Managing mental illness: When storm clouds gather
Bo Johnson doesn’t talk much. And when he does, it’s in curt single words and short sentences. He cloaks himself in layers of shirts and vests, gloves, sunglasses, a hat, protecting him from the outside world. He doesn’t usually seek company, and finds crowds overwhelming.
Bo was diagnosed with schizophrenia at age 23, but has never accepted it. Even now, two decades later, he insists that he was fine when he was first taken to see a psychiatrist.
“Business as usual,” he said. “I was signed in involuntarily.”
Bo is a classic case of someone who lacks insight into his illness. As Barry Johnson, Bo’s father and head of the Chilliwack chapter of the B.C. Schizophrenia Society, said: “If you accept it, you can help yourself. But if you don’t accept it, then you’re going to fight it. And the minute you try to fight it, forget it.”
This is a common reality for those with serious mental health issues.
“Schizophrenia is one of the hardest to treat,” said Chilliwack psychiatrist Dr. Saju Antony. “Many patients don’t accept that they have schizophrenia.”
Antony tries reasoning with them, but sometimes doesn’t get anywhere.
For people like Bo, failing to recognize the symptoms makes it harder to manage the illness, and live a normal life. It becomes more difficult to keep a job, and find decent housing, and connect with other people. Conversely, the lack of paid work, permanent housing, and social support can exacerbate mental illness.
That’s when people risk becoming chronic offenders in society. Some may also abuse drugs or alcohol in a mistaken attempt to self-medicate.
Bo has never followed that path, but Eric Hunken has a different story. Living with bipolar and borderline personality disorder in Chilliwack, he was once a heavy crack cocaine and methamphetamine user because the drugs helped him forget his personal struggles.
And he wasn't alone. Over half of the mentally ill abuse illegal drugs or alcohol, compared with only 15 per cent of the general population, according to the BC branch of the Canadian Mental Health Association.
A person may try to drown out symptoms of mental illness, such as insomnia, anxiety, and racing thoughts, with drugs or alcohol. Meanwhile, substance abuse may provoke depression, hallucinations, and paranoia.
Such a concurrent disorder of mental illness and substance abuse makes a person even more likely to come into contact with the police, perhaps for making multiple calls to 9-1-1, or for public disturbance.
Since November, 2011, Chilliwack RCMP have one officer dedicated to redirecting some chronic offenders away from the justice system, in recognition that a few residents take up a disproportionate amount of police time and resources.
“It was recognized that the police were dealing with a group of clients that we shouldn’t be dealing with, and that we’re criminalizing their behaviour by keeping them in jail, arresting them for the weekend for public order disturbances,” said Cpl. Len vanNieuwenhuizen.
Const. Valerie Conroy, Chilliwack’s first and only social chronic program coordinator, has 10 to 15 names on a list each month for whom she tries to find services and care facilities. The majority of her clients have mental illnesses.
Because the names come from other officers, the system depends on police on the ground to sift out social chronic offenders from the rest.
Hunken, who has trained RCMP officers on dealing with the mentally ill, says that police have the most direct contact with people with mental health issues in Chilliwack, but officers need to be better informed.
For instance, using words like “help” instead of “arrest” would improve a tense situation.
“The manner that they speak to us has a change in the way we respond,” said Hunken. “We need a different approach. Because we’re at a really bad place. But we’re not always going to be there.”
Another misconception that Hunken works on is that of violence. There’s a common fear in society that the mentally ill are dangerous.
In fact, sufferers of schizophrenia are more likely to harm themselves than anyone else; 10 per cent end up committing suicide, according to the B.C. Schizophrenia Society. Schizophrenics also commit fewer acts of violence per capita than the average population.
“They (RCMP officers) see people with mental illness at their worst,” said Hunken. “They didn’t realize that people get better, or have good days.”
Hunken has found that there’s a mistaken belief among officers that most people are schizophrenic with psychotic symptoms, when in fact schizophrenia is much less common than bipolar disorder or depression. He also had one officer in Chilliwack ask if there was a blood test for mental illness.
Conroy agreed that education is the way forward. Chilliwack officers are required to have training in mental health through an online course, renewed every three years.
For the Johnsons, cracks in the system are a big challenge. For example, when people with mental health issues are released from Chilliwack hospital or RCMP custody, there are no outreach mental health workers to follow-up, to check on people at home. To make sure they’re getting the medication and support they need to be healthy.
“I think they are overloaded with all their clients,” said Bo of case workers at Chilliwack’s only mental health office, where a handful of workers handle 800 to 900 clients. “They can’t keep track of everybody. People go missing in this town.”
Bo himself has several different case workers that he sees for a few minutes biweekly at the office. Other than that, he does not have free access to a therapist or counsellor, somebody he could talk to regularly about how he is managing his life.
His dad Barry believes that people who are diagnosed should be registered with the hospital and the RCMP.
Barry is 68 years old now, and figures he has another decade in him to care for his son. He warns Bo that soon he will have to manage his own housing and food. But Bo hasn’t worked for about a decade, and doesn’t pay for anything essential except for a small portion of rent. Living in his dad’s basement, he has kept out of trouble, and has not come into contact with the police.
As someone who insists he isn’t sick, Bo would need close supervision to make sure he remains all right.
Although progress is slow, Chilliwack is gaining strides in improving services for the mentally ill. The Village, a supportive housing complex, opened 22 adult suites in 2011. Cheamview Clubhouse continues to strengthen the community through a host of programs and activities to help people recover their mental health. The RCMP’s social chronic offender program is the first concrete link between police and community services for the mentally ill.
Opening in September is the Health and Housing Contact Centre, which will bring together Fraser Health medical staff, community social services, and 22 transitional housing apartments under one roof.
There is a consensus in the mental health community that providing the support that people need to control their symptoms and live full lives is more effective, and less expensive, than treating them during crises. Affordable housing, an understanding employer, and strong social networks all help to keep people off the streets, off drugs, and away from the correctional system in Chilliwack.firstname.lastname@example.org twitter.com/alinakonevski