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.