Blog dedicated primarily to randomly selected news items; comments reflecting personal perceptions

Wednesday, February 19, 2014

Homelessness, Addiction, Mental Health

"It's criminalizing mental illness. How will we be viewed, 20, 30, 50 years from now? We'll be looked on as the ones who locked up all the mentally ill people."
"It really is one of those things so rich with irony: The same society that abhorred the idea that we lock people up in mental hospitals, now we lock people up in jails."
"Fiscally, this is the stupidest thing I've seen government do."
"We've systematically shut down all the mental health facilities, so the mentally ill have nowhere else to go. We've become the de facto mental health hospital."
Thomas Dart, Cook County sheriff, Chicago
Canada’s correctional authority continues to face increasing costs and challenges in managing a higher proportion of the offender population with mental health concerns. The most recent data available indicates that the Correctional Service delivered at least one institutional mental health service to 48.3% of the total inmate population, with 47% of Aboriginal offenders and 75% of women offenders receiving services in FY 2011-12. Just over 90% (or 4,065) of newly admitted offenders were comprehensively screened for potential mental health problems last year; nearly two-thirds were flagged for follow-up mental health interventions. The Service also delivered Fundamentals of Mental Health training to 2,438 staff in fiscal year 2011-12.20
It was no doubt costly to maintain mental hospitals where people whose mental instability represented a danger to themselves and others around them, were locked into these facilities for their own good and that of society. Except that it wasn't a happy solution to the people who were incarcerated in these facilities, regardless of the medical treatment they received, never quite adequate to really help them, just to sustain the status quo.

And so, under the subterfuge of releasing these people who actually did require ongoing medical intervention, although a more useful type of intervention more suited to their individual needs, not necessarily institutional, but institutional if no other solutions could be found, society agreed that it would be more humane to release them, to allow them to care for themselves. Whether they would then take their medications, whether they might be able to function adequately, another story.

In the end, the growing incidence of homelessness, people living on the streets, the societally marginalized, the lost and confused, petty criminals, those incapable of keeping body and soul together grew, and one of the constituents of that growing base of the homeless was in fact individuals with mental illness whom no one was prepared to care for any longer. The institutions that once housed them, after all, were closed 'for their own good', allowing them liberty and freedom.

For many it meant the freedom to cope as best they could, and often enough their best wasn't good enough. But they were free to live on the streets and to persevere. Psychiatric disorders are now recognized as commonplace enough in general society; those who have family support and access to good medical care are able to function. Those without all of those supports turn to other means of survival and at times those means come up hard against the yardsticks of the permissible.

Infractions of the social order means that an arrest and prison are inevitable. Who speaks for the homeless, after all? Over half of the prisoners in the United States are adjudged to possess a mental health problem, according to a 2006 Justice Department study. The figures are even larger when it comes to female inmates; almost three-quarters live with a mental disorder. There is no reason not to believe that the numbers are similarly reflected in Canada.

Sheriff Dart speaks of working days when 60% of the jail's intake report some mental illness diagnoses. It's his opinion that the system is senseless and quite dreadful, on top of which it's an extremely expensive way to treat mental illness. The choice is not his, however. He takes in schizophrenic, bipolar, depressive and psychotic individuals delivered by local police forces to become prison inmates.

Not that facilities do not still exist for the mentally ill; they do. In 1955 there was a single bed in a psychiatric ward for every 300 Americans; there is now one for every 3,000 Americans, according to a 2010 study. More effective pharmacological treatments are available, freeing up the necessity to welcome patients into care, as long as they are adequately monitored and enabled to function. They also must be able to afford medication.

"Some people come here to get medication. They commit a crime to get in", observed a superintendent of a women's unit at the jail.  "When I'm not on my medication on a regular basis, I don't make decisions well", explained one female inmate diagnosed with depression and anxiety disorders. Outside of jail her prescribed medication costs $100 monthly which she cannot afford.

Researchers at the University of British Columbia surveyed hundreds of homeless people in three B.C. communities where substance abuse is particularly acute. They found that homeless people who regularly attend church or other religious ceremonies are less likely to consume alcohol, cocaine and opioids.

"Religion may have a protective effect on substance-use behaviours. Indeed, several of our participants indicated ... that their faith 'keeps them clean'," the paper by Dr. Iris Torchalla and Prof. Michael Krausz of the UBC School of Population and Public Health declared. The study appears to link an association between less substance use and religious attendance without proving a cause-effect relationship, in the opinion of Dr. Lisa Lefebvre, head of addiction medicine at the Centre for Addiction and Mental Health in Toronto.

A homeless man rests in a pew at a Times Square church on December 12, 2013 in New York City.  A Canadian study has found homeless people who attend religious service once a week are less likely to indulge addictions to alcohol or drugs.
Spencer Platt / Getty Images     A homeless man rests in a pew at a Times Square church on December 12, 2013 in New York City. A Canadian study has found homeless people who attend religious service once a week are less likely to indulge addictions to alcohol or drugs.
Of 380 homeless adults surveyed in Vancouver, Victoria and Prince George who claim some religious faith, 60 reported they attend services at least once weekly, according to the report published in the Community Mental Health Journal. "When people are homeless or suffering from a mental illness, there is often a stigma, or a feeling of not belonging", said Shawn Lucas, head of the spiritual care department at Toronto's Centre for Addiction and Mental Health. 

Spencer Platt / Getty Images
Spencer Platt / Getty Images    Participants in a Canadian survey of the link between addiction and religion told researchers their faith 'keeps them clean.' 
"Usually when people attend a religious organization, there is a sense of belonging." It is not only a sense of community that all human beings require to satisfy their emotional needs. It becomes incumbent on their community to pay attention and commit to services and humanitarian aid to help the homeless find a home for themselves, irrespective of their mental condition; at the very least to help them find safe haven.

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