Today I want to talk about my problem with Let’s Talk Day – a worthwhile Canadian initiative that is designed to build awareness of mental-health issues. You’ve probably seen the TV spots. One of them features a young woman in a business suit phoning her office to change her voice-mail message. She won’t be in. She puts down the phone and begins to weep. The message is that mental-health issues (not problems – issues) affect millions of people just like you. So let’s erase the stigma! And for every message you text or tweet today, Bell will donate five cents to the cause.
Well, good for Bell. But the problem with normalizing mental illness (sorry – mental health disorders) is that it blurs the line between mild to moderate issues and severe disorders, which may last a lifetime. The people who miss work from time to time, while certainly deserving of compassion and support, are in a completely different situation than the people who can’t hold a job because of the voices in their heads telling them to throw themselves in front of a subway train. And the harm we do to those people is one of the great injustices of our age. So let’s talk about them.
In the 1950s, Canada had almost 60,000 long-term psychiatric beds. Today, we have about 6,000. The number of people with severe mental illness – perhaps 2 or 3 per cent of the population – has not declined. So where did they go? They went to the streets and into the jails. We have replaced one institution (mental asylums) with another (prisons). Some people think this is progress.
A lot was wrong with the old asylums. But mass deinstitutionalization has been a tragedy. It has left tens of thousands of helpless people to fend for themselves. They suffer from serious psychotic conditions, including schizophrenia. They are a permanent feature of the urban landscape. Despite the arguments of patients’ rights groups, not all of them can be treated in community mental health clinics. A large number don’t even know they’re sick.
As Richard O’Reilly, a former president of the Ontario Psychiatric Association, points out, every other area of medicine gives priority treatment to the sickest people. The sole exception is for mental illness.
The harm these people do to themselves and others is devastating. According to E. Fuller Torrey, a leading U.S. treatment advocate, the untreated mentally ill commit 10 per cent of all homicides. They constitute 20 per cent of prison populations and 30 per cent of the homeless.
Hospitalizing or treating people against their will is an explosive subject. But families with seriously ill daughters or brothers know it can be the only way to save someone from themselves. And sometimes the only way for people to lead semi-normal lives is to stay on medication for life. They deserve the right to be well. But families and other advocates for compulsory treatment face a powerful array of opposition, including civil-rights groups, anti-psychiatry activists and “consumer/survivors” who feel they’ve been victimized by the system. Some psychiatrists, psychologists, sociologists and other professionals reject the biomedical model of psychiatric illness altogether – and some of these people run mental-health services. They argue that the roots of psychiatric illness lie in social and family factors. They think that recovery, even from psychotic illness, is possible without drug treatment and that the real key to wellness is self-empowerment.
Which is like telling someone with metastatic cancer that she can get better once she takes charge of her life and starts hoping hard enough.
So let’s talk about the disaster we’ve created – and what we need to do to fix it. That conversation is long overdue.