Staying on the meds

Peter
Peter Jackson
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"He's off his meds." How many times have you heard, or uttered, those words in a cavalier manner? To describe a friend who's said something offbeat, or as an aside to describe a stranger acting strangely?

The fact is, scores of people in this province are faced with the necessity of taking mind-altering medication in order to keep their lives intact. It's a very real fact of life for them, and the struggle to chemically suppress episodes of mania and delusion is a daily one.

"He's off his meds." How many times have you heard, or uttered, those words in a cavalier manner? To describe a friend who's said something offbeat, or as an aside to describe a stranger acting strangely?

The fact is, scores of people in this province are faced with the necessity of taking mind-altering medication in order to keep their lives intact. It's a very real fact of life for them, and the struggle to chemically suppress episodes of mania and delusion is a daily one.

Mental illness and medication was front and centre in the news last week after a man from Piccadilly on the province's west coast was found not criminally responsible for killing his neighbour, George Benoit. Christopher Sawicki was diagnosed in 2004 with bipolar mood disorder, and had been off his medications for some time prior to the incident two years ago.

Friday's verdict, which will see Sawicki committed to the Waterford Hospital for an indefinite period while undergoing treatment, has raised many questions. Many of them have been heard before.

Similar violent incidents occur sporadically. In a 1979 case similar to Sawicki's, a man on the Southern Shore murdered his neighbour with an axe. A few years later, a St. John's man murdered his parents with a shotgun.

Both men were suffering from severe schizophrenia and were found not criminally responsible. And both cases brought similar questions to the fore about how people in need of anti-psychotic medication are monitored outside of the hospital setting.

In particular, those cases - along with two police shootings of two mentally ill men a decade ago - highlighted a pressing need to revisit the province's Mental Health Act, which hadn't been revised since 1971.

The Luther inquiry, called in the wake of the 2000 shootings, eventually led to the unveiling of a new act in 2006.

The legislative update was a long time coming.

As The Telegram's Barb Sweet reported in 2006, "The Mental Health Act was devised in 1971, before the massive trend toward deinstitutionalization of mental-health patients, which created unprecedented demands and pressures on outpatient and other mental health services."

Then-health minister Tom Osborne said the delay was partially due to difficulty reaching a consensus with advocacy groups.

Controversial clause

Along with improvements in community supports, the new act included a controversial clause that would allow mandatory orders for taking medication in certain circumstances. From preliminary indications, however, it appears this measure has rarely been invoked.

How did Sawicki fall through the cracks? That remains to be seen.

But two factors should be considered.

First, we live in an age of deinstitutionalization. This philosophy took shape for a variety of reasons, not the least of which is the negative image afforded mental institutions by the media and by Hollywood.

"One Flew Over the Cuckoo's Nest" - an irresponsible travesty of a film, in my mind - painted an indelible picture of cruel doctors and nurses mistreating poor, helpless patients in locked wards. Almost single-handedly, the film created a stigma that mental health institutions still struggle with today.

But the release of patients into the community has, for the most part, been a huge success. Every effort should be made to provide those with mental issues a sense of independence and self-esteem.

Which leads to the second factor that should be considered in the wake of Sawicki's case - that is, the nature of mental illness itself.

People with schizophrenia, for example, are usually inward-oriented. They are primarily trapped in their own troubled world of hallucination (voices in their heads) and paranoia.

Bipolar disease - formerly known as manic depression - causes a person to lurch from periods of disoriented agitation to the lowest of lows.

The risk of violence, especially lethal violence, is rare.

These are horrible afflictions to deal with. And while both can be controlled through medication, the cure does not come without its own problems. As psychiatrist Dr. Nazir Ladha told CBC Radio Monday morning, the side-effects can include tremors and nausea.

The drugs are, quite literally, mind-numbing. Patients often gain weight and become lethargic. The temptation to doff the fog of chemical mind-control is hard to resist.

Are cases like Sawicki's preventable?

It's been asked many times before. And the answer is likely not clear-cut.

But any re-evaluation of the mental health-care system should remain devoted to the concept of mainstream acceptance.

When someone clearly needs to be institutionalized for his/her safety or that of the public, then so be it. But if a person can be expected to live a reasonably normal life, with the aid of medication and community supports, that must remain the primary goal.

Peter Jackson is The Telegram's editorial page editor. He can be contacted by e-mail at pjackson@thetelegram.com.

Organizations: The Telegram, Waterford Hospital, CBC Radio

Geographic location: Piccadilly, St. John's, Hollywood

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Recent comments

  • crazy person
    July 02, 2010 - 13:33

    Mr. Jackson,

    i suggest you spend some time in a mental institution if you think these are desirable place to be.

    second, you point out that violence perpetrated by people diagnosed with mental illness is rare, so why the need for ensuring they are on the meds? with draconian legislation?

    What people primarily need is acceptance, housing, anti-discrimination legislation, employment, and meaningful social relationships. The question of meds is just one among many issues that need to be addressed.

    people diagnosed with mental illness have been advocating for improved services, and increased participation in service delivery, and policy making since the 1970s. It is the work of such groups that exposed and eventually put a stop to such practices as stripping women naked and throwing them in seclusion cells (otherwise known as Therapeutic Quiet) at the Waterford Hospital. This practice persisted until the 1990s.

    The Waterford Hospital is a dinosaur with inadequate rooms, lack of social opportunities, and not even a cafeteria that serves hot meals. This would be unacceptable in any other health care facility.

    It is time to stop focussing on violent acts, and to work together toward reforming the metnal health system by investing in supportive housing, social entreprises and peer support networks, all of which have been shown to reduce hospitalization and increase quality of life. And without the side effects.

    Finally, it is well documented that the new anti-psychotics can cause diabetes and cardiovascular problems and early death - these are not benign effects and place additional costs on individuals and health services.

    I wish the author had taken the time to talk to people living with mental illness before once again focussing on tragedy and reinforcing the stereotypes about violence,mental illness and medication.

  • Peter
    July 02, 2010 - 13:15

    ... off his meds.... belongs to the author's generation. the previous saying was ....what's he smoking???.... .

    Thanks to the RNC et. al. there will be a lot of residents ....off their meds.... this weekend(?).

    The article appears well researched, but tell us, was the suicide terrorist grinch intent on ruining Christmas in MoTown in his manic phase or his depressed phase?

    Then the case of the ex-pat Polish suspect recently on trial. I think of the Polish visitor's fatal encounter in BC several years ago. Airport rage? Even sane elected MP's have organized Airport Rage, asking for a bill of rights!!! What was he thinking when confronted by Four armed guards - flashback to Soviet era Poland?

    Those poor Soviet era Doctors, how could they distinquish between justified and unjustified paranoia - without offending The Party??

  • crazy person
    July 01, 2010 - 20:22

    Mr. Jackson,

    i suggest you spend some time in a mental institution if you think these are desirable place to be.

    second, you point out that violence perpetrated by people diagnosed with mental illness is rare, so why the need for ensuring they are on the meds? with draconian legislation?

    What people primarily need is acceptance, housing, anti-discrimination legislation, employment, and meaningful social relationships. The question of meds is just one among many issues that need to be addressed.

    people diagnosed with mental illness have been advocating for improved services, and increased participation in service delivery, and policy making since the 1970s. It is the work of such groups that exposed and eventually put a stop to such practices as stripping women naked and throwing them in seclusion cells (otherwise known as Therapeutic Quiet) at the Waterford Hospital. This practice persisted until the 1990s.

    The Waterford Hospital is a dinosaur with inadequate rooms, lack of social opportunities, and not even a cafeteria that serves hot meals. This would be unacceptable in any other health care facility.

    It is time to stop focussing on violent acts, and to work together toward reforming the metnal health system by investing in supportive housing, social entreprises and peer support networks, all of which have been shown to reduce hospitalization and increase quality of life. And without the side effects.

    Finally, it is well documented that the new anti-psychotics can cause diabetes and cardiovascular problems and early death - these are not benign effects and place additional costs on individuals and health services.

    I wish the author had taken the time to talk to people living with mental illness before once again focussing on tragedy and reinforcing the stereotypes about violence,mental illness and medication.

  • Peter
    July 01, 2010 - 19:54

    ... off his meds.... belongs to the author's generation. the previous saying was ....what's he smoking???.... .

    Thanks to the RNC et. al. there will be a lot of residents ....off their meds.... this weekend(?).

    The article appears well researched, but tell us, was the suicide terrorist grinch intent on ruining Christmas in MoTown in his manic phase or his depressed phase?

    Then the case of the ex-pat Polish suspect recently on trial. I think of the Polish visitor's fatal encounter in BC several years ago. Airport rage? Even sane elected MP's have organized Airport Rage, asking for a bill of rights!!! What was he thinking when confronted by Four armed guards - flashback to Soviet era Poland?

    Those poor Soviet era Doctors, how could they distinquish between justified and unjustified paranoia - without offending The Party??