Ontario Hospitals Need to Give Their Head a Shake

I wonder what goes through the minds of patients who are pushed off hospital property to smoke in the cold with the public driving by.

Am I to believe I am valued as a person when certain aspects of myself are banished? It is quite like making a child stand in a corner to contemplate their unacceptable behaviour. It becomes difficult to see the love and respect for patients when they are relegated to the road and rain coping as they know how and finding pleasure and escape in a cigarette. These individuals have serious and persistent mental illness and we are worried about them smoking? Privileged individuals are instituting their values on marginalized individuals. Some will never quit so I suggest we stop shaming them.

When I was a forensic patient I really didn’t want people knowing I was such. I found it humiliating having to ride in the “big white vans” because most people in St. Thomas knew where the “big white vans” were from. They were part of the community consciousness and on more than one occasion I heard the “big white vans” used as amusing putdowns.

Privacy is a premise of dignity. When I am placed beside the road like a pathetic pylon I eventually become recognizable to repetitive travelers and commuters. This scenario makes community integration difficult and it compromises patient safety. What if a prospective employer, landlord or lover recognizes me from standing beside the road five times a day? It makes what is already difficult more so. Will I find employment or a date if I am publicly exposed as belonging in a forensic hospital? Nobody deserves a scarlet letter let alone for an unhealthy habit. Are we compromising patient confidentiality by placing these individuals beside a public thoroughfare?

At the old forensic hospital a friend and I ordered a pizza on a summer’s evening. We decided to eat it at a picnic table in front of the hospital. We were well back from the highway but a car full of fools drove by yelling obscenities at us. Not all motorists are mature or well meaning. Some motorists barely know the meaning of a STOP sign but we expect they will comprehend and be sensitive to STIGMA? Forensic patients are prone to abuse and discrimination and placing them beside a road is nothing more than facilitation. Having these individuals within distance of garbage being hurled at them is dangerous and unfair. St. Thomas is fairly accepting of Southwest Centre for Forensic Mental Health Care but it only takes one.

When I become a fixture standing at the end of the lane leading to a forensic facility I become recognizable. If and when I am allowed to wander other avenues I am still recognizable. We might as well dip these smokers in orange dye to further accommodate their prospective discrimination. These individuals are already compromised and marginalized and I find it shameful that an organization with a mandate to assist them is in fact harming them.

Unfortunately, these well meaning but overbearing boardroom bureaucrats fail to fathom the positives and pleasures of smoking.

I had a friend put a bee in my bonnet. It could be argued that it was always there but I shall defer a degree of credit to him. The issue is hospitals making smoking illegal for psychiatric patients.

My health or lack thereof is still “my” health. When we crowd individuals with serious and persistent mental illness off hospital grounds to smoke the message is, “we want to make you healthy and we refuse to enable non-healthy behaviours.” It appears to be an admirable avenue but it is still a slippery slope. If non-smoking initiatives are embraced it enables preventing patients from any behaviour including ingesting pizza and pop.

Obesity is as problematic as smoking. Will it be next or can we continue to consume chocolate? A serious and widespread side effect of some psychiatric medications is weight gain. If it is prescribed by a psychiatrist there seems to be no dilemma but if I thrive on soda pop it is unacceptable. I knew individuals who were policed for their pop consumption. The one individual I recall most was allowed to drool uncontrollably but liquid running in the other direction was monitored and measured.

If your argument is that second hand soda doesn’t affect others I would have you stand at the side of a highway or avenue and measure the cocktail of car exhaust you breathe in. When I first arrived at the forensic hospital in St. Thomas we had smoking rooms with cushioned chairs and TV’s. I quit for a period and don’t recall any smoke in the hallways. The smoke was contained in a humane way using air exchangers. The smoking rooms were closed while I was there but the asbestos and lead paint didn’t seem problematic.

Unfortunately, these well meaning but overbearing boardroom bureaucrats fail to fathom the positives and pleasures of smoking. We can all relate to the benefits of joining friends for a beer or meal and smoking is no different. Should relative health supersede happiness and free will? Even the executioner has the mercy to offer the beneficiary of bullets a cigarette as a last wish. Smoking is unhealthy and slightly disgusting but for a depressed patient it may offer four minutes of pleasure. It can be a reminder of normalcy and freedom in a situation of caregiver custody.

There are more productive pleasures but who doesn’t choke on other people’s ideas of what they should be doing with their Loonies, lungs or legs? Autonomy must be complete and absolute wherever possible and practical or else patients are essentially prisoners.

I was in Stratford Jail when the province issued a smoking ban in those institutions. I remember a notice in Admitting and Discharge:

“The jail will be smoke free as of November 22nd. We suggest you either quit smoking or stay out of jail.”

Hospitalization is not a choice or a poor decision. To deny a patient a pleasure they are likely addicted to on the street is punitive, cruel and misguided. If you choose not to smoke I admire you but don’t deny me the dignity of my own decisions. Don’t put me in the cold and rain on the side of the highway in the guise of care or because of your self-righteous beliefs and behaviours. Others are not stupid or wrong they simply have other priorities, likes and habits.

To deny an individual dependent on tobacco as a coping pleasure is nothing more than institutional primacy which places patients beneath the institution.

Johnathan Sher”lock” of the London Free Press calls himself an “investigative bulldog” all the while missing even simple hospital signage.

“Health Care: Ministry wants more done to protect nurses, patients in psych ward” was the headline on the front page of the London Free Press yesterday.

I have been a mental health consumer for over 30 years and I have never been on a “psych ward”. Apparently writing at a grade six level isn’t enough for the London Free Press and they have reverted to making up their own words. Unfortunately, these words carry meaning for many.

I would like to ask Johnathan Sher”lock” or his exaggerating editor which hospital they have observed signage directing the public to the “psych ward”? If a hospital has enough sense to be sensitive and current the same should fall to any reporter. I would not fault a reader for such references but an award winning health reporter should be ashamed and admonished. Sher”lock’s” misconceptions and sensationalism unfortunately have an effect on the general public. There must be a scarcity of space in the London Free Press and words like psychiatric need to be pruned. We all know it is on purpose. Sher”lock” and his editors have made a cheap attempt at an attention grabbing headline and the casualty is everyone who has, will have or is on a mental health journey. The social impact and perpetuation of stigma are incalculable.

Do we refer to the ICU as the Intensive Care Ward? Is there such a thing as a Neonatal Ward? Governments, organizations and individuals spend an inordinate amount of time and money to combat stigma and we have Sher”lock” and the London Free Press printing phrases that all but dismantle those efforts. There’s an award for that right Sher”lock”?

Sher”lock” calls himself an “investigative bulldog” all the while missing even simple hospital signage. I have a dog and all I know is it is full of feces twice a day. Thankfully the London Free Press does not have an evening edition. Often people’s misconceptions are solidified by headlines. A headline is a means to grab attention but it should be factual and current. Sher”lock” the “investigative bulldog” has stopped at the hydrant of hype and drenched the psychiatric community in stigma.

Johnathan Sher”lock” of the London Free Press reports that “Ontario’s Labour Ministry has ordered London’s biggest hospital to do more to combat violence and overcrowding…”

When I was being admitted to a jail I was placed in solitary confinement because the jail was at capacity. One of the female guards said “a full jail is a happy jail.” This is, was and always will be an oxymoron. I have been in lock-down situations and stacked three men to a cell and if my experience counts for anything the Labour Ministry, London Health Sciences Centre, Johnathan Sher”lock” and the London Free Press only need to understand one thing. If you address overcrowding you have little need to address violence. They are near being mutually exclusive.

Unfortunately, I can speak to the issue of overcrowding, segregation and the suspension of privileges and personal privacy and freedoms. Each and all have an effect on any individual but they are amplified by symptoms and serious mental illness. If individuals with physical symptoms were exposed to a similar environment we would see similar behaviors. The violence occurring at London Health Sciences Centre is environmental more than mental. Psychiatric units under normal conditions are not a breeding ground for beatings.

If Johnathan Sher”lock” was truly an “investigative bulldog” he would have sniffed out reality. Possibly Sher”lock” could have sniffed out statistics surrounding violence in Alzheimer’s patients and individuals experiencing dementia. The psychiatric community holds no ownership on violence. Head trauma can also result in personality changes and problematic behaviour but we paint psychiatric patients with a brush we would not use on other individuals in society who are also vulnerable and compromised for fear that they might be tarnished.

Sher”lock” reports that the “Ontario Nurses’ Association this week accused the hospital and the Labour Ministry of sitting idle while attacks on nurses last year surged 20-fold..”

Firstly, I am saddened by this as my mother was a psychiatric nurse and during my journey I have met dozens of nurses who deserve safe working conditions for themselves and to accommodate the great work they do. My issue again falls to language. Sher”lock” has a legal background and the word attack does not appear in quotations so I can only assume legal relevancy flew out the door when they brought in sensationalism. People are not charged with “attack”, they are charged with assault. Call a spade a spade. Surely not all of these incidents were “attacks.” Any logical person would assume some of these incidents are a harmful or offensive contact with a person. I understand there have been severe incidents but to call them all attacks is stigmatizing and sensational. To use this language to invite change is one thing but to use it to sell a newspaper is prostituting language. Only an overzealous crown attorney or a defunct defence lawyer would refer to an assault as an attack. In a court of law inflammatory inferences are often objected to and sustained. A lawyer writing for a newspaper should also be reminded of their contempt.

Is it really community integration when we have ghettos?

As a citizen of London with severe and persistent mental illness I am alarmed by the death of David McPherson and the displacement of a group of individuals with mental health difficulties.

We are giving these individuals our best when they are in crisis but we care less when they are chronic. Many surgeries are discharged prior to what would be considered good health as are mental health patients. What would we think if 25 post surgeries were displaced from a dangerous and disgusting dwelling? We can be proud of how hospitalization for mental illness has been transformed here in London but when I share my mattress with mites before and after it will be like Alice falling through the rabbit hole. Hospitalization will be a bizarre episode in a stupor of squalor.

It needs to be asked why so many individuals with mental health concerns are housed together. Is it really community integration when we have ghettos? When affordability means shared toilets and prolonged periods where privacy is extinct these dwellings essentially become a third world hospital with fewer staff. It should also be asked how much longer these individuals would have been allowed to be unsafe, unsanitary and defiled of dignity had there not been a tragic fire? Solitude is a human need, safety, security and sanitation should be absolutes.

If we are astute enough to recognize that clean and pleasing environments facilitate healing in hospital, why do we not employ it for people who are healing in the community? It all becomes mute when individuals are endangered, denied dignity and are made to endure circumstances and confines that would lead many to mental health difficulties. Possibly we would not remove the revolving door of hospitalization but fewer would need hospitalization if basic human needs were met in the community.

Many fine people and agencies came into contact with this tragedy far before it never should have been. Individuals with severe and persistent mental illness do not ask to be in these circumstances they simply need our assistance. I’m fairly certain it is against the law to do otherwise.

“It is a kind of cold and uncaring environment”

A 30 year old father has died at Elgin-Middlesex Detention Centre. On the surface it seems no correctional officer or administrator can be faulted because it was a suicide and because this particular inmate did not voice an intention or thoughts about suicide. Corrections sidestep the corpse and deny responsibility because protocol was followed. What if protocol in fact hastens or facilitates the death? Following the rules in this case could be considered the smoking gun.

According to London Lawyer Kevin Egan, who represents hundreds of London inmates “It is a kind of cold and uncaring environment.” I hope Kevin Egan didn’t have to research too many legal documents to come up with the understatement of the century.

Inmates are screened at admission about their mental health and suicidality. “Do you feel suicidal?” if answered in the affirmative will bring about a second strip search and the inmate is placed in solitary confinement or for those who like to justify its use, segregation. The inmate is given a tear proof gown and blanket to go with their toilet and 24 hour light.

For any inmate who is familiar with this system of sadism there is only one answer to the question. “No.” Inmates in solitary confinement because of suicidal ideation or behavior are checked on every 10 minutes. Interestingly, it takes about 5 minutes to die. In the case of this young man because he was segregated but not on suicide watch he would have only been checked every 20 minutes in comparison to the usual 30 minutes in the general population. This deviation points to the admission that solitary confinement creates a dangerous situation that needs increased supervision.

I realize Elgin-Middlesex Detention Center is understaffed and poorly designed but is it not possible for “cold and uncaring” correctional staff to ask an inmate if they are suicidal after intake? Surely, while under the arguably tortuous conditions of solitary confinement an inmate could be spoken to and asked if they are suicidal. Would any institution grind to a hault if such a protocol was implemented? It would require conscience and a degree of compassion but it may save a life.

To be placed in solitary confinement deteriorates mental wellness and exacerbates mental illness. This is where it becomes difficult for guards, administrators and healthcare staff to sidestep culpability. This particular inmate was taking prescribed psychiatric medication and was placed in an environment where whatever mental wellness he possessed was compromised. His mental health was compromised by the correctional system which did little proactive to prevent his eventual death.

There have been 16 coroner inquests into jail suicides since 2007 and the recommendations of better screening and monitoring of inmates has been ignored. This is not only a dereliction of duty but it is outwardly reckless and a foundation for legal culpability.

The Toronto Sun’s Failed Attempt at Facts Using Michele Mandel As A Moronic Media Mistress

It seems the London Free Press is not satisfied with their own ignorance and stupidity so they are borrowing from the Toronto Sun. It all reminds me of a group of children trying to find answers about the big world without leaving the playground. The result is a group of bedwetter’s who are confused as to what Santa Claus actually looks like.

Information mixed with ignorance and opinions are the things we find in schoolyards or typed up as an article in Sun Media. It is not journalism and it has to be dissected to be considered news. It all reminds me of some Conservative Action Plan sign where we have to discern what is real and what is simply political propaganda.

Michele Mandel seems to have fallen from the teeter totter and bruised her cranium. When your head is up your derriere these things happen. My condolences go out to her proctologist in having to figure out what is what.

According to Michele Mandel, jurors in the Luka Magnotta case “have the unenviable task of determining the murky line between evil and madness.” Evil and madness seem like simple words but beyond sensationalism they could mean anything. Evil could even be the person in the drive thru who gives me the tomatoes I decline but it seems Michele Mandel is the only one among us with a handle on it. We haven’t been able to figure out evil for eons but in this case it’s whatever Sun Media wants it to be.

Madness seems the more manageable moniker but it is not discerned in any fashion by Michele Mandel. Is she referring to mental illness in general or is madness a specific disorder? Is bipolar disorder madness? Is Obsessive Compulsive Disorder madness? Is Depression madness? Or is, as it is being argued in the case of Luka Magnotta schizophrenia madness?

What exactly is madness? I have perused my medical library, Google and Wikipedia and I can’t find an answer but it seems some journalist with a phoney degree in jurisprudence knows what it is exactly. Do share Michele Mandel. The world needs your expertise.

Let’s assume Michele Mandel knows a lick about schizophrenia and because we are speaking about Luka Magnotta that she is referring to abnormal social behavior and failure to recognize what is real. That being said Nobel Prize winner John Nash and author Jack Kerouac must also be considered mad. As a side note and prediction I doubt Michele Mandel will ever be as accomplished or recognized. We will assume Michele Mandel’s mental health is directly linked to her mediocrity.

According to Michele Mandel’s schoolyard logic there was a murky line with regards to John Nash and he somehow narrowly missed being named evil person of the year or he was at least accidentally awarded with a Nobel Prize. I realize Luka Magnotta is not in the running for any award but if he is found to have been incapable of appreciating the nature and quality of the act or of knowing that it was wrong he is neither evil nor mad, he has a mental disorder. Michele Mandel should be able to appreciate incapable as would most journalists recruited to spew for Sun Media.

I don’t mean to infer that Michele Mandel has a language deficiency as her article has an array of words for mental illness; it’s almost poetic. She gets quite technical and medically irrelevant with words like “crazy”, “insanity”, “ravings” and “diabolical.” For those with an IQ it is journalistic junk recorded in a rag.

If nothing else Michele Mandel is honest as she admits it is impossible to discern between madness and evil. Thankfully the courts do not depend on a journalistic joke and literary lightweight. Canadians don’t need to depend on people who are barely capable with a keyboard. We have forensic psychiatrists who use science to make their way through what to her is a murky line. For them it is not a political penchant but a matter of training, knowledge and experience.

Michele Mandel’s rambling recount of selective facts is thankfully not what the jury will use to determine a verdict and to utter such nonsense is a disservice to impartial journalism, justice and mental health in general. My advice to Michele Mandel is to keep your childish notions out of print so Canadians with integrity can better determine the line between guilt and Not Criminally Responsible On Account of a Mental Disorder. Your agenda and that of your employer should never find its way into print.

The Folly and Fault of the London Free Press

Yesterdays headline in the London Free Press was: “Luka Magnotta lawyer to seek insanity defence”

Only the London Free Press could screw up simple terminology.

The term insanity is still used in the United States but I expect a Canadian newspaper about a Canadian citizen in a Canadian courtroom to be referenced using current and Canadian terminology. To do otherwise is irreverent and irresponsible. The London Free Press wouldn’t have the audacity to refer to races in a historical context. This example is stigma incorporated.

“Insanity” is not considered a medical diagnosis and has not even been considered a legal term for over two decades so I find it difficult to pull anything informative out of this sensational use of words. In short it is a journalistic joke as it lacks factual flavour. The use of pejorative and offensive terms has no place in public periodicals. It is unnecessary and damaging. We only arm attitudes when we revert to old terminology in any way but most especially in a public way.

“On September 16, 1991 Bill C-30, “Proposals to Amend the Criminal Law Concerning Mental Disorder”, was tabled. Bill C-30 brought about numerous changes and created a whole new system for managing mentally disordered accused under part XX.1 of the Canadian Criminal Code. Bill C-30 was responsible for:
Creating new terminology: “a mental disorder” replaced “natural imbecility” or “disease of the mind”, and “not criminally responsible on account of mental disorder” replaced not guilty on account of insanity.”

The London Free Press says: “Lawyers for Luka Rocco Magnotta will ask a jury to declare the defendant not criminally responsible by reason of insanity.” Wrong. Lawyers are using provisions in the criminal code to determine if Luka Magnotta can be found Not Criminally Responsible on account of a mental disorder.

As further evidence of the incompetence of the London Free Press they insist that Luka Magnotta “is the latest high-profile Canadian murder defendant to seek a not-criminally responsible verdict.” Unless the London Free Press has some way around lawyer-client confidentiality this statement is less than hearsay and likely a fabrication. It is also a contradiction with the headline itself. We are told his lawyer is seeking this defence but also that Luka Magnotta is seeking the defence. Which is it? My guess is Luka Magnotta is unfamiliar with this specialized area of the law and is allowing his lawyer to act in his best interests as is usually the case. The Free Press insinuates that Luka Magnotta has conspired with his lawyer to form this defence. His lawyer is acting on his behalf not likely at his direction. Not Criminally Responsible defendants are a very small group of offenders who in no way exploit the legal system but are in fact prone to abuse by it. Luka Magnotta is presumed to be sane and to have been sane at the time of his offences and it is up to the defence to prove otherwise on a balance of probabilities.

Many individuals involved with this aspect of the law are unable to inform their legal counsel of anything, let alone a possible defence. Not Criminally Responsible in my case was not a chosen defence, it was a defence of default for me. I was incapable of any defence. The courts and medicine intervened to protect justice and my mental health. People who are unable to appreciate the nature of their crime, specifically the fact that it was criminally wrong and probably morally wrong are usually unable to appreciate the complexities of the law.

Today we have a comprehension of the power of words and the disrespect and attitudes they entrench. This terminology was once used to describe people with mental illness and mental disabilities and is therefore historically accurate but it is not socially acceptable presently or currently accurate. It is sensational and label driven. The term insane branded all patients including those with learning disabilities. In the past insane was not intended to be derogatory but can only be considered so today.

It should be noted that we take care about the language used to describe race or intellectual disability but we are less careful in describing individuals with mental illness. I can hear the cries about political correctness and language police but if that is your argument you haven’t taken the time to consider the lives of those affected by such language. The argument against political correctness held no water for minorities and it shouldn’t for any disability.

This headline is as offensive as reminding readers of how we used to refer to African-Americans. To further the insult it is not even correct. This insult is truly ignorant. Would the London Free Press call attention to individuals of different ethnicity who have over the past century been called many things? We no longer call these individuals anything we like.

You can call me oversensitive, off the wall or anything you like but don’t even come close to associating the individuals I have shared my life with as insane. They are not. They are ill; they are mental health patients and consumers. Insanity or insane is derogatory and insulting when used by others, it is also dehumanizing and entrenches unhealthy attitudes. I find it telling that such a reference is embraced when it comes to mental health.

We risk reawakening and highlighting misconceptions in individuals who feed on headlines. I believe many find the brunt of their information and knowledge from such sources. We don’t have to worry about those who are knowledgeable, for they do little to feed stigma. The people who perpetuate stigma have as a foundation of knowledge the very things the London Free Press is holding a candle to.

We combat racism by not tolerating any of it, in any form, on any occasion. References to mental health that are stigmatizing are no different. The corpse of old terms will never smell good and in fact spreads its putrid perfume on us all when it is waltzed with.

I have used the word insane to describe myself and it is my prerogative to do so, just as African-Americans refer to themselves with words they would be offended by others using. It is a way to remove the power from such hurtful speech. Insanity is not only draped in the derogatory but it also has a hopeless flavour to it; some incurable nature.

I am in no way inferring that Luka Magnotta is Not Criminally Responsible any more than I would say he is guilty or innocent. I leave those determinations up to the people appointed to ensure justice prevails despite my personal perceptions and opinions. The London Free Press seems to have other motivations. If Luka Magnotta is in fact Not Criminally Responsible he is not insane. He would be suffering from a mental disorder at the time of his offence. Further, there would be as much promise of recovery and rehabilitation as in any other case. It is not a hopeless or permanent state.

I realize it is not the mandate of the London Free Press to combat stigma but is the responsibility of every journalist to refrain from perpetuating stigma. If this article was a historical reference to “African Americans” we would be appalled and someone would be delivering papers instead of writing in them. The fact that our sensitivities do not extend to those affected by mental illness is stigma itself.

Stigma is a major barrier for individuals in need of mental health services. Casual language used to describe mental illness is often negative and I believe the London Free Press owes the one in five Londoners affected by mental illness an explanation if not an apology.

I have no short term expectation that people will stop using stigmatizing terms but if we are to start, a community newspaper is a good place. I would recommend a more honest and frank dialogue regarding mental illness so we can move beyond the stigma.

People will call me over sensitive but this is not some attempt at political correctness. It is a legitimate attempt to ease the debilitating stigma attached to mental illness. Language evolves and I see no better place to start than in a newspaper. Is it sad or sadistic that the London Free Press clings to terminology found in musty manuscripts? The use of the word insanity implies that all individuals found Not Criminally Responsible are dangerous. This myth serves no one and migrates to all individuals with mental health difficulties.

The London Free Press is using this terminology to be sensational rather than accurate. I take exception to being mislead and though it makes for good press it is a disservice and an insult to all who are affected by mental illness.

It is a euphemism treadmill where the language that is acceptable today may eventually be perceived as an insult but it is still necessary to continue on the path as a form of respect for those affected. Just because “African-American” may eventually fall as an insult does not give license to cling to and promote the terminology of the past. I see this progression for what it is…progress.