to the Riverview patients after they
Ms. Johnson: Yes,
most of the discharged Riverview patients went back to their home communities
without anything in place for them and that is why we have so many homeless. That
discharge process began in about 1985.
That is why we needed supported independent
living to give them structure to stay well, otherwise it is a revolving door in
and out of the hospital and then they become more ill and need to be
The Chairman: What
happened here is what happened in Ontario when they closed psychiatric beds and
did not provide replacement housing for the patients.
Mr. Wipond: There
is a University of Pennsylvania study on the subject of homelessness and mental
illness in New York. The nine-year study is quite comprehensive, and what they
found that it turned out to be cheaper to provide personalized supportive
housing to people than let them be homeless. In the homeless state, they are more
likely end up in emergency rooms, in jails, and they needed far more
medications, whereas when they are in supportive housing their lives are much
The Chairman: In
fact, I will get that reference from you but we have observed that we have
turned the streets and jails into the asylums of the 21st century. That is the reality.
Senator Trenholme Counsell: Ruth, this is a very useful and thorough study on housing. Thank you
I was a provincial politician and I know that
it is not easy to get the federal-provincial sharing arrangements worked out. I
suspect that with all the goodwill in the world on both sides it takes time.
Ms. Johnson: It
is so hard to get anything started in the community without administration
money to start it up.
Senator Trenholme Counsell: That is right, and the community has to have an idea and a plan.
I wanted to ask you about forced psychiatry. Obviously,
there is a great deal, Rob, in your paper about forced psychiatry but I think I
will turn to yours, Francesca, if I may. I find a contradiction in your notes. You
say on page 1 that it is your personal belief that,
Involuntary treatment of any kind is a severe
human rights violation.
Then, under the statement of principles of
mental health treatment you say in paragraph 2 regarding involuntary detention
as a last resort,
It is legitimate if a person is a danger to
society. It is also legitimate if a person is a danger to him/herself.
My understanding of involuntary detention,
involuntary treatment, if you will, is that it enforced only when more than one
physician considers a person dangerous. In some cases, two physicians must sign
the person into treatment. I do not know about every province across the land,
but I understand that the person is either a danger to himself or a danger to
Ms. Allan: Those
two statements are not perfectly aligned, but I am not perfectly aligned with
the civil liberties people either. They met me as far as they were willing to go;
they were not going to go all the way to call it a human rights violation.
Senator Trenholme Counsell: You do not agree with the principles.
Ms. Allan: No, I
agree with them.
Senator Trenholme Counsell: They are not in line with what you say on page 1.
Ms. Allan: Well,
there should be strict limits on involuntary detention and that is because that
can only happen when society is at risk or a person is in a state where he or
she is unable to make decisions on their own.
What you described about the two physicians,
that is great, but that is not the reality. That is what the law says. I have
been phoned by a psychiatrist at my home and been told that I would do what he
said, which was to add another pill to my drug cocktail, which at that time was
up to four different medications in substantial doses. He told me that if I did
not comply he would “send the police to drag me to the hospital in handcuffs.” Those
were his words. I was perfectly well at that time. That is not what the act
contemplated. I hope I made myself clear that it would be fabulous if we followed
the Mental Health Act.
Senator Trenholme Counsell: Somebody from your home must have called and said you needed more
Ms. Allan: No,
that is incorrect; I live on my own.
Senator Trenholme Counsell: Do you mean it when you say that involuntary treatment of any kind
is a severe human rights violation?
Ms. Allan: Yes,
and I think in some cases of severe human rights violations, there can be such
overriding concerns that society allows them.
Senator Trenholme Counsell: Your statement does not say “sometimes,” it is a statement.
Mr. Wipond: First,
there is not mention of “being a danger” in the B.C. Mental Health Act, or a
number of other acts in Canada. That word is not in those acts. There is no
mention now of “being a danger.” Well, there is a mention but it is academic. The
actual criterion for incarceration and involuntary treatment is “in potential
danger of mental or physical deterioration.”
A clause “if you are a danger to yourself or
others” can also be a reason but the vaguest reason that they have, the catch-all,
as the lawyers call it is that phrase “mental or physical deterioration”. What
is that? Everyone can experience mental of physical deterioration.
We are ahead of the curve and more and more
jurisdictions are following our direction. When I asked the manager of clinical
psychiatry in B.C. why our Mental Health Act is going in this direction, he said
it is because of the influence of psychiatrists and families who want more
control. This gives stronger discretionary authority to psychiatrists and puts
more trust in them to make the call. It came around after we had an inquest into
the murder of the wife of a prominent politician by their son. After the
inquest, there was a public movement to get control of these people.
Here is a compromised position: Let us allow
detention of someone who might be in imminent danger, and bear in mind here the
real problem with the word “danger” is not defined anywhere. Are you a danger
to yourself because you are a smoker? Technically, yes, you can be incarcerated
against your will for being a smoker, or any of a number of things that make
you a danger to yourself.
We need to consider the legal aspects of what
we mean even if we include a danger clause. The compromise position that the B.C.
Civil Liberties is looking at is allowing detention rather than treatment. The
detention would keep the person until he or she seemed well. We suggest that as
opposed to intervening in your brain and screwing around with your head with your
little experiments. We do not even do that to serial murderers. Somebody could
be the most dangerous person in the country and there is no law that allows you
to get into their brain and chemically lobotomize them or whatever else you
might do. So no, you would have to classify them as mentally ill first and then
do it. A mentally ill person has really less rights; they can be incarcerated
Senator Trenholme Counsell: Ms. Allen what is your basis for saying that the biochemical
imbalance theory is a fraud?
Ms. Allan: I
say that because they do not know what the chemicals are, they do not know what
the imbalance is, and they cannot show on a healthy brain what it is we are
Senator Trenholme Counsell: Who is “they”?
Ms. Allan: “They”
are psychiatrists and the medical textbooks.
Senator Trenholme Counsell: Well, there are hundreds of thousands of articles on the
biochemistry of the brain. Do you think it is all fraud?
Ms. Allan: I do
not think it is all fraud. I think there are some good doctors, but I think the
science as a branch of medicine is a fraud.
Senator Trenholme Counsell: You do not believe in any of the biochemical theories?
Ms. Allan: I
believe it is conceivable that some people can have a biochemical imbalance corrected,
but I think they would be the exception. Until they can come up with some
answers about what exactly these chemicals are and what they are trying to do I
am suspicious of the theory.
Mr. Wipond: MindFreedom
International and the American Psychiatric Association debated that issue.
MindFreedom went on a hunger strike to force the American Psychiatric
Association to provide proof that a biochemical imbalance is the basis of
mental illness. During and exchange of letters MindFreedom had its own independent
scientific panel assess the replies from the American Psychiatric Association. The
APA continued to say, “hundreds of thousands of clinical studies will prove
this” but provided only two citations to textbooks which of course are not peer-reviewed.
Senator Cook: I
would like to go back to the variation of provincial Mental Health Acts. Are
you saying that those various acts violate the spirit of the Canadian Charter
Ms. Allan: Yes,
Mr. Wipond: Absolutely,
no question, and virtually any lawyer that I have ever talked to feels that way.
The people who design the legislation try to empower the doctors in the system.
You need a lot of money to take something to the Supreme Court and you need a
good case that fits certain criteria. It is very difficult for patients and
their families to challenge an act.
Our Health Act has changed three or four times
in the last 20 years so you can imagine how hard it is to mount these cases,
particularly with somebody who is really unstable as your main client in the
Senator Cook: I
am searching to understand the gap.
How do we put forward a recommendation that is
compatible with the Charter of Rights and Freedoms, given that each province
and territory across this nation has a Mental Health Act that they believe
suits their needs? How do we get past that problem?
Mr. Wipond: Well,
for example, the Mental Health Law Program has the CLAS, Community Legal
Assistance Society, and they specialized in this area.
They have many positions but one is the idea of
consent, because even though we are deemed to have consent, it is not consent
in practice. Further, if a person wants to refuse treatment it is considered
proof that the person needs treatment. That is how doctors use it.
We have a piece of legislation that applies to
elderly people in home care, and there are a variety of options open if you are
sliding into dementia where you can sign ahead of time if you are deemed in a
reasonable state. They suggest that a person determine beforehand what to do
with their money, property, and so forth. The legal document is binding. That
is one option.
Another option is to choose a legal guardian
under those situations. That is a very good option as well, right? And this
kind of thing would rectify all the kinds of problems that people like Francesca
talk about where she could ahead of time plan for this when she is in a really
good state of mind.
This option allows the patient to make clear
his or her intentions concerning treatment concerning certain medications, or
electroshock et cetera.
Ms. Allan: The
Provincial Representation Agreement Act deals with this kind of pre-planning in
the worst-case scenario. Unfortunately, the provisions of the Mental Health Act
exclude patients from a representation agreement. It is not only the Mental
Health Act; it is the all the legislations that defer to it. It is very, very
powerful, very toxic legislation and we have to be careful using it.
Senator Cook: So
the problem is not as much with the various provincial Mental Health Acts or
the human rights per se, it is in the implementation by people that you have
lost trust in applying those acts.
Ms. Allan: Unfortunately,
I do not know what the situation is in other provinces.
Senator Cook: Well,
let us look at where you live.
Ms. Allan: I am
very familiar with the Mental Health Act in British Columbia. I believe it is a
well-intentioned document with reasonable items. As I said before, if we follow
the act we will be well on our way to finding solutions to the problems.
Mr. Wipond: To
be clear, the problem is the acts, because they are too vague. The British Columbia act gives the doctors too much discretion and as a result, we will see
more lawsuits. The act does not set out the physicians’ jurisdictions or the
rights of the patient. The legislation must be rewritten and include a
definition of mental illness, under which conditions a person may be
incarcerated, and whether a patient may appoint a representative to handle his or
Ms. Allan: Even
though it is vague, we have the law and it is in place right now and the very
least we can do is insist that everyone follows it.
Senator Cordy: Ruth,
I would like to start with you and thank you so much for the valuable information
you have given us regarding housing.
We have heard repeatedly that housing is one of
the most primary needs and when deinstitutionalization happened many years ago,
they forgot to put the money into the communities to provide for adequate
You talked about the stress of finding housing
and that a patient sometimes has to remain in the hospital because a domicile
How do they go about finding housing if they do
not have family members to help?
Ms. Johnson: Our
hospital has a hospital social worker and part of the tertiary care beds are
step-down beds where you would go from hospital discharge to a 24-hour care
facility. There is help available in our hospital and I am a peer support
worker in that area. There is some hope but there are just not enough beds and
it jams up the system. If you want to enter the system because you are ill,
there is not a bed available.
I believe in a holistic system where each of us
should choose what the right cure is for us, what the right medication is, what
the right combination is, and what options our doctor’s offer. So I have a
slightly different slant on it.
Senator Cordy: With
the shortage of housing that is available, would you have to accept a housing
situation in a community that was not your community?
Ms. Johnson: Oh,
definitely. Some of the smaller communities have to come to Nanaimo, or Victoria. Sometimes you have to accept co-op housing with four other roommates, and
roommates add stress, anybody can attest to that.
Senator Cordy: Absolutely.
The Chairman: Particularly
Senator Cordy: Is
that a short-term stay until there is housing or is there any available housing
in rural areas?
Ms. Johnson: Well,
like I said, out of the 90 SILs, semi-independent living apartments, there are
30 people already on the wait list and we started to get extra SILs about a
year ago when we started to do our next five-year plan. We just completed a
five-year segment, now we are on to our next five-year segment and already
there are 30 people on the wait list.
Senator Cordy: That
does not sound very good for the people who are waiting for housing.
I was an elementary school teacher for 30 years
and I always fought for early intervention for many problems. I am not talking
Ritalin because I was not a Ritalin pusher; in fact, I found it very
frustrating when parents would sometimes doctor-shop to find a doctor to give
their child Ritalin because it was much easier to say your child had ADHD
rather than admitting to parenting problems. I am not talking Ritalin but I am
talking early intervention to help children and families in crisis.
I get the feeling that there are no positive
points to early intervention, that it is all negative and I cannot quite get my
mind around that.
Mr. Wipond: You
mean early intervention like the child is having poor marks and you hire a
tutor to help them?
Senator Cordy: No,
I am talking if a child is having difficulty. I mean, a teacher deals with
thousands of children over a 30-year period. If a parent comes to you because
their child is not socializing and exhibiting very aggressive behaviour, should
the teacher ignore the parent?
Mr. Wipond: Early
intervention works great in breast cancer and it works great for poverty. However,
I question many of our psychological interventions because most of those are
not particularly scientific. I question the role of the school in the diagnosis
and treatment of mental illness. These type of interventions may lead to
hypotheses about X or Y syndromes.
I can see a positive role and I believe that
maybe you played a great role in that situation but I have seen many teachers
who I would not trust from that perspective. I have seen out of control classrooms
purely because of size. I have seen out-of-control teachers point to one child
as the source of the problem while the teacher is the problem. In some instances,
kids with different kinds of disabilities are in a large class and there is
total chaos. These types of situations occur with great frequency in the United States.
The U.S. Drug Enforcement Agency heard
testimony from psychiatrists that the 20 per cent of school kids on Ritalin did
not have any reason to take it.
If the front end of that wedge is very nice but
the back end is psychiatry you need to be wary because that is a slippery
slope. We have to think about that and particularly because this is so
impossible to diagnose.
Senator Cordy: What
do you do?
Mr. Wipond: You
Senator Cordy: You
help, but that is early intervention to me. Maybe our definitions are
Ms. Allan: It is
the language that we use. I know what you mean by “early intervention” and I am
for what you mean but you say it to me and I have heard that word used and that
sounds very threatening to me. That sounds like labelling and once you are labelled,
you are put on a track and that is where you stay.
Mr. Wipond: Psychologists
and psychiatrists employ that term largely to define emotional problems. If early
intervention does not mean psychology and psychiatry it is okay, but I think
you mean psychology and psychiatry, do you not?
Senator Cordy: Tell
me, when parents ask what they should do and whether to test their child should
I say that the child is too young?
Mr. Wipond: In many
cases, some of the best results occur when the entire family enters therapy.
Senator Cordy: I
agree with you; when a child has a problem, that problem does not occur in
isolation. We have mentioned poverty and housing as problems that can cause mental
Mr. Wipond: We do
not have concrete proof of that and I think we need to be a lot more careful in
the how and the why of the situation.
Senator Cordy: You
say it like that but I get the feeling that you disapprove of early
intervention of any kind.
Mr. Wipond: No,
not of any kind, I am just suspicious of psychology or psychiatry. I am against
early intervention with psychiatry. I have seen some beneficial things from psychology,
so I am a little more open to that idea, but psychiatry I think is far too
dangerous, and physically damaging.
I know a psychological specialist who is a
critic of the system and she thinks psychology is quite dangerous but I
personally would endorse psychology over psychiatry.
Senator Pépin: Then
what are we to do?
Mr. Wipond: Give
me a situation, if you are asking what to do.
Senator Pépin: Witnesses
informed us that early intervention could help two- thirds of the children with
You say you are against psychiatry and
psychology and it seems that you are against medication. What is a parent to
Mr. Wipond: I am
just trying to make you realize how dangerous the situation is. There is a well-known
psychiatrist in Victoria, who specializes in nutritional approaches to
psychological problems. This is a whole other approach; it is very non-invasive
in that sense. Perhaps that approach will not work for everyone but it does
work for some. In any case, we must look at the child's nutrition very closely
and design a nutrition program for that particular body.
Our society has powerfully deep, wide-ranging
nutritional problems, particularly in our youth. Sugar is one of the most
controversial substances that they inhale — inhale, I mean eat, but, yeah,
pretty much inhale.
The Chairman: It
is chocolate we inhale.
Mr. Wipond: Many
studies have gone on to show that this dramatically influences the
psychological state of a child and anyone who has pumped their kid up with a
lot of sugar knows that is a true statement.
I would not say we cannot approach the idea of
early intervention, I am just saying we need to be very careful of the
direction we take because early intervention does not include nutrition, social
issues, poverty, family pressures et cetera.
Ms. Allan: My
treatment began when I was an adult so it is not exactly the same but they just
do not take a very common-sense approach. They did not ask, Are you happy at
home? How well do you sleep? Do you eat a well-balanced diet? Do you have
enough money to cover your basic needs?
Without asking those questions, a doctor is
unable to give a proper diagnosis. I mean, you are just not looking at the
whole picture and I think the same applies to children. We must know how and
where children live, how they eat and how they spend their spare time.
It is like there is just a whole spectrum of
things to be looked at when you say “intervention.” If you mean “psychiatric
intervention,” you must know that none of those things is covered and they are critical
to understanding the child or adult with the problem.
Mr. Wipond: In
connection with this is a fascinating book on the principals and practices in
emergency psychiatric treatment. The book cites a number of studies showing
that 30 per cent to 50 percent of emergency psychiatric problems are actually
physical. Now, this is interesting. Cardiovascular disease, a parasite, a
nutritional imbalance, and certain nutrient deficiencies, can cause extreme
psychological problems, but the studies show that only 10 per cent of
psychiatrists ever do a standard physical check-up. I do not refer to exotic testing,
but a standard physical check-up would find this particular problem.
Ms. Allan: Some
of those tests are so simple. People diagnosed with depression should have a
thyroid test because an under active thyroid causes depression-like symptoms. The
doctors often disregard these common-sense approaches.
Senator Pépin: Many
witnesses say that more community centres could help a lot. In addition, we have
had many witnesses say that they do not want to see too many people with mental
disabilities living together in the same housing complex.
Ms. Johnson: That
is why the semi-independent apartments are around the city. CMHA provides us
with a clubhouse where members go every day. Members have a daily activity and
lunch and have work projects so they have meaningful work to do when they are
Senator Pépin: There
is also a program called Consumer Survivor Business, which, I believe, is in Ontario. That program prepares people to return to the workforce.
Do you have a similar program to help people
start or get back to work?
Ms. Johnson: The
hardest things to bear are poverty and the stigma. CMHA does have a job program
and starts people but there is such a stigma once you have a mental illness
that you lose credibility. I was a counsellor, I was a substitute teacher, I
was a daycare worker, I worked in a women's shelter, but once they labelled me “mentally
ill” I lost all credibility.
I moved and earned back my credibility as a consumer
and that is why I do peer support, because I feel I understand the needs of my
fellow consumers. I can help fellow consumers through the maze and help them navigate
the system. I can help them find an advocate, help them with the legal system, and
help them when there is a violation of their rights. I do not know if that
answers your question.
Ms. Allan: I
think that is so positive because a negative experience is now a positive
experience. Over the last few years, the people that have helped me the most
with my troubles have been lay people. Those people have helped me along the
way to getting through the system and getting better. They remember their
experiences and are very sympathetic and helpful to others.
Mr. Wipond: We
were talking about models and there is a hospital in the United States that has two boards: One, the typical board of mental health professionals
and the other board of consumer survivors. The executive director reports to
both boards and either board has the power to fire him. It is a tremendous
model; it is working amazingly well. I heard the man give a talk and he was
Senator Pépin: Francesca,
you have said that all people with a mental disability should have help to make
What are we to do about the patient on the
street, the person who is quite disturbed?
Often these people do not know anybody and they
do not have any family. How can we help them to start a program, put them in
the hospital, or start them on medication?
Ms. Allan: Yeah,
those people are in the most difficult position in society and that is where we
came up with the psychiatric advocate or ombudsman. I am lucky, I have people
around me, I can give my power of attorney away, and I know lawyers that can do
that very quickly for me.
Senator Pépin: The
majority of patients do not have that help.
Ms. Allan: I do
not know how many do or how many do not, but that would be one of the functions
of the ombudsman’s office. In the same way not everyone can afford a lawyer but
yet hypothetically we are supposed to have legal aid available.
Senator Callbeck: Ruth, you mentioned that one of the hardest things to bear is the
stigma associated with mental illness.
In Regina, we heard from a group that visits grade
8 students in the schools. They visit those children and other children’s
Do you have similar programs here in Vancouver?
Ms. Johnson: It
is definitely taking place in Nanaimo, I have done that myself. I find the high
school groups harder to talk to than the college groups. The high school groups
want to be invincible and think that mental illness will not touch them or
I think we need more of it and I think you are
on target when you talk about it. I think that is part of early intervention
and part of public awareness. Some TV commercials de-stigmatize the mentally
ill. One commercial shows a mentally ill person holding a baby; it shows that
he is a safe person and he likes the baby.
The Chairman: It
is obviously only a B.C. commercial because none of us have seen it.
Ms. Allan: It is
quite fabulous. I am not sure who puts it on but the punch line of it is you
see this man with a baby and then you see his mental illness label and then the
caption is something like, “what is sick is how your mind just changed.” It is
very powerful advertising.
The Chairman: Do
you know the sponsor?
Senator Callbeck: You spoke about visiting the high schools, have you gone into lower
grades, grade 8, for example?
Ms. Johnson: No,
we do not, but I was an early childcare worker and I learned to recognize
behaviour that was consonant and consistent with normal maturation from
behaviour that was just a little off target. I do not know how you would deal
with it but you can recognize it.
When I worked at the women's shelter, I dealt
with many children that had witnessed severe abuse and I taught them how to use
feeling words to communicate their feelings. I think communication can help
your doctor know how you are doing as a child, as an adult, as a consumer, and as
I have a good working relationship with my
family physician and he lets me choose my treatment. I think if parents,
children, therapists, and doctors would all work together then we would have a
much better system. I do not know how you as senators get that to happen but
those are things that I wanted to bring up today when you asked me questions.
Senator Callbeck: Francesca in your Statement of Principles re Mental Health
Treatment, you say
3. It also follows that there should be no
such thing as compulsory treatment.
Ms. Allan: Yes
senator, there should be no such thing as compulsory treatment.
Senator Callbeck: I understand a judge can order treatment for up to 60 days to try
to get a person fit to stand trial. You would disagree with that?
Ms. Allan: Yeah,
I disagree with any involuntary treatment.
Senator Gill: I
think I agree with many of your points about the new way of thinking about
mental health. I do not know how many people think this way and I believe that
it will be difficult to change the way that society thinks about people with
mental illnesses. Senator Kirby mentioned it is not a final report because the
final report will be different. I hope it will be different.
Ms. Allan: I do
admit to being very defensive and so I am on the lookout for anything that
looks like bias. There is good reason that I am that way and, for instance, I
did not read the three reports, I scanned them. Rob read them and it alerts my
suspicions when I hear about a heading “Access to Treatment,” and under that
title is the subject of forced treatment. I am on the lookout for that all the
Senator Gill: I
am not complaining about the way that you did that.
Ms. Allan: Well,
I heard it before.
Senator Gill: Sometimes
you have to be strong enough to be listened to.
Mr. Wipond: I am
encouraged by what you are saying but I want to emphasize that you should look
at your third report, which dropped any discussion about forced psychiatry and
the statement about Aboriginals and the statement about early intervention. I
am glad you are open to consideration of those items.
Some of the wording is very subtle as in the very
definition of “mental illness.” If you are going to discuss stigma you have to
ask that question. The moment I look at you and say that a person is mentally
ill, and incompetent, that person is stigmatized. We have to really address
that as a society and say maybe that this is the root of the problem because we
do not really know enough about mental illness.
Senator Gill: I
just want to add that our committee and others are trying to represent, as best
we can, a minority in this country. We care enough to listen to witness and try
to help solve the problems.
I have not attended all of the meeting but I
do know that the Aboriginals are having a very bad time of it. Many people are
in jail instead of being elsewhere because they are not conforming to the
society in general.
Do you think that many people in B.C. think
Mr. Wipond: Absolutely.
The overwhelming majority of patients I talk to think this way.
Senator Gill: I
am talking about the general society.
Mr. Wipond: We
receive conflicting comments from the mental health professionals that work in
the system. Some psychiatrists write extremely angry letters to say that there
are hundreds of thousands of clinical studies that show that this guy is just a
loony-tune, and we get letters from psychologists and social workers who say
that the guy is right on. Many support workers are concerned with the power the
doctors have to force therapy on the mentally ill.
One particular psychiatrist wrote to me about
his patients. He told me that in the context of his Jungian psychology program
he admitted a consumer to hospital to stabilize her while she experienced a
crisis. The doctor in fact encouraged her to go to the hospital just to try to
stabilize her. The doctor tried to see her while she was in hospital but the
doctors in the hospital refused to let him in to see her. She got worse in the
hospital but the doctor could not see to her release; she was under another
doctor’s supervision. There is some concern about the power of some of the
Ms. Johnson: It
is interesting to note that the statistics show that 40 per cent of the people
in jail have an undiagnosed mental illness and that a high percentage of the
people in jail are native people. That does not seem fair to me.
The Chairman: I
agree with you and that is what prompted my comment that we are using the
streets and prisons as the asylums of the 21st century.
Ms. Allan: I
want to get back to how many people are on our side. I believe that if more
people knew what was going on we would have more people on our side. People do
not believe me when I tell them about shock treatment; they think that it went
out in the 1950s. I had forced shock treatment last year. How can people be
outraged if they do not know about the problem?
Senator Trenholme Counsell: I have a couple of points to make and the first is with respect to early
intervention. In my experience, it started out with infants, young children,
looking at vulnerabilities, and trying to intervene early. We used the term “early
intervention” in respect to young children. It is a philosophy that the sooner
you treat something, whether it is a social condition or whatever it might be,
all the hundreds of things where intervention is necessary, so that is not
directed towards people with mental illness.
You said you would like to have an example. I
was very recently at a breakfast annual meeting of the Schizophrenia Society of
Canada. I will always remember the guest speaker because told his life story
and he really gave thanks to modern psychiatric medicine. He is thankful for
the medications that help him to function and work. He is a father and a
husband and because of modern medicine and methods, he was able to stand up and
give his speech.
I will remember you people and what you have
said because you represent an awful lot of people who have had bad luck in one
way or another with the system. I think you are telling a very important story
of many people who feel very, very ill done by the system. We have to listen to
your stories and see how to put them in our report.
You are making very strong points and so I
must ask you if you think a person with schizophrenia or in a manic phase of
bipolar should not receive treatment or medication?
Ms. Allan: I am
going to get to that, but I have also heard people tell their stories and they
are very moving and many of them thank their psychiatrists but what you are
talking about is somebody that wants to continue on medication.
I have no problem with truly voluntary
treatment; that is not the issue. I am talking about people who do not want
these things done to them and we are forcing them anyway.
You asked about a person in the manic phase of
bipolar and whether that person should be medicated.
Senator Trenholme Counsell: What would you do for them? What would you offer them?
Ms. Allan: It
depends how they came to approach the system. I would have to know what
behaviour caused such alarm before I could make a decision.
Senator Trenholme Counsell: What if the person is manic or suffering from delusions?
Ms. Allan: What
about mania; people tell me they think they are going to be on the Olympic
team, I think that is a little out there, but it is not problem. Lots of mania
is not a problem; many delusions are not problems.
Mr. Wipond: Well,
that is a very good point.
Ms. Allan: You
can ask many people who believe in God if they really think there is a person
up there watching everything. That could be a psychotic delusion; it is just a
matter of what society will put up with.
Senator Cook: Ruth
how heavily are you involved with NGOs in your community. I refer to non-governmental
organizations like churches and Rotary groups, because the administration of
housing must be complex.
I come from the Province of Newfoundland and we are engaged in a similar housing project in partnership with The United
Church of Canada who takes the risks for back rent and rent forgiveness et
cetera. How much of that do you do in Nanaimo?
Ms. Johnson: Well,
that is why I mentioned the New Hope Centre is going to provide many things for
the homeless people. There will be 16 suites for mental health people and six
crisis beds. That directly came about after a committee called SKIPPY, I do not
even remember what the acronym stood for anymore, but that is why I included
the survey from the City of Nanaimo, because they have been doing that and
Nanaimo Affordable Housing is a non-profit association that set up two
apartment buildings staffed for people in the community.
Our town really cares about the people that
are in our situations and they recognize our needs. I think we are really lucky
in some ways but we could go a long way because the smaller communities really
have to do without. A lot of the money on the Island goes directly to Victoria and then is divided up between the smaller areas. The smaller regions get lesser
portions, of course, and of course, most of the money needs to go to the most
The committee needs to realize that many of us
have long periods of wellness where we can make our own decisions, especially
with support, and it is the supported independent living that I care so
passionately about that has kept me on a committee for ten years.
Senator Cook: In
my province, we have one facility under the same umbrella run completely by the
consumers who live there. The residents have access to the board so that there
is a connection. Do you have any of that in Nanaimo?
Ms. Johnson: Victoria has a number of fourplex buildings where individuals can buy into their own condominium,
so to speak. Nanaimo does not have anything that equals that at present.
Senator Cook: Francesca,
help me to understand a piece in your brief. In number 5 of the statement of
principles you propose a better oversight system, the creation of a psychiatric
advocate, a program for psychopharmacologists, and then the one that stumps me
The appointment of civilians to the oversight
committees in the relevant licensing bodies.
Do you mean a consumer or volunteer from the
Ms. Allan: I
think it could be either but the critical thing is that it is not a
Senator Cook: A
Ms. Allan: Yes,
Senator Cook: Maybe
we could ask you to send us a bit more detail on how you see this happening.
Ms. Allan: I
would be happy to send you whatever the B.C. Civil Liberties come up with; they
have this now; they are presumably going to be approaching it.
Ms. Johnson: I
think that the committee might be interested that I sit on a hiring committee
for the community support workers that go out to the people's housing. The
staff nurse at the hospital that runs the psych ward was surprised when a
consumer, a mental health patient, was not on her hiring committee. That is
something that we expect.
Senator Cook: That
is the other point I made, that would happen primarily for your family care
homes, people who live in private families.
Ms. Johnson: Yes.
Senator Cook: So
there would be some sensitivity training or some understanding of that subject.
Ms. Johnson: Yes,
and we meet once a month.
Senator Cook: Finally,
Rob, we are very ordinary people trying to do an extraordinary job. In order to
do our job we have to listen to everyone and we have to get a balance.
I am not going on the defensive about what we
have done so far but remember they are options and recommendations.
I would like you to help me understand your
opening statement that says:
Your reports show that the Senate Committee has
a strong bias guiding it, and this bias suggests you’ll contribute to worsening
the situation rather than improving it.
Help me to understand that statement so we can
revisit it and strike a balance, especially from the discipline of
If I read this correctly and understand you,
there is a power shift and it has shifted to psychiatry rather than the rights
and the proper care of the individual.
Mr. Wipond: I
think that is a great idea because in my estimation the power balance has swung
too far to the other direction. The irony is that the power is now in the hands
of the doctors because of the failures and the inquests where the mental health
professionals win the battles. They are more articulate, they are usually more
forceful, and they usually have better research to cite than the consumer
survivors who are often trying to deal with their own internal issues at the
same time as they are trying to present a case. I have seen this battle played
out a million times.
I am happy to see that you want to strike a
balance and I am terrified when I hear about treating a person against their
will. The incredible use of the Orwellian twisting of words scares me. Treating
people against their will is seen as freeing them up and they actually say, “We
are freeing you up” because they will not incarcerate you after they have
treated you. That is where I see the pendulum has swung too far and we are nowhere
near a balance.
We must revisit the phrase “mental illness,” because
we do not have a consensus on what it is, how to diagnose it, or how to treat
We have to start there and realize that some people
respond well to these medications and they like them and they voluntarily
continue to take them and for them they are working well. Other people do not want
treatment or medications forced on them. I am looking for that balance and I do
not see it.
I am sure you have started to see this. I want
to emphasize that I have researched a million social issues and this is the
most politically and emotionally volatile issue in which I have ever been
What disturbs me most is when I interview psychiatrists
and many mental health professionals they totally deny that this is a controversial
area. They will not admit anything. If they admit that this is controversial
territory, I would respect them. They routinely say the science is clear, the
studies are clear, and it is very much like a doctor who has a certain god-like
position that says “I know, trust me.” They take that position and that is what
I find most concerning because they do not engage in debate. This is so extreme
that in the case of my articles in Victoria they never wrote a letter to the
editor challenging anything I said about them. However, the paper got a letter
saying that if they ever published me again they would retaliate against the
paper. They refused to let the health region employees grant interviews, all
because of me and the articles I have written.
We finally sat down, had a meeting, and what
was the predominant issue? They wanted the meeting off the record so I am
telling you something now I should not be telling you, but I think it is
important. The overriding issue was they did not want me interviewing patients.
They referred to the consumers as “psychotics,” who could not be trusted.
I try to do my due diligence, but why do not
we engage in a dialogue. They did not want that, even if we offered them space
to put their own position, as long as we were going to put patients' arguments
right next to them they did not want that debate and that to me is the
foundation of the problem. They are trying to deny that this controversy and
these kinds of problems exist. This committee is exposing these problems and I
think it is great.
This is a traumatic area of our society. We
need to discuss mental illness, flesh it out, really be honest about the
research and then we can strike a balance. So much manipulative stuff has gone
on behind the scenes that have disempowered the consumers and the survivors.
Ms. Johnson: In
conclusion the last thing I would like to say, because I notice we are past the
time already, is that I would like to see the issue discussed as “mental health
issues” and that we have periods of “wellness” when we can make our own
decisions. I do not like the reference of “mental illness” because that says I
am always a patient.
The Chairman: Let
me ask you, all three of you, about the word “consumer,” which we used in our
reports. Personally, I do not like the word “consumer” but in any event, we do
not like the word “patient” because clearly that is the purely medical word.
In people like yourselves and people in peer support
groups, is “consumer” the best word to describe a person who has had a mental
illness or brain disorder?
Ms. Allan: Not
if they have been treated involuntarily. I loathe the word “consumer”.
The Chairman: What
is a better word?
Ms. Allan: It is
a psychiatric label.
Mr. Wipond: The
term I use is “people who have been diagnosed with mental illnesses.” It
indicates that somebody applied the diagnosis and you may agree with it or not.
The Chairman: You
understand our problem. On the other hand, we may have to find a shorthand way
of saying that, in a long report you do not want to repeat it a million times
but we can do that through a glossary or definition.
Ms. Johnson: I
use the term “consumer” because it is a general term but when I am in daily
situations and I talk about my mental illness I say I have “suffered from
symptoms of depression,” and I do not explain it any farther than that to most
people because I do not think it is their business.
Mr. Wipond: Someone
who did a history of the psychiatric survivor movement in Canada really objected to the way your report used the word “survivor.” The word “survivor” was twisted
around to suggest that these were people who survived mental illnesses. In fact
the history of that term, and she was involved in the founding of the use of
that term in Canada, was people who survived psychiatric treatment.
The Chairman: We
will not use the word “survivor.”
Senator Cook: On
Saturday, I was on an Ottawa bus and saw a large ad that said mental illness is
a hard journey. I do not know who posted the ad.
It is a complex problem. I think that many
people can make life better but that no one segment has all the answers. I
think that what we need find an answer that will take care of that individual.
That is the reason why I am here this morning. I worry about labelling. My
daughter was anorexic for three long years after her dad died. I have never
heard anyone in our community, you know, friends or whatever, say that Jean
was, or is, anorexic. She did not get labelled. It was a mental illness, and I
believe it was, and through a long period of rehabilitation, she managed it.
Ms. Johnson: Often
that is because anorexia is visible; my mental illness is not visible.
Senator Cook: Okay.
Thank you. I have often wondered why it did not apply and I guess hers was both
a mental and physical illness.
Senator Trenholme Counsell: Francesca, you said you hated the word “consumer.” Do you accept
the word “patient”?
Ms. Allan: I
think it is better than “consumer.” I think it is more truthful.
Senator Trenholme Counsell: So maybe you could just speak to that a bit, please.
Ms. Allan: About
the word “consumer”?
Senator Trenholme Counsell: Well, the word “patient”.
Ms. Allan: I
cannot really talk about why “patient” is a better word, it is just that we are
mental patients therefore we are patients. Like, it just makes more sense. “Consumer”,
I mean I am a consumer of A & B Sound because I choose to go there and not
to another store. “Consumer” really makes the hair on the back of my neck stand
Senator Trenholme Counsell: I agree with you. Do you think “patient” is more humane, it is more
Ms. Allan: Well,
I do not care if it is more kind; I care if it is more honest and it is more
Senator Pépin: So
as a good Franco can we say “people suffering from mental disability.”
Ms. Allan: Well,
whom are we trying to please here, because if you talk to most of the people
that I discuss these things with they call themselves “escaped loonies.” I
mean, it is not a politically correct issue at all.
Mr. Wipond: The
history of the psychiatric survivor movement in Canada is in a book called Call
Me Crazy: Stories from the Mad Movement. Many people use the word “crazy” because
it indicates something that is fun and creative.
Senator Trenholme Counsell: I think “survivor” is quite appropriate when you are talking about
cancer but I think it is pretty insensitive when you are talking about mental
Ms. Allan: It is
so overused, like people are talking about surviving bad marks on their political
Mr. Wipond: Yes,
and it is insensitive to psychiatrists.
The Chairman: Let
me thank the three of you for coming. We realize we have prevailed upon your
time way beyond what we said we would. We will still take a short coffee break
and then the next panel will be allowed to run overtime too. Thank you very
much for coming.
Ms. Bonita Allen, As an individual: I thank you for inviting me here today. I have to say that I am
not a professional or an expert; I am just a mother who has experienced mental
illness for many years.
My son Gary had his first bipolar episode as he
turned 16 and during the ensuing 26 years Gary has been hospitalized several
times. Last spring he fell into a severe bipolar episode during which he
displayed bizarre, agitated and aggressive behaviour. He was involuntarily
hospitalized and rightfully certified with a mental disorder. While a patient
in the intensive care unit he was involved in an unfortunate confrontation
resulting in injuries to staff and the laying of criminal charges. The events
that followed convinced me that the criminal justice system does not lend
itself to the complexities involved in dealing with people who have psychiatric
Most of the crimes committed by the mentally
ill are the direct result of their psychosis, hallucinations or paranoia. They
have little or no control over a mind playing tricks on them. Their crimes
mainly involve lifestyle or public nuisance situations, misdemeanours, and
sometimes aggressive or violent behaviour. Does it serve any useful purpose to
punish these people? Will the additional stigma of a criminal record enhance
their already difficult lives?
I am certain that if the mentally ill could
gain easier admittance to hospitals when required, and upon stabilization and
release received appropriate accommodation, community support and case
management, there would be a sizeable decrease in the number of criminal acts
and other mental health emergencies. This begs the question: Have we, as a
society, after the deinstitutionalization of care for the mentally ill,
committed the resources necessary to provide adequate community mental health
services for those at risk of commitment or for those who persons discharged
from hospitals, prisons and jails?
I ask whether it is fair or legal to take
persons into a courtroom who are manic, delusional, paranoid, catatonic,
hallucinating, or any combination of the above. In such a state people cannot
appreciate the gravity of their situation, and are unable to act in their own
best interest. To make matters worse, police, judicial staff and lawyers do not
always have the knowledge necessary to understand mentally ill defendants.
It is my observation that the inhumane practice
of incarcerating mentally ill people in jails and prisons is cruel, unjust and
ineffective. Prisons do not have adequate or appropriate facilities, resources
or medical care to deal with the mentally ill. Poorly trained staff is unable
to handle the difficulties of mental illness.
The mentally ill suffer from illogical
thinking, delusions, auditory hallucinations, paranoia and severe mood swings;
they do not always comprehend the rules of jails and prisons. They are highly
vulnerable and prone to bizarre behaviour that prison staff must deal with and
inmates must tolerate. Such behaviour can and does result in tragic
consequences such as physical assaults ranging from lacerations to brutal
beatings and rape. They can also be subject to disease transmission and drug
To assist in their recovery, mentally ill
people desperately need the support and advocacy of family and friends, which
proves difficult in a prison environment.
The stress of prison life exacerbates the
already fragile condition of a mentally ill person and lengthens the duration
of illness. Clearly, the presence of people with mental illness in the criminal
justice system imposes substantial harm to both them and substantial cost to
I am not an expert so I cannot provide
solutions to these concerns, but I have some suggestions for your
Firstly, perhaps look at an alternate model
that diverts people from the criminal justice system. The mental health court
system used in Washington and other U.S. states, and I think maybe in Ontario,
though not perfect, is working well in this direction. The objective of the
mental health court is to prevent the conviction and jailing of the mentally
ill and/or of securing their release from jail to appropriate care services and
support in the community. Of high priority is the concern for public safety in
the arrangement of community care and supervision. Organizations such as the
National Mental Health Association are monitoring potential risks of mental
health courts and working to ensure the courts are but one part of a
coordinated community effort.
I suggest that we cease subjecting the mentally
ill to wasteful and ineffective court appearances until they are in a stable
state and able to comprehend why they are there and know their options.
I suggest we appoint an advocate to provide
assistance in reaching an informed decision. We must ensure that the person receives
a treatment plan and necessary services in a timely and appropriate manner.
Thirdly, I suggest that we move aggressive and
violent patients to a more secure environment, similar to what we have at
Colony Farm, preferably before they cause harm or injury and without the
necessity of being charged or found guilty of a criminal offence.
The reformed community-based care and resources
promised upon deinstitutionalization of the mental health system appear to have
short-changed those people in trouble with the law and those who may
temporarily present a danger to society. As I see it, the current practice
simply seems to move these people from one system to another. As such, we are
once again turning prisons into asylums. This route proves ineffective in
treating mental illness, does not respect people's rights and is potentially
harmful to innocent bystanders.
It is my request, therefore, that the National
Mental Health Policy mandate that we take steps necessary to cease the practice
of making criminals of the mentally ill.
The Chairman: Do
you want to read your last paragraph, which is terrific.
Ms. Allen: Oh,
about my son? My son is presently on probation and is recovering from his
ordeal in the criminal justice system.
I have to give credit to the criminal justice
system because it certainly provided him with decent accommodation; he is monitored
and is receiving case management and medical support.
I have to say the mental health care system has
shunned him, because of the incident in the hospital; they do not want any part
of him. He is doing quite well these days, his first book of poems is in
publication, and, as I say, one of the benefits of the criminal justice system
was the rehab care that he received in jail.
The Chairman: I
will make the observation that your last sentence was the one that struck me. I
am just going to make a comment, you say:
Perhaps the one benefit of pleading guilty to
a criminal offence is better rehabilitation support.
We will talk about this later on, but I just
cannot resist making this one observation. Ontario has a mental health court
system similar to the one that you described and we had the Chief Justice of
that mental health court make the statement that just blew most of us away. He
said if you want to have a Gold Card for getting the best mental health
treatment in Canada, the trick is to commit an offence and have yourself declared
criminally insane. The Chief Justice said that it is in jail where a person
will get the best mental health treatment.
Your comment echoes what the Chief Justice said
about the system.
Thank you very much. We will come back with
other comments afterwards but I would now ask Doris Ray to proceed.
Ms. Doris Ray, As an individual: Thank you for inviting me here. I am very pleased with your
interest in family members' concerns.
In September 1984 I received a phone call from
my son's landlady in Toronto advising me he was in a hospital psych ward after
attempting to fly out of the window of his upstairs apartment. I was convinced
then that it was the worst day of my life but of course it was not. It was the
beginning of a catastrophic rollercoaster ride, culminating nine years later
with him being judged not guilty of a second degree murder charge on the
grounds that he suffered from a mental disorder. The mental disorder that he,
his family, friends, caregivers and medical professionals had been attempting
for so long to curtail the symptoms of was paranoid schizophrenia.
For my son the problem at the time, this
happened in Nanaimo, was not that he had been non-compliant with his
medications, it was that the medication he was on either did not work, or
perhaps had ceased to work.
Earlier that awful day he had become frightened
and after describing his worsening symptoms, he went to the hospital. There
were not any beds available at the time and the physician in charge did not
recognize the severity of his symptoms, so he went back to the group home.
My son, who is not and has never been a violent
person, was overwhelmed by his paranoid hallucinations and delusions and
lethally stabbed a 21-year-old fellow resident. Later when I visited him he
confided that it had been the worst possible situation that could have
happened. When he was informed of what he had done, he spent three days throwing
himself against the walls of his jail cell in an agony of intense remorse. During
that time and during his four-and-a-half years at the Forensic Psychiatric
Institute in Port Coquitlam he never received any psychological counselling
other than a few group counselling sessions initiated by the institute's very
My first recommendation is more counselling
sessions for the mentally ill, both in and out of the jail cells and in and out
When the mentally ill become stable and face
the challenges of the real world, they are extremely vulnerable to suicide. I
cannot imagine any group of people who are in more need of psychological
counselling than the mentally ill, and in a perfect world with lots of
available finances there would be counselling for their family members.
I live in a very small town in northern B.C.,
west of Prince George. When my son first became ill, the only one who could
tell us anything about what was happening to him was our family doctor. That poor
many was extremely busy. When I finally connected, through the B.C.
Schizophrenia Society, with other families with mentally ill loved ones it was
as if a door had opened wide. At one of our meetings an RCMP officer was the
guest speaker. The officer confided that he had learned about the symptoms of
schizophrenia through his brother-in-law who suffered from the disease. His
training in the RCMP, most often the first line of defence for families in
crisis situations, especially in small towns, included very little training in
recognizing and dealing with symptoms of psychosis. I recently inquired of a
young officer if he had had any more training in that line and he said they now
receive even less training than in years past.
My son is now quite well and on an effective
medication. He is happy to have received his absolute discharge from the institute,
but last summer when he visited us in northern B.C. he was suddenly stricken
with an anxiety attack. Whenever this occurred at his group home in Vancouver he would call out for assistance and be whisked away to a hospital by ambulance.
It was a reality check for me that day to learn that there were no psych beds
at all available in Prince George Hospital or, for that matter, anywhere in B.C.
or in Edmonton. I have no idea how often that situation occurs but I do not
recall it happening in the old days.
I was dismayed when the RCMP officer frisked my
son, treating him as one would a hardened criminal, before transporting him in
a patrol car to a holding cell in the emergency room at Prince George Hospital. I understand that mentally ill people are transported always by RCMP rather than by
ambulance. It would be nice if police officers were trained to treat mentally
ill people with at least a minimum of respect.
The one other recommendation I have stems from
that well-informed RCMP officer who spoke at our B.C. Schizophrenia Society
meeting about ten years ago. It may have been just a policy in an area where
there was a significant native population but I thought it was a good one. The
officer's brother-in-law was visited monthly at his home by a mental health
worker who assessed the man's condition while at the same time befriending him
and making him feel safe. It reminded me of when my first child was born and a
help nurse would visit with valuable information and assurance for me as a
young mother. It would have been even more helpful for me if a mental health
worker could have visited my son and me when he was much older and struck down
The Chairman: Thank
Ms. Joan Nazif, Chair, Family Advisory
Committee of Vancouver Mental Health Services: I
should say that I have practically a lifetime of experience with mental illness
in the sense that my father was diagnosed with schizophrenia when I was a young
child and I have a 37-year-old daughter also diagnosed with the disease. So you
should have a copy of my report, it has Vancouver Coastal Health on top of it.
I am Chair of the Family Advisory Committee of Vancouver Mental Health Services. The role of the Family Advisory Committee is to oversee
the implementation of a family support and involvement plan and to address new
and ongoing issues regarding family involvement and support. The senior
management of the Vancouver Mental Health Services, and particularly by Kim
Calsaferri, the Regional Manager of Rehabilitation & Recovery, approved and
endorsed our plan. Without their commitment we would never have been able to
accomplish what we have done.
In setting up this committee, family members
attended focus groups that prioritized the needs and issues of their families. These
issues are discussed in our Family Support and Involvement Plan for the Adult
Mental Health Program in Vancouver and a copy similar to the front page is like
this, except of course it is not be yellow, was e-mailed to the Senate
Committee a few weeks ago.
Family representatives such as parents,
siblings, and adult children, bring their experiences and perspective to the
committee. Other committee members include a psychiatrist, a senior mental
health worker, consumers, and community agency representatives.
Our main recommendation to the Senate committee
is to advocate for the support and involvement of families.
The establishment of family advisory committees
can serve as a model for mental health systems across the country. The
advantages of a family advisory committee is that it can successfully foster
collaboration between families and mental health professionals and lead to
improved support services for families and better services and care for the
My presentation today will deal with the eight
key priorities for families, with a few suggestions for their resolution: the
importance of family involvement; the need for family support services, focusing
on the seriously mentally ill; training for mental health professionals; confidentiality
issues; recovery and rehabilitation; drug addiction and the mentally ill; and legislation
issues. I will discuss each issue briefly. More information is available for
The number one priority for families is
involvement. We feel families must be involved on two levels: In the
individual's treatment and recovery, and in an administrative capacity in terms
of strategic planning, service delivery, decision-making and evaluation of
mental health services.
It is indisputable that when there is family involvement
the outcomes are better for clients; there are fewer relapses, fewer
hospitalizations, and fewer crises. Families’ feel it should be an expectation,
not an exception, that they will be contacted, informed, invited to attend
meetings, included in the history taking and kept up to date regarding
treatment plans and progress.
The second priority is family services and
support. Research indicates that the most effective way of implementing family
support services is to establish a funded position. This is exactly what we
requested of senior management in Vancouver and Otto Lim, an experienced
psychiatric social worker too the full-time Project Lead position in September
Otto has assumed responsibility for planning,
developing and coordinating family supports and services, including
collaboration between staff and families, developing consistent approaches to
families, and assisting in the development of policies that promote the
introduction of family support and involvement to Vancouver Mental Health
Important services for families include access
to counselling, which can greatly assist a family in coping with the life-altering
illness of a loved one and working through changed expectations.
Information and education for families is
needed in many areas. Families need orientation to the mental health system,
for example, because it is very different from the regular health system. They
need education on the nature of mental illness to understand the signs of
relapse. They need to know how to access services when the relapse occurs. Education
enables family members to come to terms with mental illness.
Respite care provides relief for families who
can be overburdened by the demands of dealing with mental illness. Self-help is
also a legitimate means of support. These family-led groups are driven by the
needs of family members and they nurture and support the family as well as
strengthen family competencies.
Stigma and discrimination continue to be a
major problem in society and families feel that education of the public is of
I am not reading my whole brief if you are concerned.
The Chairman: I
was getting a little concerned you were.
Ms. Nazif: We
feel public education is of paramount importance and we strongly support
information about mental illness being a mandated part of the school curriculum
and feel that public awareness might perhaps best be achieved by starting with
We need to take into consideration the
financial burden mental illness brings to families. Disability pensions for the
mentally ill are ridiculously low and most families dig into their pockets to
provide for basic needs such as new shoes, dental care, health care items and spending
Think of single-parent families, think of the
mentally ill who are parents and have children; they cannot cope with the
financial demands. All families would benefit from a decreased tax burden, for
It is imperative that our national mental
health plan focus on the most seriously ill. Although mental illness in general
is underfunded, families feel that the resources for people with severe,
persistent mental illness are inadequate. If people with schizophrenia and
other disabling brain disorders continue to be lumped under the larger mental
health umbrella they will always be at the bottom of the heap.
We must give priority to those who have
chronic, severe, persistent mental illness in terms of care, planning, outcome
measurements, quality improvements and accessibility to treatment.
Staffing and resources need augmentation in
order to provide adequate care. Case loads for case managers in Vancouver range from 42 to 75, and I can assure you that the larger figure comes from the area
of Vancouver where they have the most difficult patients. Even the lower figure
does not permit quality care.
The fourth priority is training for mental
health professionals. Families are concerned about the old-fashioned attitudes
held by some mental health professionals. Many were educated years ago when the
family was seen as part of the problem, not as part of the solution.
Mental health professionals need additional
training to ensure they have the required skills and abilities to work
effectively with families. Professional educational programs across the country
should also be evaluated regarding their curriculum and textbook choices. Textbooks
supporting the idea that family dynamics are the cause of mental illness are still
in use in Canadian universities.
Evidence-based practices should be the standard
in all of our educational institutions regarding counselling and therapy. Programs
such as counselling psychology, social work, nursing and psychology need to
provide their students with accurate information.
A major concern for families is to access
information about their seriously mentally ill family member. Family members
are not interested in the confidential discussions between therapists and
patient but they do need to know diagnosis, care plan, medication, safety
issues, so that they can continue to provide the best support.
How can the family adequately deal with
issues, crises and problems if they are unaware of the treatment plan?
How can they provide the support for their ill
family member if they do not receive information regarding progress and
medication changes? A family advisory committee can influence clinical policy
to include greater communication with families.
British Columbia has
perhaps the best mental health legislation in the country. The British Columbia
Mental Health Act has the broadest and least restrictive language and
regulations. Like many other provinces, we have the Freedom of Information and
Protection of Privacy Act, FOIPPA, but unlike some other provinces, we are
fortunate to have guidelines for FOIPPA. The guidelines, written by our
provincial government Ministry of Health, state that a health provider may
decide to share information with family or another third party.
This document may be useful to other
jurisdictions dealing with confidentiality and privacy and a copy is before you.
mental health plan must focus on recovery and rehabilitation, especially for
those who have severe persistent mental illness. Minimal standards in these
areas need to be determined by the federal government and mandated across the
country in order to improve the level of care. Goals for recovery should be
established at the time of the initial contact with the mental health system
and reviewed regularly with both client and family. Not only does every client
need an individualized care plan, but also people with serious mental disorders
like schizophrenia must have a case manager.
All mentally ill people have the ability to
recover, they can learn and accomplish new tasks and abilities and in doing so
they will have a much better quality of life.
Supported housing is one of the pillars of
recovery and needs to meet the individuals’ needs.
We need to give particular attention to young
people afflicted with a serious mental illness like schizophrenia. They need
special help in order to complete their secondary education. Young people with
psychotic disorders benefit from alternative or regular school programs where
the teachers and counsellors have the education and knowledge about mental
illness that is essential for providing appropriate support.
We recommend district-wide policies that allow
students to take reduced course levels and psycho-education programs that
educate students about mental illness and that provide ongoing support by
providing contact with other students facing similar challenges.
Individuals with mental illness have a greatly
increased risk for drug addiction compared to the general population. Living
here in Vancouver you cannot walk on any of the downtown streets without coming
across the drug-addicted mentally ill. We desperately need a national drug
strategy. I speak personally because my daughter, who has schizophrenia, is on
crack. Crack is a relatively inexpensive drug, it hits the pleasure centres, and
it gives a sense of pleasure that is unattainable by any other means.
How can we expect a person with a serious
mental illness whose cognitive abilities are affected, who has little or no
motivation or insight, who lives a sort of hand-to-mouth existence every day,
how can they ever manage to quit?
The interventions, and resources and treatment
facilities are hopelessly inadequate. The general attitude is to wait until
they are ready to quit. Well, they do not want to quit.
Morally speaking, our society is failing these
people 100 percent. We have a moral responsibility to protect the disadvantaged
in our society, to safeguard their well-being and to show them respect and
Due to our inaction and lack of resources, we
are condoning three types of behaviour: Illegal behaviour, it is against the
law to do drugs; degrading behaviour such as sexual acts, panhandling on the
streets; and dangerous behaviours that lead to such diseases as hepatitis and
Society should protect these vulnerable
people. It is our responsibility. How can good health care include permitting
our seriously mentally ill to be drug-addicted? How can we let them jeopardize
their health and safety every day because they are unable to quit using drugs?
We should consider enforced addiction treatment
for the seriously mentally ill or at the very least a proactive outreach
program that functions tirelessly in an effort to get them off drugs.
An essential component in the drug battle is
the integration of mental health and drug addiction services, which need to be
brought together to reduce the fragmentation of services. There is also a
significant lack of addiction services tailored specifically for the mentally
ill, as they are often unable to participate in a meaningful ways in existing
detox and recovery programs.
My eighth topic is legislation. Other family
members discussed this topic and I will add that treatment in a forensic
setting is extremely costly. People with mental illness do not belong in the
criminal justice system; it is not a good long-term solution.
I would like to mention extended leave. This is
community treatment orders; we call it extended leave in B.C. It is very
beneficial to individuals who require repeated hospitalization because of their
failure to follow treatment plans. It provides for the release of the patient
from hospital to the community before the expiration of an existing committal
order. The individual understands that if he or she is not complaint with
treatment it is possible to be readmitted to the hospital without the formality
of a new committal. This is extremely important for people with schizophrenia
who, even when stabilized on medication, continue to lack insight and awareness
about the importance of continuing treatment.
Briefly stated in terms of legislation, we need
standardized legislation across the country that will ensure proper treatment
of the seriously mentally ill. The professionals’ hands are tied without good
In conclusion, families play a critical role in
the care and recovery of their family members. This is possible if families are
involved in the treatment of their loved ones and have resource support.
We must hear the voices of the families because
they advocate for the seriously mentally ill who cannot speak for themselves. We
must allow the families to participate is decision-making and evaluation of
mental health services and systems.
We need to focus on the seriously mentally ill
in our country and ensure appropriate training for mental health professionals.
Legislation needs to reflect the concerns of families in dealing with issues of
confidentiality, drug addiction and criminalization of the mentally ill.
The model of a family advisory committee can
play an important role in promoting an improved mental health system in Canada. Requirements for a successful family advisory committee include having the
determined support of the senior management team and the establishment of a
full-time staff position to coordinate family support.
We need more funding to bring the care and
treatment of mental illness to the same level as other illnesses; however, any
increased funding needs protection. It must be designated according to
standards established by our national mental health plan. Best practices and
evidence-based medicine must be used to formulate standards and ensure
accountability. We need to increase our staffs at all levels to provide proper
care. We need resources and support for families, psycho-education, respite
services, counselling, and self-help groups. We know that when we support families
we all benefit.
Immediate action must begin where the need is
greatest. We must provide help and targeted funding for the most seriously
mentally ill and their families.
I want to say to the committee how very
grateful I am for all your reports. I was just so impressed and so delighted
that you have identified so clearly the critical issues facing us and I really
want to congratulate you and thank you for this opportunity to speak with you.
The Chairman: Thank
you, Joan, for those kind words and thanks to all of you.
Doris and Bonita, your experiences with the
criminal justice system show us how differently the mentally ill are treated.
In your case Doris I gather, it turned out reasonably well, as well as things
do under the circumstances in the sense that your son seems to be better.
In Bonita's case, it is a worse example because
he did not receive the treatment and the situation although okay now is somewhat
okay in some ways in spite of the criminal justice system rather than directly
because of it.
Is it just hit and miss, that in one case
Doris's child hit a good judge, I mean good in a more responsive kind of
What do you two see is the difference between
your own two cases?
How can we get the kind of improved outcome?
Ms. Ray: Well,
my son was already in the mental health system and had been for years, so that
helped his situation. He was categorized within the system, which made
treatment easier for him to get.
When you mentioned earlier that the best thing
that could happen is to be incarcerated because of a mental disorder that is
exactly what my son's lawyer in Nanaimo said. He said, “Now he will finally get
the help he needs,” which was in the Forensic Psychiatric Institute in Port Coquitlam. It was all a matter case of finding the right medication for Bruce. In
Bonita's case, it sounds like he went to jail.
I know of a case where this happened and where
the situation still exists. Very often men do not recognize that they are
mentally ill and they seem to think that they would prefer to go to jail. My
son felt that he deserved a certain amount of punishment, but he was lucky
enough to receive it in a medical environment.
The Chairman: Do
you want to comment on the question, Bonita?
Ms. Allen: Well,
my son was actually certified and he was in a mental hospital at the time in
intensive care and he was displaying violent aggressive behaviour. When the
incident happened in the hospital the hospital wanted him out of their hands so
he was sent to jail and appeared in court a couple of days later where the
judge decided he should be assessed. Well, there were no beds in the forensic
hospital so they threw him in the jail out on Wilkinson Road in Victoria and I
am sure he would have sat there for the full 30 days had I not intervened and
screamed and yelled and made phone calls and wrote letters. They finally found
him a bed to get a proper assessment over at Port Coquitlam. He got his
assessment, and they brought him back to court, although he was very unstable. They
let him out on bail and he wandered around doing weird things for the next ten
days until they picked him up again. He had no idea of bail provisions or when
he should report and he was doing bizarre things. He went back to the Wilkinson Road jail until they found him a bed again in the institute. At the institute
things started to happen.
The Chairman: That
answers my question, if you can get into the forensic unit, though legally part
of the criminal justice system, it is much more like a hospital setting.
Ms. Allen: Yes,
they do get treatment there, I do not know if you would consider it great
treatment, but in the jail they just give him the medication and hope that he
Ms. Nazif: I
understand that it is extremely costly to have people in the forensic system.
If we educate the police to take people to emergency rooms rather than jails,
we could avoid that cost to the system. The courts must understand that these
people need treatment and hospital care and should be getting treatment rather
than court hearings. They should be going to hospitals; there should be beds in
hospitals to handle mental disorders.
The violence and so on is simply a symptom of
psychotic behaviour; it is not because they really are criminals who are out
there trying to do the wrong things.
Ms. Allen: The
trouble is though, that they can be dangerous.
The Chairman: Clearly
you need some facility for those who are dangerous but I think the point Joan
is making is in many cases they wind up in jail because nobody has any idea
what else to do with the problem.
Joan, your opinion is in opposition to the
position that Rob takes. You support the B.C. Mental Health Act, while he does
not support the act. Did you hear his comments.
Ms. Nazif: I was
here for part of it but I did have a bit of difficulty hearing him. I do think
we have a very good Mental Health Act and I do think we do need to look after
people who have mental disorders.
The Chairman: You
talk about the role of the case manager; please tell us what the work would
include. I ask that because Francesca referred to a consumer group suggestion
that involves the notion of a patient or consumer advocate.
I am trying to understand whether that idea, or
at least what I envision as her idea, is what you mean by the case manager.
Ms. Nazif: We
have mental health teams that include social workers, nurses, psychologists, and
therapists. The team sees my daughter and part of the team is the case manager.
Whether the case manager is a social worker,
nurse, or psychologist is immaterial because the manager is responsible for
organizing and planning the care plan. The case manager makes sure that my
daughter gets access to the services and resources that she needs. We go to the
case manager if she needs housing rather than looking for appropriate housing
on our own.
The Chairman: It
is a one-stop shopping model.
Ms. Nazif: Exactly.
The Chairman: We
have struggled with the problem between the privacy rights of consumers and the
need for caregivers, in many cases family members, to understand at least
something about the situation. That tension exists everywhere in the country
and the predominant view is that the privacy rights trump the rights of the
caregiver and you seem to be arguing for the other side. How do you think we
come to a firm conclusion on that question?
Ms. Nazif: I do
not know exactly how you will come to a conclusion but it just does not make
sense. It was natural for my doctor to discuss my mothers Alzheimer’s disease
with me, and Alzheimer's is a mental condition. Her brain was not working
right. My daughter's brain is not working right either. The brain is an organ
like the heart or the kidney, and when your brain is not working right, you are
not able to think very clearly.
If the doctor is going to talk to me about my
mother's Alzheimer's condition and about the treatment plan and care, why
should the doctor not talk to the family or to me about my daughter's mental
I do not want to know all the confidential
topics that they might discuss; I have no interest in them. As a matter of
fact, I know too much about her life, if you know what I mean. I do not need to
know the intimate, private things. We need to know the diagnosis and the
chances for her for the rest of her life. We need to know what we can expect;
the role of medications; the types of available social rehabilitation; what type
of medication she takes; and the prognosis. These are not secret facts. There
is somewhere in the committee reports where an Aboriginal group said that
privacy just creates secrecy about an illness. We are a family.
Now, there are instances, I am sure, where
families are not therapeutic for the individual. We are family members who love
our family member, and we give support to our loved one 24 hours a day. I mean,
I will be there for my daughter as long as I live.
The Chairman: I
agree with you; I know some cases where family involvement would actually be
very hurtful to the patient, particularly the cases of abuse.
Therefore, what you would do is have the case
manager or the doctor make that judgment based on the work they have done with
Ms. Nazif: I
hope my involvement would be from the start of the diagnosis, I hope that the
professionals would understand that I am a caring, supportive person interested
in her daughter's well-being. I am here to help my daughter and to do that I
need to know the treatment plan. I need direction.
I think this four-page fact sheet will be of
great interest to you because the Ministry of Health wrote these guidelines to
our Freedom of Information and Protection of Privacy Act here in B.C. The
guidelines deal with situations where you have a mentally disordered person,
the family wants information, and it allows the treating clinician to release
information for continuity of care if they feel it is appropriate.
The Chairman: Yours
is the clearest position we have had but as you can appreciate, we have had many
positions on the other side as well.
Senator Trenholme Counsell: Ladies, thank you for your wonderful presentations. In my province,
children at 16 can leave home. At the same time if a child is suffering from a
mental illness the parents have little ability to find out or inquire or to
become involved in their child’s treatment and recovery.
I believe in New Brunswick that the child would
have to agree to the parent’s involvement in the treatment. What is the law
Ms. Nazif: I am
not sure that I understand all the intricacies of the law, but there is
considerable weight given to young people to be autonomous. However, when
someone is mentally disordered I think things are quite different.
Senator Trenholme Counsell: Is there something in law that in fact allows the professional to
call in a family member?
Ms. Nazif: This
fact sheet explains that they can release information. These are guidelines to
our Freedom of Information and Protection of Privacy Act. This is British Columbia. There are some examples given in these three pages that discuss things in
relation to schizophrenia or mental disorders.
Senator Trenholme Counsell: Thank you very much. I think this is worthy of study.
Ms. Nazif: I
also would like to say it is not always respected by the mental health
profession and many of them do not know anything about it. We as families
sometimes go to the office or fax it to them and say did you know this document
is here then said say oh, well, I guess we can talk to you.
Senator Trenholme Counsell: If the first point of contact happens to be the physician who is
suddenly faced with the situation you need the law behind you, with you, to
contact somebody and find out something.
What happens in B.C. if a patient is violent
while in the hospital? What happens when the person is in the emergency room?
Does that person have to go to jail overnight even though the person is
Ms. Nazif: I do
not know, frankly, what happens all across the province but I do know that I
was part of the best practices work here in B.C. We recommended that all
community hospitals have a “soft room” where people cannot hurt themselves.
These people need treatment, not jail, but they cannot stay in an ordinary room
because they are violent. The best practices are very good to look at in terms
of the cross-country recommendations.
Senator Trenholme Counsell: I think every hospital can call a security person overnight, but I wonder
whether such emergency coverage is available in your smaller hospitals.
Ms. Nazif: I do
not know for sure but I do know of the recommendation for soft rooms.
Senator Trenholme Counsell: It is preferable to keep the person in that hospital setting.
Ms. Nazif: Yes.
The Chairman: Doris, do you want to make a comment?
Ms. Ray: Well, I
learned last summer that all psychiatric patients must be in a secure ward or a
secure room. My son was not a danger to himself or others, but he was worried
that his anxiety attack may come to the point where he had lost control.
I believe that if he had ever been in the mental
health system whether violent or not he has to be in a secure ward. We live
halfway between Vanderhoof and Burns Lake; both communities have small
hospitals but no secure beds so he could not stay in either of those hospitals.
Senator Trenholme Counsell: Without misrepresenting this report, I do not think small community
hospitals could ever provide that service, I think the man or woman would have
to go to a larger facility.
You could not do that in the community
hospitals. Are you saying that too often they have to spend a night or two in
jail until they can get to a proper facility?
Ms. Ray: They
might, and if they have not been previously involved, they automatically go to
Senator Trenholme Counsell: In a modern, just society that should not happen, that is wrong. Thank
Ms. Allen: My
son was never been involved in any violent behaviour so the hospital staff was overwhelmed,
surprised. He had never done anything like this before but when the incident
happened there were no security guards on that floor. They had to buzz for a
security guard two floors down. If there had been someone, there right on that intensive
care unit it may not have happened. My son spent two days in a barred hospital
room until they moved him to the jail.
Your testimony is compelling. I find myself wandering all over the place.
Joan, in the eight key priorities you talk
about family and family support services and the training for mental health
professionals. Let me go to the training of mental health professionals.
In my province of Newfoundland and Labrador, we have nurse practitioners, and nurses who deliver services in mental health
Do you see the same need for nurse practitioners,
given the shortages of psychiatrists across this land, to work with family
We hear problems and I try to find solutions
right away. I realize it is not easy but when we have to look at the
availability or non-availability of health professionals then I believe we have
to become innovative and offer up that kind of advice.
When you talk about legislation issues, the
three of you need to understand that we are a federal group trying to cope with
provincial Mental Health Acts and if there are gaps in the system there has to
be some way to develop a strategy to interact with that because if not, we will
fail. Without a continuum of appropriate legislation, we will still be in
I would like to go back and offer you what has
happened in my province. When the budget came down in February the Waterford Hospital, which is our mental hospital, opened up a short-stay psychiatric unit.
I realize I am in an urban setting but I also
live in a small province in that setting. I think that would have helped the situation
and relieved especially Doris's anxiety but I find it incredible, Bonita, that
a person, regardless of what the illness is, would be charged as a result of
behaviour in an intensive care unit. Surely, the hospital should have taken
some responsibility for the incident rather than put him on a path of nine
years in the justice system.
That system could not cope with the problems
and the more we listen we see that there is a big gap in the prisons across
this country. If you commit a crime and go to jail it is difficult enough I
would think; there is some remorse no matter how hardened you are, but to have
an undiagnosed or even diagnosed mental illness compounds the problem.
I am preoccupied with what I am reading about
Karla Homolka. It is not for me to pass judgment if she needs continuing care
or if she does not, I do not know.
Would any of you like to comment on this?
Your family advisory committee is indeed
commendable. Do you think you will ever get to the point to move beyond the
family and offer a family type of support services for those who have no
Ms. Nazif: A
family support service for those who have no family, I think that would be a
wonderful goal for us to have. We tend to feel, though, that most people with
serious mental illness do have family, they just need someone to find them. The
family often rejects the mentally ill because they are uneducated about mental
illness and have lived without any support to understand the strange behaviours
manifested by their ill family member. We take the viewpoint that the family has
abandoned its child because of those reasons. Does that answer your question?
Senator Cook: Yes,
you still emphasise continuing education and good communication.
Ms. Nazif: Yes,
we need education at every level. The Canadian public is unaware of the whole
issue of mental illness. It is ridiculous that the federal government does not
have some kind of a broad campaign to educate at all levels. We have a puppet
program from the B.C. Schizophrenia Society that goes to elementary schools.
The consumers operate the puppets and they talk about mental illness with Grade
4 and Grade 5 students.
I realize education is a responsibility of
each province, but we must mandate the education about mental illness into the
school curriculum. You can have all the resources and good things available for
people, but if it is not mandated, it will not reach the classroom. I was a
teacher librarian. The teachers have so much to teach that they will not teach
mental illness classes unless they have to. It is not because they do not want
to, but they just have too many things to do.
We must educate this generation in order to
benefit all of our society.
Senator Gill: We
have to admit that the people living in the street are increasing all the time
in all the big cities like Vancouver, Toronto and Montreal.
You mentioned that maybe it is a matter of
education, but many people have given up their responsibilities. I am talking
about parents that have left their children. That is something else than
education. I would like to have some comments on that because people are going
on the street or to jail, street, jail, jail to street.
Ms. Nazif: I
agree that education cannot solve everything and it certainly is not the reason
why we have these problems but we have a huge homeless problem all across Canada. Where do we get the help for these homeless people?
Housing for people with serious mental illness
really does have to meet their needs. Some of them might not be able to respond
to a SIL unit, but perhaps they might do well in a centre where they have a
bedroom of their own. In these centres, the mentally ill receive their meals
and have access to on-site showers. This is something that they might be able to
latch on to because they live in the back lanes and alleys and they are not
ready to cope with the things in society that you and I take for granted. You
have to provide things for them that they are willing to use. It also means
that we need funding for people to go out and, if you like, befriend these
people, and gain their trust. You cannot sit and wait for these people to come
in for an appointment. First, they do not know what day it is because they do
not have a calendar, they do not know what time it is because they do not have
a watch. People have to go out to them and help them with their needs. I really
do feel we are failing these people. I find it absolutely disgusting that our
country is doing this.
Ms. Ray: My son
was an adult at the age of 21 when he had schizophrenia; I should not be
justifying this because there are many, many people with schizophrenia who live
in group homes in various towns throughout British Columbia.
My son is in a monitored group home now and
things are working like clockwork, but before this terrible thing, he lived in Nanaimo in a series of group homes. After the terrible event, I spoke to some of these
house parents. The house parents were with him 24 hours a day, they were his
family. The system did not hear what the house parents had to say about my son.
They were his family and cared a lot about him and I think they should maybe be
included in family things.
Senator Cook: So,
there is a nuclear family and the additional family that Joan referred to, but
there is also a different connotation because this is where these people have
Ms. Ray: We keep
in touch by telephone and we visit and they visit us but the house parent is
there, you know to be sure that my son takes his medication et cetera. The
house parent had to make a scene to get my son admitted earlier in the year.
I did not know his situation had gone downhill
so badly but the house parent did and had a tough time getting my son admitted.
In Nanaimo, things have improved so much because of these terrible incidents. That
town went through the fire and things have improved a lot. There is a good
example happening there.
Senator Cook: Bonita,
the on page 3 you say,
The reformed community-based care and
resources, promised upon the deinstitutionalization of the mental health system,
appear to have short-changed those people in trouble with the law and those who
may temporarily present a danger to society.
We failed and I think we have our catching up
to do because we took people out of a place where they felt safe, where their
coping skills were not the best, and we just put them out and there was no
I think we will have a challenge to get back
what we once had. I worked in a drop-in social centre. First, it was just a
place to come out of the cold, and then it gradually evolved into a little
program. We were short of money and found some nursing students who did their
electives and we went on walks and then we found some old computers and it
I will tell you, that social centre is home to
95 to a hundred people on a regular basis. When we look at “family,” I think we
need to think outside the box.
Ms. Nazif: I
would just like to go back to the confidentiality issue. I know there are
family members in this room who have had their teenage child suffer from a
psychotic disorder as young as 15 years and 16 years, and their family doctor
refused to see them.
This is so very absurd and I think whether the
person is 15 years or 35 years, the doctor’s refusal to speak to the family
only increases the discrimination and stigma of the mentally ill. This is awful.
It is so absurd. It is so wrong and I really hope you can make some changes concerning
Ms. Nazif: I
remember the previous witness speaking about involuntary treatment. Would you
leave a family member with Alzheimer’s wandering around in the streets? Would
you leave a developmentally disabled child out on the street without shoes? Would
you leave a developmentally disabled child alone without health care or
It seems to me when you give these people their
civil rights you are giving them the right to be psychotic and the right to
die. That is all there is. They need care.
Senator Callbeck: Continuing with that confidentiality issue, it says a health
provider may decide to give out that information. Is that health provider the
doctor or can it be a nurse?
Ms. Nazif: Yes,
the case manager makes the decision after consulting with the psychiatrist who
is in charge of that patient as well. Yes, the nurse or the social worker may
make the decision.
Senator Callbeck: One person can make that decision.
Ms. Nazif: Oh, I
am not positive about that. I think they would probably want to make a joint
decision, the team that is looking after the client.
Senator Callbeck: Joan, you mentioned stigma and discrimination as a major problem
and I am sure that all three of you agree with that statement.
You talked about mental illness education
becoming a mandatory part of the school system. I noticed in your commentary a
reference to a program called “Reaching Out,” which is good, but you want it
Ms. Nazif: I was
a teacher librarian. I was in charge of all the school's resources and we would
get wonderful resources and I would present them to the staff at meetings but
still teachers do not necessarily have time to do these things.
“Reaching Out” is an excellent resource
produced by the B.C. Schizophrenia Society. It is very acceptable to teenagers
because there are three or four teenage actors and five young people with
schizophrenia in the videa. They have a great discussion about schizophrenia.
All the lesson plans are there, everything is
there, even a teacher who knows nothing about mental illness could very
adequately teach that program in two or three lesson.
Yes, I think we need public education for
everyone in the country but if we start with youth, they are our next citizens,
they are the ones who are going to carry that knowledge with them.
Senator Callbeck: What grade would you initiate that education?
Ms. Nazif: Well,
I think mental illness education should begin right from the very beginning of
elementary school. This particular resource is for senior high school students.
When we tried it out with younger students like Grade 8 they just laughed about
it, they were not yet mature enough to take it seriously, but the Grade 10
through 12 students responded very affirmatively and they learned, because we
One of the biggest myths with schizophrenia is
that people with schizophrenia have split personalities, for example. It is not
true. There are so many myths about mental illness that need to be discounted
and people need the facts and no one is giving them the facts. Anything that
comes out in the media is always sensationalism. We do not hear about the other
Senator Callbeck: We were in Regina last week and they find that Grade 8 students
respond very well to that type of education.
Ms. Nazif: Perhaps
it was more suitable for Grade 8 students. Obviously you can have many
Senator Trenholme Counsell: It is all about diversity in populations, whether it is health,
colour, or language. It seems to me that we have to start at kindergarten
almost and talk about differences because I know that children who have ADHD
whether they are treated or not, they are getting to feel as though they are
We have to start this sensitization at
kindergarten and we must do it understanding diversity, equality, and accepting
So I do not know, what do you think, I am the
one supposed to be listening.
Ms. Nazif: No, I
think you are right. There is great diversity in our society and perhaps here
in Vancouver we especially feel it with the various different ethnic groups,
for example. It is very important to teach diversity and acceptance that people
are the same but they are different.
Senator Trenholme Counsell: We need to start that very early.
Ms. Nazif: We
should start that very, very early.
Senator Trenholme Counsell: If we are going to talk about sexual orientation as is becoming
apparent in high schools then you have to prepare people to embrace all
Ms. Nazif: I
think we need to start a lot earlier than we think; the young people are ahead
of us. They are perhaps more ready for these things than we think they are.
The Chairman: Well,
let us face it, when you get to be our age it is much harder to change our
minds than it is with young people. That is just a function of growing old. It
is amazing to me that the ultimate proof is looking at data, for example, on
the same sex marriage question. Our children wondered just what the issue was.
Senator Pépin: It
is only about, as we say, at what age we start the education. I have a
granddaughter who is six years old and she is in the first grade. There are so
many cultures in her class yet, she does not see them. Our children live and
learn in this environment. I made the mistake myself and said oh, Carolina is so beautiful and so nice, what a beautiful black girl. She said, “Come on, she
is not black, she is my friend.”
I think that if we start early it will be
normal and they will be much more protective to friends rather than to try to
discriminate against them.
Senator Gill: I
think we just mentioned that with the young people there is not too much
difference, not too many difficulties, but I think people have to accept the
fact that there are differences and that we have to respect those differences. We
have to respect and we have to be educated in this way.
I think we have to go along with the fact that
there are many differences but the differences can enrich our lives. We are not
inferior or superior, we are different and we have to respect that. That is a
big problem in our society right now.
Ms. Ray: I do
not think we should homogenize all these things because mental illness,
schizophrenia, is an abrupt change in the person. It is an illness, a disease
of the brain, and it is so devastating that your friend in school all of a
sudden becomes a very different person.
I think that in the case of serious mental
illness, we have to emphasize that it is a disease, whereas these other things,
such as psychological illnesses and homosexuality are more everyday occurrences.
I mean they do not change overnight as they do with these mental illnesses. Young
people, old people, nobody understands really, until they understand that it is
a disease like a heart attack or cancer. That is my perspective.
I agree with Joan, that we must educate our
children schools because it is going to happen to some of their friends if not
themselves very quickly, in high school or university.
Senator Cordy: We
have certainly heard stories from parents. I remember dabbing my eyes a bit while
a mother told us about her son. Her boy was an honour student and top athlete,
and suddenly had a mental illness and did not get one phone call from a friend.
The mother said that if her son had broken a leg he would have received phone calls,
gifts, notes, and letters. It was as if the child had dropped off the face of
the earth and what a torment that was for a parent.
I would like to talk about “Reaching Out.” You
are right, you can have the best resources in the world but if they are sitting
on the shelf in the library or in the classroom, they are not much use to
Does the program focus on stigmatization that
certainly is so prevalent in society or does it focus on what it is like for a
child living with a family member who is mentally ill or does it focus on the
children themselves or all of the above?
Ms. Nazif: Are you
asking about this particular resource?
Senator Cordy: Yes,
I want to know about this particular resource.
Ms. Nazif: Well,
this particular resource teaches high stool students about the symptoms of
psychosis or mental illness and it has a very strong message in there that if
they feel a friend is changing and is very different, that they need to get
I think we all know that young people do not
like squealing on each other, so this is a very big part of the message, if you
are worried about your friend whose behaviour is very different over the past
six months, who just does not seem to be the same, go to someone for help. Go
to perhaps the counsellor in the school or the teacher or the principal or
perhaps that adolescent's parent. We are not asking them to take responsibility
because they should not, but we encourage them to get help.
The program teaches symptoms and the symptoms
are very broad because different mental disorders have a variety of symptoms. It
show fives young people with schizophrenia who talk about their illness quite
openly. A little drama shows the change in a young man. He looks dishevelled,
but his friend decides that she has to do something about this and she gets
help for him. The program encourages the kids to be aware of the symptoms.
Senator Cordy: The
grant from Health Canada was simply to distribute the program.
Ms. Nazif: Actually,
the B.C. Schizophrenia Society developed it themselves. I was part of that
development, and we did not have the money to distribute it across Canada. The Schizophrenia Society of Canada made a request for the grant and Health Canada handed over $200,000 for distribution costs.
We contacted all of the high schools in the
country and if they expressed an interest in the program, we sent them the
resource. People are free to reproduce the video. We are not out to make money
with this, we want people to have the information.
Senator Cordy: Have
any departments of education taken it up?
Ms. Nazif: I
think education is extremely important. Many of the counsellors in schools
really know nothing about mental illness. They have learned all kinds of things
about relationships, but they do not know anything about mental illness.
As I mention in my brief, I think this should
be a basis of all of these types of programs because they should all be aware
of the symptoms of major mental illnesses. They deal with young people every
day; they are on the front lines. We could help so many children if we educate
the teachers and the students. It should be part of their curriculum as well as
the students' curriculum.
This resource educates teachers and parent groups,
people who are trying to understand their child's illness, and it is effective
with young people that are in recovery. It helps them to see what other people
have done and how they have managed their mental illness.
Senator Cordy: Your
family centre is amazing. How do families find out about you?
Ms. Nazif: I am
not involved in any centre but I was part of the group from the Schizophrenia
Society that developed this resource.
Senator Cordy: I
am referring to the Family Advisory Committee.
Ms. Nazif: Sorry,
we struggled along for ten years trying to get a voice in the mental health
system and we did sometimes have support. We met regularly with a psychiatrist
but nothing ever happened. It was the same stories year after year, the same
issues and the same problems remained. Families were not part of the treatment
team. When senior management made a commitment things started to happen.
Kim Calsaferri, the head of Rehabilitation
& Recovery, gave us her support and we went to senior management and told
them what we wanted and how we needed to be involved. We did not expect to make
all the decisions but we wanted to be a part of them, just as consumers want to
be part of them.
It took 10 years to get a full-time social
worker to coordinate family support and services. I believe that this should be
a model for all of Canada because when there is family support the client will
Senator Cordy: Joan,
you are very clear on compliancy of medication.
I am wondering, Bonita and Doris, as mothers of
sons suffering from mental illness, how you feel. Witnesses from earlier today said
that nobody should be forced to take medication. I am interested in how you
feel about that issue.
Ms. Ray: The old
medications had severe side effects, sometimes the side effects almost seemed
worse than the disease, but the newer medications now do not have as many side
effects but with my son, they seemed to work for a while and then stopped working.
When this thing happened in Nanaimo, he was on many
medications and so I could see where it was not great but now he is medication
that works well. We must monitor and listen to the mentally ill. Those were the
big issues with my son. I have talked to other parents too, and they say their
children have similar complaints. They know when the medication is not working
for them but there are medications, so many of them out there, and the one that
my son is on, what they call the one of last resort, called Clozapine, seems to
work very well for him.
Ms. Allen: Yes. My
son, as you were mentioning, was on some drugs in the past that had terrible
side effects but they discovered that Lithium works well for him. He has had
long periods of success, seven years without a breakdown. I am hoping that will
not happen again, but before his last episode he was “toxified” by the Lithium
and he was very physically sick from it. They took him off it, which I feel led
down the slippery slope to another breakdown, because it takes a while to build
back up again. He is back on Lithium again and he seems to be doing okay. They
have to check his blood every month to ensure “toxification” is not setting in
again. Without it, I do not think my son would be alive today.
Ms. Nazif: I
would just like to tell a story, I do not think she would mind if I told this
story, her name is Loyanne, she has a mental illness, and she speaks publicly
about her life all the time. Loyanne was committed to our large mental
institution here probably a dozen times; it was a revolving door. She was
committed, she would be treated for a few months, she would be given
medications, she would walk out the door, the medications would be dropped in
the first garbage can she found and there she was until she was recommitted. Finally,
Loyanne was put on extended leave. You have to get the person's cooperation for
this and she agreed. When she left the hospital, she understood that if she was
not compliant, if she did not take her medication, if she did not come back for
her appointments with the mental health team she could be recommitted.
Mentally disordered people do not like being in
hospital. So Loyanne went, housing was provided and she said she was there for
about six months just lying on her bed taking this medication and she had to
take it because she did not want to go back to hospital. After about six months,
she finally woke up and she now has a life. She has three daughters.
She asked us how we could let her live on the
streets. She said that she was sleeping on the streets, sleeping in cardboard
containers and eating out of garbage cans. She said, “How could you show me so
much disrespect by allowing me to go out of the hospital and not to take my
medication?” This is what Loyanne talks about. The medication saved her life,
gave her dignity and the opportunity to be a real person.
Senator Pépin: The
committee believes that if there was a way to oblige government and all
Canadians to recognize the inequality and the injustice towards people
suffering from mental disability it will be if we were able to adapt the
Charter of Rights of the mental health consumer. With that charter, the people
suffering from mental disability will have access to services and have
treatment without discrimination. After that, they will have also early
identification, the diagnosis and the right treatment. They will have services
adapted to their culture and their own language.
Some people believe that charter will reinforce
stigma because those people will have different rights.
What you think about that and what is your
perception? Maybe I did not explain it well in English.
Ms. Ray: Well,
when my son received a conditional discharge from the institute where he
actually received counselling and therapy. He met up with people who told him
that medication was going to cause his brain to decay and a couple of times he
went off it and was hospitalized.
What really turned the tide was when he
received counselling from a fellow that turned his whole attitude around. In the
institute, he had developed this us-versus-them attitude. The attitude that he
developed, with the help of his counsellor, that turned things around was I am
part of the team to make me well. He actually presented to the review board
because by this time he was convinced that this fellow was right, hey, I want
to get better, and that convinced the review board also that he was on his way
to becoming a good member of society, there was hope for him.
Ms. Nazif: I
think we have to remember that the brain is sick, and when the brain is sick, I
do not think it has very good judgment about what to do about keeping the rest
of the body alive. If we find someone unconscious on the street, we will rush
in the ambulance and we do not wait for them to waken so we can ask them if
they want treatment. We are going to give them treatment, whether it is an
accident or a stroke, and I think with the mentally ill, we need to respect the
fact that they cannot decide for themselves. They do not realize they are sick.
I think that as a society we have to respect
their dignity and treat them, because otherwise it is hopeless despair; they
will be psychotic all their life. It is like people with Alzheimer's; we do not
leave them wandering around in the streets.
I think we are giving them their rights by
giving them their right to treatment. All Canadians have the right to good
health care. Why should people that are psychotic not have the right to good
Senator Pépin: Should
we stay as it is right now or carry on with the discussion to have a special
charter of rights for them?
Ms. Nazif: Well,
I think we need to look at good mental health acts across the country.
Senator Pépin: In
other cities, we met with people who told us that if a person has a stroke you
call the ambulance but if there is an incident related to someone with a mental
disability, they will phone the police who come for the person. When the person
is in the hospital, they wait for hours with the police and are at the end of
the line for treatment.
We met with people who work in the correctional
services to confirm what you say. They agree that many mentally disabled people
have very long wait times at the hospitals. The police asked us to visit the
hospitals to see how to come up with a better system.
Ms. Nazif: I
think our major emergency rooms and our hospitals in major cities should always
have qualified personnel capable of treating psychiatric disorders so that
people do not sit for hours. I even know of situations where people have
brought in their child with schizophrenia and the child has left because of the
overly long wait time.
This is a crisis, just as the crisis is for
someone else it is a different kind of crisis. We need to have psychiatrically
trained personnel in our emergency rooms.
Ms. Allen: On
the topic of emergency rooms, we found that emergency rooms do not want to look
at mentally ill people unless they have committed some act. Otherwise, as you
say, they stay at the back of the emergency room. Often the staffs refuse treatment
because they say they “feel” like they need help. Their doctors tell them to do
that, to go to the hospital if they feel an episode coming on. However, they
do not get very much cooperation in emergency rooms.
I realize that emergency personnel are busy
and perhaps there should be a different emergency area for mental health issues.
I have taken my son into the emergency room in
a manic state and, trust me; it is an awful thing to do. I mean, he is walking
around telling people they are witches and grabbing the magazines out of their
hands and scaring them and I am sitting there thinking oh, my God, what is he
going to do. I had to argue with the doctor about his condition. They tried to
tell me that he is on drugs or he is this or that. I said look, I know what he
is. I know he is mentally ill. He has records, can't you get them? No, it was
just too much trouble. You have to get into a major argument with these people.
So something needs to change there, that is for sure.
The Chairman: May
I thank all of you for coming and taking the time to be with us this morning.