When we name someone as addicted, homeless, mentally ill etc., we can distance ourselves from them and absolve ourselves of a common responsibility let alone a communal response.

Do we look at individuals with mental health difficulties and assume there is only something wrong with the individual? There is usually a genetic component but most illnesses and addictions are an expression of the environment as well. If “it takes a village to raise a child” then it must follow that it takes a village to raise an addict or a ‘depressive’ or a ‘schizophrenic’. When I see my family doctor the computer with my health information is in front of me while I wait. The screen says I am bipolar, PTSD, PNES etc. I’m not even sure she knows I have been incarcerated. Most people I meet go on less so I’m not annoyed.

It might be a weak argument but what if we put a “normal” person in the environments I have endured? Having ‘been there’ I would imagine similar outcomes and symptoms. Maybe genetics would guard against certain realities but I’m not sure ‘blood’ blocks trauma. For those who believe mental illness is a shortcoming I invite you to stand where I have stood. Spend a few weeks in solitary confinement. Spend the worst part of a year navigating other inmates while fluidly psychotic.

I’m tired of being disordered. I’m tired of being mentally ill. Society puts these labels on my experiences to limit the responsibility we all have to the vulnerable. When I flop around on my floor having pseudo-seizures society can point to me as a problem. He has PNES. No shit! You put someone in a concrete box with a toilet to talk to and he has symptoms? Go figure.

When we name someone as addicted, homeless, mentally ill etc., we can distance ourselves from them and absolve ourselves of a common responsibility let alone a communal response.

London and District Academy of Medicine – Patient Healthcare Forum: Improving Healthcare and Ending Hallway Medicine Presentation

My mental health journey began when I was 10 years old. I was admitted to the Adolescent Unit at the old Children’s Hospital here in London when I was 15 and 17. In my twenties I was admitted to the 8th floor at the Old Victoria hospital.
The next leg of my journey was Two- Years- Less- A- Day in the Correctional System. I was re-arrested in my early 30’s and spent 9 months psychotic in a Detention Centre. This included about 6 weeks in solitary confinement. I was found Not Criminally Responsible On Account of a Mental Disorder and remained in the Forensic Mental Health System for 6 years.
More recently I have experienced two ambulance rides, two mental health arrests by London Police Service, two one week stays in the London Health Sciences Centre ER department and a one month say on an acute unit at LHSC. At present I am an outpatient with Parkwood Institute (St. Joseph’s Health Care).
The difficulties I have faced accessing Mental Health Care are both personal and systemic.
When individuals fall through the cracks the costs are enormous. I might not look it, but this province has invested over a million dollars in me. You might think that would be pleasing but many days I am fragmented. It’s no one’s fault but we can do better. There are a multitude of highly qualified and deeply compassionate care providers who also need something more workable.
The ER at London Health Sciences is a miniaturization and mirror of the penal system. Patients don’t wear orange, but we are coloured by diagnosis and risk. The ER rooms are quite like solitary confinement. I hope that doesn’t sound hyperbolic because they are worse. There are no windows and when you enter the hallway there are Correctional Officers monitoring prisoner patients and if you need to use the toilet it is a shared jail toilet. Stainless steel no seat. To get there you must walk the gauntlet of police officers and security staff who all look alike. This is not therapeutic it is traumatizing and a criminalization of mental health crisis. The one room I was in I urinated in the corner drain most of the time I was there. We didn’t call it the ER in jail. It was called the Hole or the Digger.
My view of LHSC is that security runs the show. Safety and security are paramount, but this makes the situation no less stigmatizing. I realize it is cheaper to handle chaos with security rather than hire health care workers but is that ethical? Is it even humane?
In the 80’s and 90’s we had orderlies. They interacted with and were familiar with patients. In those days’ patients had many of the same symptoms and the availability of sharps was the same or worse but today we have paramilitary forces in hospital. It seems as far from therapeutic as you can get. My hospitalization’s in the 80’s and 90’s were by comparison positive experiences. To treat everyone as a risk to themselves or others is stigmatizing and redundant.
The ER and acute system are not only chaotic and frightening but once you’re there you’re only honest enough to find freedom. I deal with suicidal thoughts regularly and often repetitively. As an outpatient my mind was made up that if I made that decision it would be my last. There was no way I was going to be left for emergency services or the acute unit to impart what are in my estimation traumatic treatments.

 

We need a mental health care system that is more community based with improved coordination between agencies. My perception is that we have a funnel whereby individuals access mental health care through the ER and acute services. I’m a poor example as I have an aversion to assistance, but individuals and families would be better served in the community.
We need more Mobile Crisis Teams and Teams that can deliver care in the community. Having the police involved in mental health apprehensions is inefficient, traumatizing and stigmatizing. The police by nature are agents of control rather than agents of care. When an individual is brought to the ER by the police, health care workers have a perception of that individual and it can be a barrier to compassion and care.
Too much funding is being used by the police in mental health interactions and it becomes a snake swallowing its own tail as these forces call out for more funding for a job they do ineffectively. The further they progress the more they consume. We provide piecemeal mental health training to police who are paid 70 thousand dollars per year while there is a shortage of mental health and addiction workers who are paid 40 thousand dollars per year. Using the ‘Sunshine List’ to deliver patients for healthcare is a dim idea and there are more humane interventions.
If a perennial patient can access the system outside of emergency services it is the best possible outcome. The individual can depend on familiarity and continuity of care. These elements are not only lifesaving, but they are fiscally functional as well. It costs about 25 hundred dollars for a therapist to see a patient once a week for a year. The bill for my one month stay on the Acute Unit was over 75 hundred dollars. The personal and familial costs are incalculable.
When I consider how quickly a mental health difficulty can spiral out of control I think family doctors should be able to make a true urgent referral. Many of these incidents are a matter of life and death. My family doctor made an urgent referral and had I been swiftly seen I may have been able to stabilize without calling on emergency services. It makes absolutely no sense that you can call the police and be seen right away but to access a healthcare worker you must wait. Family doctors need to be more effectively included in the circle of care.
Spirituality seems like an odd antidote for hallway medicine but distress can be intertwined with faith structures and some of my symptoms can be overcome or integrated by utilizing a spiritual framework. Spirituality can be a basis for or link to community and community supports can be a preventative factor in healthcare. Stigma is isolating, and isolation can be lethal. When I see a person of any faith I can converse with fewer words while comfort and compassion are a gesture I do not have to see with my eyes. These individuals can dissolve portions of uncertainty and fear. In the Forensic System the interdenominational pastor was part of the team.
To alleviate hallway medicine, I believe we need a two-pronged approach. I see two pressure points on the mental health system. One point is individuals who need to be able to access the system prior to emergency care. Patients are presenting at ER because of waiting 6 months or more. If these individuals can see someone within days, there is hope. That someone could be a recreational therapist. When I see my recreational therapist, I know there is a psychiatric nurse, a psychiatrist and Team behind her. These Teams can be a great resource and can be part of a system of triage where they can recognize difficulties and direct individuals to the care that best meets their needs. Hopefully this would prevent individuals from getting worse and requiring more intensive healthcare. Sometimes what a person needs most is simply to be seen. Mental health difficulties are usually manageable healthcare needs.
The other pressure point is individuals who are more chronic and require longer term beds and more intensive healthcare. It seems counterintuitive to have a hospital bed occupied for longer but if a longer admission prevents others in the future the savings are real and in effect more humane. If surgeries were left half completed, we would be appalled. Long- term treatment is integral for a subset of individuals with complex mental health care needs.
The individuals who we fail to fully intervene with and for, may not weigh directly on the healthcare system but they still require resources from other agencies. When I drive by the Elgin Middlesex Detention Centre I know that over 70 percent of inmates need mental health care and addiction services. This is the most expensive backwards delivery of care that anyone could imagine.
If we can alleviate these two points I believe we can make headway in ending hallway medicine and hopefully much of the funding required can be recouped by lessening the demands on emergency medicine, policing, corrections, forensics and shelters.
We have been feeding the wrong end of the elephant.

Apple = Love

I wrote the skeleton of this story a couple of days before I had to euthanize my therapy dog Ani.

The question I awoke with that morning was: If you could never eat an apple again would you wish to experience it in all other forms or would you choose to have the apple disappear from all your senses?

Memory can be “madness” and awareness is sometimes the suffering. Life is basically memory and imagination if in fact there is a difference.

It seems obvious that anyone would choose to see apple trees or notice the smell of baked apple pie but the alternative might be less painful. If one is unaware do they suffer less?

The experience of missing out involves a knowledge of or expectation of something different. Being five minutes late for the bus is being fifteen minutes early for the person next to you. Both kick at the cold but the same event is grief on either side of expectation and ultimately acceptance.

Having three brothers I was accustomed to missing out on apple pie but when I was incarcerated and hospitalized I seldom experienced the depth of specific disappointment. A slight awareness and imagination was tortuous but to have been fully aware of the actual taste of my Mom’s apple pie or the feel of warm sand and rhythmic waves would have exacerbated my ‘madness.’

Reading these thoughts in light of the unexpected passing of my pet leaves me not with an answer but another question: Would you choose the experience knowing the pain that is inevitable or is Love itself an upfront acceptance of and or investment in loss?

Sanity

Most of us know triumph but everyone knows sorrow. As I type this my dog Ani is growing cold in the back of my car. She was euthanized today and I am doing my best to procure similarities with 5.5% alcohol. Ani had bone cancer and one of her bones was fractured and disintegrating. Now I am.

If you’ve owned a dog you have or will have to say goodbye. To say I was fighting back tears at the veterinarian’s view of things is laughable but I tried.

Ani wasn’t an average dog that I crated up and cursed the cold with twice a day. She was my therapy and only friend. We spent the last 10 years in each other’s company 24/7.

I did not train her but if I swore she nuzzled up to me. She knew I was having a hard time if I cursed. I guess I will have to come to terms with the fact that now no-one will love me when I am unlovable.

The veterinarian said it would only cost me 30 bucks for paw prints and a measly $400 for some assholes who didn’t love my dog to guarantee that the ashes in the urn were in fact only Ani. Screw you and your mourning marketing. Poverty is impervious.

If you’re local you’ll wonder how this asshole expects to bury a dog in March. I half built a granite garden within view of Ani’s bed in the house. That is where Ani will rest. About all I have to do is thaw 15 bags of topsoil from whichever garden centre is open and stocked.

I don’t know what most people say to their dog as they slip away but I said “thank you.” I said “thank you” and I massaged the inside of Ani’s ears like I always did.

When I first got Ani I named her sANIty. I was dissuaded by the premise that she sounded like a boat but in hindsight calling her from a distance would have been problematic. “Sanity,” “Sanity Come.” If it were that easy to summon sanity you wouldn’t be reading my blog. Part of me will always call Ani from a distance but our closeness can never be argued.

I dedicate this story to all therapy and service dogs. Very few wear a vest.

I was screaming about “21 feet” so they weren’t justified in shooting anything, but they were already 10 feet away. They finally got my dog away from me and I turned around and stripped naked without prompting. “On the floor.” And they pinned me to the floor with their Plexiglas shields and handcuffed me. The paramedics gave me a needle in the ass and I was placed on the gurney I had kicked over when they parked it at my front door.

I like to think I’m somewhere near the bottom edge of normal. Some days I imagine other people with extraordinary lives. I pretty much plant myself in the same few spots of a fifty foot by 100′ acreage. Every car I see is imaginable as extraordinary. My life has been like being on a sightseeing tour except the brochure and map are for another location and the guide doubles as a guard.

I spent a few months hiding which is leaps and bounds beyond only moving around the house in the dark. I know every noise depending on how I shift my weight. Most days I’m suicidal but I keep my pills in weekly containers to make it all seem onerous.

I used to have more kick and fight but I’m still feeling beaten down by my latest healthcare apprehensions. In March I left the house on an ambulance gurney. I had four seizures which seems reasonable after a year of two to three hours of sleep and a drinking and fasting regime. I was screaming at my mattress because I didn’t want to go in an ambulance let alone a hospital. I was unwell, and the ambulance ride was a blackout, but I recall recalling some of my story as far as justice and innocence in the emergency department. It’s important to be heard even in a CT scan. It was a bunch of psychogenic non-epileptic seizures, but I felt like I got hit by a truck. I slept for three days and only walked to the washroom.

A few weeks later I got dragged out of the house on another ambulance gurney, but things didn’t go as smoothly. I was funneled through the police before the paramedics would do whatever it is they do; the ambulance ride was another blackout. I sure as shit remember the cops and all the Plexiglas shields as I ranted from the corner of my living room protecting my therapy dog. Things would have turned out differently had I known one of the cops told my wife “we might have to shoot the dog.”

I was screaming about “21 feet” so they weren’t justified in shooting anything, but they were already 10 feet away. They finally got my dog away from me and I turned around and stripped naked without prompting. “On the floor.” And they pinned me to the floor with their Plexiglas shields and handcuffed me. The paramedics gave me a needle in the ass and I was placed on the gurney I had kicked over when they parked it at my front door.

I was only in the ER against my will for a few days. Because of my experiences in solitary confinement and the similarities with LHSC the first hours were in my world days. I lost all sense of time again and was very agitated with anyone who turned on the lights. I was strapped down at least twice but those events are basically blackouts as well. I don’t react normally to such conditions and confinement which is where some of my agitation and anxiety arise. I guess you’d have to spend a year or two with an indefinite sentence on your person to get it.

I left against doctors’ advice in part because the only other option was to remain in “solitary confinement” until they found a psychiatric bed. Maybe if they had a window in the room or something other than a jail toilet in the hallway of correctional officers and cops. I pissed in the drain in the corner most of the time I was there.

A few days later the police came to apologize, I thought, but five of them seemed to want to stuff me in the back of a police car. I had bruises for two weeks from where they squeezed the pressure points on the insides of my arms. The cops left me back in the ER with a “spit hood” on my head and some nurse trying to medicate me. I overheard someone say, “I’ll take anyone but that one.”

After about five weeks they let me wander so I can spend half my time wishing I was dead and the other half wondering if I have a choice.

I know of no other health condition that the police are likely to respond to. I understand that behavior is a symptom, but I don’t see nurses giving out speeding tickets.

Inclusion involves sharing the experience and it involves interaction and communication.

In battling with exclusion and discrimination, I think it is important to recognize the historical nature and scale of exclusion. Much of the language and imagery which intertwines with mental illness has its roots in the idea of demonic possession or evil spirits. Some of this still lingers today in public perceptions and therefore public policy. Various cultures and groups depend on folk beliefs for knowledge of mental illness which is also reflected in core beliefs. If an individual cannot understand mental illness they cannot understand an individual with it. To me inclusion involves sharing the experience and it involves interaction and communication.

Although 1 in 5 may experience a mental illness in their lifetime a large portion of society will never feel or experience mental illness personally. It is overlooked or not imagined that illness is part of the human experience. Even the strong and healthy eventually succumb to the ravages of time. Instead of “that can never be me” it needs to be recognized that “it could be me” and “will be me”. I’m not sure how you enforce empathy but to me it is the basis of inclusion. To recognize difference is easy but to acknowledge similarities takes mindful work and it is a process.

It becomes difficult to include when exclusion is a means of psychological safety. People are prone to disengage and disavow what is a threatening possibility in themselves. Exclusion is a deep rooted and timeless function of individuals and societies. Incarceration and hospitalization can and have been forms of exclusion for those who are different, disturbing or difficult. Individuals with mental health difficulties are often unable or unwilling to conform due to symptoms. Unfortunately, it is the still suffering and or untreated by which those who are identified or self-identify are measured. The gifts and unique attributes individuals with mental illness posses are sometimes lost in the telling of only part of the story. More people are aware that Vincent van Gogh cut his ear off than have browsed his significant contribution to the world of art.

If I mention to someone with no experience outside of myth and movies that I have bi-polar disorder, often I am measured and treated as the imagery that occupies the observers mind. With mental illness a point in time or episode of illness seems to define the individual. Gifts or skills take a back seat in identity and dignity is undermined by the perception that a person is an illness. Mental illness is often viewed as a permanent flaw and shrouded in risk. On a personal level it is easier and safer to discount or devalue these individuals than it is to accept or foster diversity. The consequences then become systemic and societal.

“I simply represented a normal part of diversity in the spectrum of differentness in our community.”  Norman Kunc (The Other Side of Therapy: Disability, Normalcy and the Tyranny of Rehabilitation)

Follow the white rabbit.

We sold our chicken coop not long ago. My wife mentioned that the yard looks better without it. I told her it was a painful reminder of my recent mania and psychosis. She said to look at it more positively. “Not many in London have experienced poultry as you have.”

For some reason London doesn’t allow backyard birds. I was certifiably certain the bylaw was about to change when I purchased my birds. In my mania I ended up with five ducks and ten chickens. That’s a slight exaggeration as one of the chickens was actually a rooster. In hindsight I think he was my undoing.

The first month I thought I had lucked out and had a rooster without the ability to crow. It was a delusion. He was however the most beautiful bird I have ever owned. When I picked him up from another Londoner and brought him home I opened the cardboard box and he flew straight to the top of our aluminum shed. My first thought was how to get him down in broad daylight but then, I just watched him.

We had sod in our backyard before all this but with rains my free range flock quickly turned the backyard into a mud-hole. It was too muddy for the chickens and soon they were living on our elevated deck in full view of the neighbourhood. The bylaw enforcement officer seemed quite intrigued with the five that were Jersey Giants but less so than the rooster.

I was warned several times but my seven white rabbits were basically feral at that point. My neighbours don’t speak to me but I cant wait to ask them if they thought they had lost their minds when they kept seeing white rabbits. I found the rabbits a home about 80 bucks too late but I can still hear flapping wings and the knock of a meat cleaver my buddy used to dispatch the ducks. I didn’t see it but I think the effect was about the same.

Now our food scraps go in the garbage and I have no fresh eggs to share but I did not surrender. I now have three Eastern Cottontail rabbits to eat the complaining neighbour’s rosebush. I also own several Canada Geese, at least four Mallard Ducks, a pair of pigeons, about a dozen Morning Doves, some swallows, half a dozen Goldfinches and flocks of Starlings and sparrows. We live in a new subdivision and there are two huge mud puddles right across the street. I walk over there once a week and spread cracked corn. Location, location, location.