Two weeks ago, a man went on a rampage with a hammer in Calgary and caused hundreds of thousands of dollars to the city’s Peace Bridge..Last week, another man broke into Calgary’s city hall and did extensive damage to the building as he lit fires. He couldn’t be immediately restrained as he was carrying a large knife..This week in Montreal, three people were shot and killed in what appeared to be random killings. A suspect was located Thursday in a motel and was shot and killed by police as they tried to apprehend him..The common denominator in all three of those incidents is the perpetrators were known by authorities to have serious mental disorders, but they had been released into the public anyway..With the tragic incident in Montreal, the killer was released from a mental institution last March despite a psychiatrist saying he presented “a significant risk to public safety due to his mental state.”.So if an expert felt this man was dangerous, why was he released?.It was because of an ideological adherence to the concept of deinstitutionalization..The deinstitutionalization movement came about in the latter part of the 20th century. The rationale was it was inhumane to incarcerate people with mental health disorders and with proper community supports and medication, they could safely and productively live freely within the public. In most cases this is true. In many cases though, it is wrong, and the price of failed community integration can be high..The push to keep people out of long-term mental health facilities is understandable. Nobody likes to think of incarcerating somebody for a disease which is no fault of their own. Just because a person can’t be faulted for their mental illness doesn’t mean they can’t present a hazard to themselves and others around them if they aren’t controlled, though..Mental institutions — once know by the lovely moniker, "Snake Pits" — used to be horrible places where patients were warehoused under terrible conditions, often abused and were subject to terrible experiments. In the 20th century that changed and in the developed world, institutions were reformed to become more treatment oriented and with efforts to improve the standard of living for patients..When the deinstitutionalization movement took hold, though, the goal of reformation of institutions changed to one of elimination. Populations in institutions dropped and many closed. In the long term, though, it's evident the movement has been a failure, as witnessed by the fact many people have found themselves on the streets where they really don’t belong..We have a terrible homelessness and opioid addiction epidemic, and it is killing thousands. The solution to that crisis will be complicated and multifaceted..One important facet in the puzzle is the number of homeless and addicted people with serious mental health disorders who never should have been on the streets in the first place..In a proper institution, medication can be supervised and regulated for patients. In a street setting, many people with mental health issues self-medicate with products from predatory street dealers. This compounds the person’s problems as they now have an untreated mental illness and an addiction to be fed..Let’s quit pretending the homeless person shambling along pushing a shopping cart while talking to themselves just needs a new apartment and a job. We won’t hesitate to put a person who is physically injured into a hospital. We must stop being so squeamish about putting people with mental health disorders into proper care facilities. Yes, the difference is the person with the mental illness may lose personal choice and yes, I am talking about secured facilities. We don’t have to like the necessity to accept it..Modern facilities aren't the sort of institutions of emasculating abuse as we saw in the film, One Flew Over the Cuckoo's Nest. Patients can be housed, treated and manage to live comfortable lives within secure, long-term facilities. .Harm mitigation is a popular concept these days when it comes to addictions. That term should be applied to people with serious mental health disorders as well and the means of mitigation would be institutionalization..Existing mental health facilities are overwhelmed. Conventional hospitals have mental health wings but they are full and do not provide good or comfortable long-term care. They are meant to be transitional and patients are often discharged not because they're healthy, but because the space and resources are needed..Many people with mental health challenges have been housed in senior citizens' care facilities because the units housing residents with dementia are secured and there is nowhere else to put patients. That's unfair to the seniors, the staff and of course the person with mental illness..Finally, many of those with serious mental health issues end up in our prison system. They are often abused there, and they don’t get the treatment they need..Let’s accept a number of people with mental illness can’t currently be effectively treated and must be secured within an institution indefinitely..The facility need not be a place of punishment or harsh living. Facilities should be well funded and as comfortable as possible while allowing visits with loved ones and as much supervised public interaction as is safely possible. I'm sure many families who have lost members to the streets because of mental illness challenges would have preferred if the family member was secured in a facility rather than exposed to the elements untreated..If patients truly can be stabilized and eased into society, that's the best outcome. It must be accepted that many will not stick to their medication or are untreatable and will have to remain secured..Deinstitutionalization is a well meaning, but naïve and failed policy..It’s time to tackle the issue of serious mental illness with a mixture of harsh realism and compassion. That means expanding the capacity of our long-term, secured mental health facilities and accepting they will always be needed..For the sake of the patients and society as a whole.
