By Published On: December 12th, 20072 Comments

Victoria’s 40-person Mayor’s Task Force on mental illness, addictions and homelessness didn’t include anyone identifying as a mental health system user, a substance user, or homeless. Though the Task Force conducted focus groups with street people and service users, none were around when the final action plan was being formed. That’s too bad because, if they’d been present, just about any street person would’ve warned that the plan, for all its good intentions, was flirting with disaster.

Instead, only the respectful principle of involving these people in decision-making sprouted up in the Task Force reports like totem poles on the legislature lawn.

“Street-involved people can and should play an important role in the development and implementation of programs…”.

“Participation of those with mental illness in reforming and improving the mental health system… must include meaningful involvement, democratic decision making…”

But street people weren’t actually in the planning meetings to protest, when the Task Force paternalistically chose to implement “Assertive Community Treatment” (ACT), a notorious program of social control recently instigated throughout Ontario.

ACT was developed in the 70s to keep people linked to psychiatrists, social workers and other services by visiting them frequently wherever they are in the community. For every ten clients, one team member keeps tabs around the clock over months or years. By simultaneously providing homes for clients even if they’re not abstinent or in treatment, it’s possible to dramatically reduce homelessness, along with costly hospitalizations and police run-ins.

That’s the good.

But imagine the bad.

If ACT teams are visiting you daily to “help”, then they should have something to offer. The Task Force reports describe ACT teams helping people get into detox beds, care homes, peer supports, clubhouses, group therapy, counselling, re-training etc.

That’s fantastic, if such community services haven’t been cut to the bone. In this region, if you’re poor and seeking counselling, get behind the year-long line-ups of abused children.

The Task Force Gap Analysis is therefore basically just a lengthy list of services we need but probably won’t get because ideologically-driven governments don’t care that harm reduction and supportive rehabilitation are cheaper and more effective than ass kicking and punishment.

So in such circumstances, what do ACT teams actually end up doing?

Well, consider the hopeful titular theme of the upcoming conference of the Ontario ACT Association: “Beyond Med Drops”. Or consider an Ontario government 2004 ACT performance summary (a powerpoint presentation), which notes that, thanks to “the integrated role of the ACT psychiatrist” with her/his legal powers, ACT teams submitted clients coercively or forcibly to “daily or more frequent administration of medications” in their homes.

Essentially, ACT teams become little more than roving crisis managers armed with the psychiatric toolbox of sedatives, tranquillizers, stimulants and antidepressants.

It’s why critics argue ACT is another demented product of our drug-based mental health system, the failure of which is causing Big Pharma and fundamentalists of the biochemical model of mental problems to argue that the solution is to force more people to take more drugs earlier in life and for longer periods.

Victoria’s Task Force supports ACT’s drug-based side. There are frequent references to how ACT will help “pharmacological intervention” and “medication management” as teams remain continually “attached to the client”. It’s noted that ACT “often works well with clients who are less ‘compliant’ with treatment” and who, due to negative experiences with involuntary treatment or incarceration, won’t “sign up” for services because they have “anxiety and suspicion of people who are trying to provide them with help”.

This is why U.S. critic Dr. Tomi Gomory describes ACT as “coercive and potentially harmful.”

Certainly, beyond the positives of free housing, there’s little evidence ACT helps people, e.g. neither unemployment nor suicides decrease. And Gomory underlines how “reduced hospitalizations” occur simply because ACT clients, as a matter of ACT policy, usually aren’t taken to hospitals regardless of their mental condition.

Meanwhile, at its worst, ACT’s pro-forced-treatment approach drives people back into the streets, resistant to contacting any agency or service which would let ACT teams find them again.

Unfortunately, less-invasive supportive housing options weren’t even mentioned by the mental health professionals dominating the Expert Panel.

When I ask if the Task Force weighed the potential for ACT teams to become extensions of forced psychiatry, Expert Panel chair and Provincial Health Officer Dr. Perry Kendall replies, “Do I hear some paranoia there?”

I describe Ontario’s situation, where essentially the only ACT clients are those FORCED to be clients. Kendall responds, “The idea was that we’d be focusing on the voluntary nature of hooking people up with services and supports.” But, he admits, the panel never discussed how ACT might negatively affect people’s rights.

I suggest any street person who’s ever had a run-in with our mental health system would’ve pointed instantly to the potential dangers.

“This is a whole area we didn’t get into,” Kendall concedes. “It probably deserves a report in and of itself.”

Task Force chair Charlayne Thornton-Joe also acknowledges she hadn’t considered possible civil rights issues surrounding ACT, but emphasizes she remains optimistic about the Task Force’s intent to create a program that’s compassionate, “client-focused” and “individualized”.

Hopefully, at the upcoming Action Summit, those involved will examine more carefully how ACT functions. They should put client-group representatives in oversight positions, and enact civil rights protections. If we ensure the way ACT is implemented is entirely voluntary, it could succeed as a community-building exercise.

Otherwise, the Mayor’s Task Force will be just another phase of our messy war against the homeless.

2 Comments

  1. bev honold December 15, 2007 at 6:59 am

    Thanks Rob.I too horrified and busy phoning people this week about the rights abuses.We here in Victoria I feel can do this better if Act can be modified to suit.It by all accounts is here to stay in some form.Also I sense some need for consciousness raising that these drugs forced now conceivably upon hundreds if not the whole 1000 being housed,while extending the Jurisdiction of the Mental Health Act into the housing being provided , seems there are
    serious implications for charter rights of conscience and appears that there is also discrimination on the basis of health.These drugs so cavalierly promoted by this team should first be mandatory for the Panel Members as I see a real lack of a sense of realism here(the definition of psychosis) and we will see how long they will be party to forcing such agents down others throats!also lacking a sense of fair play as managing others in this way is so cynical.since when is science a good model to think about matters of distress and despair.Surely not a good start to what is supposed to be a compassionate and humanitarian effort.

    Rob thank-you for your truth-seeking,I was the second person to ask these sort of questions of several counsellors and through client concerns at VIHA.In fact I worked all week on this networking to investigate whether there is a community of concern.I don’t feel the city and mayor are aware to the degree that they might be of the ethically trangressive and seriously intrusive nature of this model
    for the mental health population who by and large are quite sensitive persons.

    See my short hopefully logical protest-a quiet little scream a la leonard cohen about positions and I named names…If ACT can not be amended to suit the persons invoved in a way which involves substantial safeguards it should in the name of decency be scrapped.

    Thanks again for your good workRob Your passion for this topic is personally inspiring to me.In my personal experience in regards to these drugs I faced a 21 month sojourn in hell like in kind to heroin withdrawal.No one helped me with this nor did I want or welcome assistance.Independence and choice no matter how messy always the best course of action whether societally or individually.

  2. bev honold December 17, 2007 at 7:31 pm

    Salut:

    A thought this AM:health is such a personal matter that it should NEVER be politicized in well.. (the name of decency).ACT such an example of this” politication”.I can’t help feeling that the support groups in the mayors task force report should in the name of decency be scrapped.Do what they want in Addictions but Mental Health policy a very light touch and a whole array of supports offered.A whole lot of money going into teams and oversight with no thought as you have mentioned of the lack of input from people who have experience with mental health programs not to mention the controversial nature of the medications being o”offered” or as the report emphemistically says “it’s worth watching folks that they take medications” which they may have in all conscience and or instinctually said no to.I do not think they have no place but I would draw attention to the 500 million dollars worth of law cases now in the US court system over these the very medications such as people would receive under the treatment model in ACT,perhaps enforcable which totally ignores the more time-consuming but appropriate model based on consumer/survivor feedback.Also appropriate to consider the phychotherapeutic model for treating mental health despair and consequent break-downs.As one doctor put it people where getting well before the current vogue in
    treating folks solely with drugs and then leaving them yes addicted both psychologically and biologically and also addicted to the mental health system .This seems to me a tragedy in the making .the “tip of iceberg of a different sort””Brevity is the soul of wit” I hope I’ve been brief. cheers

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