HEALTH

Bitter battles

Critics dispute early release of the mentally ill

MICHAEL HARRISON February 26 1990
HEALTH

Bitter battles

Critics dispute early release of the mentally ill

MICHAEL HARRISON February 26 1990

Bitter battles

HEALTH

Critics dispute early release of the mentally ill

The basement that serves as a referral centre for homeless people in downtown Montreal is aptly named Dernier recours—“Last Resort.” And last month, the centre faced a last resort of its own after a controversial demand by city councillors that the city shut it down. Their reason: although the centre was not designed as a shelter, Montreal’s housing shortage had prompted Dernier recours officials to let about 150 homeless—including more than 80 former psychiatric patients—sleep on the centre’s floor each night. But neighborhood residents complained that the centre had become a haven for drug addicts and prostitutes. And Dr. Georges Etienne Cartier, a Montreal psychiatrist, said he was concerned that the centre was not a suitable environment for the expsychiatric patients. Cartier said that one of his patients told him that at the centre he “could trade his prescription drugs for a pouch of tobacco.”

The Montreal controversy underscored the difficulties that have faced many psychiatric patients in Canada since provincial health officials began earlier release of mental patients from institutions about 25 years ago. The policy reflects a belief that many schizophrenics, manic-depressives and other similar people can function better while living in the community, rather than in institutions. The policy has sparked bitter battles in neighborhoods where residents objected to having residences, known as “group homes,” for psychiatric patients, mentally handicapped people, released convicts and others from outside mainstream society. As well, critics say that in most provinces, adequate support systems, including medical supervisors and counsellors, do not exist for the thousands of mental patients who now live outside of institutions.

At the same time, health experts say that they are concerned about chronic government underfunding of group homes. In many areas,

nonprofit organizations have sprung up in an effort to fill the gaps. Still, in many parts of the country, the network of support services is evidently inadequate. As a result, said Patricia Cameron, regional director for the Canadian Mental Health Association in Calgary, “many mentally ill people end up on the streets.”

As well, there have been incidents in which members of group-home staffs have been charged with abusing their charges. Last October, the owner of a home for former psychiatric patients near Orillia, Ont., was convicted on 13 charges of assault and sentenced to five years in prison. Witnesses at the trial of Jean Thibault and his wife, Mary, who herself received a fourmonth sentence, said that the couple subjected residents to regular beatings.

Despite recurring problems, programs to get mental patients out of institutions and into the community continue across Canada. Vancouver’s Riverview Hospital, British Columbia’s major mental institution, now has only 1,000 patients, compared with about 4,000 in the 1960s. In Quebec, where health officials began earlier discharge of patients in 1962, only 12,000 mental patients remain in institutions while about 25,000 live in the community. In some parts of the country, patients stay in mental institutions only because there is nowhere else for them to go. Since 1985, 110 mentally handicapped patients have been designated as ready for release from the Restigouche Hospital in Campbellton, N.B. But only 10 were actually released; the rest remained in the hospital, because no other accommodation could be found for them.

Some released psychiatric patients wind up on the streets. James Bell, a 64-yearold Halifax schizophrenic and former librarian, says that he has spent part of his adult life in hospitals and part of it in aimless wandering. Bell told Maclean ’s that he once tried sharing an apartment in an unsupervised building, but was unable to function. After that, Bell became dependent on the Salvation Army and other emergency hostels for help. Finally, he found a room in a special-care home in a downtown Halifax neighborhood. Said Bell:

“For me, a group home means one thing: security. It’s a home base.”

Despite the problems that have plagued group homes, many experts say that community living has proved the most effective way of caring for the mentally ill. Stephen Scott, housing manager of the Vancouver Mental Patients Association, for one, said that the cost of care per patient in group homes can be as low as $36 a day, compared with $300-$400 a day in larger institutions. At the same time, patients have a chance to live in a noninstitutional environment. Helen Garigan, a 68-year-old former psychiatric patient at British Columbia’s Riverview Hospital, said that she enjoys

her present life at a group home in Kitsilano. Garigan said that “the screaming you have to put up with” in a mental hospital disturbed her. She added, “I just walked around and stood around.” With increased funding and a

more effective support system for discharged psychiatric patients, the group home concept could yet prove a successful way of accommodating Canada’s mentally ill.

MICHAEL HARRISON with correspondents’ reports