Psychiatric Social Control Invades Toronto Shelters

Graeme Bacque (gbacque@idirect.com)
Thu, 26 Nov 1998 07:17:10 -0500


(Under something like Bill 78, I wonder just how invasive this approach
is going to become? - Graeme)
-----------------------
Treating them where they live

A team takes the hospital to the hostel to care for the mentally ill

Thursday, November 26, 1998
MARGARET PHILP - The Globe and Mail

There is no couch. No framed diploma on the wall. No waiting room. But
there is a psychiatrist at work in this cramped basement office at
Seaton House, an institution-like shelter for homeless men. Chin cupped
in hand, Clive Chamberlain listens thoughtfully to a young man with a
nervous stare who hears his brother's voice in his head and sees visions
of "very nice, dazzling things" everywhere he turns. Even now, behind
the doctor's head, he watches a fountain spurt water into the air.

The man has visited a psychiatrist before, but he has never returned.
Now, his life is a mess -- he has no work, he has severed ties with his
family and he has slept for several months on a hard Seaton House bunk,
along with hundreds of other down-and-out men.

But he wants nothing to do with antipsychotic drugs, fearing that they
would leave him an addict. "I have a kind of medication that doesn't
lead to addiction," Dr. Chamberlain says soothingly. "That's something 
you don't need to worry about."
  
The troubled man is a very early visitor to a new makeshift
mental-health clinic. At a time when shelters are
brimming with mentally ill people no longer welcome in hospitals, which
are cutting beds, a small band of nurses, doctors, outreach workers and
psychiatrists are taking the hospital to the hostel.

Clinics are slated for five Toronto hostels and one detox centre -- an
attempt to reach the growing number of former psychiatric patients now
bypassing the health system. They are a combined effort of the Centre
for Addiction and Mental Health -- Queen Street division, where Dr.
Chamberlain is vice-president of mental-health
programs, and the  Toronto Hospital.

"We're dealing with people who in some cases haven't seen a family
physician in years and years and years," said Cynthia Karlton, who
co-ordinates the program.

Running the clinics will cost $1.1-million a year, including $600,000
from a special $2.8-million provincial fund. (The other sites are the 
Salvation Army Maxwell Meighen Men's Shelter, Rendu House women's
shelter, the Fred Victor Women's Hostel, the Salvation Army  Emergency
Shelter for men and the Women's Own Detox.)

Known as shared mental-health care, the program works like this: A nurse
provides routine care while an outreach worker wanders the  corridors
striking up a conversation with any likely candidate for the clinic. The
doctor drops in two days a week and the psychiatrist visits once a
week.  The staff are paid salaries (fee for service would require
patients to possess health cards), and the goal is to operate on a
shoestring budget with the expensive psychiatric care reserved for the
most challenging  patients.   Hostel workers have complained that they
have unwittingly become part of the mental-health system. (In the era of
deinstitutionalization, there are accounts of hospitals discharging
patients directly to shelters, even picking up their taxi fare.)

In the Seaton House men's residence, which is separate from the 
shelter, Bob Frankford has been the physician in the first-aid unit for
the  past few years and has treated men with schizophrenia and severe 
depression.

With no formal psychiatric training and no psychiatrist to consult, he
has  filled prescriptions despite having no easy way to trace a person's
psychiatric history. "I would very much like to stream those people to a
specialist colleague and ask them for guidance," he said.

Back in the stuffy basement office, the young man is leaving, but he has
agreed to accept a prescription for a mild dose of a psychiatric drug.

"I got involved in this because it's important and I thought there was a
symbolic value in having a fairly senior psychiatrist. . . ," Dr.
Chamberlain says. "It's important for institutions to recognize some
people need tailor-made approaches. They can't take it off the rack."

Margaret Philp is social-policy reporter for The Globe and Mail.



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