House call comeback

>> Province’s failure to reintegrate mentally ill into society increases need for home care

by CRAIG SEGAL

VENOR

James Farquhar was a teenager when one of his family members became seriously mentally ill in the mid-’60s. Suddenly, the relative was spending more time in bed, becoming severely depressed and even attempted suicide.

“Doctors didn’t take the time to help my family understand the problem,” says Farquhar, in his office at the Douglas Hospital in Verdun. “Too much of nothing was happening. This person was in and out of hospitals for 20 years.” It was not until Farquhar became a psychiatrist himself that he learned his family member had an unusual version of an illness. Farquhar did some research, and found a treatment that allows his relative to live a normal life.

Now Farquhar is on a one-man mission to revolutionize the way the province treats the mentally ill. The soft-spoken doctor is the founder of the Coalition of Physicians for Social Justice, whose goal is to make sure the provincial government follows up on its 1997 promise to reintegrate thousands of deinstitutionalized psychiatric patients.
The provincial government has been slashing the number of hospital beds for the mentally ill since the 1960s. The Douglas Hospital, for example, cut its 2,200 beds down to 250 over the past 40 years. Since 1997, the number of beds in Quebec has dropped from 6,000 to 4,086. The effort was based on the belief that the mentally ill are better off living with the rest of society. But to live in society, the mentally ill have many needs, Farquhar says. Typically, they need to live in a home with some degree of medical care, home visit teams and staff to help organize budgets, chores and day-to-day living.

The money saved on hospital beds was supposed to get redirected into community resources, but there were problems. Many mentally ill patients ended up in hospital-like institutions that did not help them integrate into society. Others ended up on the streets. That’s because mental health spending fell by as much as 12 per cent since 1994, says Farquhar, who claims as many as 40 per cent of Montreal’s estimated 12,000 to 20,000 homeless have serious mental health problems.

Complex problems, rigid answers

In 1997, Quebec’s auditor general spanked the reintegration effort, calling it a complete failure. Two months later, Health Minister Jean Rochon promised to pump in the money the province had saved on hospital beds. Rochon proposed to fix things by adapting mental health services to each person’s needs. “Individuals with mental health disorders need a varied range of services, including treatment, rehabilitation, crisis support and intervention, and the help necessary to get back into the work force, etc,” said the paper, Orientations for the Transformation of Mental Health Services.

But patients and caregivers are still waiting for Rochon’s promises to become reality. “There was no investment after deinstitutionalization,” says Ghislain Goulet of Action Autonomie, a local rights group for the mentally ill. “The problem is not of deinstitutionalization; it’s more a problem of resources that should exist in the community. Many programs are imposed on people and not adapted to them. There is no flexibility. They need to be heard. They need to be listened to as humans, not as sick people.”

A downtown social worker who runs a shelter for the mentally ill homeless says the provincial government doesn’t know what’s happening on the street. “Very often, when you leave the funding in the hands of the institution, they design their plan, and it’s rigid and inflexible,” says Isabelle Leduc, coordinator of the St. James Drop-In Centre. “The person has to fit from A to Z or else they’re just not wanted. We need to come up with as many solutions as possible for all the different needs out there.”

Farquhar, who heads a home visit team at the Douglas, says community care is affordable. He says the Douglas saves $200,000 a year by doing home visits. But increasing home care looks less and less realistic in the face of budget cuts to health care and the superhospitals, he says. “The hidden agenda is that the government is deciding home care should be private. It’s the darling project of the rich.

“It’s very bizarre we would even think about building a superhospital when we’re $70-million short for mental health per year,” says Farquhar, a onetime Montreal Star reporter. “If we have that kind of money, how come we’re not giving the mental health budget what it needs? I’m trying to help people think about that. Is a nice building more important than essential services?” :

Check out www.quebecmentalhealth.org for more information