See Serena Kataoka's letter to the editor to the North Bay Nugget on their site attached, but for ease of reading and potential discussion here it is... http://www.nugget.ca/2017/11/2...e-death-of-1000-cuts
To the editor:
My brother, Jason, is the type of person who is happy to share whatever he has with those around him.
When there was a car accident in front of our home, he was there for survivors with water, blankets and gentle care until first-responders arrived. When a neighbour in need was depressed, Jason went to their home every day to do their dishes, bring a smile to her face, and accompany her to a community event once a week.
When Jason went missing on Friday, even the staff at our local convenience store were upset, because “he is a good guy” – gentle, compassionate, funny and polite.
I hesitated to write this letter because Jason struggles to live with dignity in a society in which people who live permanently with “mental illness” are stigmatized and socially excluded.
Collectively, we have taught him that in order to be seen as “a good guy,” he needs to lock down the mental anguish and emotional impacts of living with complex, serious mental health issues (that have been variously labelled over the past 20 years). As his sister and best friend, I have helped protect his dignity from the schoolyard, through to the home we now share on Nipissing territory. But in part because Jason lives with dignity, the mental health care system in Ontario is failing him and, ultimately, our entire community.
Friday afternoon, Jason boarded a bus from North Bay to Toronto, with no plan and nothing aside from the clothes he was wearing, a partially-charged cellphone and $30.
On one hand, this reckless move was predictable. Four years ago, he had walked from Huntsville to Toronto and landed on the streets (a lot shared with some 447 other people there, according to the Homeless Hub) – scared and alone.
Four months ago, he had requested a respite stay in the hospital (which he has used in the past to do intensive therapeutic work, but such treatment is no longer available). And over the past few months he has been requesting an appointment with his psychiatrist (who he only saw twice in the previous year, for therapeutic purposes).
The day before, he had left a note on our kitchen counter that read “I am so sorry, but I have to go. I love you”and purchased a bus ticket to Toronto; in the course of four hours waiting at the terminal. However, he became so scared that he returned home of his own free will, for the night.
On the other hand, Jason’s departure Friday afternoon from a loving home and toward the streets of Toronto was shocking.
Over the past few years, working alongside members of his Assertive Community Treatment (ACT) Team, I have seen Jason ease into routines that have enabled him to rebuild his life – to manage his weekly budget, prepare his own meals, quit smoking and even become more involved in activities outside the home such as going to the YMCA for recreation and social events.
So when I took him to the North Bay Regional Health Centre on Friday morning to try to provide him with a more structured opportunity to work through the extreme “stress” that had made him want to leave the day before, he presented with dignity (as opposed to “disturbing the peace”) and did not meet the “suicidal” criteria for admittance.
But how could his plan to live on Toronto’s streets in this cold, wet November have been interpreted as anything other than an attempt to throw his life away? I was mad – angry at a system that could refuse to help someone that was showing us (even if not telling us) how very much he needed it.
Within six hours of being turned away from the hospital, and one hour of leaving a social activity with his ACT team, Jason was on a bus, headed toward Toronto’s streets. He left no note this time, but when I returned to an empty home, I knew he was gone. My heart sank.
Along with ACT team members and my loving partner, I combed through the throngs of people at the Old Fashioned Christmas Walk, where Jason was meant to be. I traced his usual pathways through North Bay, and eventually arrived at the bus terminal with a copy of his community treatment order (CTO), and staff confirmed that he was en route to Toronto.
Thanks to the strong relationships Jason builds, our uncle John was happy to put his Friday night on hold to surprise him at the Toronto bus terminal, and host him for the night.
Anxious to connect with Jason before he strayed toward the streets again, my partner and I drove to my uncle’s condo, arriving in the middle of the night to the welcome sight of Jason curled up on an inflatable mattress.
With the immediate stress of trying to find my brother dissipating, I realized that I myself was becoming mad – overcome by stress in trying to fill the widening gaps in our mental health-care system, I was no longer in my right mind. But there is no professional support available to me to negotiate this strain, unless things get so bad that I come to consider harming myself or someone else. So I sat on my uncle’s bathroom floor with my partner to have a drink and take a breath. Not the healthiest choice, but it was the best I could muster in the situation.
Successful as our intervention in Jason’s plan to become homeless in Toronto seems to have been (with him returning home with us), it made me an accomplice to a longer history of failures.
After three days of living on Toronto’s streets in 2013, Jason was picked up by the police for behaviours stemming from coming off his medications so quickly, and admitted to the Centre for Addictions and Mental Health. Deemed “medication-resistant,” he was subjected to electroconvulsive therapy (which research suggests is inappropriate for people living with his diagnoses), and I was forced to stand on the sidelines, watching as this “hail Mary” robbed my brother of his memory and made him permanently disoriented.
After his release, I invited Jason to live with me in North Bay. And after a two-week trial, we moved into a new apartment together. I was happy to be close with him again, and as his secondary decision-maker under a CTO, working with a caring interdisciplinary ACT team, I swore I would never let things get so bad for him again.
But apparently, they have.
Why is Jason’s psychiatrist so overextended that he can only do biannual meetings with some clients?
Why did the hospital turn him away?
Why has his ACT team lost two of the three members that my brother is comfortable sharing his inner world with?
Why am I and other family members left carrying the emotional, financial, social and professional costs of making much-needed interventions?
As a university professor whose dignity is given, and who has done research on homelessness in Canada, I have the privilege of affirming Housing First as a more affordable and effective model for supporting people who live with a “serious mental illness” (SMI).
But housing is not enough. Even with a strong network of supports, therapeutic work is needed.
Furthermore, the burden of that work would be lighter if our wider society embraced the diverse ways people contribute to our communities. My brother should not have to over-perform being “OK” (which is how he describes his state of being most of the time, even though he lives with mental strain that would break most of us), in order to live with dignity. I should not have to transmute my own madness – both anger and mental/emotional stress – into crisis, in order to be heard and supported.
Cliche as it might be, we are killing our communities through a thousand cuts. Cuts to hospitals that once provided respite care, cuts to psychiatric services that have lowered the bar from “wellness” to “maintenance” of basic functioning, and cuts to community-based social services that make medication-delivery their primary activity.
Police and family members are dealing with the fallout of these cuts, and neither are adequately trained or funded for doing so. Communities are losing out on the potential contributions of people living with SMIs (e.g. Jason maintained part-time work at a pet store when he was well, rather than relying solely on ODSP), and the fulsome contributions of family and friends who are “spent” (literally and figuratively).
This letter may not be news, insofar as it is ‘just’ a personal instalment in a well-worn story of a broken system, but I hope you might read it as an indicator of how very bad things have become.
Jason is a model community member with a loving home and caring friends, who is doing everything right – in terms of seeking access to and complying with mental health services.
If things have become so bad for him that being homeless in Toronto is a compelling option, then what does that say about the majority of the 481,766 Ontarians who report having a mental health or addiction disability (Ontario Human Rights Commission 2015), who do not have similar supports?
How many more people and families must be sacrificed in Ontario (and Canada, more generally), before governments heed calls to provide adequate funding and enhanced therapeutic and social services for mental health care? How close does mental illness need to strike in your own family or community before you embrace and become an ally to people with extraordinary minds?
This letter is my cry for help.
The ultimate cost for ignoring such cries can be measured by the growing numbers of people – especially young men – committing suicide in this country, each year. It has become critical that all of us “Speak up for mental health” (CMHA). Add your voice to movements for improving our mental health-care system, and to fight stigma in our communities (see letter templates on the Facebook page: @FortheloveofJasonKataoka). Demand answers from mental health-care providers and government officials about why people are falling through the cracks, and how we can support them in making much-needed improvements to our mental health-care system. Find, encourage and respect the dignity of people like my brother, whether on the streets or in your neighbourhood. Together, we can make our communities places that offer better options than the streets or death, to people living with mental health issues.
Serena Kataoka
North Bay
This framework does not present a definitive listing and categorization of services and supports; those listed are not exhaustive but are illustrative of the services and supports that are needed. Thus the model should be regarded as one useful way of depicting the range and types of services and supports that are required in a transformed mental health system.
Each level of need is associated with a particular array of services and supports. People will usually receive most of their services from within a particular level, but they are not limited only to the services within that level.