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Friday, 5 August 2011

Community Mental Health – Turning a blind eye until it is too late.

A gruesome assault in Penticton BC mirrors the notorious Manitoba Greyhound bus attack that killed a young man in July 2008. A father in Merritt BC killed his 3 children several years ago.  Outside Canada there are questions about the tragic massacre in Norway, the Fort Hood shooting spree, the Virginia Tech massacre and even further back to the Montreal Polytechnical Institute massacre of 1989.   While the four massacre examples may have a different basis, they likely share a common theme of persons with mental illness in the community. 
The victims of all these tragic situations were innocent.  Families and loved ones are left suffering. Their grief and pain is something we all need to understand, feel and empathize with.  Their losses are irreplaceable and form the fears that many hope they never experience.
Details on the Penticton situation have not been released, but there is enough media testaments to suggest the perpetrator suffered from a chronic mental illness and was inadequately treated.  Hence the parallel to the Manitoba situation on which more scanty information has been released.
Mental illnesses are a diversity of diseases and do not have the same causes.  In any society, there are about 3% of the population who suffer or have suffered from illnesses that cause a break from reality (psychosis).   1% are diagnosed with schizophrenia, about half as many with either bipolar (manic-depressive) illness or major depressive illnesses.  There are only enough psychiatric beds for about 1 in 60 of these individuals at any one time.  The other 59 live in the community, most requiring long term medication.  Many of these have insufficient case management to support their needs to remain functional.
When a person with a chronic mental illness fails to show for an appointment with their caregiver/case manager, there may be some limited attempts to reach them and reconnect.  After several failed attempts, the individual may be dropped from the caseload. One of the most common reasons for someone with a chronic mental illness to not follow through on an appointment is deteriorating mental illness.
Fortunately most persons with chronic mental illness are unlikely to put others at risk but may put themselves at risk.  The most unusual behaviours may be displayed on street corners, they may find themselves friendless and homeless as a result of their illness, or they may cope with the unpleasantness of their illness through using alcohol or drugs. Then we can victimize the individual rather than blaming the system that has failed them.
Occasionally, mental illness decompensation may be associated with disturbed thought processes that put others at risk.  In the case of the Greyhound  and likely other attacks mentioned. This results in public outrage and horror.  The solution is to find criminal fault with the person undertaking the attacks even when the proverbial “psychiatric assessment” has found mental illness as a major contributor to the event.  
Mental illness can be treatable and controlled by a system of services designed to manage individuals and support them within the community. Persons with mental illnesses are often constructive contributing members of society when well.  We do not criminalize people who have heart attacks or strokes.  Not only that,  we insist on having the best medical care available when such events happen and build bastions of health care for their needs.  Prisons have become the psychiatric institutions of this century, thankfully some recognize their role in providing humane care.  
Why in a supposed civil society do we continue to treat some people with mental illness as outcasts and deny them the best possible medical care?  Why when floridly ill and their actions hurt others, do we place them in prisons instead of putting the system that failed them on trial?

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