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It is really about basic dignity and respect – Louise Bradley on mental health care and living in institutions

KJIPUKTUK (Halifax) – For me, the testimony by Louise Bradley was one of the highlights of this week’s proceedings at the human rights inquiry I have been reporting on over the last while. The enquiry looks into the lack of community living options for people who live with mental illness, and/or physical and developmental disabilities.

Louise Bradley at the NS Human Rights enquiry. Photo Robert Devet

Much like dr. Catherine Frazee’s fascinating testimony about ableism an austerity a week earlier, Bradley focused on structural issues that plague the current system; a lack of choice, insufficient opportunities, and stigma.

“It is really about basic dignity and respect. To tell somebody they aren’t capable or shouldn’t have choices is really putting people down.” 

Bradley is the president and CEO of the Mental Health Commission of Canada (MHCC), where she initiated the housing first chez soi project, that demonstrated the immense benefits of providing unconditional choice and agency to homeless people.

Earlier in her career she helped implement a recovery-oriented, patient-centric approach at the East Coast Forensic Hospital in Halifax, where, as we learned earlier, residents often continue to languish in the hospital for years after receiving a conditional discharge because of a  lack of supportive housing.

The focus of our conversation is naturally on the mental health system, but you may find that much of what Bradley says applies equally to Nova Scotians who live with physical or developmental disabilities.   

“The work we have done with the Mental Health Commission has not been with these people. We all have limitations in terms what we can do, but even within those limitations there is still choice,” Bradley says.

On choice in the mental health system

The mental health system is one of the only parts of the healthcare system where we don’t outline the choices and options people have and let them choose. When I am diagnosed with a cancer, I expect my healthcare provider to outline what the various option are, what the risks are associated with each option, and I am the one who chooses. It really shouldn’t be any different for people with mental illness.

Very clearly people have said that they were exasperated by the care previously provided by the system, that looked at them and said that because they had a mental illness they weren’t capable of understanding. We tend to be far more successful when we find something that meets our needs and is appealing to us. Choice is very important, but unfortunately it seems to be a novel concept in the mental health system as compared to the rest of the health system.

It is really about basic dignity and respect. To tell somebody they aren’t capable or shouldn’t have choices within their limitations is really putting people down and showing huge disrespect for them.

On stigma

If you look at somebody and consider what their strengths are, as opposed to simply seeing their limitations, then your approach becomes very different. What we have learned in the ten years of studying stigma at the CMHC is that stigma itself is the thoughts, and its result is discrimination.

Therefore it very much impacts the health care profession, in that think we know what’s best for “these people.” You’d expect to find stigma in the media, but among health care professionals? It’s a complex issue, we continue to make progress, but we still have a long way to go.

On the liberating effects of community living and the need for supports

To live in community does have a liberating effect. I saw that time and again during my tenure at the East Coast Forensic Hospital. I got to know the clients there quite well, and we had people going to school, to university, and then eventually return to live in the community.

In the media we don’t hear about the hundreds of times people come back, but the one time somebody doesnt is the one we hear about. There are numerous examples of people who successfully reintegrated and I have to tell you, there is nothing more rewarding than seeing that happen.

An institution it is not a home, no matter how much we make it homelike. People who live there live by rules and regulations that you wouldn’t see at home You want to sleep in one morning, or get up in the middle of the night and have a cup of coffee, you can’t do that.

Then suddenly you are placed in a situation where none of this is in place. It is no wonder people lose these skills, and they lose their confidence. It takes time to rebuild those skills, and we can’t just thrust people out without giving them support.

We used to call it the revolving door syndrome, where  people would be discharged after a lengthy hospitalization, only to find within a matter of time that they would be back in again. We’d scratch our head wondering why. Well, we were setting people up for failure.

On the very long waits of East Coast Forensic Hospital residents after receiving a conditional discharge  

People at the Forensic Hospital have committed crimes, and they were found not responsible for those crimes because at the time they were suffering from a mental illness that did not allow them to understand the nature of the crime or appreciate the consequences.  

You have a team that worked with you, and believes in you, that has said yes, you are ready to go into the community. The Criminal Review Board has agreed, and gives you a conditional discharge.

Then to be sitting there and not be offered anything, if affects your self worth, it emphasizes that you aren’t valued and respected, let alone given a choice. Hope comes into play in these situations. It is devastating to be institutionalized under those conditions. Even under the best conditions it is bad, it must be absolutely horrific. It is terribly stigmatizing and the consequences are so damaging to that person, and also to family and friends.

We didn’t talk about it directly, but check out the MHCC’s National At Home/Chez Soi report, a research demonstration project, which examined Housing First as a means of ending homelessness for people living with mental illness in Canada. The project followed more than 2,000 participants for two years, and was the world’s largest trial of Housing First. You will find many of the same principles that we discussed in this interview in that report.

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