THE MACRO
The moment I stepped out of my car, I could hear yelling at the back of the parking lot. Then, a store employee — gathering stray shopping carts — walked by.
“I’m not going to let anyone yell like that at me,” the young man said. When I asked what was wrong, he told me that an older man was wandering the parking lot, yelling random profanity at customers and employees in a menacing tone.
I saw the man, ranting to himself and occasionally lashing out verbally at anyone unlucky enough to cross his path. Some people yelled back with their own profane comments.
Later, as I was leaving the store, some of the staff were looking out the front windows, still complaining about the man. A store manager made moves to go out into the parking lot as staff started to become more anxious.
I finally interjected. “This man is clearly experiencing what appears to be a crisis. Why don’t you call 911 and ask for some sort of assistance?” The manager shrugged and walked away.
As I returned to the parking lot, I saw more people confronting and yelling at the raging old man. Then, the front passenger of a vehicle rolled his window down and flashed the finger at the old man as they drove away.
I don’t take issue with anyone who feels threatened in a situation like that. What I do take issue with is the fact that anyone would take what the man said or did so personally that they would rant back.
This isn’t going to be one of those “when did we lose our compassion and empathy” commentaries, largely because we’ve never really had much in the way of compassion and empathy for the mentally ill.
In past eras, Western nations largely stockpiled the mentally ill and those with cognitive impairments in warehouses otherwise known as asylums, sanatoriums and mental hospitals. These facilities were more like prisons than hospitals, and ultimately the patients more like inmates where they were subjected to all forms of experimental or extreme treatment.
Starting as far back as the 1950s, those facilities started to be phased out. And while de-institutionalization has been a generally positive development, we’ve never really figured out how to provide adequate support and intervention for all those people we used to just lock up and forget.
In fact, there is a strong argument that the end of the age of the asylum triggered the massive increase in mental health problems in jails and prisons, the proliferation of homelessness and the crises in mental health and addictions we are experiencing today.
A study published this year by the Rand Corporation, a non-profit global policy and research organization that is generally considered among the most factual and least-biased think tanks in the U.S., found the number of Americans in need of inpatient psychiatric services has risen from four per cent in 2018 to more than 13 per cent in 2020. At the same time, the number of beds in psychiatric hospitals has fallen.
It is important to remember, however, that one of the reasons de-institutionalization is being blamed for some of these problems is that most countries failed to provide community-based support for the mentally ill once all the asylums were closed.
In 2021, the World Health Organization found that of 194 member countries studied, only 51 per cent “reported that their mental health policy or plan was in line with international and regional human rights instruments,” and that only 52 per cent “met the (UN) targets relating to mental health promotion and prevention programmes.”
What does all that look like at street (or parking lot) level? More homeless people suffering from mental health and addictions. Fewer in-patient treatment options and insufficient community supports. Oh, and the burden of interventions falls to police and paramedics.
The collision between the fear and frustration we feel when we come into contact with someone in the throes of a mental health crisis, and the lack of appropriate support, is top of mind for anyone who lives in a city. Nobody is quite sure what to do, but that does not mean some are not trying some radical approaches.
New York City this fall introduced a plan to involuntarily commit people found suffering mental health crises. Mayor Eric Adams called his bylaw an act of compassion, and a “new pathway forward to address the ongoing crisis of individuals experiencing severe mental health illness left untreated and unsheltered in New York City’s streets in subways.”
Needless to say, Adams’ plan has drawn a lot of debate. Many New Yorkers are in favour and agree with Adams’ assertion that not committing people is tantamount to ignoring the problem. Others are concerned it’s only a temporary solution that clogs an already overwhelmed and under-resourced hospital system.
I honestly believe the solution will be found in devoting more resources to appropriately trained, multi-disciplinary teams of heath and law enforcement personnel to intervene when someone really needs the help. And a massive increase in community access to psychiatric care.
That seems so much better than forcing people into hospitals or leaving those suffering from mental health problems to be ignored or menaced by an indifferent and cruel public.
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