The past few years have seen a resurgence of interest in the use of psychedelic substances. The word “psychedelic” is an umbrella term for natural or synthetic substances that alter the senses, change thinking and impact mood. Also known as hallucinogens, they belong to various classes of drugs, and include peyote, MDMA, LSD, ayahuasca, ketamine, psilocybin, ibogaine and others. Though it is not fully understood how the different classes of psychedelics might have a therapeutic effect, neuroplasticity—the ability of the brain to “rewire” associations, impulses, emotions and memories—is thought to play an important role.

Psychedelics have been used by humans for various reasons, including traditional healing, spiritual practices and recreation, for millennia. They have received special legal and moral scrutiny in North America since their use became associated with the so-called “counterculture” of the 1960s. During that time in the US, the criminalization of psychedelics granted authorities a reason to target Vietnam war protesters. Since then, psychedelics have been subject to the “war on drugs.” In Canada psychedelics are considered a controlled substance with criminal repercussions whether one has them for personal use or with the intention to share with or sell to others.

This is why it was such a surprise to hear Mike Ellis, associate minister of mental health and addiction at the time, announce on October 5, 2022, that for patients with substance use disorders and trauma, psychedelics would now be available as treatments. Did I hear that correctly Alberta’s UCP has consistently opposed decriminalization and regulation of illegal drugs. In the words of its previous leader, Jason Kenney, “flooding the market with government-provided illegal drugs is not something Alberta will be doing.” Yet, with this new policy, the UCP would allow criminalized drugs to be used in as-yet unproven therapies for substance use disorders.

It was such a surprise to hear that psychedelics would now be available in Alberta as treatments.

As an addictions physician, I pay close attention to changes in drug policy. As a street doctor with family-physician values, I’m constantly on the lookout for new resources for my patients. I wanted to believe there was something in Alberta’s new regulations that would help my patients.

I had grounds for skepticism. At the same October 2022 press conference, in just as radical a departure, Ellis announced new restrictions to supports for patients with opioid use disorder. Those patients’ physicians would be prohibited from offering certain treatments, and would even be required to send patients to a difficult-to-access clinic called the Narcotic Transition Service to be taken off their medication. Tapering stable patients off their opioid medications can sharply increase the risk of death from drug toxicity and should only be done cautiously in the context of a strong therapeutic alliance, such as with one’s primary care provider. It was devastating news for patients who were stable on these medications. For some the change proved fatal.

At the time, the juxtaposition of these two changes puzzled me. Why were evidence-based harm-reduction interventions being quashed while unproven therapies using illegal psychedelic drugs—that the UCP until recently found abhorrent—were receiving enthusiastic endorsement?

On Tuesdays I wear work boots and cargo pants. The extra pockets are needed for latex gloves, a mask and hand sanitizer. I stuff donated socks, first-aid supplies and throat lozenges into a backpack. In winter I layer on thick long johns and a toque. A portable oxygen monitor and naloxone kit are clipped to a D-ring on my waistband, and my boot treads have spikes. I want to be prepared for anything. Not only are Tuesday patients often quite ill, but many have had terrible experiences in the healthcare system: stinging moments, while sick and asking for help, of dehumanization or outright racism.

Having internalized the stigma of violence over many years, homeless people often tolerate subpar conditions of outreach care. They don’t expect anything more than what US medical anthropologist and physician Paul Farmer calls “shitty care for the poor.” They will express gratitude for a bit of antiseptic spray and a band-aid to cover chronic ulcers and emotional wounds. Just doing my job, I say, struggling to tuck in ragged edges of tattered gauze. I try to hide my fury and sadness from patients who need their doctor to have a strong back.

The chronic rubbing of the bandage’s ragged edges, combined with the recent government announcements and my stubborn yearning for less-shitty care for the poor, may be why, one day last winter, I noticed a chic new storefront clinic near downtown. The interior gleams with glass and white marble. Plants thrive on windowsills streaming with natural light. I imagine the air is filtered just so, warm and humid with a hint of eucalyptus. I gaze up from my slushy streetcorner at shiny chrome letters: The Newly Institute.

I pull out my smartphone: “More like a spa than a clinic,” reads an online review. The Newly Institute website confirms it is a facility for psychedelic treatments enabled by new UCP legislation—ibogaine, psilocybin and ketamine, though Newly’s director is also “looking forward to pushing the boundaries of psychedelic therapy by employing substances like LSD and ayahuasca.” Photos portray clinicians in immaculate scrubs while executives in smart suits exude corporate confidence. A beautiful place, filled with beautiful people, for helping folks struggling with their mental health. I feel dowdy and damp in my muddy boots and sweaty layers.

Nevertheless I try to imagine practising within the Newly Institute’s pristine walls. In my mind I steam up a fresh espresso between appointments as patients relax amongst the plants and pleasantries. I stride across gleaming maple hardwood in spotless sneakers, dripping with efficacy. If this place, I reason, provides the newest treatments for the most intractable cases, then my current patients would be good candidates for its services. I think especially of one soul who lives with complex post-traumatic stress and substance-use disorder. He has been to residential treatment programs many times and to residential school before that. So many of my patients carry the most severe forms of the illnesses the innovative Newly Institute treats. I want to get them inside. So I make a call.

“I have a few patients I would like to refer to your clinic,” I say. A staffer in the spa clinic reassures me that they can help.

I had noted that the website mentions drumming, so the first thing I ask is whether there is an Indigenous adviser or elder on staff. The staffer apologizes. No, there is not.

Most of my patients live in homelessness or poverty, I explain, still a little hopeful. Is there a cost for treatment Well, yes. Consultations and treatment are “fully private,” I’m told, and paid for by the “client, an employer or by an insurance company.” Later I discover that the cost of psychedelic treatment courses varies widely but can range into the thousands of dollars. The standard one-month “intensive outpatient” program for mental health at Newly, for example, costs $12,950. Bloom Clinic in Calgary advertises a 10-week ketamine-assisted program for $5,965.

I try again. If someone has Alberta disability or income supports, will they be covered No. What about Indigenous patients with status under the Indian Act No.

The friendly person educates me cheerily: most of their clients—I feel chastised for saying “patients”—with substance-use disorders use only alcohol, or maybe cannabis, but not opioids. Those clients, I am advised, should first go to medical detox if they have opioid-use disorder.

Thanking the person on the phone, I feel a familiar disappointment, but also bafflement. If only their suggestion were that easy. So-called “detox,” or safe withdrawal, is a notorious bottleneck in Alberta’s system of care. Getting a spot when it’s needed is nearly impossible. Instead, in a wealthy province that now sees a drug poisoning death every five hours, our government is ushering in an intervention that helps only those who can afford it and are using the “right” substances.

I asked Dr. Leah Mayo, Parker Research Chair in Psychedelics at the University of Calgary, about the access disparity in the world she studies. She agreed that “major limitations to these interventions [are] becoming mainstream, and a lot of thought will need to go into how to make access equitable.”

And equity is about much more than simply access or cost. As a young anthropologist, I worked in rural Mexico with a group of curanderos, or traditional healers. During long drives between Indigenous villages, where they worked with young mothers learning to grow and use medicinal herbs, I listened to the healers as they grappled with the problem of commercialization of their plant medicines. In a recent forum on psychedelics, the Canadian Public Health Association voiced a similar concern: “…We must question how traditional Indigenous knowledge, cultural rights and opportunities for economic participation will be adequately protected as psychedelics gain prominence in Canada.”

Though services might struggle to be inclusive of Indigenous practices and perspectives, they must. We have the guidance: biomedical colonialism is addressed in Canada’s Truth and Reconciliation Commission Calls to Action and in the UN Declaration on the Rights of Indigenous Peoples and should always be explicitly included in any new health-related regulations, programs or services.

Drug policy in Alberta is determined not by science, safety, access or equity but by commercial potential.

Maybe, after witnessing the toxic-drug crisis rampage for the better part of the past decade, I’m becoming impatient. Novel approaches take time; we have to gather data and properly implement sensitive aspects such as inclusion and reconciliation.

It has been well over a year, however, since Alberta’s new regulations were implemented, and though scientific evidence might someday prove the therapeutic value of psychedelics, it hasn’t happened yet. In a search of clinical trials registered by Health Canada for two of the psychedelic drugs approved under the UCP’s new regulations, one of the drugs—psilocybin—had only two clinical trials, both now closed. The other—a traditional central African root medicine called ibogaine—has no clinical trials registered. Dr. Mayo acknowledged that only one psychedelics clinic in Calgary, SABI Mind, is currently involved in a regulated clinical trial of its therapies. (The Newly Institute website has since removed references to treatments using ibogaine and psilocybin. Other clinics, including ATMA CENA in Edmonton and Calgary, are offering MDMA and psilocybin as well as ketamine.)

Meanwhile, evidence in favour of the interventions blocked by the UCP’s new legislation, including studies of prescribed safer supply of opioids, continues to accumulate.

Despite Mike Ellis’s stated rationale, his ministry’s mash-up of regulatory changes improves neither access nor safety for my patients. So, what’s really behind the changes The answer is disconcerting. Many psychedelic facilities and, it should be noted, residential treatment facilities receiving massive taxpayer-funded “investments,” are run by privately held, for-profit companies. The reality is that the public system of care holds no market prospects, while, as noted on Nasdaq.com, “psychedelic stocks have a bright future.”

The truth is that even during a crisis that annually kills thousands of Albertans, and despite sneaking in words such as “compassion” and “stewardship,” drug policy in this province is determined not by principles of science, safety, access, equity or human rights but by commercial potential. Alberta’s UCP government believes that health services should be driven not by a patient-centred mission but by marketing strategies like the Newly Institute’s: “We are firmly rooted in our collective commitment to excellence, whether it’s patient care, inter-office communication, or the impact of the colour we choose for our wallpaper in the office bathrooms. No detail is too small to be considered.”

As I lace up my spiked boots for yet another Tuesday of street medicine, I’m conflicted. While I’m glad for the existence of clean and beautiful places for patients, and for new approaches to treating severe mental health disorders, I recognize the pipe dream. My espresso fantasy melts away like dirty snow as I realize that neither my patients nor I would be any more welcome in a fancy private clinic than we are in general society. This is because, wherever we go, we expose the marble-clad foundation of discrimination upon which both for-profit clinics and society itself are built.

While the UCP cheers on the psychedelics industry to monetize its visions, I am deeply sad for the ongoing loss of lives and dreams in my community. Regardless of whether we use the word “patients” or “clients,” people are still people, not commodities, with challenges that are still illnesses, not market prospects. It turns out that what we sacrifice in a private system is accountability. Even more chilling is what we sacrifice in a for-profit health system: care.

If current conservative governments continue their path of destruction all in the name of profit, too many people will have to continue to hold their breath while waiting for care out in the cold, some until they simply stop breathing.

Bonnie Larson is a physician and community organizer who for 15 years has worked with people experiencing homelessness.

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Holly: It is the late 1980s in Edmonton. I am 18 and working full time as a psychiatric aide in a large provincial psychiatric hospital outside the city with 12 buildings full of people diagnosed with mental illness. The campus has beautiful grassy fields within a boundary of tall, thick trees. After only eight hours of orientation to psychiatry, I spend most of my time “sitting constant” with people who are suicidal or have eating disorders. Every unit has its own culture: some are chaotic and unpredictable, others are slow and monotonous. People stay here for a long time—months, even years. They tell me of the various reasons they were brought here, including hearing impairment, Huntington’s disease, promiscuity, acts of violence, episodic voices of God or Satan, ideas of magic, paranoia, euphoria and deep sadness.

My job is to observe and monitor each individual as they are. It is hard to see them existing beyond the unit setting; this place is like a community. For some it’s the only form of home they’ve known. Still, I hear whispers of other places: the farm, a bus to Whitby, the community up north, the parent/partner/friend who is missed.

It is hard to see people existing beyond the hospital setting. For some this is the only form of home they’ve known.

Leif: It is 1990 and I’m 18 years old. I have a home, a school, friends, a hometown. More than that, I am part of a community. But I have lived my life under the dark shadow of mental illness. My mom requires hospitalization for severe depression; my dad’s drinking makes my home almost unlivable. Somehow I’ve managed to carry this weight while holding down jobs and buying cars, motorcycles, clothes and video games.

I have experienced severe, crushing depression for most of my teenage years. I’m under incredible stress, going to school during the day and working night shifts at a grocery store. Home life is even worse than my toxic workplace. My dad has grown angrier, more violent and less logical since I became old enough to move out, even though I’m not done high school. As this pressure cooker heats, I begin to show the classic signs of bipolar disorder with psychosis, and later, symptoms of schizophrenia with severe anxiety. One day I pick a fight in school and am non-compliant with the school administrators. When the police arrive, I fight with them too. There are no more options: I’m taken to Alberta Hospital. My hopes for the future shatter at once. I’m locked up, heavily medicated, disconnected from everything around me.

My hopes for the future shatter at once. I’m locked up, heavily medicated, disconnected from everything around me.

Holly: Five years go by, and I keep this job while finishing a nursing degree. After graduation I move to the US and start working at an inpatient psychiatry unit. Here the care is different: the people come in only for stays abbreviated by managed care. The units are locked. There are no grassy fields or recreational outings. The units are busy, with a frenzied energy that comes from having people with mania and psychosis in a small space. Restraints and seclusion are regular occurrences, often exceeding the capacity of available seclusion rooms. People come in sick, are medicated heavily and sent out to community or day-hospital programs—or the street. They come back with signs of the outside: dirt from the street embedded in their skin, new drugs in their toxicology screens, new stories of relationships and struggle.

This, however, is the 1990s, “The decade of the brain.” We are all enchanted by the promises of new medications and believe in the potential cures. Like alchemists we tinker to find the right mix of medications, monitoring side effects and symptoms. We shape our patients through chemical compliance. Side effects appear more often than we’d like—but the pharma sellers convince us otherwise, so we tell our patients to eat healthy and give the medications time to work.

Leif:The hospital works a miracle. In just two months I go from violent, raving mad, delusional and psychotic back to “normal.” Sane, stable and as capable of functioning as I ever was. I find work at a factory but am unable to keep up. I blame the medication and stop taking it. I feel fine.

The feeling doesn’t last. I begin to hear radio announcers say grandiose things about me, like I have wealth beyond measure and movie stars are romantically interested in me. I think maybe I just need the discipline and structure of a military lifestyle to keep the voices at bay, like I had in cadets. The first Persian Gulf War is flaring up, and so I try to join the Canadian Army. I’m turned away because of my psychiatric records. I sell my motorbike for $20, close my bank account and hitchhike to the west coast. I meet new people, make new friends. I’m having the time of my life. But without medication the psychosis eventually comes back, and with a vengeance. After returning home, then spending another six months living in Vancouver, going hitchhiking and trying to earn a pilot’s licence, my illness returns. Hospitalization and more medication follow. I leave what little I have and return to Edmonton with nothing.

Once again I’m homeless, only this time in my own city while on a medication that leaves me debilitated. I run into people I went to school with and tell them I’m sick and waiting to get into hospital. They don’t understand that I’m mentally ill, not physically sick. Mental illness had never been part of our education. I can’t function, can’t work, and I have no money or friends. My reality is poverty, delusions and hallucinations. I hope another hospitalization will allow me to function and take away the voices and thoughts that torment me.

I’m finally ready to accept diagnosis and treatment after losing everything in my life that mattered, including home, friends, family and all my possessions. I wrongly think that if I quit drinking and go back on medication, then old friends will beat down my door to reconnect. Instead, I face extreme isolation and loneliness. Several times I give up on the world outside my apartment. I sleep for days. I don’t go outside unless I need food. For a time, I have no phone and disconnect the intercom to my apartment. Over the coming years I will go off medications several times, go in and out of the hospital system, attempt suicide and put my parents through hell. There seems to be no end in sight.Holly: I’m working in adolescent psychiatry in a posh neighbourhood in downtown Chicago. My patients are almost all kids from what is considered to be the most violent neighbourhood in the US. Many of the young girls are diagnosed with generalized anxiety disorder, a diagnosis that means they worry too much. They also tell us they oversee getting three siblings and three cousins to school each morning, as mothers and grandmothers must cross the city by bus to get to work. I oversee teaching these kids about anxiety and medications. I teach them to reframe their “distorted” thoughts. They listen to me and sometimes smile with a wisdom I’m only beginning to recognize: They’ve been told this before. They know that in this clinical space we don’t understand what their home is like. That we can’t understand.

Two years later I move to outpatient psychiatry. I’m in grad school now, working on becoming a nurse practitioner. I work in an office building. Here the people I work with are “clients,” not “patients.” They come in voluntarily and sit in a waiting room quietly, then come to my office and sit in the comfortable chairs. They tell me how things are going, falling apart at times but in a more controlled way. There is a shift in power and control in this place. The keys I carry are different; there are no locked doors but there are disability forms and prescriptions. It’s hard to focus on the clinical pathways built by biomedicine that tell me what to prescribe first, second, then third. These paths tell me to diagnose symptoms and treat illness. The people in my office tell me of other paths and barriers.

Clients tell me about workplaces that are not accommodating of mental illness, of relatives that don’t get it, or of a lack of food or heat. I can hear the hollowness of cognitive therapy treatment and how disconnected it is from the problems my clients face. One day a client is reciting to me their symptoms of stress and alludes to the fact that they’re hungry. They tell me about their struggles to keep perishable food cold in the warm spring weather—they have no electricity. The $300/month they live on does not go a long way. A subsidy is available, but it requires navigating a bureaucratic space. We talk about strategies to cope. One day I realize that the best way to spend the allotted 50 minutes might be to go to the utility commission with a client. Coming back into the office I see a fellow trainee who asks me where I was and I tell him about the field trip. He smirks and asks, “Don’t you have any boundaries?”

This comment gives me pause—was this the right thing to do At this point I’ve been working in psychiatry for 14 years and I’m not sure all my experience and training has made me that helpful. For many, the tinkering with medications and strategies for coping aren’t enough. The biomedical model of psychiatry is placeless; it situates all the problems within the individual and ignores the contexts in which they live. This revelation takes me in a new direction that coincides with a move back to Canada, where I find a role in community mental health nursing—working in crisis teams, home support and primary care settings. Much of my work here is creative, incorporating counselling and assessment skills with material goods such as a pack of cigarettes or a sandwich to help offset a crisis. I unpack clients’ moving boxes and help fill out rent subsidy forms. But this work isn’t highlighted on the charting forms or in workload reports that account for my time, so as funding is cut, so is my ability to do this kind of work.

Biomedical psychiatry situates all the problems within the individual and ignores the contexts in which they live.

Leif: Living on my own, money is constantly an issue. I move several times until I find a place I can afford. Rent is $160 a month for a shoebox apartment. I have a sink, stove, fridge, toilet and shower. My whole life must fit into 150 square feet. Money is tighter than ever. For my Christmas gift, I ask my best friend for a can of tobacco so I can save $25 for food and coffee. My mental health is reasonably good. I’m in remission. Most would describe me as weird; I’m not wealthy enough to be eccentric. Years pass and I wonder if maybe I’m not as sick as I thought. Without full knowledge of what could happen, I lower one of my medications without my doctor’s advice, which spells disaster. After a particularly unpleasant episode (which included running around screaming that there was a bomb in my apartment building), I have a short stint in the hospital. I’m released within a few days.

A series of mental health workers come to see me, but I convince them I don’t need to be hospitalized. Then one day I agree to go by ambulance to Alberta Hospital for an assessment. I experience a tidal wave of paranoia and am involved in a chase around the grounds of the hospital. I spend the next six months confined; time slows to a crawl. I sleep all I can, as mountains of endless, frustrating time tick by. I’m unable to focus on reading or TV and have no one to talk to. I’m living the hell of constant banishment to a seclusion room, for hours or days at a time, despite already being in a confined ward. I clash with my doctor. The staff don’t believe a word I say.

When finally discharged, I feel my life is over. I have only two people on my side: a kind social worker and my formerly abusive dad. I’m placed in a well-run, supportive group home. Then, for the first time, I’m not lonely or underfed. Fifteen years pass in the group home, and I’m given a subsidized apartment in another housing project. With the support of my dad and a strong desire to tell my story and somehow make some sense of all my suffering, I publish a book about my lived experience, get a job with the Schizophrenia Society and almost by accident find work as a teacher at the same hospital that once confined me. Finally I have come out the other side. But beneath it all I’m still sick.

Flash forward to 2024. I’m now teaching two classes at Alberta Hospital and will soon be facilitating a support group too. I write for magazines and pay close attention to the news. I regularly see reference to mental illness in the media. Recently in Edmonton, a 16-year-old shot and killed two police officers, then turned the gun on his mother, then himself. I learn he was the subject of a mental health call several months earlier. In response, the provincial government promises $8-million in new funding to crisis response teams for mental health calls.

I’m left wondering why more isn’t directed to prevention efforts rather than reacting to the fallout. I wonder why wait lists to see a psychiatrist or a counsellor are preposterously long, with youth often waiting up to two years. Too often, people reach out to me for help with loved ones who have schizophrenia or bipolar disorder. I don’t have solutions, but I know that prevention programs and support for meaningful recovery should be more easily available. When I was finally placed in a supportive group home, these got me through. But thousands of people in Alberta need this help, and we have so few places like this. Parents, young and old, are often the only ones advocating on behalf of their mentally ill child.

Only when I feel fully accepted as a member of society, my mental illness fully out in the open, will I truly feel I was right in returning from Vancouver—that coming home was the right decision.

Psychiatric care perpetuates placelessness—perhaps echoes of the asylum system that didn’t require people to have a home.

Holly: I am struck but not surprised by how long it took Leif to find his way “home.” My own reflections on working in the treatment system make it easy to understand why.

What is it about psychiatric care that continues to perpetuate a sort of placelessness of the people we diagnose with mental illness Perhaps it’s the echoes of the asylum system that didn’t require people to have a home outside the institutional walls; that imprisoned people, away from the rest of the world. It seems ingrained in our practice to extract the person from their network, which limits possibilities for recovery and the “good life.” We work with some of the most structurally marginalized people. We must incorporate practices that include their sense of place.

Who we are as individuals and what we feel can both create place and be created in place. Home, then, is more than a house or apartment—it is a place of meaning and belonging, achieved by the careful arrangement of people, objects and ideas. These arrangements shift, and may be precarious, so they require constant attention and care.

Nowhere does the issue of place and belonging seem more relevant than in the current discourse around mental illness. In Canada it is estimated that at least one in five people experience a mental illness each year. Risk factors for poor prognosis and recovery include some of the social determinants for mental illness: poverty, trauma, social isolation and poor housing. Our continued focus on funding crises and acute short-term responses to mental illness does little to change the possibilities for people to find and keep a home and a place of belonging and safety. Our healthcare system needs to reconceptualize home not just as a simple address but rather as a stabilizing set of careful and meaningful social and material arrangements, a necessity for people living with mental illness.

Holly Symonds-Brown is an assistant professor of nursing at the University of Alberta.

Leif Gregersen is an Edmonton author and mental health advocate.

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Tonight we’ve gathered in an underground LRT station passageway. Beside us, a long stretch of yellow fencing separates us from a lone electrical outlet, a rare treasure in public spaces. The outlet was recently deemed too popular among the city’s unhoused citizens—hence the fence.

Through slurred speech, Brandon Shaw fawns over my toque, which reads “Hoot ’n’ Blow” beside an owl logo. I offer it as a trade for his, but he declines. Someone later explains Shaw was afraid he’d picked up lice in the shelters. He was protecting me.

Brandon is the namesake of the organization (“For B”), which was launched by his mother, Angie Staines. He’s 28 years old and still alive after 12 years unhoused—but only just. In the summer of 2022, Staines and her team found Brandon blue-lipped, deep in a fentanyl poisoning. They revived him with naloxone and oxygen. But in the ensuing months he was set on fire during a drug deal gone wrong, then suffered a kidney infection, then withered through the dysentery that hospitalized over 100 of his unhoused neighbours.

Half of Alberta’s treatment beds are in explicitly faith-based facilities, with an overwhelming focus on total abstinence.

Like everyone down here, Shaw’s life could have taken any number of trajectories. Twelve years earlier he had been a multitalented and athletic kid running full speed into behavioural challenges. “I left home for the first time out of fear and shame of the pain and harm I was causing my family,” he says. “I knew something was up with me; I just didn’t know what.” He quickly gave up on youth shelters. “I didn’t last long, because of my drug use and mental health,” he says (many shelters have strict abstinence policies). “And nobody asked me what I want or what I need.” So, managing bipolar disorder and ADHD with street drugs, the runaway teenager took up residence in a tent.

Years later Shaw would wait months on a medical detox list, only to be refused support for his potentially seizure-inducing benzodiazepine withdrawal. Given that his earlier attempts at detox from benzodiazepine-laced fentanyl “felt like having a stroke,” he was desperate for a better option.

Like so many other people 4B was out to support that night, Shaw is up against systems seemingly built to fail. Successive provincial governments have ignored survivors like him while holding fast to outdated conceptions of drug use and addiction.

In 2014 Dr. Esther Tailfeathers sounded the alarm about a sudden escalation of opioid poisonings in her native Kainai Nation (Blood Tribe or Blood Reserve), bordering Lethbridge, where she practises family medicine and advocates for harm reduction. “I had no idea we wouldn’t get on top of this, we wouldn’t have a good strategy—[that by 2024] we’d still be chasing the tail of the problem,” she says. At the time, she remembers, “We thought we were an anomaly, that it wasn’t happening anywhere else to this degree.”

Kainai was at the vanguard of the cataclysmic shift in Canada’s criminalized opioid supply, from use of regulated pharmaceuticals and “old-school heroin” to potent synthetics such as fentanyl that are made without opium poppy. Recognizing the trauma of people who use drugs, their families and frontline responders, Tailfeathers’s daughter Elle-Máijá documented the period. In 2021 she released the film Kímmapiiyipitssini: The Meaning of Empathy. 

Recently the doctor and her daughter “started counting the number of people in the film that have died. It was over half of them.”

Alberta has lately seen a seven-year drop in Indigenous life expectancy. In 2015 life expectancy for a First Nations man in Alberta was 67; today it’s 60. For First Nations women, it’s dropped from 73 to 66. This decline has been attributed in large part to our province’s narrow scope of drug policies, centred on abstinence. To Tailfeathers it seems like a conscious reframing of John A. Macdonald’s “clearing the plains” starvation politics. “Macdonald and all these other leaders thought they knew what was best for Indigenous people,” she says. “In 150 years there’s been no change… Making decisions about us, without us, is still colonial.”

During the NDP term in government (2015–2019), AHS incrementally piloted and adopted interventions falling under a “harm reduction” umbrella, such as naloxone distribution, supervised consumption sites and prescribed injectable hydromorphone. But these measures were too little, too late. While the tide of regulated opioids retreated—in an overcorrection to what some experts saw as loose prescribing practices—annual toxicity deaths in Alberta rose from around 100 in 2012 to 805 in 2018. In 2023 Alberta was on track to exceed 2,000 opioid-related deaths for the first time. (The data is not yet finalized.)

Elaine Hyshka, Canada Research Chair in Health Systems Innovation at the University of Alberta, still agonizes over the opportunities missed in the early days of the crisis. “The exponential increase in deaths was directly related to a change in the illegal drug supply. Before, people were primarily using prescription opioids. Those became less available, and the illegal market moved to fill that void.” With dangerous drugs flooding in, and deaths rising fast, drug policy experts called for immediate harm-reduction measures to save lives.

In the years since 2019, however, harm reduction has been turned into a political wedge, and “addiction,” an amorphous term increasingly avoided by drug-policy experts, has been reinforced as the nexus of public interventions. But we’re taking aim at the wrong target, says Hyshka. As Brandon Shaw’s story illustrates, this isn’t an addiction crisis, it’s a mass poisoning.

Successive provincial governments have ignored survivors like Brandon while holding fast to outdated conceptions of drug use and addiction.

When Jason Kenney’s United Conservative Party took power in 2019, it began cutting harm-reduction services. By 2023, grassroots overdose prevention sites had been criminalized, the number of supervised consumption booths in Alberta had been reduced by 35 per cent, and every patient in Alberta accessing a prescribed supply of hydromorphone (a synthetic opioid) was forced to accept a regimen of “witnessed oral dosing” in central facilities. To harm-reduction advocates, these restrictions became synonymous with the government’s recovery-oriented (or abstinence-oriented) focus.

Brandon Shaw experienced first-hand the staggering increase in poisonings during the transition to synthetic opioids. “I moved to BC [in 2013] when you could still buy actual heroin. …I had a somewhat normal life, working day labour, living in a ‘wet house’ [sober-living facility with loose rules]. Then fentanyl came along and everything changed.”

“At first, we just thought we were getting strong-ass dope… then we noticed all our friends were dying. My routine was on its head. Before, I would use four times a day. Then fentanyl came out and I was using sporadically, at weird times of day.” Shaw describes fentanyl’s lack of “legs,” its shortened effects compared to heroin or other opioids. After losing many friends to poisoning, he recognized the threat to his survival and returned to Edmonton in 2015.

As in BC, the ground in Alberta had fundamentally shifted. But a public health response equal to the crisis was nowhere in sight in this province. With few options to choose from, Shaw returned to residential treatment for his third time—for his first, as a teen, he had been involuntarily committed through the Protection of Children Abusing Drugs (PChAD) Act. He would eventually tally a total of seven attempts in the system.

Through these stays in “rehab,” Shaw learned some basic living skills. But these didn’t help him overcome his biggest barrier: securing stable housing. What he needed, according to Alberta’s drug-treatment system, was to be drug-free. “When you’re using drugs, that alone really screws you for a lot of options—there’s very little low-barrier housing. A lot of these places are 12-step-oriented.”

The 12-step method, developed in the 1930s for people dependent on alcohol, is rooted in Christian values to support people through abstinence. Countless people credit 12-step’s community support for their eventual success in maintaining abstinence. But the method has its limits and drawbacks. Critics refer to the community shaming that reveals itself, as one example, when people admit to resumption of drug use (or, to use the more stigma-laced term, when they “relapse”). Speaking of her own experience in a 12-step program, New York Times journalist Maia Szalavitz put it bluntly: “Such clearly religious practices would not be accepted as medical or psychological treatment for any other condition.”

An internal AHS document reveals that 12-step-based strategies are central in publicly funded facilities harbouring three-quarters of Alberta’s treatment beds. Around half of Alberta’s treatment beds are in explicitly faith-based facilities. Between religious undertones and an overwhelming focus on total abstinence from drugs, rehab can exclude people seeking other approaches to recovery, including ones that don’t aggravate their existing shame.

But one life-altering experience in treatment stands out for Shaw. “I’ve experienced all kinds of trauma through the last 12 years,” he says, summarizing lifetimes of harm in one breath. During an extended stint at Our House Addiction Recovery Centre in Edmonton, Shaw says, he underwent six months of trauma therapy with a professionally certified counsellor. That length of time “was the only way I was able to get vulnerable… I had to trust him more than anyone I’ve ever trusted.”

Trauma therapy, however, is expensive, intensive and outside the scope of most treatment facilities in Alberta. It takes weeks or months to conduct pre-screening and ensure that a participant is in position for routine follow-up and therapeutic work outside of regular sessions. In effect, trauma therapy requires someone to be sheltered, supported by a close network and ready to face their demons. Shaw wanted “treatment that would fit [him] individually, not just a one-shoe-fits-all, for every single person coming in.” Instead, the option offered by most rehab facilities he visited in Alberta seemed to create “a revolving door. It doesn’t work.”

After decades of advocacy by mental health professionals, Alberta not long ago was set to expand its therapeutic options. But in 2021, a day before the ribbon was to be cut on the College of Counselling Therapy of Alberta, the provincial government announced the college was “no longer a priority.” It cancelled the launch, preventing the professionalization of oversight and regulation of mental health and addiction therapy. Instead, the Kenney government doubled down on treatment facilities that are cheaper and unaccountable.

The lack of accountability at Alberta’s existing treatment services troubles Tailfeathers. “Without evaluation, we have no idea what works and what doesn’t,” she says. “[A program] might look good, but are we actually evaluating whether it’s successful or not Is there an overall decrease in mortality, an increase in people returning to the workforce, children staying in their households with their parents?” Our government is “shooting from the hip, putting all their eggs in one basket.”

Despite regularly publishing data on drug-related EMS-dispatch and drug-related mortality, the government of Alberta hasn’t shown how treatment impacts the odds of survival—if it even knows. Hyshka suggests the starting point to assess success would be to see if people who attended treatment “had any EMS activations or attended a hospital for substance use disorder for six months and one year following discharge.” In Alberta’s centralized medical system, this should be easy.

Alberta’s Ministry of Mental Health and Addiction did not reply to any of my questions. Reporting requirements to the government were, however, disclosed to me by a director and a manager at two private but publicly funded residential treatment facilities and a staff member at an AHS detox facility. (They requested anonymity to protect their provincial funding.)

The responses from the three facilities provide a rare insight into the government’s selective data management. By collecting client participation data such as number of people initiating and completing treatment, number on wait lists, and participant demographics, the government attends to the needs of the treatment industry.

Conversely, the government appears to actively ignore client outcomes, including how many people maintain abstinence or even survive in the months following their participation in a treatment program. And while the government tracks the number of people discharged early from treatment and the reasons for early discharge, this information is not publicly disclosed. As a result, the industry is protected from evaluation and scrutiny while clients continue to be ushered through the system. And the fact that one facility admitted to a “triage process” while another did not suggests the possibility of “pay-to-play”—priority access for people with the right network and a willingness to make donations.

The collecting of data on people using services and what helps them complete programs can create an impression that the programs are supporting recovery goals. But this hinges on how we define recovery and success. The lack of follow-up with patients, says Hyshka, “means the system isn’t accountable to [the public] or to patients. If you’re a politician and you’re not measuring success, you can’t be held accountable for your policy decisions.” And as Shaw points out, a “revolving door” system in which clients leave treatment only to re-enlist months later—at thousands of dollars per stay—represents a tremendous business opportunity.

It turns out that, in the distinct but overlapping worlds of addiction and drug poisoning, definitions of “recovery” and “success” are not universal.

The Alberta government claims that “acute interventions,” a veiled reference to harm-reduction services, have “come at the expense of supporting the long-term wellness and recovery of individuals, families and communities.” The implication is that helping people stay alive while using drugs comes at a cost to the individuals and their communities by delaying their transition to “recovery.” The government defines recovery as “a process of sustained action toward physical, social and spiritual healing and wellness while consistently pursuing a substance-free life.” This contrasts with harm-reduction-oriented definitions, many of which centre a person’s own goals related to drug use alongside informed consent on supports.

The goals, actions and performance metrics built into recovery-oriented (abstinence) systems of care are detailed in the 2023–26 business plan for Mental Health and Addiction. The ministry’s budget is $300-million for 2023–24, of which at least 80 per cent is allocated to addiction and mental health recovery programming and capital costs. In a rare instance, the plan specifies a secondary objective of reducing “opioid-related overdoses in the province, with a focus on Indigenous Albertans who are disproportionately affected.” The initiatives listed are limited to residential and day treatment, a helpline and an expansion of the Virtual Opioid Dependency Program (VODP)—hardly a complete recipe for managing a toxic drug supply.

The VODP was originally designed to provide access for people in rural settings to treatment and opioid agonist medications (such as methadone and Suboxone); it was recently adopted for use in prisons. However, a 2022 study funded by AHS and co-authored by Nathaniel Day, the medical director of VODP, showed considerable participant dropout. Those who could be studied, the authors admitted, “were individuals who remained in treatment and were agreeable to completing assessments, [so] they may have also had more positive outcomes.”

The best treatment for opioid use disorder is medication. “Rehab” for opioid use has little supporting evidence.

Alberta’s recovery-oriented system is operating as a flimsy raft in a storm of toxic drugs, unaffordable housing and structural neglect. Thousands of Albertans, unable to hang on, are annually lost at sea. Others, with resources, luck and a willingness to define recovery as abstinence, are eventually carried to dry land. How many Albertans are saved, and for how long, our government either doesn’t know or won’t say.

In their emphasis on mortality, advocates for harm-reduction options misinterpret the ideology underpinning Alberta government’s approach to the poisoning crisis. Long term, the government’s apparent hope is that its recovery-oriented system will give rise to drug-free communities. In the short term, however, the “pursuit of a substance-free life” is being prioritized over minimizing death and illness caused by an unregulated supply.

The way treatment programs are instructed to monitor participant mortality rates helps illustrate this ideology. An executive director at a facility (residential treatment facility #1 in the table) told me that they only learn about the deaths of recent participants through alumni, 12-step meetings, mentorship programs or when someone voluntarily reports a death to the facility. If a participant’s death is reported within two months of the person’s exit from a program, it is relayed to the Alberta government. That completes reporting.

In the run-up to the 2023 provincial election, UCP candidates frequently celebrated their system’s supposed ability to reduce deaths. But during the same period, drug toxicity deaths rose steeply, topping 195 in April 2023—Alberta’s worst month on record. The government has since pivoted to a “Recovery Capital Index” to measure the success of treatment. This approach defines recovery capital as “the combination of personal, social, community and other supports that a person can draw upon to begin and sustain their recovery from addiction,” including housing, employment and family connection among the eight factors in the framework.

An individual’s index is measured at several timepoints during treatment using the My Recovery Plan app. Created by BC-based Last Door Recovery Society, the app was licensed to the Alberta government through sole-source contracts totalling nearly $1.8-million.

David Hodgins, a professor of psychology at the University of Calgary, describes recovery capital as an “increasingly recognized construct describing dimensions of recovery beyond reduction of problematic substance use.” He points out that no research yet exists on whether the app improves outcomes, though this is typical for mental health apps. Hodgins is also careful to emphasize that recovery capital “has nothing to do with reducing drug poisoning deaths, beyond the idea that more people being successfully treated is a good thing. It may help people maintain abstinence by pointing out areas of strength and areas of need.”

The director at residential treatment facility #1, mentioned previously, was enthusiastic about Alberta’s new framework, saying, “I see the successes every day… Recovery capital is measured in simple points: when they come in, at the 30-day mark, when they exit… we see huge increases at those points and huge decreases in the barriers to recovery.”

Recovery Capital Index scores, if they improve—and assuming they can be trusted and are released transparently—may eventually help justify the Alberta government’s focus on rehab. But, says Hyshka, “if the number one goal is to reduce the death rate, funding treatment beds is not going to do that.”

She emphasizes that the gold-standard treatment for opioid use disorder is medication, while residential treatment has little supporting evidence thus far. In any case, she reminds us, “a large percentage of people who use opioids or other substances are not going to meet the criteria for substance use disorder [or for being admitted to treatment], but they’re still at risk of dying—especially if they’re accessing drugs from the illegal market.”

The Mental Health and Addiction ministry’s $300-million budget in 2023–24 is a roughly 40 per cent year-over-year increase. This is laudable spending against historical underfunding on mental health and substance use supports. But the same budget announcement designated just $14.5-million for supervised consumption sites, a 30 per cent drop that was obscured in subsequent budget releases. Underscoring this quiet manoeuvring, the UCP’s fall 2023 annual general meeting passed a resolution calling for the wholesale defunding of supervised consumption services. And the Alberta government continues to build out its plans for its notorious Compassionate Intervention Act. This legislation is expected to empower police, families and healthcare providers to obtain court orders that compel people deemed a danger to themselves or others to undergo addiction treatment.

“Tough love” might seem compassionate to some. But Hyshka says the evidence shows that people are at “much higher risk of death from poisoning” following a period of forced abstinence. She also worries that “we already have trouble encouraging people to talk openly about their [drug] use and speak out and reach for help when they need it.” Fearful of being subjected to involuntary treatment by those they trust, “people will stop reaching out for help.”

Despite plans to construct 11 “therapeutic communities,” at least four of them in First Nations communities, including Enoch Cree, Kainai, Siksika and Tsuut’ina first nations, the government is signalling further privatization in the ownership structures. Not only will the success rates of treatment remain unknown to the public and to patients, it’s unclear how public money is being spent. Tailfeathers is troubled by this lack of transparency: “It’s like building all the brick residential schools… we’ve got these things built, but nobody knows what happens inside.”

The government’s first such contracts, in Red Deer and Lethbridge, were awarded to Edgewood Health Network and Fresh Start Recovery. Edgewood is a private company backed by undisclosed investors, while Fresh Start is a non-profit. Both corporations are perennial Lead Sponsors of the Recovery Capital Conference, a public centrepiece of the UCP government’s recovery-oriented system of care.

The conference also happens to be organized by Last Door Recovery Society, the organization that licenses My Recovery Plan to the Alberta government. After a former staff member was charged with multiple sexual assaults in 2023, Last Door came under fire for alleged attempts by senior staff to prevent survivors and community members from coming forward. As individuals and treatment facilities load recovery capital scores into My Recovery Plan to shore up the government’s appearance of system monitoring, Last Door will grow its financial capital. Reducing deaths will remain a secondary concern.

To Tailfeathers, addressing deaths must be a top priority. The trauma of unending crisis and loss is “wearing down people at the frontlines,” while the government’s strategy is “way off the mark in terms of… healing people who are seeking the drugs.”

“If politicians are not measuring success, they can’t be held accountable for their policy decisions.”

It’s a sunny fall day seven months after my first meeting with Brandon Shaw, and my phone call with him is interrupted by someone dropping boxes of naloxone at his apartment. He’s been housed since spring, after detoxing at home with Staines’s support and getting access to a safe supply of hydromorphone. When he picks up the phone again he tells me, “Things are going amazing. I’m at a place in my life where I have more now than I ever have—emotional supports, people I work with in advocacy—all these people now that have come into my life…  Without my mom, I can’t guarantee you I’d be here today.”

When he was unhoused, he says, he was stripped of his voice and “tired of people crossing the street to get away.” With the support of 4B Harm Reduction, Shaw has launched a public education project—The Curbside Philosophy—to restore power to his community. As a society, he says, we spend so much time talking about unhoused people—Shaw wants us to speak with them. His project makes short videos situating real people inside the politics.

Not everyone from Shaw’s past has been able to transition to a life like his. “What keeps me up at night are the people I had to leave behind,” he says. His voice breaks as he describes the displacement of people who used to meet every day at the recently relocated Boyle Street Community Services, a ripple effect of the gentrification that is driving unhoused Edmontonians and their services out of the core.

Shaw knows his luck—in having Angie Staines as his mother, in surviving his interludes between the “revolving doors” of treatment, in finding a purpose with 4B Harm Reduction, in the grassroots community that supported him while he faced exclusion by the system. “I don’t want my whole recovery to be founded on… the fear of 12-step—having to tell everybody what a screwup you are. …When I screwed up, my community was behind me. People were just happy to see I wasn’t driven by fear and shame.”

Euan Thomson co-launched EACH+EVERY, which supports evidence-based, humane solutions to unregulated drug toxicity.

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Later that month, the Kenney government announced a panel, co-chaired by MLA Matt Jones and Minister of Children’s Services Rebecca Schulz, designed to address that question, or a version of it: How are children and teens being affected by the pandemic

The co-chairs tapped Kelly Dean Schwartz, an associate professor of applied child psychology at the University of Calgary, to be one of the experts leading the Child and Youth Well-Being Review. Schwartz signed on with reluctance. He was busy, he told me, deep into the largest ongoing study of kids’ mental health in Alberta during the pandemic. He didn’t want to join a panel that required his time only to write a report that would go nowhere. “I have 40 years of skepticism built into my bones,” he said about his initial response. But the co-chairs assured him there was a genuine appetite for bringing together different ministries, identifying problems and finding solutions. So Schwartz came on board.

For six months he and colleagues met with different representatives of government ministries and interviewed parents, agency representatives, teachers and physicians. They read nearly 10,000 surveys submitted by the members of public, including more than 500 from kids and more than 7,000 from parents. As the panel later pointed out in their report, the survey, while valuable, captures a moment in time during the pandemic and the responses come from a group of individuals concerned about the pandemic’s negative impacts on children, rather than a representative sample.

The panel heard a lot of frustration. Adults, including 75 per cent of parents and 90 per cent of professionals who took the survey, said they saw a worsening of child and youth mental health. Just over half—53 per cent—said they could not access sufficient mental health resources for kids. Children and youth said they felt lonely and isolated without being able to interact with their friends. They missed sports, libraries and extracurricular activities, and their mental and physical health suffered as a result. Teens told the panel their school counsellors were overwhelmed and unable to support them. The Kids Help Phone received 38 per cent more calls and texts and chats from kids over a 12-month span between 2020 and 2021 than in all of 2019.

Kids from low-income families were hit particularly hard. Many already lacked the basics essential for well-being; not just computers and internet access for school, but enough food. “Agency after agency and school divisions” told the panel they had to increase funding for breakfast and lunch for children at the expense of other services, said Schwartz. The families who struggle with food security, the panel heard, are often racialized and Indigenous.

Racialized children and youth, particularly from immigrant and refugee families, were disproportionately affected by the pandemic. Before COVID-19, they faced racism, poverty and language and employment barriers, in addition to, for many, trauma related to their migration. The pandemic made these worse. The 270 Indigenous parents who responded to the panel were also more likely to report that their children’s well-being worsened significantly over the pandemic. That was true in each category of well-being: social, physical, educational and mental. And Indigenous and Métis youth were already at greater risk for poor mental health and well-being pre-COVID—five to six times more likely to die by suicide than non-Indigenous youth.

Teachers told the panel that students had lower motivation and more stress, anxiety, hopelessness, aggression, bullying, self-harm and suicidal ideation. The educational impacts of the pandemic remain unclear, the panel found, but the evidence to date suggests things are not going swimmingly. Standardized testing in Grade 3 showed statistically significant declines in literacy and numeracy.

75 per cent of parents and 90 per cent of professionals saw a worsening of child and youth mental health.

The Child and Youth Well-Being Review report reinforced what individual experts had been saying about children’s mental health in COVID-era Alberta.

According to Schwartz’s own ongoing study, which he and colleagues launched at the onset of the pandemic, the impact on kids in Alberta has been uneven. Over the last two years, at three-month intervals, the team has surveyed a group of mostly teens, ages 12–18, in Calgary and Edmonton. It’s a diverse population of youth, including 37 per cent who don’t identify as white. Still, Schwartz acknowledges that the survey doesn’t reflect everyone’s experience across the province. The study excludes young children and rural youth—two groups that may have experienced more hardship than urban teens throughout the pandemic.

With data now collected up to the beginning of 2022, their findings suggest that many Alberta teens are doing OK when it comes to mental health. Sure, they hate the pandemic. They really hate it. They’re frustrated. They’re sad and stressed. They spend untold hours staring at screens. They miss all the things the pandemic has robbed from them: graduations, after-school sports, dating, face-to-face time with their peers. Those are natural and normal reactions to a ghastly situation. “I kind of bristle whenever I hear people saying, well, most or all youth are really struggling or suffering or in crisis, because our study would suggest they’re not,” says Schwartz.

But many others are really struggling. “The analogy that we’re all in the same storm but different boats—that really holds true for youth,” he says.

About 30 per cent of kids surveyed by Schwartz are having a very hard time. They’re acting out in dangerous ways, such as substance use and self-harm. They can’t concentrate or focus at school. They have higher rates of self-reported anxiety and depression. Some of those feeling the harshest effects of the pandemic had a previous diagnosis of a cognitive or mental health issue, and their symptoms have worsened. The kids most likely to be grappling with poor mental health are often girls, and they’re in the teenage population, between 15 and 18 years old. They’re more likely to live in families that have experienced major financial pressure during the pandemic. As for the effect of school closures, kids who went through multiple quarantine periods also reported more problems with concentration and attention, or had higher stress reactions than youth who attended in-person when schools were open or who were online the whole time. In other words, uncertainty and irregularity—of which there’s been plenty—hurt their mental health.

At Alberta’s hospitals, schools and clinics, mental health services for youth are overwhelmed.

Schwartz’s findings are playing out in hospitals, schools and clinics, where mental health services for youth are overwhelmed. “Kids are coming in record numbers for support, and they have more mental health diagnoses than ever before,” says Sterling Sparshu, a child and adolescent psychiatrist in Calgary. Our mental health system for children and teens was already stretched thin even before COVID. The province didn’t have enough school counsellors or mental health therapists or child psychologists or family physicians, pediatricians or psychiatrists, or even hospital beds designated for mental health patients. A 2019 report by the Canadian Mental Health Association of Alberta found that mental health was chronically underfunded here compared to other jurisdictions, with youth ages 12–24 representing the most underserved population. The pandemic made everything worse.

To deal with demand, mental health professionals are now squeezing kids in where they can, even if it means directing them to services where children can be seen faster but the care isn’t tailored to their issues. For instance, the wait-list for kids with treatment-resistant ADHD is very long in Alberta, says Sparshu. These children often end up seeking help from pediatricians or adult mental health services, even though they should see specialists in ADHD.

With nowhere else to turn, kids arrived at emergency departments in record numbers last year for mental health care. Between January 2021 and September 2021, 2,378 youth were seen at the Alberta Children’s Hospital for mental health issues—up from 1,725 over the same period in 2018. Across the province there were 7,106 emergency room visits by youth for self-harming, compared to 6,252 in 2018. “We’ve been overwhelmed by the increased numbers in our ERs,” says Chris Wilkes, professor of child psychiatry and pediatrics at the University of Calgary. “There is so much suffering and compromise going on.”

Eden McCaffrey, a child psychologist who works in public and private practice and helps train family physicians to care for kids with mental health issues, says she’s seeing more severe mental health symptoms in the children who end up in hospital. “There’s a lot of eating disorders, increased depression, anxiety, a lot of self-harming and ADHD,” she says. Kids with mental health issues are ideally treated at home with community supports. “It takes a lot for kids to have to be admitted to hospital,” she says.

Pediatrician Roxanne Goldade runs a private practice specializing in kids with mental health issues. In her 26 years of caring for kids, she has never witnessed this level of need. “I’m exhausted. My staff are struggling. Parents will phone and say, ‘My child has been cutting,’ or ‘My child talks about suicide and they need to see the doctor now’,” she says. In order to see as many children as possible, Goldade books in patients an hour earlier in the morning than she used to, and she sees them over lunch and into the early evening. “We’re just stuffing patients in,” she says. But her wait-list never gets shorter. It’s now three months long.

Kids who did multiple quarantines at home reported more problems with concentration and attention or had higher stress reactions. Image by Alamy.

The crush on the province’s doctors and hospitals is being driven by storms on two fronts: on one side, the pandemic, and on the other, the absence of a strong, publicly funded, community-based mental health system for children. In an ideal world, children’s mental health care wouldn’t begin with privately paid psychologists, or even with pediatricians, psychiatrists, emergency physicians or family physicians. Care would start in the community and begin long before a child’s mental health becomes a case of illness.

Goldade says the best mental health care system functions like a pyramid. At its base are schools, where families are supposed to be supported by a team that is alert for potential issues in students. Schools would have readily available counsellors and support staff to help individual children with learning disabilities, speech issues and behavioural problems—things that can leave lasting scars into adulthood if left unaddressed. School staff would be able to teach and model mental health literacy, which requires time and energy, two things in short supply in schools at present.

The next level of the ideal pyramid is publicly funded psychologists. In Goldade’s dream, there’d be no restriction on the number of visits. “Right now you can get six sessions and that’s it, you’re out,” says Goldade. “Nobody gets fixed in six sessions!” At the next level of care, a child can access family physicians and pediatricians for mental health care; above that, psychiatrists. At the very top of the pyramid is hospital care, the last stage in an integrated system. Goldade says she’d be delighted if her patients could get help long before they saw her or a psychiatrist or needed hospital admission. “If we could empower families and the schools at the bottom end of that pyramid, we would serve them so much better,” she says.

In her view, mental health care should function like cancer care, where patients generally move seamlessly through levels of care with different disciplines of medicine and community supports working together. As it stands now, in mental health, it falls to parents and caregivers to navigate a system consisting of a patchwork of programs designed for kids, but parents have no one to help them figure it out. Families are forced to pick through a hodgepodge of government services and agency programs, all while managing the stress of having an ailing child and the challenge of being a caregiver during a pandemic, when school might or might not be available this week. “I hear parents who are really, really struggling and have been doing the best they can,” says Sparshu. “They feel frustrated trying to navigate a system that’s incredibly complex.”

Tarita Carnduff, a mother of five in Camrose and a former public health nurse, has spent more than a decade trying to find the best options for her kids, two of whom have learning disabilities and another who has mental health issues. She says they can’t get the help they need in schools. She pays out of pocket for one child to see a psychologist, spending $400 each month to cover two private sessions. She’d like to send at least one other child to a psychologist but can’t. “I can’t afford to have more than one child being seen by a psychologist,” she says.

The school-based mental health system, which was never robust, has over the last three years been eroded by cuts. In spring 2020 the UCP government stopped funding the Regional Collaborative Service Delivery (RCSD), a partnership among schools, AHS, Social Services and community stakeholders. The RCSD oversaw delivery of services such as mental health supports, speech language therapy and occupational therapy in 17 regions across the province. The funding was redirected to school boards through grants—a change made, in part, at the request of school authorities. But that shift disrupted how these services were delivered and led to the removal of AHS mental health therapists who had been working directly in schools—severing a connection between schools and mental health professionals.

“My first wish to address kids’ mental health is to bring back the school mental health system. Please bring it back,” says U of C’s Chris Wilkes. “We just don’t have the frontline services in schools that could keep kids from needing care in emergency rooms.”

Most children and teens spend five days a week in school under the eyes of adults whom they generally trust and who get to know them well. Image by Alamy.

It makes sense that schools play a vital role in kids’ mental health. Most children and teens spend five days a week in school under the eyes of adults whom they generally trust and who, in turn, get to know them well. Teachers and other school staff can pick up on changes in a child’s behaviour early, leading to early intervention that can stop the spiralling consequences of neglected mental health or cognitive issues. Logistically, school-based services are relatively easy for families to access. Maybe a parent can’t get time off work to take a child to see a therapist in the middle of the day or they can’t afford the $180 (or more) per hour for private therapy. “It’s not that parents don’t want help for their kid,” says Schwartz. “They just can’t get it.”

He says that 8 out of 10 kids who do get support for their mental health receive it in schools. It’s often done informally—a teacher, librarian, speech pathologist or counsellor assists a child who’s struggling. Before the pandemic, a teenager who’d come to Canada as a refugee told me that, with her teacher’s encouragement, she used to write notes to her teacher about what she was feeling as she adjusted to life in Calgary. This had really helped.

In rural Alberta, schools might be the only regular source of mental health supports for kids.

In rural areas of the province, schools might be the only regular source of mental health supports for kids, says Leigh Wincott, a pediatrician at the University of Alberta who also works in rural and remote areas. Many northern Alberta communities lack mental therapists, child psychiatrists, pediatricians and even family doctors. Schools try to fill the gap, but they don’t have the supports they used to. “Schools have also lost a lot of their financial resources,” says Wincott. “They have to make some hard decisions about where to put resources.”

The Alberta Teachers Association (ATA) said its members are reluctant to speak on the record about how they see the pandemic weighing on students’ mental health because they’re worried about their jobs or about being seen as criticizing school boards. But the ATA has conducted regular surveys of teachers throughout the pandemic. In November 2021, 79 per cent of teachers told the ATA they were moderately or extremely concerned about student mental health, particularly anxiety and depression. About 85 per cent said children in their classes were struggling to learn.

Given the state of things, many teachers feel beaten down and burnt out. They feel the effects of a multi-layered crush brought on by the ongoing curriculum debacle, contract negotiations, ballooning class sizes and, on top of everything else, the pandemic. Three-quarters of teachers in the most recent ATA survey said they’re worried about their own mental health. COVID-19 has kept them on a rollercoaster ride. They’re facing classrooms with more kids than in the past and kids with more complex and diverse needs.

“I keep telling [my colleagues] that the cavalry’s not coming,” said one teacher who asked not to be named. “Nobody is coming to say ‘You’re going to get a counsellor at your school or have additional supports in your class.’” The pandemic means extra duties for school staff, including making online lessons for students at home and managing contact tracing. Eighty per cent of principals in the province have performed contact tracing for their school, which can take as long as three hours for a single case.

Phil McRae, associate coordinator for research at the ATA, questions why no additional supports have been provided by our provincial government to schools during the pandemic. “If they’re truly concerned about mental health, why don’t we have more counselling available in school?” he asks. “It’s been a slow, constant erosion of support.”

The Child and Youth Well-Being Review Panel released its report just before Christmas 2021 with 10 recommendations for the provincial government. They called for new supports designed for children and youth, along with a review of existing child and youth mental health programs to bring them into alignment. Schwartz said Alberta’s existing resources for youth mental health are too disconnected and hard to find. “If I don’t know about them,” he said, “how does a family who’s not in this field begin to know about them?” The panel called for changes to make it easier for families to access help. They want better broadband internet services and “more equitable access” to devices such as laptop or tablet computers.

In their report, Schwartz and colleagues said schools can and should play an essential role in caring for the mental health and well-being of students. To do that, schools need more support. “I’m a huge proponent of school-based mental health services,” said Schwartz. He added that the recommendation to turn schools into hubs for mental health services is not designed to foist more responsibilities onto teachers. It’s intended to take pressure off. “Right now [teachers] feel like they have to be the social worker, the psychologist, the nurse,” he said. “Let’s allow them to just be the teacher.”

Schwartz believes the province needs to focus on “go-to structures”—services in places where children and teens already are. Those places are schools. Schwartz wants schools to provide wraparound services such as psychologists, mental health therapists, speech therapists and even nutritious meals for kids from lower-income families.

Everyone who spoke to me for this story recommended the same thing: Schools should be a hub where kids can receive support for mental health in addition to being places of learning. It’s not enough for the government to say it’s keeping schools open to protect kids’ mental health. That’s the bare minimum. We truly protect kids by getting services and care to them, and the best place to do that is schools. The buildings exist. The kids are there. The services are the missing component. And kids do improve when they receive good care. “There are safe and effective treatments for mental illness,” says Sparshu. ”Although there is a lot of suffering right now, there’s still hope.” 

For its part, the Kenney government says it will review the recommendations and create an action plan, to be released “this spring.” At least one expert remains skeptical. “To accomplish these recommendations there would have to be a shift both in how we think about services and how we coordinate child and youth services,” said the U of C’s Chris Wilkes. “Most importantly, financial support is required. I see no evidence that children and their well-being and mental health are going to become a true focus for this government.”

The two UCP MLA co-chairs who organized the review announced the panel’s report at a December 2021 press conference at south Calgary YMCA, where the sounds of rubber balls squeaking on gym floors below echoed up into the microphone. The pair’s words did not inspire hope that this government will build a community-based health system designed to support kids over the long term.

“Our kids need help right now,” said Minister Schulz, “which means our strategy will focus on the immediate action without tying our hands for the future.” In the meantime, wait-lists are growing.

Christina Frangou specializes in reporting on health, medicine and social issues and has won a National Newspaper Award and two National Magazine Awards for her feature writing.

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“I’m at the St. Albert Inn and I think someone has poisoned me.”

“We’ll send someone right away.”

I hadn’t been poisoned. I had just spent the night in a hotel room after taking cabs all over town, causing all kinds of “disturbances.” One of them was going to the home of a young woman I went to school with and walking into her house and talking to her family. When her dad found out who I was, he exploded and told me to get off his property. I tried to ask him what wrong I had done him or anyone, but he was livid, so I got back in the cab I had waiting and went back to the hotel.

I had just eaten breakfast, which was served by another young woman I went to school with. Everyone knew everyone in St. Albert. I even knew the front desk clerk from my Air Cadet days, but didn’t talk to him as I sat and waited for the police to come. They asked around, found out I was a local and ended up asking me to come with them. They took me to the Sturgeon Community Hospital. I was experiencing severe psychosis, and my call to 911 was a desperate cry for help.

At the hospital my mind kind of went in different directions. The police stood staring at the wall, silent as death, and I read out loud from a children’s book for no apparent reason. Then the doctor came and I called him derogatory names and said I went to the young woman’s house on orders from her father, who was a general in the Canadian Armed Forces (he wasn’t). A struggle ensued and I was given a powerful injection and taken back to the police car.

This wasn’t the first time I had been taken to the hospital in this way. But I had the same fears as the first time. Were these cops going to take me out of town and beat me up and leave me in a ditch Were they going to take me to my multi-million-dollar mansion my delusional thinking told me I owned Or was I simply going back to the one place in the world I never wanted to be: 9B-South, the lockdown ward of Alberta Hospital?

In my own experience, psychosis has four parts. The first is delusions. These are thoughts, false thoughts that can be persecutory, grandiose or religious. Mine were usually grandiose. The thoughts would take things I saw and heard and reinterpret them. I would mishear something and then play it over again in my head and it would come out as a fake memory that my delusions ran with. Hallucinations are the next part. I didn’t experience these often when I was younger, but basically hallucinations are delusions in action. They are false sensory inputs which reinforce your delusions. If you have a delusion that you’re a billionaire, you may hear someone say your limousine is waiting outside to take you to your mansion.

The next aspect is paranoia. Every part of psychosis takes small steps towards making your delusions seem like the most logical possible answer to what you’re experiencing. If you keep having delusions that people can read your thoughts and that you’ve travelled far forward in time, you may logically conclude that you’re not in a hospital, but under the control of alien invaders. It may be so convincing that you run down the street with your clothes off (of course the aliens can’t see you, only your clothing), screaming and shouting that people have to hide and run away. You realistically believe you’re saving lives, but in reality you scare most people half to death.

The last aspect of psychosis, and one of the main characteristics of major mood disorders such as schizophrenia and bipolar disorder, is that you have a general susceptibility to believe bizarre and unusual ideas. In recent times, amazing medications have been developed that help with these symptoms, making people once unable to align themselves to reality almost fully functional.

Gregersen teaching in an Alberta Hospital cafeteria, 2022. “I tell my students about journaling, how it can benefit writing and mental health, and then I teach them simple poems.”

I woke up in 9B-South on a comfortable bed in an isolation room. It was worse than having a hangover, because when I started to recover from the severe side-effects of the tranquilizer I’d been given, I was heavily medicated. This sort of left the feeling that I’d been beaten up with repeated blows from a rubber hammer. And to top it all off my thoughts were going a mile a minute.

When you’re in the hospital it’s so critical to have a buddy, a friend you can talk to. One of the unfortunate things about Alberta Hospital in Edmonton is that while they may acknowledge this fact, they leave it up to you to make friends. The first time I was there I had no friends; I was, in fact, a stuck-up jerk. I didn’t feel that the people in the hospital were worthy of my friendship, and I was under the mistaken idea that I had many friends back at school. In reality only one person outside my family visited me, and I treated him poorly. Once, in a hospital in North Vancouver, BC, I was assigned an employee as a “buddy” or peer support worker. He would show me around the ward, explain the rules, mediate if I got into any disagreements. It was amazing.

During the hospital stay after being taken out of the hotel in St. Albert, I had a buddy who was my age and was a patient. He seemed perfectly normal, but at odd times we would talk about something and he would just sort of “click” out of his normalcy and repeat things I said, and for some reason I felt I had done something wrong. It was so critical to have him as a friend, though. At one point I was in a terrible state, watching TV and feeling the pain and guilt of being in the hospital, as well as my illness, combined with boredom, and he simply said, “Do you like to draw?” He was drawing on some paper beside me.

“Yeah, I guess so. I’m not really that good.”

“Here, try to draw a picture of this.” He handed me a drawing of a tiger and a blank piece of paper and a pencil.

I sat there and focused for a while. It was hard, but I pushed myself to do it. Anything was better than sitting there listening to the dialogue going on in my head. About a half hour passed and I was starting to enjoy the activity. Then my new friend said, “You see Now we’re no longer in a mental hospital.”

I think I’ll carry that advice to my grave. I’ve now used it so many times when I didn’t feel like showering or doing my laundry or sitting down to write things no one would read unless they were perfect.

The time when I first went to the hospital, at the tender age of 18, a woman seemed to mistake me for a man named Vern, who had done her some wrong. She often yelled at me for it and there was no convincing her she was mistaken. Then, a month or two later, I had miraculously improved with medications and was soon going to be released. I ran into the woman on the grounds, and she seemed to have improved as well.

She told me, “Oh, good to see you’re feeling better. You’re going home now?”

I hate myself sometimes for what I said to her: “Of course I’m going home. There never was anything wrong with me!” There had been a lot wrong.

This condition, known as anosognosia, is common with mental illnesses. Even though I’d gotten into legal trouble and fights and was thinking preposterous things, and under treatment had seen my thoughts return to near normal and had forgotten all of my delusional, grandiose ideas, I didn’t understand I was ill. This is what often makes it very hard for people to keep taking their medication, which I of course didn’t do when I had a chance to go home.

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I have an illness called Schizoaffective disorder with anxiety. I have a few odd symptoms of other illnesses but none sufficient for a diagnosis. What my official diagnosis means is that I have a rare combination of schizophrenia and bipolar disorder, and that some things, like social situations or being in a car and not being the driver, can get me so worked up I want to jump out of the car or run away from the situation. I believe I also have post-traumatic stress disorder, because even now, years after certain traumatic things happened (like being arrested in my high school and taken to a locked psychiatric hospital ward), events keep replaying themselves through my head. I also have symptoms of obsessive compulsive disorder. For example, there is a young woman I dated in high school who I last spoke to over 25 years ago, and though I don’t contact her, I often have romantic dreams with her in them and I often replay our final conversations over in my head.

It terrifies me to think that I might be a stalker. I’ve never gone to the point of getting binoculars and hiding out at someone’s workplace or home to take pictures of them. A couple of times, in states of desperate loneliness, I’ve written to this woman, but not for 20 years. I went to my psychiatrist and told him my fears and he said that if I were a stalker, I wouldn’t be coming to him for help with the obsession, which quieted my fears.

The amazing thing about my severe mental health conditions is that all of them are treatable. I take a lot of medications each day. I take a mood stabilizer, an antidepressant, an antipsychotic and a pill for side effects of the other medications, such as tremors in my hands. I need more medications to treat my diabetes, and I get an injection of antipsychotic medication every two weeks. I’ve wanted to go into therapy, but I’ve run into a lot of barriers in cost and availability of counsellors. This is sad, because studies have shown that therapy alone is proven to work better than medication alone. This isn’t an indication that I need to stop taking my medication and get therapy; I’d like to do both for the ultimate benefit.

During the hospital stay when I learned to draw to focus away my difficulties, I was sent to a more open ward. I made a friend there who was suffering from severe schizophrenia and often talked in delusions. I accepted that he had ideas that weren’t based in reality, and we ended up close friends. One time I looked in his eyes and it was as though I could see his troubles—his madness, if you like—and he said, “I am everything at once.” Another time a similar thing happened and he said, “That girl doesn’t want her husband, she wants me, because I’m the smartest and the strongest.” These were odd thoughts, but I understood where he was coming from.

A few years later I ran into this same person… or at least he looked similar. It was in a clinic, and he had gained a fair bit of weight. Understandably; medications make you hungry and tired most of the time, so weight gain is almost inevitable. But he had transformed in another way. He was completely rational and clear-headed. He didn’t remember me, but I confirmed with another person that he was the same young man. At some point medications known as “personality drugs” were developed that can bring people back from the brink.

Every day at work I see staff members I know, or knew, or worked with. They have become like family.

On Sunday evenings I always try to go to bed early. Though I don’t like doing it, I will take a pill to help me sleep if I don’t feel tired enough to drift off right away. I wake up at around 5 a.m., as I do each day to take my morning medications, but Mondays I stay up. I often fidget and am nervous. I pick a clean, collared, long-sleeved shirt from my closet and shave, brush my teeth and put on some cologne. I might read or watch YouTube for awhile, then finally 8:20 comes and I walk to the bus.

I take the bus to the LRT, then take the LRT to the very edge of town. Then I board a bus headed for the boonies. The road has changed since I first went down it in the back of a police car. There are no direct routes to the hospital; the bus takes a circuitous route through a residential district, then bounces and bumps down a badly kept road, and finally I’m back at Alberta Hospital. I make my way to the bistro. It used to be a patient-run cafeteria where you could get cheap hamburgers and fries and coffee that was better than what they had on the wards. Now it’s a room full of tables and chairs, and it is my workplace.

I usually start up my laptop, handle any business I need to take care of and then plan for my lesson. I teach creative writing to patients each Monday morning, and I’ve done it for long enough that I don’t need to do much to prepare.

I’ve learned so much from doing this. Even though I haven’t been that 18-year-old jerk from St. Albert for a long time, I still need to humble myself. Some people who come to my class are still very ill. Many of them have experienced horrible things, from childhood sexual abuse to treatment-resistant schizophrenia. One young man who used to come to my class to develop a newsletter has spent five years of his life in here, with no end in sight. I try to give these people my best.

The staff here are incredible. I work with a recreational therapist and I make her do all the exercises I give the class and she enjoys doing them. Every day at work I see staff members I know, or knew, or worked with, and they are not monsters. They have become like family.

Sometimes I get the chills as I walk past buildings I spent long, deeply unhappy chunks of my life in. But there is so much beauty in this place. Even in Building Three. This is the Helen Hunley Pavilion, where people found “not criminally responsible” for their crimes go. I have had friends who were in there for short periods, and they say they actually prefer it to the stricter rules in the rest of the hospital. I think Building Three is beautiful, because even the worst criminals, even the people who have done unforgivable murders, are given care, understanding and forgiveness, not just whipped and chained.

On a normal day I spend part of the class teaching from a poetry book that’s actually meant for young students but is perfect for the cross-section of people in my classes. I tell them about journaling, how it can benefit writing and mental health, and then I teach them simple poems, how to write haikus, then rhyming poetry. Once, just a few weeks back, I had all the patients work together on a group poem. Each person in the class contributed one or two lines, and I wrote them out, polishing things up a bit. With their permission, I took the poem home and typed it up and submitted it to a literary journal put out in Saskatchewan by the Canadian Mental Health Association, TRANSITION. To my great joy, the editor loved it and told me it was exactly the kind of thing they exist for. They’ll send a small payment for the poem when it’s published, and I’m going to buy some very deserving patients donuts or possibly pizza.

When we eat, I’m going to tell them: “You see, when you focus, it’s no longer a mental hospital.”

Some in Gregersen’s writing class “have experienced horrible things, from childhood abuse to treatment-resistant schizophrenia.” Photograph by Leif Gregersen.

One other thing I do gives me a sense of pride. I work for the Schizophrenia Society of Alberta and I give talks to groups in the general public about mental illness. I put everything I have into these talks. I give a set presentation, but I like to constantly learn more and relate what I teach to what I’ve been through. One group I’m always sent to is the Edmonton Police recruit class. This is an interesting experience, because I give my talk to 50 uniformed cadets. Once, going into a local hospital, an officer was just leaving and he stopped me.

“Hey—you taught my class!” he said.

“Yeah, that was probably me,” I replied.

“I want to tell you that I’ve had two mental health calls today alone, and what you taught me was totally invaluable.”

These situations mean the most to me. When I know I’ve taken all the pain, all the fear, all the anger from being “cursed” with a mental illness, and turned it into something meaningful and important to others who also suffer. At times like these, my mind has an odd reaction. Even though I’m way too old and my health isn’t up to it, I often now have dreams that I’m a cop. And it actually feels kind of cool.

Leif Gregersen writes about living with mental illness and works for the Schizophrenia Society of Alberta in Edmonton. His newest article for Alberta Views is in the March issue, on newsstands now.

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The scene is at odds with the hotel’s gilded past. Thanks to its proximity to Northlands Coliseum, the 16,839-seat arena just across the road that the Edmonton Oilers used to fill, travelling athletes and celebrities once stayed at the Coliseum Inn, including the Rolling Stones, Deep Purple and the Eagles. When COVID-19 arrived in March, the Inn’s 98 rooms were shut down like all Edmonton hotels. Weeks later the rooms were reopened. The new guests were not rock stars but homeless people.

One of them was Rob Sharkey. Sharkey slept on his brother’s couch for six months until COVID-19 hit. That was when the 40-year-old and his brother realized that their dad, who has a lung disease and who also lived in the house, was at high risk of contracting the virus. Sharkey left. Some nights he slept under brush, others on a mat at an Edmonton gym repurposed into a shelter. Sharkey, a father and ticketed welder who once owned his own company and now has colon cancer and bad credit, would wake and get himself across Edmonton to the city’s day shelter at the Expo Centre, which was feeding people. During those first few weeks of COVID-19, nothing else was open. Finding food, he says, was constant work. It left him with near zero time to solve his actual problem, which was that he was homeless.

Sharkey’s strategy was to build up energy for apartment viewings. “The choice was eat and remain homeless or starve on a ‘maybe’ for an apartment,” he says. Meal lineups at the Expo Centre shelter, where he and more than 500 others gathered daily, took at least 90 minutes. Apartments that fit his $700-a-month budget dictated by the Assured Income for the Severely Handicapped [AISH] he collects were often at the city’s edge. The bus to view them ran on a reduced schedule. If he wanted a clean shirt so he didn’t “smell like bugs” and had a better shot at impressing a landlord, he had to sign up for a laundry machine, take more time, miss more meals. Given that his cancer means he needs a high-calorie diet just to keep weight on, Sharkey says every three days or so he could charge up enough to see an apartment. “That was about the best you could do.”

And yet Sharkey says that while the pandemic put him outside, several weeks later it also created a roof for him. In late April he got a shared room at the Coliseum Inn. Here he was able to clean his clothes, search the internet for apartments, get references from outreach workers and eat regular meals. The hotel is one of several across Canada—including one in Toronto dedicated to women fleeing domestic abuse (a “shadow pandemic” of violence against women has been a side-effect of sheltering in place) and one in BC bought outright by the provincial government—to house people during the pandemic. All of it happened as a response to COVID-19.

Albertans may have expected homelessness to be less of a challenge as the pandemic arrived. The province, after all, had committed to “A Plan for Alberta: Ending Homelessness in 10 Years” back in 2008. Twelve years later, in the seven cities where the push rolled out—Edmonton, Calgary, Lethbridge, Medicine Hat, Red Deer, Grande Prairie and Fort McMurray—the results were wildly impressive. But they are also incomplete. Medicine Hat is now known as a city that “eliminated” homelessness in 2015, but officials there say shelters are still used and demand has grown during the pandemic. In Calgary, of 2,911 people experiencing homelessness in 2018, more than 1,900 were chronically homeless (i.e., had been homeless for a year or longer). Edmonton’s 755 emergency shelter spaces (as of June 2020—the number fluctuates with funding), which should now be only for short-term crises, were often 90 per cent filled on a typical night before the pandemic. A 2019 report found that 1,923 people were chronically homeless in the city, and 486 of them, about half of whom self-identified as Indigenous, chose to camp outside.

Homeward Trust, an agency that leads several other Edmonton organizations in the collective push to end homelessness in their city, has managed to house more than 10,800 people—just a touch less than the population of Canmore—in the 12 years. But the organization has struggled with those who are chronically homeless. Simple housing isn’t the solution for this population, says Susan McGee, the organization’s chief executive officer. “They need home care,” she says. This includes various supports such as treatment for addictions and help with managing the challenges of daily life. Without such support, the chronically homeless end up back on the street and in shelters at night.

Shelters are always a concern but become doubly so during a pandemic. When COVID-19 hit, politicians suddenly saw them as a liability. In Calgary this fear proved warranted when 24 people staying at the Drop-in Centre tested positive for COVID-19. The federal government, in early April, committed $157.5-million in emergency funding to the homeless-serving sector across Canada “to just do whatever we could to house people as fast as possible,” McGee says. Public opinion was firmly behind the idea. Soon after, in late April, Homeward Trust partnered with Boyle Street Community Services to offer bridge housing at the Coliseum Inn. Days later Sharkey moved in. 

Organizations in Edmonton have called for bridge housing for years. Wait times for a homeless person seeking housing in Alberta average more than 40 days, and often stretch beyond 90. People need somewhere safe to be during this period. Homeward Trust had inspected locations for bridge housing and written requests for proposals. Small pilots at Edmonton hotels had been evaluated and greenlighted. But the idea to scale it up always hit a wall.

Until the pandemic.

We may be witnessing a permanent shift. More-liberal elements of society have long called for homelessness to be eliminated on moral grounds. Later, research showed that every $1 spent putting someone in housing in Canada saved the public $2. If we add to these two imperatives the public health benefits of housing the homeless—and our growing realization that shelters are potential threats to all of us—the political will found during the pandemic might just continue.

The story of how Alberta came to be a leader in ending homelessness starts in Calgary in 2007, at the apex of an oil boom. Many people couldn’t afford rents and teetered near homelessness. Tim Richter, who worked at TransAlta at the time but now runs the Canadian Alliance to End Homelessness, took a role on a committee tasked with ending homelessness in the city, and says he was struck by the promise shown by one of its underlying big ideas—housing first. It was a 180-degree flip from former policy. Previously social agencies required people to be sober and off drugs before they would be provided with housing.

In practice, says Sam Tsemberis, a Canadian who created the Pathways to Housing program in New York that came to be the model for housing first, we were asking too much. “We don’t require average citizens to be clean and sober to sign a lease,” he says. “Imagine how many more homeless Canadians there would be if we required that!”

According to the Canadian Homelessness Research Network, “housing first is not contingent upon readiness, or on ‘compliance’ (for instance, sobriety). Rather, it is a rights-based intervention rooted in the philosophy that all people deserve housing, and that adequate housing is a precondition for recovery.” This, mixed with Calgary’s heightened empathy and community leaders demanding change, created a decisive moment. “The culture in Alberta allowed us to look at this and say, ‘If this is a solvable problem, why don’t we just get on with trying to solve it?’” Richter says.

The new approach was to house people as quickly as possible to save lives and costs. If a person needed to dry out, be treated for mental health challenges or weaned off substances, they could better do so in their own house than on the street or in shelters. Tsemberis came to Calgary in 2007 to plant the seed. By 2008, thanks to Richter and others on the new Calgary Committee to End Homelessness, housing first became provincial policy and spread across the seven Alberta cities.

That same year, the federal government got on board with “At Home/Chez Soi,” the world’s largest-ever trial of housing first, across five Canadian cities. The study found that people in the housing first program stayed in housing 80 per cent of the time, versus less than 40 per cent of the time using traditional approaches. This led Stephen Harper’s Conservative government to change federal policy. The Trudeau government has since introduced a 10-year national housing strategy in 2017 which commits $55-billion and promises the building of 125,000 new homes.

Thanks to this work Alberta is the only Canadian province to have reduced homelessness across the board, Richter says. Richter has since formed the Alliance to share how Alberta succeeded, since so many people were asking. Several communities are following our lead. “We’re seeing Alberta’s fingerprints in the responses we’re seeing around the country,” he says.

The stars are Edmonton, which has reduced overall homelessness by nearly half and has predicted an end to chronic homelessness by 2022, and Medicine Hat, which in 2017 became a worldwide success story featured in The New York Times. The city’s housing-first work since it launched in 2008 has put 1,269 people into an apartment or other housing. “We were known for ending homelessness,” says Jaime Rogers, who leads the Homeless and Housing Development department in the city. “But that doesn’t mean we don’t have people who are still falling into homelessness. What it means is that our system of care is operating effectively to actually get people quickly out of the state of homelessness. That’s housing first.”

During the pandemic, that system has hit many bumps. “The biggest shift is the volume of people we serve that are new to the system,” Rogers says. These people were vulnerable before the pandemic but have tumbled into homelessness during its first months. In addition, a large number of people were released by the corrections system to reduce the chance of viral spread in institutions—without forewarning or planning—and ended up “downstream” in the community’s housing system.

What’s it like to be homeless in a pandemic? To answer this, I’m walking with Doug Cooke, outreach manager with Boyle Street Community Services. It’s mid-April and we’re in Edmonton’s river valley, which during the ongoing lockdown has become a cluster of colourful tarpaulin camps and associated dumps. Cooke says the city has agreed to leave these during the pandemic (though as this story went to press, city bylaw officers and police had cleared some camps and their residents due to public outcry).

Cooke says we are looking for “Frank.” He lives just below the office towers downtown in a forest bisected by a freeway. Hundreds of others live here and in other valley nooks year-round, Cooke says, in areas with special names: Coyote Landing. UFO Camp. Jug-handle. The camps are impressive things. We walk to one where a man has burrowed a sort of bunker house into the soil just 10 feet from a popular bike path. Another has built a house, complete with a front door and windows, on an unused staircase in a park. Neither is home when we stop by.

But Frank is. He’s happy to see us but unhappy with the pandemic. “It’s hard to do anything,” he says, emerging from beneath a blue tarpaulin. Frank is white, in his late 40s or early 50s, skinny. His eyes are reddened. He wears a flannel jacket, brown Carhartt pants and a headlamp. “It’s hard to get meals, to maintain any sort of diet.”

Frank is chronically homeless. Cooke’s team has found housing for him in the past through Homeward Trust, but Frank has ended up back in his camp.

For many in his situation, it’s a common story, Cooke says. Without medical support and help in managing an apartment, people can revert to the “known” of homelessness. Finding accommodation again is difficult. The wait is long. Keeping tabs on people is always a challenge, but the pandemic makes it nearly impossible. Landlords have not been showing apartments. Doctors have not been seeing patients. All these steps slow the ability of a person like Frank to get out of a camp and into a house.

And Frank says he feels better outdoors during the pandemic. Shelters are closed except for the night facility at the Kinsmen Sports Centre or the isolation area at the Expo Centre for those with COVID-19 symptoms. “I pretty much isolate myself from everyone. I don’t want company.”

Today the scuttlebutt in the camps is about one guy with apparent symptoms who’s out in the river valley. “He’s a junkie,” Frank says. “He won’t turn himself in because he doesn’t want to be dope sick [at the isolation shelter, which does not have a supervised consumption site]. Somebody needs to go on TV about it. The cops have been looking for him.”

Last year the United Conservative Party government cut into parts of Alberta’s social safety net. This included shrinking the Rental Assistance Program by 24 per cent and reducing the affordable housing maintenance budget by $53-million. Calgary mayor Naheed Nenshi called the latter move “a shocker.” “We are in a position where [when] someone moves on, out of affordable housing, we can’t give their unit to someone else because it doesn’t meet basic life requirements,” he told reporters. “No good can come of this… what a bizarre place to cut your capital budget.”

Many people I spoke to said off the record that they were “troubled” by other parts of UCP government policy, particularly abstinence-based programs around substance use. “How can we possibly go backward?” one person asked. “We just spent years demonstrating that this doesn’t work very well.”

For homelessness, the competing force to this trend is COVID-19. Public health can now be added to cost savings and the moral imperative to end homelessness.

And demand is only expected to grow. “We are going to have a tremendous amount of families that will experience homelessness for the first time,” Rogers says of the next year in Medicine Hat and Alberta in general. “If people have housing right now, we need to maintain them in their housing and then work really hard to get those currently experiencing homelessness out of that state. Housing is key. We need to have adequate housing and rent supplements in place.”

There will be renewed questions of jurisdiction. Housing First has been a collaborative push from community organizations, municipal and provincial governments and Ottawa. But when it comes to spending big money, the situation has often been “the political equivalent of a high-school dance,” Richter says. “Everybody’s stood along the wall looking at their feet, waiting for someone else to make the first move.” What needs to happen post-pandemic, he says, is for the Alberta government to get engaged and support its biggest cities—a woefully missing ingredient at the moment—on accessible housing. (As this story went to press the City of Edmonton committed $600,000 to add 78 bridge-housing units at a former jockey dormitory at Northlands, and $40-million for another 207 units of permanent supportive housing—with Mayor Don Iveson citing the “provincial government’s abdication of leadership.”) Better provincial support could “drag the feds” to invest more, Richter says.

Challenges from often hidden causes are inevitable. Ronald Kneebone, a University of Calgary economist who has studied the effects of public-sector policy on homelessness, says a key driver of chronic homelessness is poverty. This is linked to the paltry support—Assured Income for the Severely Handicapped and other benefits—people receive in Alberta, especially those who are single. “On that level of support [AISH], about $8,000 a year, there’s no frigging way they can maintain their housing in Calgary, and so they end up in shelters,” he says. “It’s very much the canary in the coal mine. If the shelter system is tending to overflow, there’s something wrong with the rest of the system.”

Targeting shelters won’t change this reality, Kneebone says. Targeting poverty will.

But there will also be financial reckonings. Pre-pandemic, Alberta had switched to an austerity footing, with cuts across the public sector and more planned. Some may want to believe circumstances require Kenney to spend more on social goods. But Kneebone and several others are not convinced. “When governments are scrambling to save money, poor people tend to be left out of the equation,” he says.

The most powerful tool to prevent a massive backslide toward a homeless epidemic is framing. Providing the homeless with housing saves money and doing nothing costs money. That’s one frame. To this, add the frame that housing is a form of healthcare.

Says Susan McGee: “We’re just killing ourselves to house individuals, working as hard as possible to keep those numbers up all the time, support people and maintain their housing. The rest of the system isn’t coming into place the way our original efforts envisioned.”

Tim Richter, though, is optimistic. He sees a similar groundswell of public empathy post-COVID-19 that he saw 12 years ago in Calgary. “Albertans are now at home, and we see that housing is health care. We feel the same anxiety and uncertainty around the future. I think there’s an opportunity that Albertans will say ‘We see how close we came.’ ”

Back at the Coliseum Inn, I ask Rob Sharkey if the pandemic could change things for the better. “There’s obviously the need. This place has a bunch of people in it and there’s a lot of people on the street.” Without a hotel, or somewhere to stay to find your feet and actually get into more permanent housing, he says, “you’re not helping stop the spread of anything.”

That’s likely true of homelessness as well as viruses.

Sharkey tells me he now has the energy to view three to four apartments a day, and even has a line on a place for next week. And he sees the irony. “If it wasn’t for the pandemic, the funding wouldn’t be available, so there’s a silver lining in every cloud.”

Tim Querengesser lives in Edmonton. He is finishing his first book and producing a history podcast with Canadian Geographic. 

Amber Bracken is a photojournalist arrested in 2021 while reporting pipeline protests. In 2022 she won the overall World Press Photo of the Year for “Kamloops Residential School.”

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The post Suddenly There’s Room at the Inn appeared first on Alberta Views.

Coleman has an affinity for big-picture, strategic thinking. He studied the measurement of organizational performance of police organizations for his Ph.D. from the University of Regina. He was also a cop in Calgary for 27 years and then the chief of police in Moose Jaw for another 10. In the early 2000s Coleman formed an unlikely partnership with a forensic psychologist from Ontario. Coleman and Dorothy Cotton set themselves the ambitious goal of reforming how police respond to citizens in a mental health crisis. They collaborated on pioneering research and advocacy that inspired a paradigm shift in the culture of Canadian policing.

Police have a complex and challenging job. Except for paramedics, emergency room staff and firefighters, they’re the only public service available 24 hours a day, seven days a week. We call the cops if there’s a bank robbery. We call the cops if we come across a 3-year-old wandering alone. We call the cops if we see someone running naked outside in the middle of winter.

They have also become the front line for a chronically underfunded and overwhelmed mental health system. Police agencies across Canada are reporting year-over-year increases in the number of calls involving people in a mental health crisis. The most recent Statistics Canada numbers, from a 2012 survey, indicate that five million Canadians come into contact with police every year. Of those, 18.8 per cent, or about one in five, meet the criteria for having a mental health or substance use disorder.

These encounters are not always positive. In the spring of 2018 the CBC published the first national database on police-involved fatalities. It took six months to compile the numbers from thousands of coroner reports, court records and interviews with families. Between 2000 and 2017, police killed 461 people in Canada. The CBC found that over 70 per cent of the victims had mental health and substance abuse problems.

I drove to High River in early June to meet Coleman and to learn about what police services are doing to improve how they respond to people in crisis. I was also curious about what inspired a police officer turned police chief with decades of experience on the street to devote the second half of his career to convincing people that cops should behave more like social workers.

Police have become the front line for a chronically underfunded and overwhelmed mental health system, and these encounters are not always positive.

At 73, Coleman is still at it. He has the air of an engineer, someone with faith in the power of practical solutions—and a pen in his dress shirt pocket to jot them down when they occur to him. He works as a public safety consultant, and his home office is mission control. Coleman teaches two online courses, one on organized crime for Athabasca University and the other at Dalhousie University about strategic human resources. He has testified as an expert witness on de-escalation and mental health at several police-involved-fatality inquests and reviewed the training curriculums at police academies across Canada.

Before I arrived that afternoon, Coleman had received an email from a Toronto Star reporter. Durham police had arrested two people on what had been a mental-health-related call and the reporter wanted Coleman’s opinion on the video clip.

“It’s an expectation and a legitimate service of the police to attend to people in these sorts of states of crisis or distress,” said Coleman (who moved to Calgary from England in his early twenties and still speaks with a subtle accent). He explained that the term “mental health crisis” includes a range of conditions and behaviour. A diabetic who is hypoglycemic, for example, can have delusions and psychotic episodes. The umbrella term includes people with brain injuries, people on drugs, people under a lot of stress. All of us, including police, are vulnerable. “I always say, and it’s been supported by the literature, policing is a human service,” he said.

Coleman also got a request that morning to review the latest version of a new type of de-escalation training the Ontario Ministry of Community Safety and Correctional Services is considering implementing at the provincial police college. A multidisciplinary team from across Canada developed the training program. The group includes academics, police officers, use-of-force instructors, forensic psychologists, mental health clinicians and people with lived experience of a mental illness.

The team also employed theatre professionals. “It used actors, not police officers pretending they’re a person with a mental illness, because that’s been fairly common in recent times and it’s ineffective—totally ineffective,” Coleman said. He’s been a part of the federally funded project since it got off the ground in 2017.

We sat in armchairs in the living room, which overlooked the backyard and a gradual hill down to a wooded streambed. The verdant setting, vintage wallpaper and exposed wood beams gave the house the feel of a rural cottage. Coleman grew up in the East Sussex village of Isfield, just north of the English Channel. “It was always talked about on the farm. ‘Strong guy, tall guy—you’d make a good police officer,’” he said. Watching a short film about the Stampede helped draw the young man to Calgary in 1967. “This was pretty exciting for an English farm kid. Riding bulls Chuckwagon racing just seemed wild.”

Reality fell short of that vision of a tough cop wrestling his way out of scraps and bringing swift justice to unsavoury characters. He joined the Calgary Police Service in 1969 and found himself responding to situations with vulnerable people in desperate situations. “These people were not involved in criminal activity, but they were involved in health issues,” Coleman said. “We had absolutely nothing in the way of preparation.”

Looking back, knowing what he knows now, Coleman wishes he had approached numerous interactions differently. One in particular made an indelible impression. “It was not far from Marda Loop. These things stick with you, and if the house is still there, I could probably take you to it,” Coleman said. It was around 1976 and he and his partner were assigned to apprehend a woman for a psychiatric assessment. The family had obtained an order for her apprehension by police under the Mental Health Act.

They arrived midmorning and the husband answered the door. Two kids in their early teens were also home. “She was obviously acting irrationally. You could see that when you came in. She was very agitated. She spoke loud and she would… I’m not sure she screamed, but she would shout out.” They tried to calm the woman, who was in her late 30s, but she refused to co-operate. “Looking back on it, she was scared. Very, very scared.” Coleman described how the situation escalated. “She fought and fought and fought. In the end—this is sort of the part that I really regret—we rolled her over on the chesterfield and handcuffed her, and dragged her into the car screaming.”

Throughout the ordeal, Coleman kept thinking there had to be a better way.

Dorothy Cotton experienced the same sort of unfortunate circumstances, but from another perspective. She was promoted to administrative director of forensic services at the Kingston Psychiatric Hospital in Ontario in 1999. The unit treated people found unfit to stand trial or not criminally responsible for their actions. The new role brought her into regular contact with police. As Cotton got to know some of the officers, they started coming to her with questions.

“The police would have people who they were extremely concerned with out on the street,” she said. Someone refusing to go to a shelter, even though it’s the middle of winter and they might freeze to death. Someone regularly wandering into traffic. Someone calling 911 dozens of times a day.

“There was a trend, certainly during the years when I worked in forensics, when you had people who clearly had substantial mental health problems, but somehow weren’t able to access the mental health system,” Cotton said. She explained how the problem began in the 1970s, when psychiatric institutions were shut down but funding for community-based mental health supports never materialized.

Without other options, police charged people with minor offences: vagrancy, disturbing the peace, jaywalking. Once charges were laid, the courts could step in and order the person to a psychiatric hospital. “I started becoming really aware of the completely no-win situation the police were in—that they would see people out there who were very ill, who really needed help, but they didn’t have the resources or there was nothing they could do,” she said.

And so Cotton reached out to the Canadian Association of Chiefs of Police (CACP). Her message was similar to Coleman’s sentiment that day in Marda Loop: The police and the mental health system are working with the same people. Why not find some way to coordinate resources There had to be a better way. “I actually think [the CACP] misunderstood, and thought I was talking about the mental health of police officers, because they sent the letter to the human resources committee,” Cotton said.

Luckily, Coleman, with his penchant for strategic thinking, served on that committee. (He still does.) He remembered how his colleagues were stymied by Cotton’s proposal. Even as a forensic psychologist, she was an outsider. Police have traditionally been stubbornly insular organizations and suspicious of external influence. The committee, which has about 20 members, meets in person three times a year. It had taken about a year and a half before Coleman even stepped forward. “I put up my hand and volunteered and the rest actually changed my professional life,” he said.

Coleman and Cotton met for the first time in Quebec City in 2002 and launched the inaugural Psychiatrists in Blue conference later that same year. They organized the conference in cities across Canada for the next five years. It was the first national forum for police to get together and not only learn from international experts in the field of mental health and de-escalation, but also to share ideas about what was working in different parts of the country.

“It was very clear to me early on that this was probably the most important thing I was ever going to do with my life,” Cotton said. She quit her job at the hospital after getting pressured to stop working with Coleman. Hospital leadership thought her research collaboration with a police chief added to the stigma that people with a mental illness were more prone to criminal behaviour. “I was very dogged—my mother always called me Dorothy Persistence.”

After the Mental Health Commission of Canada was created in 2007, it tapped Coleman and Cotton for research on how police are trained to handle interactions with people in mental health crisis. Out of that work came a proposed learning model called TEMPO: Training and Education about Mental Illness for Police Organizations, completed in 2010. Coleman and Cotton provided a comprehensive update in 2014. It was a blueprint for the type of training Coleman wished he’d had before setting out on his career as a police officer.

New officers are trained at a variety of facilities across the country. Some provinces, such as Ontario and BC, have one authoritative academy that trains every officer, except for the RCMP, which runs its own facility in Regina. In Alberta, the Lethbridge, Calgary and Edmonton police services all deliver different training programs. TEMPO was the first effort to create a national baseline for teaching police how to respond to people undergoing a mental health crisis. It was designed as a gap analysis tool so that each training program could identify what they were getting right and where they needed to improve. It was not mandatory, however, and training facilities could pick and choose what, if anything, to implement.

Before Bill Moore became the executive director of the CACP in July of 2017, he had been a deputy chief with the Halifax Regional Police and in charge of the service’s mental health programming. He credits Cotton and Coleman with inspiring a profound shift in the perception of what constitutes legitimate police work.

“They were probably instrumental in the concept of a police officer as a social response person,” Moore said. “They assisted in making it part of mainstream policing.” And with TEMPO they supplied a roadmap for cultivating the requisite skills. “The second thing they did is they assisted in bringing an increased level of professionalism in the way that we did it.”

That kind of change had to come from within in order to take root, explained Moore. “[Coleman] was an insider. He was a chief of police. He had immediate credibility in the policing community because he’d walked in our shoes.” And when Coleman and Cotton cracked that door open, they made room for others to follow.

Jennifer Lavoie, an associate professor of criminology from Wilfrid Laurier University, has noticed a significant change in the last few years in police services requesting outside help from academics and researchers. This trend is especially pronounced in determining how best to prepare officers to respond to people in crisis. “You’ve really seen a willingness, an openness, that I haven’t seen before in police services,” Lavoie said. “They see that they can’t approach this alone anymore.”

She cited several reports on high profile, police-involved fatalities from across Canada in recent years that have ratcheted up the pressure on police to make substantive changes. The latest review of police conduct in Alberta was undertaken by retired Court of Queen’s Bench chief justice Neil Wittmann and published in the spring of 2018. Then-Calgary police chief Roger Chaffin asked Wittmann to examine the service’s use of force after officers shot 10 people, killing five, in 2016. It was the most shootings by any police service across the country that year. Wrote Wittmann, “I have found that there remains an urgent need to explore and address the issue of police encounters with persons in crisis.”

The former justice made 65 recommendations for reform, many of which emphasized the need for better de-escalation and crisis intervention training. Lavoie described how many of these independent reports keep coming back to the matter of training. She has also studied the efficacy of mobile crisis teams, which include a police officer and mental health professional responding to calls together. “Most services don’t have the funding for mobile crisis teams. Those that do can’t offer the services 24 hours a day, seven days a week,” she said.

Several Alberta cities, including Calgary, Edmonton, Red Deer and Grande Prairie, have Police and Crisis Teams (PACTs), which are jointly funded with Alberta Health Services. The teams, comprised of an officer and a mental health clinician, are on call seven days a week, from 6:00 a.m. to midnight. Wittmann’s review, however, noted that they’re used in a post-crisis capacity. They’re called in after the initial emergency response.

“We have to train officers, all front-line officers, on how to respond to people in mental health crisis,” Lavoie said. She is one of the lead researchers on the new scenario-based training program Coleman works on.

The research project is in the second year of a four-year term, and officers from the Durham Regional Police Service are helping to test the scenarios. The team is gathering evidence to see if the program develops a specific set of competencies associated with de-escalation. “It’s one of the first studies in Canada to look at whether a particular type of training, in this case scenario-based training, is effective and will lead to performance changes,” Lavoie said. This evidence-based approach is part of what attracted the attention of the Ontario government. The team has also fielded inquiries from several police academies from across Canada.

Many of the core ideas in TEMPO have been implemented in the new training program. Lavoie described how an officer works through one of the scenarios and then talks with a panel of experts about how it unfolded. Mental health clinicians, use-of-force instructors, people with lived experience of mental illness, and police trainers all provide feedback on how the officer handled the simulation. Coleman and Cotton recommended this kind of multidisciplinary approach, specifically highlighting the value of including people who have experienced mental illness. TEMPO was a direct challenge to the status quo of having only police train the police.

“Much of the feedback we get from officers after the training is around how impactful it was to hear about the experiences of people with significant mental illness, and to understand recovery,” Lavoie said. Cops invariably meet people who are having a very bad day. Sometimes they encounter the same person, under the same awful circumstances, over and over again. Police don’t have as much exposure to people who get better or to how, with the right supports, people with a chronic mental illness can lead regular lives. “I think that message gets across in those lived experience stories that are shared with the officers,” she said.

Lavoie described how Coleman made a big impression on the research team at one of the first meetings back in 2017. He was on a video call from his home office in High River when he introduced the concept of procedural justice. “The idea of police responding to people—all people, but especially people in crisis or with mental health challenges—with dignity, fairness, respect. And how those principles, that way of responding to a person, can engender de-escalation,” Lavoie said.

Procedural justice is not a new idea. Coleman said the basic tenets have been applied in policing for a long time, but they weren’t explicitly articulated as part of a coherent philosophy. “It’s about fairness. It’s about due process,” Coleman said. “At the end of the day, the person understands what is happening to them and why.” He first heard the term procedural justice used in relation to policing at criminology conferences in the US in the wake of the protests in Ferguson, Missouri. The unrest began in 2014 after Michael Brown Jr., an unarmed African-American, was killed by a white police officer.

It takes time and patience for police to engage with people in crisis in such a way that they understand and accept what’s happening. “We didn’t do that the day I had the bad experience,” Coleman said of his interaction with the woman in Marda Loop. He estimated that he and his partner were at the house for no more than half an hour. “I’m not sure we were in a hurry to go to another call. We were just trying to get it over with. We didn’t take the time.”

Coleman described a recent case in Calgary where he thought police did exercise patience and take the time needed to resolve the situation peacefully. In late May officers responded to reports of a domestic incident at a house in the community of Panorama. They waited outside the home for 16 hours before the man gave himself up. Coleman explained how the traditional model of policing taught officers to stand their ground. Responding to people in crisis requires an understanding of when to take a step back.

 BEFORE I LEFT HIS HOUSE IN HIGH RIVER, Coleman showed me a memo written by the superintendent of the East Sussex Constabulary. It was framed and hung on the wall just inside the front door. The document was dated September 15, 1940, and outlined how Coleman’s grandfather, during the Battle of Britain, apprehended a German pilot who’d crashed into the field right next to where he was farming. Coleman’s grandfather, unarmed except for a pitchfork, escorted the prisoner back to his house, locked him in the shed out back and then had someone go to the nearest telephone to alert the police. Coleman doubts his grandfather had some innate gift for de-escalation. The pilot was probably only too happy to make a graceful exit from the Second World War.

The post Changing the Culture of Canadian Policing appeared first on Alberta Views.

Family caregiving can be like that.

Family caregiving, for those unfamiliar with the modern usage of the term, is an informal, ad hoc process associated with family members caring for other family members who are experiencing an ongoing illness or disability, and whose existence would not be sustainable without some kind of support.

In a sense, before a name was provided, there has always been family caregiving—caring is, after all, what families do—but the contemporary term has evolved as modern medicine itself has evolved. As medical practice developed in sophistication and scale in the 20th century and became an integral part of western society’s social contract, designed and controlled by federal governments and universally expected as a right by citizens, governments were confronted with a dilemma. Intractable medical problems, ones for which there were no quick fixes, required significant resources and proved enormously expensive. By using a family caregiving model, patients still requiring extensive medical attention could be released earlier from hospitals to their families, who with guidance from medical staff could provide the necessary support. Patients would enjoy greater comfort in their own home, greater autonomy, feel less isolated and receive more personalized attention. For individuals recovering from strokes, or coping with cystic fibrosis, or the early stages of Lou Gehrig’s Disease, or any one of a variety of other chronic disorders, it made no sense to expose vulnerable patients to the viruses and germs that enter a hospital. And, from the government’s perspective, the care was provided free of charge, and so a line item could be extracted from the healthcare budget.

In the 1960s through the 1980s, another major component of health-care followed this trend: the care of patients with mental illnesses. Up until the early 1960s the prognosis for the treatment of mental illnesses had been so poor that apart from a few mostly ineffective treatments (think insulin therapy—induce a coma with insulin injections to shock the brain and somehow reset it—or hydrotherapy, in which the application of cold or hot water somehow has therapeutic value upon the brain) the dominant solution had become simply to isolate and aggregate psychiatric patients. Enormous asylums and mental institutions were constructed, ostensibly offering “care” to patients suffering from mental distress.

In the late 1950s and 1960s, however, new drugs were invented that promised a better outcome for psychiatric treatment; patients were not entirely cured by these medications, but the most obvious symptoms of mental disorders were mostly controlled. Medical professionals soon realized psychiatric patients were better served practising their social skills in the community rather than being warehoused in institutions. As psychiatrist Werner Mendel wrote in 1976 in his “The Case for Closing of the Hospitals,” “The hospital as a form of treatment for the severely ill psychiatric patient is always expensive and inefficient, frequently anti-therapeutic, and never the treatment of choice.” The concept that evolved out of this was that patients would, instead, receive care and attention in the community, and by doing so would become more fully integrated into society. As psychiatric institutions closed, though, funds that were supposed to follow patients into the community to create these services never really did. Instead, as Andrew Scull observes in his book Madness in Civilization, “In the midst of all the excitement about the replacement of the mental hospital and the breathless proclamations about the virtues of the community, it seems that few people noticed the degree to which the new programmes remained figments of their planner’s imagination.”

Which remains the case today. Every official report in this country—see the latest Canadian Mental Health Commission’s “Mental Health Strategy for Canada (2012),” and every government-funded report prior to it—declares mental health care to be woefully underfunded. And the community services component is particularly neglected.

Family caregiving is a term, I must confess, that I’ve never much liked. It sounds too neat, too clear, too tidy. The impression it lends is that there exists a particular paradigm: someone who gives care, and someone who gets it. In my experience that model is too simple.

Our family has lived alongside schizophrenia for 40 years. My younger brother, Ben, was diagnosed in 1977, and in 1978, unable to see a good outcome in his future, took his life. My older brother Olivier began displaying delusional and paranoid thinking in 1979, and following a diagnosis of schizophrenia in 1980, and his own attempted suicide, entered Calgary’s Holy Cross Hospital psychiatric unit. When Olivier was discharged from the unit, jobless, adjusting to his medication and its debilitating side effects, and struggling with the new reality of living with a life-long illness, he moved back in with my mother. That living situation went through many adjustments, some of which Olivier and I chronicled in our previous book, Bitter Medicine: A Graphic Memoir of Mental Illness.

My mother provided financial and emotional support for my brother. In return, Liv provided emotional support and companionship and physical assistance for her. My oldest brother Nic and I stayed close and provided emotional support, assistance with groceries, communication back and forth between a variety of medical and government agencies, arranged transportation to medical appointments around town, and facilitated emergency interventions when health situations arose. The combination of all these intersecting efforts allowed life to carry on. What we all provided was less a direct give-and-get than an interconnected, complex network of care, like a spider’s web.

But it wasn’t pretty. The truth was it more closely resembled the flawed, wonky structures generated by those spiders given LSD during lab experiments in the 1960s than the glorious, dew-dappled symmetry you might spy hanging from some branches on an early morning walk. It was a web fashioned as much from good intentions and competencies as from compensations, mistakes and frailties. It sustained and supported, but only barely. Snap a single thread and everything tumbled away.

When I realized my mother was displaying signs of dementia, I could sense that particular thread shearing, and for three or four years my family scrambled to construct a new web.

I knew that finding a solution—a solution transitioning out of the previous situation that would benefit both my brother and my mother—would be difficult. I just didn’t understand how difficult.

For one thing, everything about my mother and Olivier’s living arrangements was so entirely meshed. They co-owned an apartment and split the monthly condominium fee; they shared grocery expenses, utility expenses, telephone expenses, daily household responsibilities; provided help and emotional support for one another in a thousand different ways. As well, both of them were creatures of habit and had nearly 40 years to establish a comfortable routine.

Once my mother began manifesting signs of dementia, the living situation deteriorated rapidly. Nic and I tried to solicit medical help, but my mother, always independent, resisted intervention. She began to fall, so we had railings installed and obtained an alarm bracelet and necklace. She responded by “losing” the bracelet and refusing to wear the necklace, and continued to fall. When she lost the ability to prepare meals or clean herself, we arranged for home care to assist—she vigorously rejected it. The phone was disconnected and the utilities went into arrears because bills weren’t being paid, so I took over the finances. She grew physically ill and contracted infections. The conditions around the apartment became unsanitary and dangerous. As the situation spiralled downward, my brother’s mental state became precarious.

At times it seemed like we were playing a perverse game of Whack-A-Mole—whatever problem emerged we hit, only to have a brand new problem instantly pop up. We couldn’t arrive at a collective solution because my mother wouldn’t agree to one, couldn’t even agree that there was a problem, was adamant that she remain home where she could provide care for her Olivier, and at least initially her family doctor was unwilling to offer any clearer diagnosis beyond what he characterized as “age-appropriate memory loss.”

Obtaining medical assistance or advice in this situation was difficult because each separate medical branch viewed the other as representing “the problem.” In the eyes of Olivier’s medical supports, my mother and the increasing complications of her dementia represented the problem. I received a call from a member of his psychiatric support team telling me I had to do something. Did I know how challenging my mother was, how unsustainable the situation was becoming for Olivier He was depressed, I was told; the living arrangements were unhealthy. What was I going to do But from the perspective of the paramedics who arrived in one instance when my mother fell, and who took her to the hospital to see if she had any broken bones, my brother’s mental condition was the complicating factor in her untenable living arrangements. What was I going to do about that?

Desperate for answers, I enrolled in a couple of online courses, one on dementia and one on caregiving and dealing with psychosis—at this point my mother was already beginning to see and hear things. I discovered we were far from alone in our family-caregiving distress. There were, in fact, many, many people struggling to find a way forward as their family aged, not just in this country but internationally, and they too were unable to find answers or support. In the chat room provided for students, one participant from Ireland wrote, “My biggest worry is what will happen when I die. Who will look after my son Some practical advice on preparing for this inevitability would be extremely helpful.” This sentiment was echoed by others, and in response another member of the chat group chimed in, “The anxiety is there on the other side too! My parents are getting elderly and I’m really anxious about how I’ll cope without them.”

Which perfectly reflects a few of the central weaknesses associated with family caregiving. There’s no particular training involved in family caregiving beyond what you find or improvise. As Carol Levine writes in her article “Family Caregiving” on the Hastings Center website, “Although family care-giving has always been an important kinship obligation, changes in demo-graphics, workforce patterns, healthcare economics and service delivery have resulted in dramatic change in its extent and complexity… Family caregivers are expected to provide the level of care that only a few decades ago was reserved for hospitals. But they are typically not trained or supervised.”

The books I read and the online courses I took certainly helped, but at no time did I feel like an expert as I struggled to develop solutions to the problems that arose, or even especially competent, and I often felt overwhelmed. When my brother experienced some-thing that looked like a seizure—clutching the back of a chair, his body rigid and trembling—I wondered: Is that a symptom of undermedication, overmedication, or is it an entirely new disorder When my mother insisted that the plumber had stolen her dentures, or imagined that a host of uninvited guests had spent the night partying in her home, or when she fell and wouldn’t permit home care staff to lift her or even touch her, what was the procedure, I wondered, that I should follow

In addition, very little support or advice can be found to assist with transition as caregivers age. In an institutional model of care, of course, if a doctor or nurse or any of the staff of a hospital falls sick or must leave or retire, they are replaced. That option doesn’t exist in most families. There may not be any children, or spouses, or in-laws with a particular skill-set available, or who live in proximity, or who have the financial wherewithal to take up these duties.

Nor is the relationship between family caregivers and hospitals and medical staff at all clear. Doctors and nurses frequently don’t know what to do with family caregivers, how much information to share, what kind of medical privileges or responsibilities they can or will authorize. As Levine continues in her article, “…professionals often turn the question (Why shouldn’t families care for their relatives?) on its head: Why don’t all these meddlesome families just stay out of our way?” While some in the medical profession are more open to including family caregivers, in my experience this is very hit or miss. I’ve been informed in Emergency to step back, told not to interfere, informed by doctors that they aren’t permitted to disclose information about prescriptions that I may actually have to administer. I may be part of “a team,” but I’m always made to feel like the very most junior member.

I would have preferred to write one of those articles that chronicle triumph over adversity and conclude with an uplifting message and a ringing endorsement of future solutions. Instead I can only share a story of very mixed results—one that ends with questions rather than a solution.

Because my mother was unwilling to let anyone else care for her, and because the dementia advanced at a pace that outstripped any preparations we could put in place, and because the living situation for Olivier was so chaotic and presented such a risk, my mother ended up being moved to a long-term care facility—the very last place she wanted to be.

And dying in the last place she wanted to die, as it turned out. On New Year’s Eve, 2016, she passed away from pneumonia. I wish to heavens my family had been able to coordinate an easier, clearer, cleaner, less troubled, more organized transition. That transition was enormously difficult for Olivier, emotionally trying, difficult to work through. He’s doing well now, but the adjustment to a new living arrangement tested him. Tested all of us.

The irony of the family caregiving model is that while there’s no particular protocol to follow, the responsibilities are vast and there is an enormous capacity for resulting feelings of guilt. When my mother finally moved to the transition unit of the Rockyview Hospital, she wept bitterly as soon as she realized she was never returning home, her biggest fear being how her son would survive. “Who will make sure he takes his pills at night?” she cried, certain she had failed him. And when I spoke with Olivier the day after my mother left, his biggest worry wasn’t for himself, but that he might have failed in his duty to look after our mother.

There are millions of earnest, desperately unprepared, underqualified families providing care for ill or aging relatives the best way they know how, improvising solutions for medical troubles they’ve never been trained to recognize or treat—an enormous number of them ill or aging themselves. They are hanging on as best they can, but they need help.

Hospitals can barely accommodate the present numbers of patients, let alone hope to accommodate in a conventional way the enormous numbers of aged looming on the horizon. And as the family caregivers the government relies on to perform caregiving in their homes falter, how will the healthcare system cope The Alzheimer’s Society of Canada estimates that 564,000 Canadians currently live with dementia and that in 15 years those numbers will increase to 937,000. The odds are good that many of those nearly one million elderly individuals are presently caregivers themselves.

“Most of the arguments for supporting family caregivers rest on economics: family caregiver assistance is essentially irreplaceable,” Carol Levine notes. “Beyond the loving relationships embodied in family care, there is simply not enough money, nor are there enough workers, to replace family members as the broad base of the workforce.”

This is absolutely true, and it will continue to be true. But if the family caregiving model is to be employed, some serious thought must be given to the notion of transition.

It’s long past time we had a hard look at the family caregiving model and determined how it can be better integrated into the healthcare system. What supports can be provided What will happen when a significant number of our caregivers themselves require care Whose needs will be met, and how In a medical system that only barely—and very informally—acknowledges family caregivers, who will offer support and mediation when things go sideways When so very much is at stake—lives, after all—what support and guidance can be provided?

Text by Clem Martini
Illustrations by Olivier Martini

Clem and Olivier Martini’s book The Unravelling, about their family caregiving experiences, launched in September 2017.

The post When Things Fall Apart appeared first on Alberta Views.

You’ve received a phone call. Disoriented, you fight sleep and attempt to make sense of what the voice on the other end of the line is telling you. You discover that your son/daughter/brother/sister has tried to kill his/herself. There’s blood. Pills. You should come immediately.

There’s a hurried race through darkness to the hospital. On a gurney sprawls a limp, cold, familiar body made suddenly terribly unfamiliar by deep, disfiguring cuts. For a period of time—a long, tortured period—you understand that death is possible, perhaps even a likely outcome. You’re horrified. Stunned. Hurt. Confused. Angry. Angry. Crushed. Sad beyond measure. You’re all those things at once. Nothing seems to make sense. Nothing seems to connect this bloodied image to the person you know. Knew.

Doctors struggle through the night to repair the damage. The stomach is pumped. Tests are administered to discover the nature of the drugs taken. Shallow cuts are bandaged, deeper cuts stitched. There will always be scars. A drip is hooked up and intravenous drugs administered. The days pass. Slowly, slowly it seems recovery becomes possible. As the patient stabilizes she/he is transferred to the psychiatric ward for assessment. You feel some faint hope. You feel you will have someone to help you. An advocate. A guide. Someone who can help you comprehend the situation, someone who can help you fathom your son/daughter/brother/sister. Someone to help you repair things.

But that’s where you’re wrong. The assessment comes back as Borderline Personality Disorder. The patient is not kept in for treatment. Instead you’re made to understand that the hospital offers no particular treatment. A provincially funded clinic provides therapy, but there’s a six-month waiting list. In the meantime, there will be no assistance. Your son/daughter/sister/brother is released into your confused and thoroughly uninformed, unqualified, unprepared care. 

And you’re informed that, no, the Mental Health Act of Alberta, which permits involuntary detention and admission to a hospital for examination and treatment against an individual’s will if their life appears to be at risk, cannot be applied—because the diagnosis is Borderline. And no, there is no answer about what you are to do for the next six months until a therapy session can be scheduled. And no, there is no answer to the question of what is to be done in the periods between those weekly hour-long sessions of therapy, of what to do when she/he gets too anxious or angry or frightened, or what to do if the patient refuses to attend therapy. That is over to you in your household. And when she/he next tries to take their own life, the turnaround at the hospital will be quicker, and she/he will be out on the streets to find help—or not—somewhere else. Unless of course, she/he carries it through next time. After which there will be no next time.

So much of mental health care is downloaded to families that the real costs can never be truthfully tallied.

Bienvenue to a world on the very edges of healthcare. Psychiatric care exists on the periphery, receiving the minimum of support, attention and hospital resources to begin with. This is acknowledged time and again in reports generated from within the medical system itself, year after year. “Mental health care is the orphan of the healthcare system.” “Marked socioeconomic disparities were found in the use of care from a psychiatrist. Unlimited coverage of physician-provided mental health care is insufficient to fairly distribute services to those most in need.” “A major criticism of mental health services and supports and addiction treatment in Canada is that it is largely organized around (and often for the convenience of) providers, not patients/clients.”

And Borderline Personality Disorder (BPD), the ugly duckling of the mental health care system, exists on the very furthest edge of that edge. Mistrusted. Misunderstood. Unwelcome. In a recent medical review, BPD was characterized as “a suspect category, largely neglected by psychiatric institutions, comprising a group of patients few clinicians want to treat.” That sense of its being a “suspect category” is reflected even in the initial definition and description listed by the National Institute of Mental Health (NIMH) in its explanation of the disorder, and provides an indication of how individuals diagnosed with the disorder can expect to be viewed. Although that description states that BPD was “originally thought to be at the ‘borderline’ of psychosis,” in fact, people with BPD suffer from a disorder of emotion regulation. It goes on, however, to state that BPD is “less well-known than schizophrenia or bipolar disorder.” That sense of unfamiliarity, of being “less well-known” and a relative newcomer to the diagnosis lists places the disorder in a category all of its own.

Significantly, the NIMH explanation then goes on to state that “there is a high rate of self-injury without suicide intent, as well as a significant rate of suicide attempts and completed suicide in severe cases. Patients often need extensive mental health services and account for 20 per cent of psychiatric hospitalizations.”

So, to sum up: this disorder, which falls within a “suspect” category and is “less well known,” also requires considerable attention at the emergency level of hospital care—where notoriously few resources are allocated for the mentally ill patient. And BPD also requires additional in-care hospitalization support, at a time when every effort is being made by hospital administrations across the continent to outsource mental health treatment. This confluence of circumstances can only spell trouble for BPD clients and their caregivers. 

So, for instance, in a situation such as one in which the person has tried to kill themself and is likely to try again, and the hospital won’t keep her/him in for observation and treatment, let us try to determine what precisely the medical establishment believes a parent or family member or friend is supposed to do. You can wrestle and physically restrain the individual to prevent them from doing themselves harm—although technically, unless you can absolutely prove that self-harm is imminent, that could be viewed as assault. You can call for assistance from a special emergency care unit, which would upon arrival hold an intervening conversation with the client—knowing that the client might simply listen, play along and feign agreement until the emergency unit had gone, and then attempt suicide once more. Or you can allow the person to carry on as they had, knowing they might end up dead.

Often when dealing with loved one’s illness, you will not only be the first but the second, third and only aid.

How is it that BPD warrants this kind of hands-off response Partially, it suffers from being “new.” It only appeared on the radar at the end of the 1960s, and only recently has begun to come into any kind of clear diagnostic focus. The disorder, characterized by impulsivity, chaotic relationships, instability of emotions, blurred identity and a propensity for self-violence, was first described in the 1970s when it was found to fit into neither the neurotic nor the psychotic category, and so was simply labelled as “borderline personality organization.” It didn’t appear to respond well to classical psychoanalysis and it didn’t respond consistently to neuroleptic drugs. In fact, as one researcher commented, “It was commonly believed to be a ‘wastebasket’ diagnosis, lacking in diagnostic precision and validity, and only useful for patients who did not fall clearly into other diagnostic categories.” In psychiatric circles, BPD became known as a “troubled diagnosis.”

So Borderline is a recognized mental disorder, yes, but a very particular recognized mental disorder. It appears to have a high degree of “heritability,” confirming the likelihood of its being a brain disorder. Nevertheless, discussion continues in the psychiatric world about how much the disorder is affected by psychosocial and environmental influences. The most successful treatments for BPD at this point appear to be Dialectical Behaviour Therapy and Mentalization Based Treatment, techniques that involve continued group and individualized therapy components. However, perhaps because these treatments are relatively recent phenomena, and perhaps because BPD has yet to find its way into the psychiatric training curricula, these treatments are almost impossible to obtain through public hospitals. As one research article noted, “Appropriate teaching—both academic and clinical—for residents is non-existent in all but a few institutions.” 

Not long ago I enrolled in a program titled Mental Health First Aid, which offers the layperson a kind of fast recognition and first treatment for mental illnesses. It was modelled upon the standard first aid program that was so successfully developed to deal with physical emergencies.

The philosophy informing the program was that laymen with a little information could offer the necessary immediate intervention that would allow the mentally ill patient to survive in the short term until more informed, better-trained treatment could take place. In the world of physical medical emergencies, this makes complete sense and has given rise to a variety of procedures meant to keep the patient alive and well—CPR, for instance—until better informed, better prepared medical resources are made available. The problem—and where the “first aid” parallel begins to fall off the rails—is that too often when dealing with mental illnesses, you will not only be the first aid but the second, third and only aid. You may very well bring a person to the hospital, but after that the situation may be bounced back to you, along with the responsibility for caregiving. 

The carelessness of these actions is staggering. It’s worth noting that the majority of suicides don’t occur in medical facilities. They occur elsewhere, back in the homes of caregivers struggling to make sense of the situation. They happen in the living rooms, basements, attics, washrooms, bedrooms of caregivers who have often requested assistance and received none. And consequently, when deaths occur, the responsibility is theirs. And the pain and long-term struggle to cope with ensuing guilt will also be faced alone. 

I refrain from citing any specific individuals, because I understand that even writing about a specific individual who has received the BPD diagnosis carries risk. It carries risk because the diagnosis is sufficiently stigmatizing that sharing names and identities can have implications for the social, educational and occupational aspirations of the individual diagnosed with the disorder. It carries all kinds of troubling baggage—of being antisocial, unco-operative and terminally troublesome. 

Which is, after all, kind of true of the response the general public has for all mental illnesses. To even discuss mental illnesses is to be viewed as potentially damaged. I have in the past written a number of articles about mental illness and that has been enough for some people to assume—to say to me—that they can tell that I’m troubled as well. That’s the way it is with mental illness. Even talking about it carries stigma. 

I had one person who had the—let’s call it temerity, because that’s more polite than stupidity—to tell me to my face that after reading my book Bitter Medicine that by simply looking at me they could tell that the mental disorder my younger brother died from and that my older brother struggles with, was probably my disorder as well. That’s they way it rolls with mental illness. You are tarred instantly by proximity. 

Do you want to know the truth about the difference between mental illness and illness There are two truths of considerable importance. The first is the Truth of Cost. The incidence of mental illness is surprisingly high, but the amount of federal healthcare funding allotted to individuals with mental illnesses is disproportionately low. The mentally ill have been squeezed out of the healthcare system so successfully, the costs eliminated so triumphantly, that the prison system has become one of the principal “treatment centres” in the country. The mentally ill are incarcerated every day because of their crazy, criminalized behaviour. And so much of care has been downloaded onto families that the actual hard costs associated with caregiving can never be truthfully tallied. 

The other truth you should be aware of is the Truth of Fault. If you end up in the hospital with a ruptured appendix, nobody will ask “Why have you come here?” Or demand “Go heal yourself.” But mental illness is so steeped in fault that even those in the helping professions can’t see how they contribute to continuation of the cycle of blame, guilt and shame. You’re too weak, they imply—go home. You’re taking up time and beds and resources that might more profitably be devoted to those with genuine illnesses. 

And if the patient is too delusional or troubled to be blamed directly, then that blame can swiftly and easily be transferred to the family. You raised them wrong. You raised them badly. You raised them inappropriately. You spoiled them. You were too strict. You didn’t demonstrate love. You didn’t demonstrate love the right way. You messed up. 

And if that fault for the illness can be shifted, then of course it only follows that the costs for treatment should revert back on the people who are responsible. Pursuing this logic, it makes perfect sense not to allocate sufficient funding for mental illnesses in the public healthcare system nor to provide adequate support for it. After all, the prevailing unspoken subtext is “It’s your fault, suck it up. Don’t feel so sorry for yourself. Everyone has a bad day, just don’t kill yourself”—or conversely “It’s all your fault; if you had raised your family correctly they wouldn’t try to kill themselves, starve themselves, cut themselves, burn themselves, exhibit odd behaviour, exhibit violent behaviour, exhibit self-harming behaviour. They wouldn’t weep all the time, they wouldn’t talk to themselves, they wouldn’t throw themselves off bridges, they wouldn’t step in front of cars, they wouldn’t be so, so, sooo damn crazy.”

But there they are. And they do try to kill themselves. And if left to their own devices, they succeed with numbing, relentless regularity. One million people die through suicide worldwide each and every year. That’s about two a minute. People find strange comfort in believing that mental illness is the illness that happens elsewhere, in other countries, other cultures, other households. This comfort is an illusion. According to Health Canada, 20 per cent of Canadians will personally experience a mental illness in their lifetime. Suicide accounts for 24 per cent of all deaths among Canadians aged 15 to 24. This could be your child. This could be your brother or sister. It could very easily be someone you love, and if it is, then one night you may be confronted with a realization and a decision. When the phone rings, or the door knocks, you will be startled out of the fog of deep sleep, and you will be presented with the dilemma of what to do next.

You wake up.

Clem Martini is an award-winning playwright and head of the Department of Drama at the University of Calgary.

The post Edge of the Edge appeared first on Alberta Views.

McEachern is a former member of 1 Princess Patricia’s Canadian Light Infantry, based in Edmonton. He was diagnosed with PTSD in 1997 after serving in peacekeeping missions in Croatia and Uganda. He left the military in July 2001. Shortly afterward, he enrolled in the eco-tourism and outdoor leadership program at Mount Royal College. In 2006, he was inspired to create a non-profit charity, the Canadian Veteran Adventure Foundation (CVAF), to help traumatized veterans regain a “lust for life” by rafting, hiking and riding horses in the Alberta foothills and Rocky Mountains. 

“We’re just getting started,” he says of the foundation. “It’s been four years of hard work and obstacles, government bureaucracy, that kind of crap. But we had our first program last summer, a raft trip, and a couple of guys came up to me in tears after that. They said ‘thanks, man, that’s the best thing that’s happened to me in a long time.’ ” 

He stares out the window. Three horses forage near a wooden fence at the edge of the ten-acre property. “The guys that I’m going for are probably slipping through the cracks of the system,” he says. “A lot of the guys, they don’t trust anybody anymore. I want to give them a second chance, convince them they’re good people still, that yeah, you can have nightmares, intimacy issues, but you can still have a good time.” 

“Like with me,” he adds, “the PTSD hasn’t gone away. But I’m doing way better than I was. I don’t think about blowing my head off. It’s nothing like that now.” A thin, dark-haired woman appears at the living room door: Monica Culic, McEachern’s partner and the communications director for CVAF. She says the foundation is vital. “If we come out of Afghanistan in the next couple of years,” she says, “we’ll see a vast increase in the number of veterans with psychological injuries.” 

McEachern nods. In the past decade, the Canadian Forces have made great strides in treating PTSD. But, as a federal standing committee noted in 2009, the treatment and prevention of the illness is a work in progress. There’s a lot of room for improvement, and charitable programs such as the CVAF could fill a gap, helping to ease the symptoms of what can be a lifelong disorder. “When you come back from a mission it can be hard to reintegrate into civilian life,” says McEachern. “If you don’t get any support, it’s like someone helped push you over the edge.” He shakes his head, his voice trailing off. “If I can make somebody’s life worth living again…”

“When you’re standing in the cereal aisle, having a severe panic attack, it starts to mess with your confidence.”

PTSD is a complex brain disorder caused by exposure to extreme stress and trauma. Simply put, traumatic images, sights and smells are “burned into” the brain. Weeks, months, even years later, the trauma can reappear in nightmares and flashbacks. A person can become hypervigilant and view harmless situations as threatening. They can suffer insomnia and a lack of focus, and avoid situations that trigger further symptoms and traumatic memories. If not treated, PTSD can lead to major depression, substance abuse, even suicide. While anyone can get the disorder—the Canadian Mental Health Association says PTSD will affect nearly 1 in 10 Canadians in their lifetime—members of the military are significantly more likely to develop the disorder. And they are developing it: in 2003, Veterans Affairs had 1,800 clients diagnosed with PTSD. Today they have 9,000. PTSD is now the number one pensioned psychiatric disorder in the military.

Historically, the disorder has been easier to diagnose than treat. And even the diagnosis took a long time to emerge. Amid the carnage of the First World War, traumatized soldiers were said to have “shell shock.” Afflicted soldiers were often accused of cowardice. Treatment included solitary confinement and electric shock. In the Second World War, doctors recognized “combat trauma,” but little treatment was offered to veterans suffering psychological stress after the war. As a diagnosis, PTSD did not officially exist until 1980, when the American Psychiatric Association recognized it as a combat-related illness.  

In the Canadian Forces, the stigma around PTSD has been hard to shake. Dr. Greg Passey, a psychiatrist and veteran who spent 22 years in the Canadian military, much of it at CFB Edmonton, did the first large-scale study of PTSD rates among returning peacekeeping soldiers in 1993. “At the time, in the general population we had a baseline PTSD rate of about 2.7 per cent, because of car accidents, sexual assault, crime,” he says. “But when these guys came home the PTSD rate was 15.5 per cent. What we found is that one out of five people had PTSD or major depression or a combination of those coming home from the tours. The military at that time thought that was ridiculous. They said my statistics were flawed.”

In the 1990s, Canadian forces served in multiple crisis zones, including Rwanda and the former Yugoslavia. In 1994, corporal Christian McEachern deployed from Edmonton to Croatia. He had no idea the UN peacekeeping mission was the beginning of a journey that would lead through the Canadian courts and trigger a national review of PTSD in the military. At the time he was simply gung-ho for the mission. It was what he’d always wanted to do. “I joined the cadets when I was 12,” he says. “The helicopters and the armoured vehicles, it was like playing guns. I just took to it. I had no aspirations of doing anything else.”

In the Balkans, the former Yugoslavia was torn apart by warring factions. UN forces had no mandate to intervene. “We had to stand there and watch things happen and we had no power to prevent it,” says McEachern. As he tells stories from the war, he speaks faster, energetically waving his hands to punctuate the tales. “One night we were playing cards, Go Fish, the Serbs and Croats were fighting, and we were in the middle, with rounds screaming around us.” He saw a Canadian engineer blown up by a landmine. A sniper shot his friend, “a good buddy.” One evening a Serbian soldier led McEachern and others into a minefield. They wore night-vision goggles, but an electrical storm short-circuited the goggles, and McEachern stood blind in the middle of a minefield in a bombed-out part of town. 

On a second mission, to Uganda, McEachern saw a woman raped and a man beaten to death, but was ordered not to intervene. He saw birds pecking at a dead child. “It’s like a negative image that’s permanently imprinted into your brain,” he says. “You remember smells, colours. You’ll never forget those situations.” 

Back in Alberta in 1996, though still in peak physical shape—a high-end infantryman—he began to withdraw, and felt headed for a breakdown. “I started getting panic attacks,” he says. “I’d wake up completely soaked, freaked out, I didn’t know where I was. I had crying spells where I didn’t know why I was crying. I didn’t know what was going on.”

At CFB Edmonton, Dr. Passey diagnosed McEachern with PTSD. McEachern went on sick leave. He was treated with medications and therapy, but his symptoms got worse and he felt stigmatized by his peers. “I probably stared at the noose in the garage 10–15 times,” he says. “I wanted to die.” At a cadet base, he chanced upon a picture of himself on a wall. “I was 16 years old, all done up in dress uniform,” he says. “And here I was now, a vet of 14 years, a couple of tours [behind me], and at that moment I knew I was done.”

On March 14, 2001, McEachern was told that due to a policy change, in which sick leave would be counted as holiday time, some $25,000 of his paid leave would be revoked. That same day, he received a service medal in the mail rather than with his unit. He felt humiliated, and went home to drink beer. The next thing McEachern remembers is a knock on the door of his Nissan Xterra, which was now inside the garrison headquarters at CFB Edmonton. In the early morning hours he had rammed his SUV through the front doors of the garrison and driven around an empty office, toppling desks and computers. But, as he says, “most of what happened that night I heard for the first time in the courtroom.” 

Before his trial, McEachern filed a complaint with the military ombudsman, André Marin, about the Canadian Forces’ lack of support, training and treatment for soldiers afflicted with PTSD. Marin found the complaints justified. His 229-page report was blunt. “Post-traumatic stress disorders in the Canadian military are pervasive and system-wide,” wrote Marin. “We found a disturbingly high incidence of soldiers returning from missions who were burnt out and broken. Those who reported their illness felt stigmatized and abandoned while many others had not disclosed their symptoms for fear of being ostracized by their leadership and peers.”

The report did not affect the trial’s outcome. Charged with impaired driving, assaulting a peace officer, mischief and dangerous driving, McEachern was convicted on four charges and given a 14-month conditional sentence and a $2,000 fine. The decision in R. v. McEachern, according to lawyer Benjamin J. Kormos, hinged on whether or not McEachern was aware of his actions and knew right from wrong at the time of the incident. In a 2008 article on PTSD and Canadian law for Criminal Law Quarterly, Kormos noted that Dr. Passey testified McEachern had been in a PTSD-related dissociative state, in which he could perform complex actions but “would not be aware of thoughts, emotions, morals, ethics or even laws at that point.” Conversely, the prosecution’s expert, military psychiatrist Colonel Randy Boddam, testified McEachern had been aware of his actions. Yet Boddam admitted he had never interviewed McEachern or read his medical files. Kormos wrote that since Colonel Boddam had “barely a scintilla of foundation for his opinion… it was unreasonable to prefer the Crown’s expert.” The case, Kormos concluded, was “wrongly decided.” 

The Canadian Veteran Adventure Foundation helps soldiers “reclaim their lust for life.” Here, participants navigate the Kananaskis River. (Christian McEachern)

“A slew of [PTSD-related] cases have been reported,” says Kormos, who I met in his 28th-floor office in downtown Calgary. “So there’s a bunch that you can safely assume are not in the case reports.” Out the window we can see people walking on the streets far below. In his article, Kormos wrote that until the military takes steps to treat and prevent PTSD, “soldiers will continue to bring home landmines in their rucksacks.” I ask what he meant. “By definition this disease can take years to appear,” he says. “It’s like a landmine because a landmine is sort of planted and forgotten about. If you don’t prevent this disease, if you don’t treat it, someone is going to step on that landmine and a lot of these cases are going to end up in court. This is an issue that needs to be dealt with.” 

CFB Edmonton, the home base for 6,600 Canadian Forces members, is situated on 2,550 hectares along the northeast border of the city. On a cloudy winter day, I drove north up Highway 28, past strip malls and gas stations, through a gate in the chain-link fence topped with razor wire that surrounds the base, and met Greg Prodaniuk, the western regional coordinator for the operational stress injury social support program. It’s a peer support network that connects soldiers, veterans and their families to treatment options for Operational Stress Injuries (OSI), a military term for post-deployment psychological difficulties such as anxiety, major depression, substance abuse and PTSD. 

“I really have a reaction to people that characterize the injured population as so unstable that they’re a risk to the security of their communities,” says Prodaniuk, who was himself diagnosed with PTSD after serving in Croatia. “That’s not the case. The vast majority of them suffer in silence and in their basements, and they don’t hurt people.” He leans forward in his chair, a tall, hefty man with an eye-to-eye gaze. “But they do destroy relationships,” he says. “They have difficulty controlling their emotions. They have reactions they’re not in control of. I tell them if you have PTSD, your life is simply not compatible with booze. It’s like throwing gasoline on the fire.” 

Prodaniuk’s clear and frank talk is part of an evolving culture within the military. Since the blunt Marin report in 2002, the Canadian Forces have worked to minimize stress injuries through screening and improved treatment. Education programs now train soldiers in the factors that cause OSIs, including trauma, fatigue, grief and moral injury, defined as “a disruption in trust in moral values.” New stress injury clinics have opened across the country. “Raising awareness and overcoming stigma about mental health is a top priority,” said general Walter Natynczyk a few months before the latest OSI clinic opened in Edmonton, in December 2009. 

The effort has paid dividends. Currently, the PTSD rate in Canadian soldiers returning from Afghanistan is about 5 per cent, down significantly from the high rates in the 1990s. Still, about 11,000 people in the military are believed to be suffering from a stress injury such as PTSD, and the exact numbers are unknown. In 2008, a follow-up ombudsman report on PTSD lamented that a database to track psychological injury levels within the military would not be online until 2011, the year the current commitment to Afghanistan is supposed to end. Even then, the data will likely be incomplete. With the delayed onset of many OSIs, veterans who develop symptoms after leaving the military may not be counted. 

 “If you understand the soldiering culture,” says Prodaniuk, “if you understand the [nature] of these injuries, you’ll understand that the vast majority of people will not face them while still in uniform. The stigma still exists. There’s a lot of self-imposed stigma.” 

I ask if he thinks there’s a need for alternative treatment options, such as outdoor recreation. He nods. “I would like to see the government fund more outside-the-box therapies and care,” he says. “Maybe guys just need to get out of their home environment for a while to readjust. So yeah, places where they could go and engage in sports and enjoy the outdoors, I think there’s something incredibly therapeutic about that. Does it fit within the rigid treatment model the government may sign off on Probably not.”

He walks me outside to my car. “There are a lot of soldiers here in Alberta,” he says. “A lot of veterans. Should they be treated special I think they probably should. They’ve put themselves in harm’s way, and a lot of them suffer from mental health impacts that they would not have suffered if they had not volunteered to go over there on our behalf.” Prodaniuk points: the flags are at half-mast, honouring Canadian soldiers who recently died in Afghanistan. “Unfortunately,” he says, “that happens a lot these days.” 

Before driving to Priddis to see Christian McEachern again, I speak on the phone with Dr. Passey in his current office at a PTSD clinic in a Vancouver hospital. In a clinical setting, he says, PTSD patients are treated with medications and therapy. While the majority of cases settle down in the first year, “anywhere from 30 per cent to 47 per cent of people will continue to have significant symptoms even 10 years down the line.” In Canada, the Canadian Veteran Adventure Foundation was the first to offer free outdoor programs to help minimize the symptoms of PTSD. Passey went on the CVAF’s first raft trip, in August 2009. “The beauty of Christian’s program,” he says, “is it brings together people struggling with similar symptoms. It gives them a chance to be in nature without the danger and fear they may have been exposed to on their tour. It has a lot of potential.”

McEachern with Sozo, near Priddis, 2010. (Tadzio Richards)

At McEachern’s place, the sky overhead is blue, blown clear by an incoming chinook, and the Rockies to the west shimmer in the sun. McEachern and Monica Culic are standing by the barn that holds their three horses. McEachern is unshaven, dark circles under his eyes. He says the CVAF is in trouble. It needs funding. Not only that, it has competition: Outward Bound, funded by the Royal Canadian Legion, is launching a similar program to help veterans readjust to civilian life. Their first expedition is in the spring, a one-week ice-climbing trip in the mountains west of Calgary. 

“I’m happy,” says McEachern. “More vets are going to get programming, and that’s what we wanted.” He shakes his head. “But by the same token we’ve let the opportunity slide away.” He looks at Culic. “I still think there’s a stigma attached to the garrison incident,” he says, talking about the slow trickle of donations to the CVAF. “I’m still ashamed by it. It wasn’t a conscious choice, but, boy, I wish I could take it back. I mean, it’s part of the story, but at what point can the story switch?”

“The clients are there,” says Culic. “They’re still hanging out in their basements, they’re still struggling. Maybe the story for you is that you got a second chance. That’s the story that the guys who came here in August liked. You said, ‘we don’t care what you look like, what kind of shape you’re in, what people are saying about you, we accept where you’re at, warts and all.’ We’re not looking for the guy that can climb Yamnuska; he’s not our client.” McEachern nods, and enters the barn. 

“He’s a pretty crusty hard dude on the outside,” says Culic. “But the care he has for those people and those horses is deeper than the average Joe.” We stroll into the barn. McEachern is in a stall, kneeling on straw beside his 17-year-old ex-racehorse. He and Culic rescued it from a slaughterhouse. When they got the thoroughbred, they were told its name was “Sozo,” which in Hebrew means “to heal.” Months ago, Sozo tried to leap a fence, and the gash on the horse’s foreleg has been slow to close. We watch as McEachern wraps gauze around the torn skin. 

Tadzio Richards is a two-time National Magazine Award winner. He lives in Calgary and, as much as possible, the mountains.

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