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Mental health systems are by and large changing very quickly these days. In Ontario mental health services restructuring is called "Mental Health Reform" and it was originally a ten-year process of shifting funding from hospital services to community treatment and support services, starting in 1993. Most of North America and England has been doing the same thing and like Ontario they are having mixed results. The intention of such restructuring was to raise the quality of life for the mentally ill by facilitating their integration in the community.
Hospital services cost lots and lots and money, and in a lean, mean economy it was expected that mental health services restructuring would be more cost effective. The focus of most mental health services restructuring was on the serious and potentially disabling illnesses, such as schizophrenia. But mental health services restructuring has generally been a disaster wherever it has been attempted. In Ontario it was exactly the population with schizophrenia and to some extent bipolar disorder that suffered the most. The number of homeless people with schizophrenia increased dramatically as did the number of people with schizophrenia appearing in court, usually for minor crimes but occasionally for murder. Our Ministry of Health actually had back-to-back press releases, one promising further reductions of psychiatric beds, the other announcing the opening of new forensic beds. The forensic beds were needed for NCR (not criminally responsible) assessments, an assessment to determine if someone is too mentally ill to be held responsible for their crime. Many people were being held illegally in jail, some for up to a year, waiting for a forensic bed to determine their NCR status in court. The Ministry of Health wasn't documenting the success or failure of Mental Health Reform. It eventually became an election issue. The public became very concerned for the homeless, particularly the homeless suffering from an untreated mental illness. Eventually the city of Toronto commissioned "The Golden Report," an excellent study of the homeless problem in Toronto. The Ministry of Health-funded study called "Pathways to Homelessness," by contrast, appears to have been a cover-up of the numbers of homeless with untreated mental illness. The public also became very concerned for their own safety with untreated mentally ill people on the streets. One incident in particular had a major impact. Someone with a history of schizophrenia pushed a young beautiful woman engaged to be married in front of an oncoming subway train and she was killed. Anyone who used the subway after that made sure they weren't standing close to the edge of the platform and you couldn't help but think of the tragedy while you were waiting for your train.
The copyright of the article Mental Health Services Restructuring in Schizophrenia is owned by . Permission to republish Mental Health Services Restructuring in print or online must be granted by the author in writing.
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