My friends at the Treatment Advocacy Center (TAC) in the US would classify the death of Teenage Head guitarist Gord Lewis and the not criminally responsible (NCR) verdict for his son Jonathon as a preventable tragedy. Jonathon has untreated schizoaffective disorder but now that he has been declared NCR, he will get the treatment he should have had. For years, TAC has maintained a database of these preventable occurrences.
This death in Hamilton. ON and the many other similar deaths did not need to happen if we had a proper system of mental health care. According to the Lewis family, Jonathon had been involved with repeat hospitalizations, outpatient visits and trips to the ER. He was diagnosed in 2019 at the local psychiatric hospital in Hamilton and prescribed medication but he relapsed and was rehospitalized a number of times. Between July 28 and August 4, Jonathon went to the ER in Hamilton, Toronto and Brampton ten times. He would tell the staff he was being poisoned by his father but would leave without being seem by a doctor.
At an August 1 visit to Sunnybrook Hospital in Toronto, he told the doctors about being poisoned by his father but was discharged with an appointment for August 11. On August 7, police found Gord Lewis dead in his apartment at the hands of his son.
We don’t know just how much follow up he had after his initial diagnosis in 2019 but Jonathon did not appear to reach stabilization. We do know that patients are often discharged well before they attain stability and there are insufficient community resources for them .Clearly, Jonathon should have had more follow up and resources than he received but this is typical.
The best known example of a preventable tragedy was Vince Li who murdered and beheaded his seatmate on a Greyhound Bus in Manitoba in 2008. Li began to develop schizophrenia in 2004 and his condition deteriorated. In 2005, Li was found by police disoriented wandering along Highway 427 in Toronto and was taken to a local hospital. He was not detained, diagnosed or treated even though patients who are potentially dangerous to themselves or others can be held for a certain amount of time involuntarily. Doctors are often reluctant to do so and many in our society including the United Nations are totally opposed to this and demand the practice be ended.
While involuntary committal may be an extreme tool, it can be very effective and does come with numerous safeguards built in to prevent abuse. Li was found NCR and committed to a secure psychiatric facility for treatment. Today, he is living as normal a life as possible back in the community. Unfortunately, he has to live with the knowledge of what he did while his victim’s life was ended and that family must live with the aftermath.
While many branches of medicine are making progress, treatment for serious mental disorders is deteriorating. My blogging partner, psychiatrist David Laing Dawson, recently wrote about the decline in mental illness treatment from the 1980s on here. Previously, he said, teams of psychiatrists, nurses, social workers and psychologists ensured that the severely ill received appointments very quickly. Each member of the team was prepared to help with medication compliance and monitoring, medical care, budgeting, finding bus passes, talking to families, giving shopping lessons, helping with all activities of daily living and also counselling.
Then, the situation changed and hospital stays got shorter and they downsized services for the seriously mentally ill to save money. What had been done in hospitals shifted to the community which lacked the ability to take on difficult, seriously ill patients. That shift also resulted in social workers and mental health professionals no longer working in teams with psychiatrists but as independent professionals. Their independence often came with a shift away from medical models to counselling theories such as cognitive behavioural therapy (CBT) and other concepts which were of no value for those with serious mental illnesses.
This was compounded by the so-called recovery model, which really means that if you try hard enough and think good thoughts (CBT), and are sufficiently “supported”, you can recover fully. If you don’t, its your fault. Added to that is a naivete among lawyers and civil libertarians believing they are protecting individual rights by having patients released from hospitals. That often results in what doctors call being allowed to die in alleys homeless and untreated with their rights intact, increased mentally ill in the prisons, the growth of locked Forensic Psychiatry Units, and a sad return to locked doors for the rest of the hospital now dominated by the Forensic units.
As a society, we need to do better!
The blog post that David wrote, The Decline of Mental Illness Treatment from the 1980’s on, is quoted above. It first appeared in 2017 but continues to be one of the most read posts and, sadly, becomes more and more relevant as time goes on. It is worth reading again.