As someone who has always voted for the NDP, I am concerned about some of this government’s approaches to severe mental illnesses, writes the mother of a daughter living with schizophrenia. Getty Images / PNG
Joy MacPhail, in her recent opinion piece, makes clear how pleased she is with the new provincial plan to improve mental health and addiction services. She believes that this plan, called A Pathway to Hope, can help “improve the well-being of all citizens.”
As the mother of a daughter living with schizophrenia, I disagree. Many unmet needs of adults living with the most severe psychotic disorders are not addressed.
MacPhail focuses on the high rate of hospitalization as evidence of the failure of the current mental health system. It is disappointing that she doesn’t acknowledge the many people with untreated psychotic disorders whose suffering is very visible on the streets of cities and towns throughout the province. Lack of treatment for this population leads to homelessness, victimization, addictions and incarceration.
The article seems to argue that all mental illnesses arise from negative social factors. It is unclear if MacPhail knows that psychotic disorders like schizophrenia and bipolar disorder cannot be prevented. It is also unclear if she knows about anosognosia, the brain-based inability of many people in psychosis to understand that they are ill. This symptom leads people to reject treatment when they most need it.
It is good that increased funding will probably be used to expand B.C.’s too few Early Psychosis Intervention programs. These time-limited programs, unlike much of the rest of the mental health system, are known for educating clients and their families about the illnesses they are living with. I have seen how people who receive adequate psycho-education have a much better chance of understanding, accepting and learning to manage their illnesses.
Most people with schizophrenia can have their psychotic symptoms alleviated by anti-psychotic medications. However, there is widespread and ongoing disability in this population because psychotic disorders often involve significant cognitive losses. B.C.’s many influential anti-psychiatry/anti-medication activists should learn that these losses often appear before the use of any medications.
These cognitive losses include difficulties with concentration, short term and working memory, problem solving, judgement and social skills. These problems can make many of the tasks of daily living, including remembering to take medications and attend medical appointments, very difficult.
All clients and families need, but currently do not have, the chance to learn about these cognitive losses. As well, clients deserve access to the evidence-based cognitive remediation programs that exist in many other countries.
A coalition of representatives from the B.C. Schizophrenia Society, B.C.’s Early Psychosis Intervention programs, the B.C. Psychosis Program and B.C. Psychosocial Rehabilitation put on a sold-out conference in 2017 on Bringing Cognitive Remediation to British Columbia. This group has gone on to submit several proposals for training staff in implementing evidence-based cognitive remediation programs. So far, this government has chosen not to provide necessary funding.
As someone who has always voted for the NDP, I am concerned about some of this government’s approaches to severe mental illnesses. The recent recommendations from the B.C. Ombudsperson, for example, will embed the Community Legal Assistance Society in hospitals to provide advice to all involuntary inpatients. This is an organization fighting to abolish access to involuntary treatments.
Currently, nurses and social workers inform involuntary patients about their rights and about ways to access review panels to ensure that people are not receiving unnecessary treatments. Patients will soon receive advice and legal assistance from an organization that publicly doubts the value of anti-psychotic medications.
Hopefully, the NDP can be persuaded to better meet the needs of people with the most severe mental illnesses. Rather than spending millions of dollars on lawyers, the right kinds of services for this disadvantaged population could be implemented.
A lot of money is about to be spent on various mental wellness programs. Some of these funds should be used to improve mental illness literacy programs. Educating the public about psychotic disorders can increase their ability to help people access and stay engaged in essential services.
Susan Inman was an English and drama teacher at Windermere Secondary School for 24 years. She has a daughter living with schizophrenia.
Nearly a year before two young man died of fentanyl overdoses in houses operated by the Step by Step Recovery Home Society, the B.C. Health Ministry had investigated and substantiated complaints that it was failing to meet the most basic standards.
Within nine days of each other in December 2018, 21-one-year-old Zachary Plett and an unnamed,35-year-old died in different houses operated by the non-profit society that has a total of five houses in Surrey.
A month earlier, inspectors had substantiated complaints at all five houses. According to the ministry’s assisted living registry website, none met the most basic standard of providing residents with safe and nutritious food.
None had staff and volunteers with the skills or qualifications needed to do their jobs. There was no counselling support for residents at any of the houses or any transitional help for those who were leaving.
Late last week, Step by Step closed its house at 132nd Street where Zach died. In a brief conversation Thursday, director Deborah Johnson said it was done “voluntarily.” She promised to call back after speaking to the other directors and staff. But that call didn’t come.
Late Thursday, a spokesperson for the Addictions Ministry said the assisted living registrar was aware that two Step by Step houses had been voluntarily closed, but was still attempting to confirm the closures.
Up until May, Step by Step had taken action on only one of the 65 substantiated complaints. It got rid of the mice at its house at 8058-138A Street in November. But it took 18 days from the time the inspectors were there before the exterminators arrived.
Despite all that, all five houses have maintained their spots on the government’s registry.
What that means is that the social development ministry has continued paying $30.90 a day for each of the 45 residents who are on welfare.
It also means that anyone ordered by the court to go to an addictions recovery house as part of their probation can be sent there.
In late May, Plett’s mother and others filed more complaints about Step by Step that have yet to be posted. But a spokesperson for the mental health and addictions ministry confirmed that they are being investigated.
Plett is incredulous. “My son died there and nothing’s been done,” she said this week.
In an email, the ministry spokesperson confirmed that no enforcement action has been taken and that there is no specific timeline for the investigation to be completed.
“The review of complaints is a complex issue that can often involve a number of agencies conducting their own investigations (which can also require a staged process),” she wrote.
“Each case is different and requires appropriate due diligence. Throughout the process of addressing non-compliance, as operators shift and improve the way they provide service, new assessments are conducted and status is updated online within 30 days.”
A senseless death
Two days after Zach Plett arrived at 9310-132nd Street in Surrey, he was dead. According to the coroner, he died between 9 a.m. and noon on Dec. 15, 2018. But his body wasn’t discovered until 4 p.m.
Plett described what she saw when went to collect Zach’s belongings.
“The house was horrible. The walls were dirty. The ceiling was stained. My son’s bed sheets were mouldy.
“His body was already taken. But the bed was soaking wet with his bodily fluids. There was graffiti on the furniture. The drape was just a hanging blanket. It was filthy.”
To add insult to grief and despair, Plett noticed that his roommate was wearing Zach’s shoes.
Worse than the state of house is the fact that Zach died in the daytime and it was at least four hours before anybody noticed.
Plett wants to know why nobody had checked on Zach? Were there no structured programs where his absence would have been noticed? Didn’t anyone wonder why he missed breakfast and lunch?
“I had no idea what it was like or I would never have sent him,” said Plett.
After battling addiction for seven years, Zach had spent the previous three months in Gimli, Man. and what Plett describes as an excellent facility that cost $40,000.
But Zach wanted to come home, despite Plett’s concerns about omnipresent fentanyl in Metro Vancouver. They agreed that he couldn’t live with her.
A trusted friend gave Plett the name of a recovery house and within a week of returning to British Columbia, Zach went to Into Action’s house in Surrey. It is a government-registered facility that has never had a substantiated complaint against it.
Because he wasn’t on welfare, his mother E-transferred $950 to Into Action to cover his first month’s stay. She was told that the staff would help Zach do the paperwork to get him on the welfare roll.
Later that day, Zach called his mother, asking her to bring him a clean blanket and pillow because the house was dirty.
Because family members aren’t allowed into the house, Plett met him at the end of the driveway to hand over the bedding. It was the last time she saw Zach.
The next day, Dec. 13, he called to say that he had been “kicked out” for “causing problems.” He told Plett that it was because he’d complained about the house and asked to see the consent form that he’d signed.
Later that day, someone from Into Action drove Zach to Step by Step’s house on 132nd Street. Two days later, he was dead.
Because of the confidentiality clause in the informed consent forms signed by all residents, Into Action executive director Chris Burwash would not even confirm that Zach had been a resident.
But he said before signing those forms, residents are given “a clear outline of the expectations of them” and “a clear description of what the rules are.”
They are told that there are no second chances if they break the rules.
“If they outright refuse to participate or outright breach our zero tolerance policies — violence or threats of violence, using illicit substances, intentional damage to facility, etc. — we are put in a position where it is impossible for us to allow them to stay. We have to ask them to leave,” he said.
Staff provide them with a list of other government-registered recovery houses and sit with them while they make their choice without any advice or interference, Burwash said. Once a place is found, Into Action staff will take them there.
Burwash emphasized that only registered recovery houses are on the list, which speaks to the importance of the governments registry. But he said it’s frustrating that operators don’t comply with registry standards since their failures reflects badly on all recovery houses.
“We absolutely support the media shining a light on the facilities that are operating below the standards that they agreed to abide by,” he said. “We are certainly not one of them.”
He invited me to visit any time.
On Dec. 14, Zach and his roommate went to an evening Narcotics Anonymous meeting. Plett found the sign-in sheet from the meeting when she collecting his belongings the following day.
“What he and Billy (his roommate) did between then and early morning, I don’t know,” she said. But another resident told her that she thought they were “using” until around 5 a.m.
The toxicology report from the coroner indicated that the amount of fentanyl found in his system was no more than what is given cancer patients for pain control. But because Zach hadn’t taken opioids for six months, his tolerance for fentanyl was minimal.
“Had he died in the middle of the night, I would never have gone public with his story. But he died in the daytime. If they’d woken him up for breakfast or tried … ” said Plett, leaving the rest unspoken.
“He wasn’t monitored. He wasn’t watched … If I had known I would never have sent him there.”
Last week, Plett had an hour-long meeting with Addictions Minister Judy Darcy and the mother of the other young man who overdosed. He died Christmas Eve at another Step by Step. His body was only discovered on Dec. 26 after other residents kicked in the door of the bathroom where he was locked inside.
“She (Darcy) was very genuine and sympathetic,” Plett said. “I don’t think she realized how bad the situation is.”
Problems left unresolved
Step by Step’s first non-compliance reports date back to an inspection done Jan. 23, 2018 at its house at 11854-97A Street in Surrey.
Inspectors found that meals were neither safely prepared nor nutritious. Staffing didn’t meet the residents’ needs. Staff and volunteers weren’t qualified, capable or knowledgeable.
On Nov. 2, they returned. Nothing had changed and more problems were found.
The house didn’t safely accommodate the needs of residents and staff. Site management wasn’t adequate. There was no support for people transitioning out of the residence.
Critically, there were no psychosocial supports to assist individuals to work toward long-term recovery, maximized self-sufficiency, enhanced quality of life and reintegration into the community. Those supports include things like counselling, education, group therapy and individual sessions with psychologists, social workers, peer-support counsellors or others with specialized training.
On Feb. 4 and March 27, inspectors went back again because of a fresh set of complaints. As of May 8, none of the substantiated complaints had been addressed.
On the same day in November that inspectors were at the 97A Street house, they also went to Step by Step’s other four houses in Surrey — 132nd Street where Zach Plett died, 78A Avenue where the other man died, 13210-89th Avenue and 8058 138A Street. Step by Step doesn’t own any of the houses, but one of it directors, Deborah Johnson, is listed as the owner of 138A Street.
Not every house had the same complaints. But all of the complaints were substantiated and there were commonalities.
None had provided properly prepared nutritious food. None had adequate, knowledgeable or capable staff. Not one house was suitable for its use.
None supported residents’ transition to other accommodation or provided psychosocial support.
Since then, there have been repeated inspectors’ visits but the last posted reports indicate that nothing has change.
The first of five guiding principles for the province’s assisted living registry is protecting the health and safety of residents. Promoting client-centred services is also on the list. But then it gets a bit fuzzy.
Others are to “investigate complaints using an incremental, remedial approach” and to “value the perspectives of stakeholders — i.e. residents and their families/caregivers, community advocates for seniors and people with mental health and substance use problems, residents, operators, health authorities and other agencies.”
But as a result of this incremental, remedial approach and seeking of stakeholders’ perspectives, there were two preventable deaths.
What more do inspectors need before the registration for these five houses is cancelled? How much more time will the province give Step by Step to bring them into compliance?
And, how much longer will the ministry of social development continue writing cheques of close to $42,000 each month to an organization that can’t even comply with the most basic standards?
British Columbia is four years into a public health emergencies that has cost 4,483 lives since a public health emergency was declared in 2016.
More than a year ago, a coroner’s death review urged better regulation, evaluation and monitoring of both public and private treatment facilities following the 2016 overdose death of a 20-year-old in a Powell River recovery house.
It’s unconscionable that the government continues to waste precious resources on substandard recovery houses, while doing so little to force bad operators into compliance. At a time when good quality services are more desperately needed than ever, the registry ought to be the place that vulnerable addicts and their loved ones can find those.
Until this is fixed, Maggie Plett is likely right to believe that Zach would have been better off homeless. At least on the street, someone might have noticed him and done something to help.
Ending Canada’s opioid overdose crisis will likely require much more than sophisticated drug therapies. In fact, it might mean following the lead of First Nations health-care providers and transforming how we think about and deliver medical services.
First Nations people are dying of opioid overdoses at three times the rate of the general population. Hidden in that data are Canada’s most-neglected victims — Indigenous women.
Unlike in the general population where men comprise 80 per cent of the victims, Indigenous women are as likely to overdose or die as their brothers, fathers, husbands and sons.
They are eight times more likely to overdose than other women, and five times more likely to die from an overdose.
It’s not really surprising, says Dr. Evan Adams, the First Nations Health Authority’s chief medical health officer. The terrible numbers track other devastating indicators of how their health and longevity diverge from those of other Canadians.
“A lot of First Nations women who have substance-use disorders are exploited women. They are women who are victimized by the sex trade. They’re victimized by their partners,” said Adams, who worked for five years in Vancouver’s notorious Downtown Eastside, the epicentre of Canada’s opioid crisis.
What the opioid crisis highlights for him is the endemic problem of the western medical model, where people go passively to doctors’ offices and say, “Heal me.”
“Our (First Nations) model is that the doctor gives you a chance to get better. But, you make yourself better,” he said. “It’s your family that does most of the work of helping you get better, not that doctor who you visit for 15 minutes every week, if you’re lucky.”
Unlike in the western model, healing and wellness in the traditional Indigenous way involve mind, body and spirit. For First Nations men and women to achieve wellness, Adams said they require much more than medicine.
“They need healers who can do ceremony. Maybe they need love. They need justice.
“How can a woman recover from opioid use disorder when you won’t let her see her children? It’s disgusting,” he said.
The day Adams and I met, the FNHA offices were being “swept” by a group of elders carrying cedar boughs and candles using traditional ceremonies to restore the spirits of the people who work there.
“Some people would say an elder is less trained in opioids than an addictions physician,” Adams said. “But wouldn’t it be nice to have both?”
It’s not that FNHA rejects modern medicine. It continues to expand access to opioid agonist treatments such as methadone and Suboxone, which quell cravings, making it available at all FNHA nursing stations and at four of the nine FNHA-funded residential treatment centres. FNHA reimburses treatment fees charged by private clinics and has spent $2.4 million in grants to 55 communities for harm-reduction programs.
Yet, for Adams and his staff, drug therapies are only a small part of what he calls harm reduction’s suite of services.
“Harm reduction is not just, ‘Let’s make sure you don’t overdose.’ It’s the whole person that you have to treat, not just this one aspect of the person that is craving opioids.”
To incorporate First Nations wisdom into other programs, FNHA created two peer coordinator jobs at the Crosstown Clinic in the Downtown Eastside. Its compassion inclusion initiative has engaged another 144 Indigenous people with lived experience across B.C., and its Indigenous wellness team has taught indigenous harm-reduction and wellness programs in 180 communities.
“Opioid use disorder is everyone’s business. It’s yours and it’s mine and it’s everyone around us. It’s not just the domain of physicians with 24 years of training,” he said. “Why can’t Grandma help, or a family member?”
What concerns Adams about the response to the opioid crisis that is heavily grounded in the medical model is that it could widen the gap between his people and mainstream Canadians.
Indigenous people don’t necessarily trust health providers who don’t look like them or where there is no acknowledgment of the historical trauma they have suffered and their unique experiences in the world.
That’s just one more reason why the FHNA, which is unique in Canada, is so adamant that it must transform the way health care is delivered to its people so that they are empowered to help in their own healing within their own circles of trusted friends, family and elders.
This current crisis is rooted in the western medical model. The seeds were sown by an aggressive marketing campaign by Purdue Pharma, which falsely promoted its Oxycodone as being non-addictive. What followed was an epidemic of opioid over-prescription by physicians and other health-care professionals that eventually created a demand for synthetic opioids on the black market.
With so many deaths and no end in sight, this might be the time for all of us to reconsider whether the best responses to this crisis ought to be done within a much broader context of healing and an expanded understanding of what wellness really means.
Erik Bjarnason was literally on top of the world, near the peak of Canada’s highest mountain, when disaster struck — and his descent from that life-changing event more than 13 years ago continues today.
He has not been in a freefall since that day, but just like a tough mountain climb, his life has had some exciting ups and challenging downs.
He experienced the low of losing nine fingers to frostbite, and the high of returning to work as a North Vancouver City firefighter.
The low of feeling judged by his disability, and the high of reconnecting with a long-lost daughter.
The low of suffering from depression, and the high of getting an innovative, new hand.
After attending a unique therapy program for first responders, Bjarnason now has renewed hope and, on the eve of his retirement after three decades as a firefighter and volunteer with North Shore Search and Rescue (NSSR), is sharing his story in the hope it could help others with disabilities or those suffering from workplace trauma.
“You are not alone. There is help and you should go get it,” he said in a recent interview. “A year ago, I was a basket case. Now I have a mission: Now I can feel useful again because I’m going to go out and hopefully help other people.”
Bjarnason has already spent the last 30 years helping people, but in a different way — as a firefighter and search-and-rescue volunteer. His efforts, occasionally chronicled in the pages of this newspaper, include: coordinating the 1995 search in the North Vancouver mountains for murder victim Lynn Duggan’s body; recovering four-year-old Eagle Brown, who drowned in a Squamish river in 1996; and organizing a team to help quadriplegic Dan Milina climb Mount Kilimanjaro in 2002.
Then in May 2005, Bjarnason himself had to be rescued, along with two other NSSR members, while climbing Mount Logan to celebrate the organization’s 40th anniversary: They were trapped for more than three days by a sudden, vicious storm that blew away their tent, Bjarnason’s gloves, and nearly all hope of being saved.
The climbers were plucked off Canada’s highest mountain, but Bjarnason’s severe frostbite would force the amputation of all eight fingers and his left thumb.
Told he would likely have to work a desk job at the fire department, Bjarnason fought back, passed difficult tests conducted by the Workers’ Compensation Board, and was reinstated as a full-time firefighter just 10 months after losing his fingers.
“I worked very, very hard to go back. Everything was different, everything was more difficult, everything was harder. But I was still able to do it,” said Bjarnason, who tattooed “courage” in large letters on his right arm to help himself get through this process.
“I had a hard time doing buttons, shoelaces, really small, intricate stuff (without fingers). But everything firefighters do is holding big stuff — hoses, axes.”
Bjarnason continued to make headlines, and his life seemed good: shortly after his amputation at Vancouver General Hospital, he reconnected with a daughter he hadn’t seen in 17 years; one of the first firefighters on the scene, he rescued a worker stranded on a crane high above a North Vancouver construction site in 2006; he climbed Mount Elbrus, Europe’s highest peak, in 2006; and took a teenager who also had amputated fingers to the Everest basecamp in 2008.
“As soon as I went back to work, I went climbing again because I wanted to feel normal. I wanted to feel just like I was before,” he said.
But not everything was normal. He felt stigmatized by people who didn’t think he was up for the job, and he now believes he was struggling under the weight of the traumas he had witnessed over the years.
“I thought I was tough,” he said. “But first responders, we see people at their worst and that has to affect you after a while.”
He first asked for help for depression a decade ago, but there weren’t many programs — or much understanding — available then, he said.
“Before, it was kind of a taboo subject and you went through your life never talking to anyone, never complained.”
Although he was a fire captain who had a management role at the fire hall, Bjarnason started to retreat to his office and isolated himself from co-workers. On his days off work, he drank too much alone. He didn’t take care of himself, making the mountain climbing and mountain rescues he once loved nearly impossible.
“In 2009, I climbed Everest to 20,000 feet, and now I can barely climb a flight of stairs.”
One of the darkest moments of his career came in 2014, when the much-loved leader of North Shore Search and Rescue, Tim Jones, died of a massive heart attack while hiking with Bjarnason and Jones’ daughter Taylor out of the NSSR cabin on Mount Seymour.
“Tim did save my life on Logan and it was my turn to return the favour,” he said, noting Jones had arranged the helicopters for the Mount Logan rescue back in 2005.
“That was one of the worst calls I was ever on.”
Bjarnason knew he was not alone with his depression, because he attended a half-dozen funerals in recent years for firefighters lost to suicide. “All of them were good family people, had lovely spouses and families who cared for them, and good friends at the fire hall.”
However, there are efforts being made to reverse that trend.
“The attitude is changing today. I’ve seen more help in the last year than in the last 30 years,” he said.
Vancouver Fire and Rescue, for example, now has a trauma dog, Lola, to help firefighters with mental illness. And next weekend in Richmond, 350 first responders, including police, firefighters, paramedics and dispatchers, along with their bosses and experts, will discuss mental health challenges at a new conference held by the multi-agency B.C. First Responders’ Mental Health Committee and chaired by WorkSafeBC.
Help for Bjarnason came from the Resiliency Program, which was started in 2017 by two UBC professors in the faculty of medicine and the B.C. Professional Fire Fighters Association. It brings peers together in a UBC-owned lodge in Maple Ridge for four days to discuss mental health. Bjarnason was in the first group of eight firefighters to complete the program, and has been back six times as a peer leader for others attending the retreat.
The Resiliency Program has now run seven retreats since February 2017 for 70 participants, 60 of them firefighters from B.C., and the rest from Manitoba, Saskatchewan, and Washington, D.C., along with three search and rescue members.
Bjarnason, who at age 53 says he now “feels good again for the first time,” is taking what is technically early retirement after 30 years on the job, and hopes to turn his attention to other pursuits that will benefit people.
He has been asked to speak in June at a medical convention in Whistler, alongside the doctor who amputated his fingers, about his recovery process. This summer, for the third year, he hopes to return as a counsellor at a B.C. Professional Fire Fighters’ camp for children with burn injuries. He will also demonstrate to other amputees how his brand new hand works, potentially attending trade shows with the Washington-based company that made it.
Indeed, Bjarnason is one of the first people to wear this mechanical hand, which was created by Naked Prosthetics about a year ago out of stainless steel with silicone rubber fingertip grips. When he moves his knuckles, the hand mimics the extension of a natural finger.
He tried other prosthetics over the years, but found they focused more on looking like a real hand rather than increasing his strength and functionality. His new prosthetic resembles something out of a science fiction movie, but gives him a stronger grip and allows him to do more.
“Before, it was like living my life wearing an oven mitt. Imagine wearing that for a decade,” he said. “This gives me better range, better control, basically helps me to do every day-to-day duty a little simpler.”
Bjarnason feels like he has “a complete full hand again,” and rather than being self-conscious about the unusual appendage, he likes it when people ask him about it.
“When people stared before, it was because I was injured. Now when people stare, it is because they see something interesting.”
Bob Thompson, president of the company that created Bjarnason’s new hand, believes these prosthetics have a psychological benefit because “self-esteem, function, getting back to what you were doing is really important.”
The company set out to build a functional prosthetic that got people back to work, he said, noting 86 per cent of Americans who lose fingers are men, many of them in manual labour jobs.
“For most males, it is heavily wrapped in being able to look after yourself, go back to work, and look after your family. The way (the prosthetic) looks is way down the list,” Thompson said.
Bjarnason hopes the new hand will help with practical, altruistic and adventurous pursuits.
Last year, he went on an ice-climbing trip in Colorado with the D.C. Fire Fund Foundation, which works with injured firefighters. Once considered an expert climber, he was the only person there with experience in the sport — and the only one who didn’t summit because his left hand was too weak to hold the axe.
He plans to return this year with his new secret weapon.
“This year with my new hand, I think I will be looking down at them,” he laughed.
For January’s Alzheimer Awareness Month, Mackenzie said the biggest stereotype she wants to break down is the belief that the majority of British Columbians 85 and older have dementia. They don’t.
“If you look at age 85 and over, 20 per cent do have a diagnosis of dementia — but four out of five don’t,” Mackenzie said Monday.
When it comes to nursing homes, most people might think that every resident has dementia or Alzheimer’s. In fact, about 35 per cent don’t and two-thirds have only mild cognitive impairment, she said.
Mackenzie said dementia is a spectrum. Someone who is diagnosed with dementia may be fully competent in some areas but not in others. In some cases, a person may never go on to develop full dementia.
“It’s a journey,” she said.
In B.C. in 2018 about 70,000 people were living with dementia. By 2033, that’s expected to increase to almost 120,000.
Experts don’t believe the rate of dementia is changing. Instead, the numbers are increasing because there are more older people living longer than ever before.
The aim of this year’s Alzheimer Awareness Month is to eliminate the stigma around the disease by changing attitudes. Events culminate on Jan. 31 with a two-hour open house starting at 3 p.m. at the Alzheimer Society of B.C.’s Resource Centre, 301 — 828 West 8th Avenue, Vancouver.
One family dealing with the affects of dementia is that of Lisa Glanville and her mother Ollie, 82.
Glanville said her mother worked for years as the property manager of Vancouver apartment buildings she owned after her husband died. She also worked as a bartender at the Billy Bishop Legion in Kitsilano.
Glanville said she’s seen stigma directed against her mother when she went to an estate planner and explored options for nursing homes. She was told that it didn’t matter because her mother’s dementia meant she wouldn’t remember anything.
Glanville said the most challenging times for her was before her mother was officially diagnosed. When she found out that her grandfather died of Alzheimer’s, she wondered if her mother had it. Initially, her mother passed tests measuring her cognitive abilities.
But Glanville noticed that things were starting to go awry. One day, she discovered that her mother’s online accounts were locked because someone had unsuccessfully tried to access them.
On another occasion, her mother showed her a cup with five of her molars in it. She’d never told her daughter she had any problem with her teeth.
“I thought: ‘Whoa, what is going on here?’” Glanville said.
The clincher was a visit to the dentist.
“The receptionist said to me after my mom went in. ‘Can I give you some advice?’. I said ‘sure.’ ’Have you got enduring power of attorney yet for her Alzheimer’s?’”
Since Glanville is an only child, her mother’s well being become her responsibility. As part of her efforts to seek help, she started attending monthly Alzheimer caregivers support group meetings at the Alzheimer Society of B.C.
She said the stigma can even discourage people from getting a diagnosis or even telling people they have been diagnosed.
In a survey by the Alzheimer Society in 2018, one in five Canadians said they would feel ashamed or embarrassed if they had dementia; one in five admitted to using derogatory or stigmatizing language about dementia.
“I’ve heard so many family members say they wish their family member had cancer because there is so much more of an understanding and acceptance of cancer than this disease,” Donahue said.
An early diagnosis can mean the person is displaying few, if any, symptoms at first.
“This disease is often so invisible, as with other mental health challenges.”
The B.C. government has announced plans to develop a 24/7 virtual resource for post-secondary students dealing with mental health, stress and addiction challenges. fizkes / Getty Images/iStockphoto
The B.C. government has announced plans to develop a 24/7 virtual resource for post-secondary students dealing with mental health and addiction challenges.
The program will include phone, online chat, text and email support for young adults available around the clock, including confidential virtual counselling sessions.
The province will be posting a procurement notice to B.C. Bid in mid-January to seek proposals from parties interested in working with the B.C. government to develop the support tool.
“Adjusting to a new environment, learning to balance classes with new jobs, new friendships and relationships can be challenging for students who may be living away from home for the first time, far from friends and family,” said Minister Melanie Mark.
“Whether mild or severe, mental-health concerns are very real among post-secondary students who have been calling for action to this important issue on- and off-campus. That’s why our government is working to develop a mental-health service that is available to students around the clock, provincewide.”
A total of $1.5 million has already been approved for the first year of the 24/7 support resource, with further hopes of expanding the program to reach teens.
The 2016 National College Health Association Survey surveyed Canadian post-secondary students about their mental health experiences in the past 12 months. According to the survey’s results:
• 44.4 per cent said that they had at some point felt “so depressed it was difficult to function” • 13 per cent had seriously considered suicide • 2.1 per cent had attempted suicide • 18.4 per cent had been “diagnosed or treated by a professional” for anxiety
“Expanded mental health services are in demand for post-secondary students in B.C.,” said Aran Armutlu, chairperson of the British Columbia Federation of Students.
“Having more options for counselling and other services available, and having 24/7 access to these services, is a welcome addition to the changes this government is making for students.”
The service will be available to B.C.’s approximately 275,000 students at 25 public post-secondary schools and 51,000 students at private training institutions. There are about 1.3 million children, youth and young adults living in B.C.
The project will be a collaboration between the Ministry of Advanced Education, Ministry of Mental Health and Addictions, Ministry of Health and Ministry of Children and Family Development.
A Vancouver duo has won $50,000 to launch a mental health program for those working in the bartending industry who deal with anxiety, depression, addiction or workplace harassment. HANDOUT / PNG
A Vancouver duo has won $50,000 USD to launch a mental health program for those working in the bartending industry.
Vancouver bartender Alex Black and psychology advisor Mackenzie Chilton were named the winners in the inaugural Tahona Society Collective Spirit competition, receiving a $50,000 USD grant to expand their concept Mind the Bar.
The pair pitched a mental health network called Mind the Bar that aims to improve mental health in the service industry by providing counselling and resources.
Black and Chilton will now use the grant to hire counselling staff who will be available to talk to and give advice to those dealing with addiction, workplace harassment, depression, anxiety and other industry-related challenges. The counselling program will initially launch in Vancouver but the pair hope to scale up and expand the platform across Canada in an effort to improve bartender welfare.
“It’s time to take care of ourselves as well as we take care of our guests,” reads a slogan being used on Mind the Bar’s social media platforms.
Chilton called the next step of Mind the Bar “transformational for the bartender community in Canada.”
“I can’t wait to return home to work on this amazing project and to ensure that anybody who needs help, gets help,” she said after winning the competition hosted in Los Altos which is located in the state of Jalisco, Mexico.
Black is currently the head bartender at Wildebeest Vancouver.
“This is just the beginning of the #lastcall for mental health issues in the industry,” Black wrote in an Instagram post.
The competition is hosted by Altos Tequila and challenges bartenders to present new sustainable initiatives, events or projects that benefit bar staff, customers, the community or environment. A total of 15 finalists competed this year.
“We are incredibly excited by Black and Chilton’s Mind The Bar project as it resonates with Altos’ care for people and we look forward to seeing it being brought to life in Canada,” said Dré Masso, Altos co-founder.
Participants were treated to two days of immersive tequila training last month prior to the competition where 15 finalists were selected to present to a panel of judges.
There is a push on in B.C. to provide more mental health services to first responders, the people we depend on to help us in times of trouble, but who often shun asking for help themselves.
Adding to the traditional grimness that B.C. paramedics, police officers and firefighters endure — fatal accidents, devastating fires, murder scenes — is the opioid overdose crisis that has killed more than 3,500 people have died since January 2016. Thousands more have been saved by injections of the overdose-reversing medication naloxone.
“We will go to a call involving a fentanyl overdose, we will give the person naloxone. When they regain consciousness, they will have no idea what happened. They are often combative and often will refuse hospitalization. Sometimes they are in hospital gowns with the hospital tag still on because they just got released,” says Matt Johnston, a firefighter in Metro Vancouver.
“You go back to these repeated customers, and pretty soon it will wear on your spirit and you (think): My ability to be compassionate against this patient is next to nowhere.
“So when you are going to three or four calls of overdoses per shift, all of a sudden the world doesn’t look as shiny any more. And it has a way to generalize to other areas of your life where you are more cynical about human nature.”
Johnston is acutely aware of the effects of trauma on first responders. Before becoming a full-time firefighter in 2012, he graduated from UBC with a masters in counselling psychology and opened a local practice that helped at-risk youth. Even though he worked as a registered clinical counsellor, he still occasionally struggles when responding to calls in his new profession.
Combining his two worlds, Johnston now sits on the B.C. First Responders’ Mental Health committee, which has brought together management and workers from a variety of agencies to develop a provincewide best practices guide and online resources for problems such as suicidal thoughts and depression.
Research has shown that first responders are at an increased risk of mental health problems. A 2017 national study by University of Regina psychology professor Nicholas Carleton that surveyed nearly 6,000 dispatchers, correctional workers, police, paramedics and firefighters found 44.5 per cent showed signs of least one mental health disorder, much higher than the average of 10 per cent in the general population.
In April, the provincial government announced it was removing barriers to helping first responders get mental health help. PTSD and other mental health conditions are now presumed to have been caused by the nature of their work, so first responders no longer have to prove such illnesses happened on the job.
“First responders, sheriffs and both provincial and federal correctional officers who experience trauma on the job and are diagnosed with a mental disorder should not have the added stress of having to prove that their disorder is work-related in order to receive support and compensation,” Labour Minister Harry Bains said at the time.
This is a significant policy change, said Sean Gjos, owner of Boreal Wellness Centres in Yaletown, which is developing a new trauma counselling program for first responders.
“For many of these individuals, their normal day-to-day work life is dealing with situations that, for most of us in the general public, is one of the worst days of our lives. … And over a period of years, all of those experiences can accumulate and be a really heavy burden for first responders,” said Gjos.
“So making it easier for them to access appropriate care is a huge win, and long overdue.”
The mounting number of suicides by first responders in B.C. showed that change was desperately needed. A website kept by a retired paramedic, Lisa Jennings, counts nearly 60 suicides by police and corrections officers, paramedics and firefighters over the past three years.
And yet, for a province with about 17,000 police officers, firefighters and paramedics, the number of claims made to WorkSafeBC for mental health problems is low. There were 269 claims in 2017: 84 allowed, 41 refused, and the rest abandoned.
The Labour Ministry said it is too early to know whether April’s rule change will substantially boost these numbers.
Why are there so few claims if research suggests almost half of first responders have some type of mental health injury? Stigma. This stops many in paramilitary, “tough guy” careers from asking for help, experts say.
“We did a survey to find out what first responders’ current attitudes were about mental health, about seeking help, and about stigma. And the response we got back from that was: Yes, stigma does exist in these organizations,” said Trudi Rondou, WorkSafeBC’s senior manager of industry and labour services, who chairs the First Responders’ Mental Health committee.
Last year, the committee launched the “Share it. Don’t Wear It” campaign, featuring the stark faces of first-responders covered with chilling words, such as: “There’s this heavy feeling. It’s more than a bad call or a bad day. It’s like all the time.”
In a survey this year, 62 per cent of respondents said they were more likely to speak up for help as a result of the campaign, said Rondou.
That’s a promising sign for first responders, whose most common mental health diagnosis is depression or anxiety, with PTSD making up just seven percent.
But to whom do they turn for help, once they are ready to ask?
Johnston, who has done mental health outreach work with firefighters, has designed a two-day course for mental health professionals interested in working with first responders. Over the past year, 250 clinicians in seven B.C. cities have taken the course.
Given how hesitant first responders are to seek help, the course gives clinical counsellors tips on the appropriate language and approach to use so that these workers will continue to return. Through his website First Responder Health, Johnston has also created a telemedicine option that links first responders in rural communities with trained clinicians.
“First responder jobs can be brutally difficult,” said clinical psychologist Mary Ross, who has taken Johnston’s course and whose expertise includes PTSD. “And more than I think the public appreciates, there are very kind, well-meaning, sensitive people joining these organizations and some of what they deal with impacts them hugely and, unfortunately, makes some really, really sick.”
Responding to the increased number of calls where people have died or are in need of repeated intervention because of the opioid crisis makes it even more difficult for first responders to find a balance between staying emotionally unattached at work and being emotionally open in their personal lives.
“You create the barriers you need to stay sane (at work),” said Ross, who works at Boreal. “Then how do you go home and be a dad and a husband when you’ve been building walls all day?”
Gjos, who worked in financial management and had several health care organizations as clients before opening Boreal, said first responders, veterans and nurses make up 40 per cent of the clinic’s patients. He expects that the 10-week, outpatient trauma program that Boreal is developing will be popular with first responders, and could also help emergency-room doctors and nurses, dispatchers, correctional officers and Crown attorneys.
Gjos is in discussions with WorkSafeBC about his clinic becoming a recommended provider, which would mean those seeking counselling there for approved claims for workplace injuries would have their sessions covered financially.
“We are trying to help people who have had traumatic experiences to develop tools and become more resilient so they become more functional across all layers of their life,” Gjos said, adding that vocational rehabilitation experts work with patients who have taken a leave of absence.
“We are collaborating on their return-to-work path. It is a really important aspect, especially in safety sensitive jobs.”
Ross, who has been a clinical counsellor for 20 years, believes first responders are more willing to ask for help than they were in the past.
“Now it’s a little easier to do it more openly and have the support of your workplace behind you in a way that wasn’t quite there before,” she said, but added that more work needs to be done.
Johnston believes changing the language from “disorders” to mental health “injuries” will encourage more first responders to come forward for help, just as they naturally would with an injured arm or leg.
He also senses a change from the dire situation a few years ago, when his department lost two members to suicide in just seven weeks, to more encouraging times now.
For those in the early stages of feeling down, Johnston has a few recommendations: Get more sleep, which is often a challenge for those who work shifts; stay connected to friends and family, which can also be difficult when you work nights and weeknights; and have a physical outlet or hobby that can clear your head. For Johnston, a former Team Canada distance runner, it is going for long jogs.
For those more mired in workplace gloom, he hopes his take-away message for first responders is that “taking a knee” in counselling will make them more confident in other elements of their lives.
“If firefighters can understand that idea that it will help you become stronger in your job and your personal life, not weaker.”
Angela Ayre proudly served in the Canadian military for 14 years until an injury forced her to resign prematurely. Her transition to civilian life was relatively smooth compared to many of her colleagues. Yet the mention of Remembrance Day brings a visceral response of grief and regret.
“It’s definitely a difficult time. It’s hard that I’m still here and other people have lost their lives. And some people have lost their family. It is absolutely a hard time,” says Ayre, 35, pausing to stifle tears.
“(Remembrance Day) is a time to grieve and mourn, but also a time to celebrate.”
That conflict brews inside many active and retired military personnel at this time of year, experts say. While wearing poppies and attending parades on Nov. 11 are ways for Canadians to show respect and gratitude, these events can trigger dark feelings in veterans.
In April, the federal government committed $147 million over six years to expand the Veteran Family Program to help medically released veterans, and their families, with the often difficult transition from active service to post-military life. These veterans, who retired due to physical or mental health challenges, can now get help from the 32 Military Family Resource Centres across Canada, which offer a range of services, including a new mental health first aid course.
Ayre helps coordinate these courses in B.C., provide the veterans, their relatives and their close friends with skills to respond to drug overdoses, suicidal behaviour, panic attacks, psychosis and acute stress.
While she grappled with “losing her identity” when medically released from the military, the former medic at least knew where to go for help. But the transition hasn’t been as easy for most of her friends.
“We get stuck in an area where we don’t know what else to do. Career-wise, job-wise, we just feel lost. For a lot of people, the suicide rate has gone up. That’s a big concern. So mental health is absolutely crucial in the transition,” Ayre said.
There are more than 22,000 former members of the army, navy and air force receiving federal disability payments for a mental health diagnosis, a number that has jumped by 60 per cent in just four years. Three-quarters of those veterans have been diagnosed with post-traumatic stress disorder, according to Veterans Affairs Canada.
It may not necessarily be the case that more veterans are suffering mental health problems, but rather that increased public dialogue and improved social acceptance have encouraged more people to come forward to ask for help, said Oliver Thorne, executive director of Veterans Transition Network.
The non-governmental, charitable organization, which for 20 years has helped veterans adjust to the civilian world, runs two dozen group sessions each year across Canada, including four in B.C. Interest in the courses, which last 10 days spread over several weekends, peak in the fall, Thorne said.
“We definitely see a spike around Remembrance Day of the number who reach out and ask for help,” he said. “Remembrance Day for those of us who are civilians, it is a celebration, a hope that we honour those who served us. For veterans, the remembering is much more personal.
“What we hear from the people who take our programs is that Remembrance Day is a very personal reminder of the things they’ve encountered and the people they’ve lost.”
The Network, formed in 1997 by a University of B.C. counselling professor, Marv Westwood, has offered the 10-day courses for a decade to address issues such as anger, trouble sleeping, feeling down, avoiding public places, dissatisfaction with civilian workplaces, and “seeking out the adrenalin rush of dangerous situations.”
Academics have tracked participants after course completion and report improvements to their health, including an 80 per cent drop in suicidal thoughts, depression symptoms cut in half, and one in three saying self-esteem had increased.
It is not clear exactly how many former and current military members have mental health problems. The number could be much higher than the more than 22,000 receiving mental health disability payments. A recent report by Canada’s veterans ombudsman, Guy Parent, harshly criticized Ottawa for the length of time it takes to grant disability benefits to former soldiers who have applied.
It is hoped that people who need help will come forward now that more services are being offered by community agencies and that mental health is being spoken about more frequently in public, said Tracy Cromwell, executive director of the Military Family Resource Centre in Vancouver.
“Not everyone who is releasing out of the military is broken,” she said. “Most people probably go through transition quite successfully. But there are people (who need help) and we are having trouble finding them.”
She hopes the new mental health first aid course will help, noting it is provided free by her non-profit centre and other locations in Canada. So far in B.C., courses have been held in Vancouver in June and Langley in September, with more scheduled for Chilliwack in November and Prince George, Kelowna and Vancouver in the near future.
The course, developed by the Mental Health Commission of Canada with assistance from veterans, aims to teach how to have conversations about mental illness, how to recognize the most common challenges, and how to decrease stigma and discrimination. It also encourages participants to be willing to help others with problems such as drug use, mood swings, psychoses, and trauma.
“The same way that you or I might attend a first aid course to learn how to take care of a sprained ankle or to stop the bleeding when someone has been cut … we have never really had the opportunity to look at mental health in the same way,” Cromwell said.
Statistics show that nearly 60 per cent of veterans collecting disability benefits for a mental health condition are married or have a common-law partner.
That is one of the reasons Veterans Affairs Canada decided this year to allow medically released veterans and their relatives and close friends to access services at the country’s 32 Military Family Resource Centres, which had previously been open only to active service members and their families. Cromwell’s Vancouver location serves all of mainland B.C., while there are two other centres on Vancouver Island, in Comox and Esquimalt.
“Anything that affects the veteran or the serving member is going to affect their family,” Cromwell said. “It could be their parents, it could be their spouse, it could be children, or it could be a really close friend.”
The courses are also open to people who work or volunteer with former military members, especially with those who are medically released and who often have more trouble adjusting than those who leave military duty of their own volition.
“When a person is released, it is very difficult, and a lot of us do have mental health problems or issues we are trying to deal with and the family is the one that gets first-hand experience of what that’s like,” said Ayre, who works part-time in the Vancouver resource centre.
Ayre entered the military from high school and served from 2001 to 2015, first as a medic and then a clerk. But she was medically discharged after an accident badly injured her back and neck, and she found it hard to adjust to life as a civilian.
After taking the first aid course in June, though, Ayre said it helped her to better relate to her own struggles, those of her former colleagues, and also the veterans who she sees in her office at the Military Family Resource Centre in Vancouver.
“A lot of people with mental health issues, they don’t know how to ask for help because they are stuck in whatever they are going through,” she said. “A lot of my friends and veterans are going through the mental health issues themselves, so it just helped me be a better coordinator at my job and helps me better understand my personal life as well.”
Most of the veterans collecting mental health disability payments from the federal government are male and most commonly 40 to 59 years old.
Nancy Szastkiw, the family liaison officer for the Military Family Resource Centre in Vancouver, says the relatives and friends of struggling soldiers often tell her they notice moodiness, distraction and insomnia in their loved ones — especially in late fall and early winter.
“From the end of October to the end of January are trigger times,” said Szastkiw, a clinical counsellor. The triggers include Remembrance Day, Christmas, and the fact that there were a high number of casualties in those months in Afghanistan during several tours of duty.
“Remembrance Day brings it out because the idea is remembering the fallen, and (these veterans) are not remembering history — they are remembering in their own life,” she said.
The advice Szastkiw offers to these families is to talk to loved ones openly about how they are feeling when approaching a difficult time period, and to “try to be more patient and compassionate at these times.”
And to remember that the poppy is a sign of gratitude and respect, but also one that can bring back difficult memories.
For more information about the mental health first aid courses, email [email protected].
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