Windsor Star
October 10, 2002 Thursday Final Edition
SCHIZOPHRENIA: Survival after
diagnosis of schizophrenia
Studies conducted for a 10-year
period
(applies to U.S. and Canada)
25 per cent completely recover
25 per cent are much improved
25 per cent are much improved but
require extensive support
15 per cent become hospitalized indefinitely
10 per cent commit suicide
Studies conducted for a 30-year
period
(applies to U.S. and Canada)
25 per cent recover completely
35 per cent are much improved
15 per cent are improved but require
extensive support
10 per cent are hospitalized indefinitely
15 per cent commit suicide
-- Source: National Institute of
Mental Health
Vancouver Sun
October 9, 2002 Wednesday Final Edition
Mental institutions eroded, new
supports needed: Deinstitutionalization
has become a catastrophe for families
According to the American Psychiatric
Association's Diagnostic and Statistical
Manual of Mental Disorders, a delusion
is "a false personal belief based
on an incorrect inference about external
reality."
Ruth Millar of Victoria knew all
about delusions. Then, one night in
1998, her son drove a sword through
her heart. Aaron Millar, who suffered
from schizophrenia, had been living
with his mother because she was unable
to find satisfactory care for him.
On the night of the homicide, Aaron
was experiencing delusions and hearing
voices warning him that his mother
was about to harm the family.
Unfortunately, the Millars' sad tale
is far from uncommon.
A six-month investigation conducted
by the Windsor Star found that Canada's
mental health system is on life support:
The report noted deficiencies in institutional
and emergency psychiatric care, in
the availability of anti-psychotic
medications and in provincial legislation
aimed at coercing patients to take
their medications.
The report also lamented the insufficient
training provided to police officers
who confront psychiatric patients,
and it highlighted the deleterious
effect of the violent mentally ill
on the criminal justice system.
Many of the problems detailed in
the Star's investigation can be traced
to deinstitutionalization, the policy
that favours treating patients in
the community rather than in psychiatric
hospitals.
Conceived in the 1950s, deinstitutionalization
was a response to evidence that confinement
in hospitals frequently exacerbates
the condition of psychiatric patients
because it separates the patients
from their loved ones and from community
support.
Provincial governments have embraced
deinstitutionalization with a passion
-- partly because the closing of hospitals
can provide an economic windfall.
According to the Canadian Mental
Health Association, demand for acute
care psychiatric hospital beds in
British Columbia has been steadily
increasing. Yet the number of beds
was unchanged from 1986 to 1996, and
then dropped in the next four years
from 717 to 680.
However, while governments are pursuing
deinstitutionalization, the policy
has come under increasing scrutiny.
Critics argue that the policy is harmful
to patients, their families and society
at large.
As far as patients are concerned,
deinstitutionalization has has proven
to be just as bad, if not worse, than
the ill it was meant to cure: civil
commitment.
The policy arose as a reaction against
the often brutal confinement of patients
against their will. Yet deinstitutionalization
has been implemented in identical
fashion: While patients were once
forced into psychiatric hospitals,
they are now forced out, regardless
of how ill or desocialized they have
become.
And in all of this, the patients
themselves are not asked what they
want, thereby proving that there's
a fine line between what we do for
people and what we do to them.
As for family members, the Star's
investigation says it all.
Deinstitutionalization has been a
catastrophe for families, largely
because governments have been aggressive
about ushering people out the hospital
doors, but passive about placing patients
in the hands of competent caregivers.
The end result, as the Millars' story
vividly illustrates, is that the patients'
family members become the primary,
and in some cases, the only caregivers.
As the Star's report notes, family
members are often assaulted and sometimes
killed by their mentally ill relatives.
Although the families of patients
may try their best to support their
loved ones, they are usually lacking
in both the expertise and facilities
needed to help someone confronting
a serious mental illness. Sometimes
love is not all you need.
And when there is no love -- when
patients have no parents or children
or siblings who are willing and able
to care for them, the streets and
the penitentiaries become their homes.
Patients who would have been confined
in psychiatric hospitals in the halcyon
pre-deinstitutionalization days are
now languishing in jails.
The report ought to be taken as a
call to action. The rationale behind
deinstitutionalization -- that patients
do better when they are cared for
in a supportive and loving environment
than when they are warehoused in an
institution -- is solid enough. But
all we have done is eliminate the
warehousing. The community supports
that were once understudies to the
institutions have failed to take the
stage and the lead.
If we are to care for the mentally
ill and for their families and for
ourselves, then we need to be just
as aggressive at developing community
psychiatric resources as we are at
destroying the psychiatric edifices
of yesteryear.
If we believe otherwise, then we
are the ones experiencing delusions.
Windsor Star
October 9, 2002 Wednesday Final Edition
SCHIZOPHRENIA: Mentally ill jamming
Canadian jails;
'Internally, externally decaying'
system
By: Veronique Mandal Star Health-Science
Reporter
Canada's prisons are turning into
the mental institutions of the new
millennium.
Psychiatric inmate populations have
grown by more than 10 per cent a year
since the early 1990s and by 2020,
experts predict, 75 per cent of inmates
will have a mental illness.
The trend prompted Dr. Richard Schneider,
a forensic psychologist, criminal
defence counsel now an Ontario judge
and two colleagues to brand Canada's
criminal code the "Mental Health
Act of last resort" while presenting
the prestigious Cambridge Lectures
in Cambridge, England in 1999. They
questioned why populations of the
mentally disordered continued to grow
while Canada's general arrest rates
were falling.
Today, Schneider blames the tough-on-crime
attitude of the 1990s, the reform
of the insanity defence and a prison
system content to "warehouse"
rather than reform its inmates.
"The model championed by civil
libertarians is based upon dangerousness,"
Schneider said. "We may only
interfere with an individual's freedom
if he is perceived to be a danger
to himself or others. If an individual
is not seen as dangerous he is free
to roam the streets madder than a
hatter.
"The problem with this dangerousness-based
legislation, some say, is that we
are not able to determine with any
degree of accuracy who should be contained
and who should not. We make all sorts
of mistakes. False positives and false
negatives."
Prison cells have become the catch-all
for people unable to find beds in
an ever-shrinking supply of mental
institutions. The number of beds in
Ontario's psychiatric hospitals dropped
to 2,800 in 1997 from more than 5,000
in 1976. A further 2,000 could be
lost by 2005 when six of the province's
10 long-term psychiatric hospitals
are due to close.
Dr. Marnie Rice, of the Ontario Review
Board, said that in 1992 about four
per cent of psychiatric beds were
occupied by forensic patients. In
1997 that had increased to 18 per
cent.
"If no more (of the present)
psychiatric beds are lost in the province
all provincial psychiatric hospital
beds will be occupied by forensic
patients by 2004," said Schneider.
Dr. Hyman Bloom, a lawyer and forensic
psychiatrist, says Canada's care of
the mentally ill is "broken and
sorely in need of repair," and
the growing number of mentally disordered
offenders is "regressive ...
and constructed on the failures of
an internally and externally decaying
system."
More suicides than murders
Schizophrenics are far more likely
to take their own lives than someone
else's. Fourty per cent of schizophrenics
attempt suicide and up to 25 per cent
succeed, according to the Schizophrenia
Society of Canada.
A Correctional Service of Canada
study, released in 1992, revealed
that 10.4 per cent of the federal
male inmate population suffers some
form of schizophrenia (compared to
one per cent in the general population),
another 29.8 per cent is depressive
and 55.6 per cent have anxiety disorders.
The lifetime prevalence of psychotic
disorders was found to be highest
among inmates in security units (29.3
per cent). In treatment centres, the
rate was 25.3 per cent.
Windsor Star
October 8, 2002 Tuesday Final Edition
SCHIZOPHRENIA: Widower demands
the right to know
By: Veronique Mandal Star Health-Science
Reporter
Ramsay Millar is telling parents
across North America to demand information
on their children's mental illness,
because not having it killed his wife.
Ruth Millar was stabbed to death
in her Victoria, B.C. home by their
24-year-old son in 1997. Had she known
he was schizophrenic, her widower
says, steps could have been taken
to safeguard the family. "This
happens far too often and it's totally
absurd that parents, who are on the
firing line to be hurt, are never
told how serious their child's condition
is, what medications they're on and
what precautions they should be taking,"
said Millar, a computer consultant.
Doctors go too far in refusing to
divulge diagnostic and treatment information
that could prevent harm to the mentally
ill person and family members, Millar
said.
"I don't think they want to
give us the information but their
thinking is backward and one day the
issue will ultimately be settled by
families in a class action lawsuit.
There is a section in the patient
confidentiality manual which gives
us the right to know."
That section is Article 22 of the
Canadian Medical Association code
of ethics, which states: "Respect
the patient's right to confidentiality
except when the right conflicts with
your responsibility to the law, or
when the maintenance of confidentiality
would result in significant risk of
substantial harm to others or to the
patient, if the patient is incompetent;
in such cases take all reasonable
steps to inform the patient that confidentiality
will be breached."
Doctors knew three years before Ruth
Millar died that her son, Aaron, had
paranoid schizophrenia. "I was
also not notified when he talked about
suicide and tried it a few times,"
said Ramsay Millar. "He saw 11
psychiatrists over two to three years
who said he was OK and did not put
him on a treatment plan. He only received
treatment when he got in trouble with
the law."
Dressed in camouflage gear and wrapped
in tinfoil, Millar's son cut satellite
cables at a Victoria newspaper and
TV station, believing it would block
messages from aliens. He was catatonic
and talking gibberish.
Unable to find residential treatment
for Aaron, Ruth took him in. But one
night, while she was doing the supper
dishes, Aaron lapsed into a psychosis
in which he became convinced Ruth
was evil. He pulled a ceremonial sword
from the wall and killed her.
Ramsay Millar, now living in Portland,
Ore., has become a crusader for the
mentally ill, speaking openly about
his wife's murder, lobbying governments
and making documentaries in Canada
and the U.S.
Today, Millar's son is stabilized
on the drug clozapine and remains
under scrutiny of the B.C. Review
Board, which oversees that province's
mentally ill offenders. He working
as a mechanic and teaches snowboarding.
Dr. Jeff Daskalakis of Toronto's
Clarke Institute, supports parents'
right to information. "It's a
cornerstone to treatment. If a family
member is kept in the dark and cuts
the loved one off because he won't
seek treatment, it shuts the patient
out of that family and alienates the
person from society," said Daskalakis.
ONTARIO GUIDELINE
According to the Ontario College
of Physicians and Surgeons, a doctor
may give information about the condition
of a patient, or any services provided
to the patient, to "the patient's
authorized representative, health
professional for the purpose of providing
care to the patient or for the purpose
of research ... if they reasonably
believe that the person will protect
the patient's identity."
Vancouver
Sun
October 7, 2002 Monday Final Edition
Families of mentally ill pay terrible
toll: Psychiatric patients are killing
and assaulting their families at an
alarming rate
By: Veronique Mandal
The sturdy oak bar snaps snugly across
the door leading to Robbi-Lynn Jessop's
bedroom. Her parents, Bob and Pamela,
place it there each night to prevent
their daughter from killing them.
Once a gifted student at Riverside
secondary school in Windsor, Ont.,
Robbi, 18, has for two years spiralled
into the deepest abyss of schizophrenia.
In 2000, she tried to set the family
home on fire. Last year, she admitted
to visions of stabbing her parents
and two sisters, arranging their bodies
liked toppled dominoes in a pool of
their own blood.
Unable to find a residential treatment
centre for their daughter, the Jessops
took the extraordinary step of barricading
Robbi's bedroom each night and taking
turns standing watch. Where once they
lovingly tucked her in, now they fearfully
lock her in. "Right now there
are nights when I am so mentally tired
I want to say, 'Here Robbi, here's
a knife, just to put an end to it,'
" says Pamela Jessop. "If
only we could get proper help for
her, things might be different. But
the system sucks and if you're mentally
ill, God help you."
And God help your parents, siblings,
husbands and wives.
Forced to provide their children
with the love and sanctuary no longer
available in institutions, the families
of Canada's mentally ill are paying
with their lives.
Assembling court transcripts, coroner's
inquest reports and other archival
records, a Windsor Star investigation
has documented more than 130 murders
and murder-suicides across Canada
since 1997 in which mental illness
played a prominent role. They occurred
in a five-year period while Ontario,
B.C. and other provinces were stepping
up campaigns to close mental institutions
and treat patients in the community.
Psychiatric patients are assaulting
and murdering their loved ones at
an alarming rate, with family members
the victims in three out of four killings
committed by the mentally ill, the
Star has found.
The six-month Star investigation
into mental illness in Canada, particularly
schizophrenia, the most chronic and
debilitating of the diseases, uncovered:
- Critical gaps in institutional
care, particularly 24-hour emergency
psychiatric care, undermined by a
lack of psychiatrists and delays in
psychiatrists responding to calls.
- Deficiencies in provincial laws
aimed at forcing the dangerously mentally
ill to take medication.
- A staggering increase of mental
illness in the criminal justice system,
with a commensurate rise in the use
of the insanity defence, particularly
in Quebec.
- Restricted access for many schizophrenics
to the most effective, and costly,
anti-psychotic drugs.
- Inadequate training for most law
enforcement officers confronting the
mentally ill, who die at the hands
of police at the rate of about two
per year.
Four years ago, Ruth Millar, 49,
of Victoria, couldn't find suitable
treatment for her schizophrenic son
Aaron, 24, so she took him into her
home. One night, as Ruth was doing
the supper dishes, Aaron, tormented
by voices which told him Ruth was
going to harm the family, plucked
a ceremonial sword off the wall and
drove it through her heart.
A coroner's jury, created for the
inquest into Millar's death, called
for immediate funding for a day hospital
in Victoria for psychiatric patients
and that money should be provided
to staff an assertive outpatient and
outreach program.
Although charged with second-degree
murder, Aaron was found not criminally
responsible by a B.C. Supreme Court
justice and he spent more than two
years in the Forensic Psychiatric
Centre in Coquitlam.
In a 1993 case predating The Star's
investigation, a 79-year-old Vancouver
woman was murdered by the son of her
nephew after she took him because
he had nowhere else to go.
Mark Andrew Bottomley, then 24, was
charged with second-degree murder
after Kathleen O'Sullivan's partially
clad body was found in the lane behind
her basement suite early Christmas
Day. He pleaded guilty to manslaughter
in September, 1994.
Mental illness was unequivocally
established as the cause in 108 of
the killings since 1997 examined by
The Star. These included murders in
which a court found the accused not
criminally responsible due to a mental
disorder -- the former insanity defence
-- and murder-suicides in which mental
illness was found to be a determining
factor. In these cases, 80 of the
108 victims were related to their
killers by blood or marriage.
A further 23 victims were friends,
neighbours, employees, roommates or
fellow residents of an apartment or
rooming house, meaning that in 103
of the 108 killings, the assailant
and victim knew each other. A scant
five cases were random.
The most recent case occurred about
two weeks ago in Lorraine, Que. Andre
Letellier, 30, whom neighbours said
had a history of schizophrenia and
roamed the neighbourhood singing and
talking to himself, killed his parents
and hanged himself.
Many of the victims had opened their
homes and hearts so their troubled
loved ones could get well. Twenty-seven
of the victims were parents or grandparents,
ranging from middle-class Montreal
suburbanites to the town historian
in Smoky Lake, Alta. Their killers
often led deceptively routine lives
-- honour-roll students, gifted athletes,
kids who paddled canoes and peddled
newspapers.
"He was cheerful, witty, unassuming,"
mourner Perry Anglin said of Geoff
Fertuck, a 35-year-old schizophrenic
who stabbed to death his parents,
Ed and Margaret, before throwing himself
in front of a freight train in the
Montreal suburb of Beaconsfield. "He
was so tender and gentle and full
of self-doubt that he didn't realize
what a terrific person he was."
A report recently issued by the Quebec
coroner's office said Fertuck was
found to be schizophrenic in August
2000 while he was being treated for
depression. In January 2001, a psychiatrist
told Fertuck's parents it would be
dangerous to keep him at home. But
they decided to keep looking after
him while his condition was monitored
by a psychiatrist and a social worker.
On May 16 of that year, the three
were found dead.
A 911 call on the night of June 13,
1997 captured the horror of 11-year-old
Kenny Meehan as he witnessed his father
Joseph, 43, nearly dismember his younger
brother Michael, 8, in their Toronto
home. Suffering what psychiatrists
called either bipolar disorder or
a form of schizophrenia, Joseph Meehan
fell under the delusion that his son
was the devil.
"My dad's killing my brother,"
Kenny told the 911 operator. "He's
got blood all over him ... I'm gonna
die. He looks so sick. He was strangling
him. Oh, my God ... I think he's not
alive."
Two years ago, a Toronto court ruled
that mental illness rendered truck
driver David Patten, 45, not criminally
responsible for the bludgeoning death
of his parents Manus, 81, a retired
garbageman, and Clare, 73, a retired
nurse, with whom Patten lived. He
beat them in their driveway with a
red-handled spade.
Patten thought he was the "leader
of the British Army" heading
into the Third World War and could
avert the conflict by killing the
devil possessing his parents, according
to court records.
"He thought he was killing the
devil inside his father and that his
father was still alive and the devil
was then transferred to his mother,
so he killed her," testified
Dr. Graham Glancy, a psychiatrist
who estimated Patten suffered from
mental illness for more than 20 years,
perhaps since Grade 8.
Schizophrenics often perceive their
caregivers as enemies because they
enforce difficult rules. Under a new
Ontario law, designated decision-makers
-- typically parents -- can obtain
the legal authority to hospitalize
their children or force them to take
medication that often carries unpleasant
side effects such as weight gain.
Many of the killers in The Star's
investigation were defying court orders
to take their meds, often in the belief
that because their symptoms had subsided,
they were cured. Typically, the assailant
experienced a quick snap into psychoses,
striking out as if in a trance. Many
heard non-existent voices which cast
their victims as NASA spies, satanic
agents or seven-foot monsters.
"It's a very common story to
hear that the victims have been parents
or someone close to the mentally ill
person" said Dr. James Young,
Ontario's chief coroner. "Family
members are seen as the enemy, the
people who call the police, take them
to hospital or seek a court-ordered
admission."
The cases involved some of the most
brutal attacks this country has seen
-- bizarre acts of dismemberment,
decapitation and cannibalism. In a
1997 murder in Toronto, Gregory Workman,
44, said he stabbed his mother Noel,
77, five times in the neck, chest
and back because he believed he was
a surgeon carrying out a medical procedure.
"I lost my mind, and two people
lost their lives," Brian Eugene
Wessel, 30, told a Regina courtroom
in January 2001 after pleading guilty
to manslaughter in the deaths of his
wife and brother-in-law in Fort Qu'Appelle,
Sask. Four days after his supply of
anti-psychotic medication ran out,
Wessel cleaved the pair in their sleep.
It's the nature of psychosis that
the mere act of killing isn't enough;
a ritualistic climax is also required
to quiet the voices, said Dr. John
Bradford, a leading Canadian expert
on criminal insanity.
"The mind is so disordered the
person acts in a frenzied rage, often
with amazing strength," said
Bradford, head of forensic psychiatry
at Royal Ottawa Hospital. "If
the mind is convinced the victim is
a demon you can imagine how desperate
the person is to get rid of such a
threat. It's very sad but not unusual."
Family peril was the key finding
of a Star investigation into mental
illness in Canada -- particularly
schizophrenia and its close cousin,
bipolar disorder -- prompted by the
April 9 killing of Windsor heart specialist
Dr. Percy Demers. Earlier that day,
Demers was unable to get his mentally
ill son Thomas, who had stopped taking
his medication, admitted to hospital.
Thomas Demers is charged with murdering
his dad.
The mental health establishment has
long asserted that psychiatric patients
pose no greater threat than the general
population. However, a growing body
of evidence suggests that those not
taking their medications -- and the
estimated 10 to 15 per cent who do
not respond to treatment -- are prone
to violence.
A recent study by the American Psychiatric
Association, cited by Bradford, showed
the risk of violence is six to seven
times higher among people with major
depression or schizophrenia. The risk
rises to six to 12 times higher in
schizophrenics who drink alcohol and
35 to 40 times higher for those on
cocaine.
"Unfortunately there is a correlation
between severe mental illness and
violence," said Bradford. "Up
until the early '90s psychiatrists
played down the fact there was a relationship
because we were worried about the
stigma to patients."
Clearly, families and friends are
shouldering more of the burden of
caring for the mentally ill. Over
the past 30 years the number of mental-health
beds in Canadian hospitals has dropped
by more than two-thirds, to 15,011
from 47,633.
Meanwhile, the mentally ill represent
the fastest growing segment of Canada's
prison population, with estimates
that by 2020, more than 60 per cent
of people with schizophrenia will
have a criminal record.
