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By law, people with mental illness are entitled to the same benefits of citizenship as other Canadians. In practice, however, many people with mental illness or addictions are denied access to a broad range of opportunities in our society such as employment and adequate housing.
The personal costs of mental illness and addiction may include a job, a family, an education and the ability to participate in social activities and community events. But few community resources are available to support people who wish to reclaim these activities.
For 40 years now, as part of a process called "deinstitutionalization," the mental health system has been moving away from traditional institutions in favour of a community-based model. But, unfortunately, the process has been less than smooth. Institutions, community services, and community supports haven't been integrated effectively. General hospitals and communities have been underfunded and inadequately equipped for their roles in helping patients leave large institutions.
Without appropriate income and community-support services, people with serious mental health or substance use problems can become trapped in a "revolving door syndrome." Once released from hospital or residential treatment, many people with mental illness or addictions are forced to resort to substandard housing because of a lack of money. There, their health deteriorates, resulting in return visits to the hospital or treatment centre and an increase in the symptoms of their mental illness, or a relapse.
Housing problems are directly related to poverty, the shortage of affordable housing and discrimination—all of which are major concerns for people with major mental disorders. For example, unemployment rates for people with psychiatric disorders hover around three to five times higher than rates among people with no disorders.
As for income, research has found that low socioeconomic status is strongly associated with mental health problems, particularly the development of mood or anxiety disorders. There is also a link, independent of mental illness, between low socioeconomic status and attempted and completed suicides. The combined stress of poverty and living with a mental illness can increase a person's vulnerability to problem alcohol and drug use, resulting in even more challenges to recovery. As many as one-half of people with a serious mental illness may also have an addiction. Nevertheless, many individuals with mild, moderate or major symptoms of mental illness recover without developing a substance use disorder. But they, too, may face tremendous personal losses as a result of their illness.
Stigma, misconceptions and discrimination leave people with mental illness and substance use problems among the most devalued of all people with disabilities. A major US study investigating consumers' personal experiences of discrimination found that just over half had been discriminated against in employment settings, and nearly a third had encountered discrimination in housing situations. About a quarter had been discriminated against by police, and just under a quarter had experienced discrimination in mental health service or educational settings.
Maurizio Baldini, 44, is a mental health advocate and former lawyer with schizophrenia. After five years of practicing law, Baldini experienced his second acute episode of schizophrenia which involved a delusion that compelled him to light some candles in his house. When a large portion of his house caught fire and burned, Baldini was charged with arson and sent to BC's Forensic Psychiatric Institute to await his trial.
Although he was acquitted, Baldini says he was overwhelmed by the prospect of undergoing a disciplinary hearing to reapply for his license to practice law. "At one point I attempted to do that," he says, but adds that he changed his mind when he discovered the amount of time and money involved. "It's like another trial, going through the whole process all over again, just to get my license."
Baldini says it was hard to let go of his law practice, but it was much harder to cope with losing custody of his son as a result of his period in hospital. "My ex-wife was so bitter that she denied me access to my son," he says, adding that the courts have stood by her for 13 years. "The really sad part is, with an illness like this, he has a 10% chance of developing it himself," he says. "I could have been there for him."
Despite his experiences, Baldini has created a fulfilling life for himself and considers himself lucky. But some people who have been in the mental health system for an extended period of time lack the basic self-confidence and social skills that would allow them to feel comfortable in a community setting. Because of this and because of shame, prejudice and discrimination, many people find it difficult to gain employment and develop and maintain rewarding relationships with friends and co-workers.
Mental illness can take its toll on relationships with family members as well. For example, children who are living with a parent with a mental disorder may be confused and upset with their parent's behaviour or a sibling may feel jealous of the amount of time and energy their parent is spending on a child with mental illness. In some cases, relatives begin to feel trapped and overburdened as they struggle to balance caregiving with their other responsibilities.
The effects of substance use on family members can be just as distressing. A parent's drinking or drug use can impede their ability to care for their child adequately. As the child grows up he or she may learn drinking or drug use as a coping mechanism, if this behaviour has been modelled by a parent. Also if a young person or an adult experiences problems with substance use, the effects on their parents are significant. They may suffer feelings of guilt, as well as extreme concern for the health and safety of their child.
Nevertheless, family and friends who understand the nature of their relative's illness can greatly improve his or her chances of long-term recovery. The key is to seek help from family counselors, self-help groups and other services that offer education, respite services and emotional support for families dealing with mental illness. With outside help, the experience can even draw family members closer together, as they learn to foster hope and support each other through difficult times.
Without adequate community services, people with mental illness may lose access to:
adequate housing
employment
proper nutrition
a livable income
their children
community activities
leisure opportunities
Sources
Cook, J. A., Leff, H.S., Blyler, C.R. et al. (2005). Results of a multisite randomized trial of supported employment interventions for individuals with severe mental illness. Archives of General Psychiatry, 62(5), 505-512.
Gresenz, C.R., Sturm, R. & Tang, L. (2001). Income and mental health: Unraveling community and individual level relationships. Journal of Mental Health Policy and Economics, 4(4), 197-203.
Kirby, M.J.L. & Keon, W.J. (2006). Out of the shadows at last: Transforming mental health, mental illness and addiction services in Canada. Final Report of the Standing Senate Committee On Social Affairs, Science and Technology. www.parl.gc.ca/sencom-e.asp
Sanders Thompson, V.L., Noel, J.G. & Campbell, J. (2004). Stigmatization, discrimination, and mental health: The impact of multiple identity status. American Journal of Orthopsychiatry, 74(4), 529-544.
Taylor, R., Page, A. & Morrell, S. (2005). Mental health and socio-economic variations in Australian suicide. Social Science & Medicine, 61(7), 1551-1559.
Substance Abuse and Mental Health Services Administration, United States Department of Health and Human Sciences. (2005, January 31). Many patients have co-ocurring mental and substance abuse disorders—both must be addressed for sucessful treatment. www.samhsa.gov/news/newsreleases/050131nr_TIP42.htm
Links in the Sources section are up to date as of June 2006
