Canada Day: 2014

My Alma Mater
I’m nuts about my Alma Mater, Dear old Essondale,
I love it like the old grads love, Their Harvard, Duke or Yale
I’m wild about shock treatment, And coma-insulin.
They’ve got the best lobotomies, This side of old Pokin.
So here’s a toast to sewing room, To dorm and concert hall,
The doctors and the nurses, By goom, I love them all.

By A.R., E3, Published in the Leader newsletter, November 1948
Riverview Hospital: A Legacy of Care and Compassion

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     One of the unifying events we celebrate as a nation, is Canada Day.  Each year on July 1st, every citizen in the country takes this single day to celebrate the blessing of living in what is defined by many as one of the greatest countries on earth.  I do agree with this sentiment.  We are blessed in Canada, beyond measure really.  When we compare our inner struggles to struggles within borders of other nations, most who live in Canada do so with a slight hint of what it means to experience heaven on earth.

As I glance through the window in front of the desk this morning, the colours in the trees, so vibrant this time of year, snaps me into a blissful memories of the soul's possible recollection of Eden.  It's a tad dreary this morning.  Somewhat misty.  A deep fog still lingers on the tops of the mountains that surround my family home.  It's raining, but only a drizzle.  Despite the low cloud hanging in the trees, the scene is peaceful, serene. 

As I consider the blessing of Canada today, the fog I see in the mountains reflects to me the fog in politics guiding services for our citizens struggling with mental health issues and addictions.  Many this day will brave a similar wet and cloudy day.  Some will find sun and heat, yet even these Canadians will need likely to find shelter this night in the streets and still others are held in confinement in various prison cells across the country.  This is the state of our nation on this Canada Day, 2014.  With the population of homeless growing in our inner-cities, we are a country politically frozen to improve these broken lives it seems.

The writing I frequently offer about the politics of our nation is judgmental, I'll admit.  I'm highly charged to examine social and political issues for personal reasons.  My Provincial Government and I were recently engaged in battle.  A consequence of my employment in BC as a paramedic, infused my being with Post-traumatic Stress Disorder, a common outcome for First Responders who experience this illness, some estimates suggest, at rates 30% above those in the general population.  

I share this to clarify that the critical nature of my political writing is rooted still in living with the knowledge that many are discarded in employment as I was when we hit a wall that trauma on the job can cause.  I've developed an underdog world-view, due in no small part to the excommunication my condition forced my employer and Province to impose in my own life.  

Much of the healing we find from PTSD comes to us in isolation.  Most of the knowledge I've acquired of mental health issues and resulting political critique of our systems of governance, stems from my own battle with the system to find appropriate care.  My personal journey of healing, as is the case with pretty much every one of us living with mental health issues, is unfortunately through necessity self-directed.

As I worked towards reconciling my own inner angst of trauma, my self-analysis required that I journey deep into my families past.  When we live with a diagnosed mental-illness, in my case PTSD, depression and addiction, we sometimes need to examine our ancestry to determine whether or not the demon we live with might have roots in heredity.  

Shaking the potentially rotten apples from the family tree did uncover a history.  My grandmother died at Riverview Hospital on the west coast.  When I received her medical records and shared my findings with a physician, what I learned she suffered with was a condition we now label as postpartum depression.  Grandma was institutionalized due to the limited understanding we held of the illness in her time.  I was assured that this would likely not contribute radically to my own experiences of depression, which started for me in my youth. I was further assured that my experience of PTSD was work caused, the result of witnessing far too much unnecessary death to others living in my home community.

My grandmother died in the institution of tuberculosis, a common situation that developed in institutions that warehoused Canadians in those days.  Those of us who were a threat to ourselves or others were often whisked away to these frightening places.  Given the difficulties and expense of travel from the Kootenays to the Coast (the early 1940's) it's no wonder that I found (reviewing the records) that Grandma had few visitors in hospital.  However many letters from my Aunt and Grandpa found in her medical file, calmed the pain I felt for her inside myself thinking she was abandoned there to die.  The proof of love, care and concern jumped off the pages of the letters from her family with every word.  

Grandma had only once demonstrated abuse towards my father as an infant and was institutionalized to protect her children.  Although such intervention of society may happen still today, when children are at risk of abuse, postpartum depression is pretty much accepted as no reason to toss anyone behind stone walls. In her time, it only took the intervention of a single physician to make such a decision.  

Today, under our Mental Health Act in British Columbia, any admissions to a designated facility requires the examination and declaration of a doctor which allows for detention of no more than 48 hours.  With a second physician submitting an additional certificate, a patient can be detained for a longer period but we no longer detain mental health patients beyond 30 days without reviewing the necessity for such detention.  

The question I pose this Canada Day is this: are we really today doing our mentally ill population any better service than was provided to them then?  The Canadian Housing and Renewal Association in Ottawa, conservatively estimates that between 150,000 and 300,000 Canadians are currently homeless.  Further estimates suggest that between 60 and 100% of these citizens live with substance abuse and mental illness.  Information from the Canadian Mental Health Association in British Columbia states the following in regards to the numbers of persons with mental health issues in Canadian prisons:

"Research indicates that the majority of those in BC prisons face mental health problems. A 2008 study found over 30% of the corrections population had been  diagnosed with a substance use disorder and an additional 26% were diagnosed with a mental disorder. Of those diagnosed with a substance use disorder, more than 75% were also diagnosed with a non drug-related mental disorder. Corrections Service of Canada (CSC) (PDF) reports "a considerable increase in the number of offenders experiencing mental health problems upon admission to CSC facilities. From 1997-2007, rates have risen by 71% among men and 61% among women.  (http://www.cmha.bc.ca/get-informed/public-issues/justice).

The streets are certainly an inadequate space in which to serve the needs of persons with mental illness.  News stories have highlighted the inability of the correctional system as well to deal appropriately with mental health care.  The most significant case recently reported, the Ashley Smith case, pointed out very clearly, our justice, policing and correctional systems need greater understanding and education when it comes to serving individuals with mental health issues behind bars.

Smith, who was jailed numerous times starting at the age of 13, was moved to 17 different locations across different provinces and remained mostly in solitary confinement.  Ashley's family pointed out that correctional staff continuously moved her to skirt regulations to limit confinement to 60 days without a psychiatric assessment.  

On Oct. 19, 2007, Smith strangled herself to death at the Grand Valley Institution in Kitchener, Ont., as guards watched. The guards were allegedly told not to intervene.  Video surveillance tapes, which shed some light on the treatment of Smith by prison guards, showed graphic images including guards duct-taping Smith to a chair and threatening to put tape across her face.  This was shown after rejection in court of the objections of the Correctional Service of Canada.  Further video showed clearly, Ashley strangled herself, while guards watched her do so through a window, allegedly under the order of their superiors.

Looking at the statistics, and the Ashley Smith case, it would appear as though we haven't moved much beyond the experience of institutionalization for persons with mental illness, regardless of what the closing of Riverview Hospital in July of 2012 might suggest.  Through recent planning for the Riverview Hospital lands however, each of the province’s five regional health authorities now has responsibility for providing mental health services in BC.  Progress in service delivery has created smaller, more home-like psychiatric facilities developed throughout the province to replace Riverview’s outdated buildings.

In British Columbia, new facilities have opened in the Lower-Mainland, on Vancouver Island, in the Interior and in the North. When the process is complete, there will be close to 500 beds in the Lower Mainland and 415 beds in facilities located throughout BC, according to the 2008 Riverview Redevelopment Project. As we now move dramatically towards community-based services for persons with mental health issues in BC, we assume to improve as well our struggles with homelessness, the question remains: what will happen for the overwhelming numbers of persons with mental health and addictions issues currently housed behind prison walls?

The future certainly sounds wonderful on paper.  In contrast to the dorm-style accommodation at Riverview, or the single windowed solitary box Ashley died in, the new facilities provide patients with private rooms and a more home-like environment. Patients can participate in cooking, cleaning and other activities of daily living.  Unlike the asylum model, these facilities have strong links to the communities in which they are located, which makes it easier for patients to live more independently and re-integrate into the community. 
Accommodation and Real Estate Services (ARES), a provincial agency formerly known as the British Columbia Building Corporation (BCBC), owns and operates the Riverview lands. Once the health authorities have completed their planning and determined their facility needs and locations, ARES will be in a position to determine the long-term implications for the lands. 

At least according to this version of the report.  The discussion of what to do with these lands has gone on now for decades.  Every year since 1993 this same report has seen redraft.  In a follow-up report issued in 2012, we were no closer to finding the ultimate solutions implemented.

Ashley Smith's treatment behind bars and subsequent suicide is example enough for why mental illness should be treated by the health care system and not the prison system.  The Federal Government admitted that much needs to change following the revelations of this case.  At the time of the investigation, the Canadian Government released the following through a spokesperson:

"Certainly the very sad case of Ashley Smith shows all of us that individuals with mental health issues need to be in professional facilities, not prisons," said Candice Bergen, parliamentary secretary to Public Safety Minister Vic Toews. 

The Federal Government also said they "instructed" the Correctional Service of Canada to fully co-operate while the Ontario coroner's inquest probing Smith's death, which closed in December of 2012, high-lighting over one hundred recommendations and determining Ashley Smith's death, a homicide.  This Canada Day, 2014, it would seem movement may finally come on the issue of what to do with Riverview, my Grandmother's lingering Alma Mater.

Just this past month, Coquitlam City Planning & Development released a new plan for Riverview Hospital Lands.  The City retained Dr. John Higenbottam to translate their long-held vision for the Riverview Lands as a place for healing and caring into required programs, services and associated facilities. The result is the creation of Into the Future: The Coquitlam Health Campus.  The City web-site, describes the following vision for the future of the old Riverview Hospital.  The vision for The Coquitlam Campus reflects and builds upon the 2005 City of Coquitlam Riverview Task Force Report, For the Future of Riverview:

"Anchored with a psychiatric hospital and an acute care hospital, The Coquitlam Health Campus would also consist of integrated clinical care, long-term residential and rehabilitation programs and services, education and training facilities, a health and wellness business park and public uses."

"The land’s tree collection and natural features along with its heritage and cultural values will be an integral part of The Coquitlam Health Campus, in order to leverage the therapeutic benefits and respect the land’s history and community values."   (http://www.coquitlam.ca/planning-and development/resources/heritage/riverview.aspx).

It remains unclear just how far along the Federal Government and Corrections Services Canada are in implementing all the recommendations laid out for them following the Ashley Smith inquest.  It does appear, however, that her death may well have not been in vain.  As things progress, we all wait with Ashley, her soul likely in some sort of twisted, spiritual limbo, to see just how compassionate our leadership in Canada actually feels towards the mentally ill in our nation's prisons.

Today, as we celebrate Canada Day, lets take just a moment to reflect on the troubling issues our nation continues to live, when it comes to servicing the needs of those in our country struggling with issues of mental health and addictions.  Let us reflect on the need for further change. 

As fellow Canadians, let us choose today that, henceforth, we will refuse internally any temptation to invoke stigma towards those of us who need to fight so hard to maintain contact with others.  Support with prayer alone isn't enough when we know our people are suffering such things as Ashley as we battle the symptoms of illness in the mind and in our hearts. 

We are Canadians, a polite, caring, loving and compassionate people.  This Canada Day, let us remember, if just for a moment, the lives of folks like my Grandmother, Myself and My Growing Group of New Friends, all PTSD survivors.  Above all, let us never forget the life of Ashley Smith: may her death never be thought of in vain.
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References:
Internet Resource: Couquitlam Health Campus: Our Riverview Lands Vision: 2014. http://www.coquitlam.ca/planning-and-development/resources/heritage/riverview.aspx
Internet Resource: Canadian Housing and Renewal Association: 2014. http://www.chra-achru.ca/en/index.php/our-work/homelessness/
Internet Resource: Canadian Alliance on Mental Illness and Mental Health: 2014. http://camimh.ca/mental-illness-awareness-week-english/about-mental-illness/what-is-mental-illness/homelessness-and-mental-illness/
Internet Resource: Canadian Mental Health Association BC Division: 2014. http://www.cmha.bc.ca/get-informed/public-issues/housing
For The Future of Riverview: Riverview Task Force Report for The City of Coquitlam: February, 2005.
http://www.coquitlam.ca/documents/FortheFutureofRiverview2.pdf
RIVERVIEW HOSPITAL: A Legacy of Care & Compassion (Rev. ed.):  Published by British Columbia Mental Health and Addiction Services: Copyright 2010. http://www.ebrochuresite.com/media/36078/riverview.pdf

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Riverview Hospital Videos

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