Encouraging conversation around mental illness is good. For too long it’s been in the shadows. I’ve had people hang up on me for the temerity of mentioning mental illness. Anything that gets this psychic garbage out in the open, that normalizes its place in discourse and tells sufferers they’re not alone, is to be lauded.
But too often this discourse degenerates into trite mental-health inspo. I was lost but now am found: You can be, too. It elides the messiness inherent in these conditions. Mindfulness, “me-time” and breathing exercises are great but often insufficient when you’re having a psychotic break or plunged in suicidal depths.
The neat and redemptive narratives this discourse popularizes belie the often excruciating and complicated course of mental illness. This can further alienate those who haven’t found that simple wellness trajectory themselves. You can write a book about suicidality and still find yourself sucked into its grip. I recently got a note from someone who said they were glad I “chose life.” Which is very kind. But, buddy, I haven’t made up my mind.
The facile, feel-good mental-health discourse is unforgivable when it papers over the ways our inaction fails people with mental illness. The primary treatment modalities – pharmacotherapy and psychotherapy – remain outside most public-health coverage in Canada. Waits for care stretch to months and when you fall into the crisis this inadequate preventive care almost guarantees, you’re often confronted by cops and, if you’re lucky, stuck on a plastic waiting-room chair before maybe getting a few days in hospital, then released to begin the cycle anew. You’d never send someone home from surgery without a post-op plan but we regularly discharge severely sick people into a treatment abyss. Some hospitals have gotten better: One of Unity Health’s Toronto hospitals almost sent me away with a list of phone numbers 12 years ago but the organization now has “transition planning” for all patients. It’s not good enough to call people “hard to reach” when you’re the one not reaching them.
Asante Haughton was reminded of the imperative for improvement last month, when a friend in the grips of psychosis was stuck waiting untreated for almost a week in the ER, beset by uncertainty and lashing out at the loved ones who’d brought him there. “It was scary,” Mr. Haughton told me. The friend was admitted and is doing better but Mr. Haughton knows it could have gone another way – that, fed up with waiting, someone less enveloped by human support could have walked out, gotten worse, gotten in trouble.
Mr. Haughton has been a mental-health advocate for years. “I’ve always had this idea that it’s really important to have the anti-stigma conversation. But it’s also important that we are ready for the volume of people who are now accessing services,” he said. “When you see it happen that close to you, you want to make sure that, for him and for others, they’re able to arrive at solutions quicker.”
Our inaction is a betrayal: We coax people into disclosure, then fail them when they seek help.
Last fall, the Canadian Mental Health Association launched its Act for Mental Health campaign because they saw a need we weren’t meeting. They’d expected a permanent mental-health transfer, as the federal Liberals promised in the 2021 election campaign. “We all got very excited and then there wasn’t anything there,” CEO Margaret Eaton told me. (Last I checked, intergovernmental talks about that transfer were ongoing.)
Act for Mental Healthcalls for cash, with strings attached; for legislation; for decriminalization; for housing and income supports. It’s made an impression: The Prime Minister’s Office and the Minister of Mental Health’s office have been in touch, Ms. Eaton said. No concrete promises but she’s hopeful.
We’ve gotten better at talking about mental health, Ms. Eaton said. We haven’t gotten better at caring for it. “The action piece is what we feel is missing.”
Last week, Toronto’s mayor called for a national summit to address the “mental-health crisis” playing out on city streets. This call was tied to acts of violence, as though mental-health care exists to keep society safe from sufferers, not to, uh, attenuate suffering. But any summit that delivers stasis and slogans, or ignores that crises on the street are just the most visible result of decades of neglect, is a waste of a catered lunch.
We can do better and we have to. Not just because it’s compassionate but because it’s cost-effective. Hospital stays are expensive. Incarceration, policing, court time are expensive. Helping someone stay in the work force, if that’s what they choose, is cheaper than supporting them once they’re shunted out of it.
But the true cost is human. I talk to people who try to calibrate their crazy to be just acute enough to get a bed in a psych ward but not so nutsas to lose their autonomy. To people who wait months for care, struggling to navigate a labyrinth as they spiral. To people whose loved ones killed themselves or were killed by police in their most vulnerable moment, while their brains turned on them.
It’s 2023. We need more than feel-good bromides. Every time someone prominent utters something about how important mental health is, the follow should be: So what? What are you doing about it? And when?
We need “universal” health coverage that includes the universe of disorders attacking your mind. Enough with programmatic patchworks. We need ongoing, attractive, preventive care as well as compassionate, voluntary-whenever-possible-and-respectful-when-involuntary interventions for the crises we can’t prevent. We need real alternatives to cops as “psychiatrists in blue,” because they are not. We need treatment breakthroughs for people whose intransigent illnesses don’t respond to what’s available now.
Is positive change so anathema we can’t manage these smidgens of progress?
Let’s talk about that.