This has been a horrific few weeks. Two cops (aged 30 and 35) shot to death in Edmonton by a 16 year old when they responded to a call from his mother for help. She was also badly hurt when she tried to wrestle the gun away from her son who then killed himself with it. Then we have a 16 year old kid murdered in an unprovoked knife attack while he sat on a bench at the Keele St Subway station in west Toronto. The 22 year old accused has a long history of offences including being referred for mental health counselling. That was followed by a 20 year police sergeant in small town Quebec killed when she responded to a mental health call.
That wasn’t all but just the most publicized. Then, the Hamilton Spectator ran a story about three recent murders where (in their words) “the killers are so sick, they are not criminally responsible”. One I wrote about as the preventable killing of Teenage Head lead guitarist murdered by his son. Since writing my book on schizophrenia in 2008, I’ve written countless stories of preventable deaths.
A big part of the solution was covered in the Spectator story in their interview with forensic psychiatrist Dr Gary Chaimowitz. He has been involved in hundreds of such cases since the 1990s and said:
“If people were adequately housed, had access to treatment, meaningful employment, were surrounded by people who cared for them, had treatment for substance-use disorder, there would be much less mental-health driven crime and people in the forensic system.” He added “I wish we didn’t need a forensic psychiatric system, because it is to some degree a barometer of failure.”
Science and medicine know to treat more effectively but politicians (society) do not allocate the money and resources to provide the proper treatment for mental illness. If we treated cancer the same way, we would operate to remove malignant tissue, discharge the patient and wish them luck. Instead, we provide them with chemotherapy and/or radiation therapy to fully eradicate cancer cells and try to prevent any further spread or recurrence.
With schizophrenia, we keep people in hospital barely long enough in most cases to stabilize them with medication and then discharge them. There is little or no follow up or rehabilitation and they are forced to live and be cared for by aging, tired parents, the street, shelters, jail and with no meaningful activities.
The community care adults with schizophrenia should get according to Health Quality Ontario includes:
- a care plan that is regularly reviewed and updated, and that is informed by a comprehensive assessment
- timely access to community-based intensive treatment services based on their needs and preferences.
- readily accessible interventions that promote physical activity and healthy eating.
- For those who wish to find work or return to work, they should be offered supported employment programs. Adults with schizophrenia who are not seeking paid work should be supported in other occupational or educational activities, in accordance with their needs and preferences
- a safe, affordable, stable living environment that reflects their needs and preferences.
In his recent book, Maladies of the Mind, Dr Jeffrey Leiberman points out that medication alone is not sufficient. Psychosocial therapies and support services are also needed as well as a stable residence. Recovery, he says, requires a safe living place in the community or in a supervised residential facility. (P 306)
The challenges of housing was recently described by a man with schizoaffective disorder from Edmonton who has been lucky to find a caring community. He said “There is something very healing about living in a community of others with similar mental illnesses and compassionate staff members.” He added that “A careful, human-centred plan to house people, regardless of their type of neurodivergence, would likely cost less than just ignoring the problem. It would cost less in dollars, cost fewer human lives and result in less needless suffering.”
He mentions the community of people with similar problems as being comforting and that reminds me of the absurdity of some supportive housing groups that combine people with different conditions – specifically mental illness versus addictions. A recent study by the Pew Charitable Trust in the US looked at annual arrest rates for the general population, those with mental illness, addictions and mental illnesses and addictions combined.
The typical person on the street has a 1% chance of being arrested in a given year while those with mental illnesses have a 2% chance of arrest. Those with addictions have a 9% chance of arrest while those with co-occurring conditions have a 12% chance. Imagine the result if all three were thrown to live together in the same place.
We know how to minimize much of the random violence we see on the streets and we’ve known for a long time. Schizophrenia can be successfully treated and, as Lieberman says, “we know what to do but we just don’t do it”. That is a huge social injustice that we must work to rectify.
The final word belongs to Andrea Magalhaes, the mother of the murdered 16 year old. Despite her grief, she told CBC radio that “More needs to be done to help people in crisis, more needs to be done so people don’t get to the point where they are in crisis.” She went on to say “We need more social services, we need more investment into physical and mental health. We need more support for housing. I feel like if things keep going the way they are going right now, so many people are going to be suffering the horrible pain that I’m going through right now.”
Please lobby your elected officials for these improvements wherever you are.