Mind and prejudice

One of the many times she attempted suicide, Patti Crory was rushed to the emergency room with deep cuts on her arms, breasts and along her jaw line.

She sat for several hours in the hospital waiting room, covered in bandages and dried blood, before the resident doctor was able to see her. Crory remembers his confused expression.

“When I explained that I had multiple personality disorder, he went away and when he came back he said to me, 'Did one of your personalities jump out beside you and cut your face?'”

Crory, 47, laughs now at the memory of what she considers an absurd question.

“He was deadpan serious,” she says. “No understanding, no concept of the disorder, no nothing.”

Michael Kirby, chair of the Mental Health Commission of Canada, unveils a new logo for the Opening Minds anti-stigma initiative.

Crory, an organist and piano teacher from Timberlea, Nova Scotia, has been to the emergency room more than a dozen times since she was diagnosed with dissociative identity disorder — formerly called multiple personality disorder — in 1997.

She is one of the millions of Canadians who seek treatment each year for mental illness and hit roadblocks: discrimination, wait times and a system that is extremely difficult to navigate. Many of these people end up in emergency rooms because the services they need do not exist or are difficult and confusing to access.

Crory has experienced wait times of more than 24 hours, heard emergency room staff call patients with mental illness “crazy” and has had doctors send her home immediately after suicide attempts.

Last August, as she sat on a gurney waiting to be admitted to a short-stay unit in Halifax, she overheard a paramedic tell hospital staff that traffic was backed up because there was a “jumper” on the bridge. The paramedic, loud enough for people around to hear, said he wished the jumper would make up his mind because he was holding up traffic.

Crory says a lot of people, health professionals included, can’t understand or tolerate why and how someone could get to a place where they’d want to hurt themselves.

“When you have a broken leg people fix it. They put it in a cast and everybody knows that your leg is broken and that it’s healing.”

The problem with mental illness, Crory says, is that the injury is invisible.

“People don’t see the hurt, people don’t see the confusion, and people can’t see the struggle that is healing,” she says. “And people prefer that it remains invisible because they’re really uncomfortable when you say ‘I live with a mental illness.’”

Defining emergency

The emergency services offered in Canadian hospitals vary drastically from province to province, and between cities, towns and villages.

The Mental Health Commission of Canada’s (MHCC) framework for a mental health strategy says it’s inaccurate to call the existing array of programs and services a “mental health system.”

“People seeking help often confront a confusing and fragmented maze made up of programs that have been developed at different times, at every level of government, straddling numerous ministries, departments and agencies, as well as involving the private, community and voluntary sectors,” the framework reads.

Some emergency rooms have specialized mental health services, such as psychiatric nurses and in-patient beds reserved for people with mental illness — but many do not.

Some hospitals have partnerships with community services so that people with mental illness are connected to the support they need before they leave the emergency room — but many do not.

The one thing they do have in common is stigma, which experts say is pervasive in hospitals across the country.

Louise Bradley is the chief operating officer for the MHCC and a nurse who has worked for 30 years in both Nova Scotia and Alberta.

"When I explained that I had multiple personality disorder, he went away and when he came back he said to me, did one of your personalities jump out beside you and cut your face?" — Patty Crory

“As a health care professional myself, I’ve seen the stigma that has to be endured by people with mental disorders in a variety of health care settings, and it saddens me to say that, but that is the reality,” Bradley says.

She says emergency rooms are the place where people want to be seen as quickly as possible and to be taken seriously. But for people experiencing psychiatric emergencies, this is often not the case.

“What tends to happen in many situations is that the other emergencies take precedence over the mental health ones,” Bradley says. 

One of the MHCC’s national initiatives is a 10-year anti-stigma campaign called Opening Minds, which aims to change attitudes and behaviours toward mental illness. The first phase of the campaign will focus on youth and health professionals.

It will target doctors, nurses and people who work in emergency room reception, because people seeking help say they experience some of the most deeply-felt discrimination on the medical front lines.

Bradley says belief systems have to change before there can be any real progress in transforming the mental health system.

“How can we possibly provide a service that will meet their needs when we have a belief system that is so contrary to what the real problem is?”

“Stigma is the polite word,” she says. “It really is downright discrimination.”

Putting the "care" back in health

Stigma can hurt people who seek care for mental illness, and it can also prevent them from getting treatment in the first place.

“Stigma, and self-stigma, can influence people’s decision to go seek care,” says Michelle Gold, senior director of policy and programs for the Canadian Mental Health Association’s Ontario division.  

Gold says research also indicates that people with mental illness experience more barriers when they try to access primary care than people without a mental illness.

When Lisa Duncan seeks treatment for her physical health problems, her mental illness often becomes the focus instead. 

Duncan, 41, has a brain aneurism and a rare neurological disorder that leaves her with regular migraines and constant pain. The aneurism causes stroke-like episodes that make her collapse, lose her ability to speak and temporarily paralyze the left side of her body.

Lisa Duncan reads over her discharge report from the Ottawa Civic Hospital. She says emergency room doctors attributed her physical problems to mental illness because her records showed she was taking anti-psychotic medication.

She had one such episode in her home in Barrhaven and was taken to the emergency room at the Ottawa Civic Hospital. But instead of treating her physical symptoms, Duncan says the trauma team blamed her paralysis on mental illness, even though they knew about her neurological condition. 

“Once they realized I was on mental health prescriptions, the treatment was totally different,” she says.

“I can remember the doctor, the head of the trauma team, yelling at me, [saying] you better move the left side because if you don’t we’re going to give you the stroke medication and if you’re not having a stroke your brain is going to bleed.”

After the incident she filed a letter of concern with the hospital, and later received a written apology. But she says the experience was so traumatizing that she won’t go back to the emergency room, even though she experiences the stroke-like symptoms regularly.

“You’d think the medical field would be the least stigmatizing, and sometimes they’re they most.”

'Now is the time to work even harder than ever'

At Ridge Meadows Hospital in Maple Ridge, B.C., patients who experience a mental health emergency have specialized services to meet their needs.

Lisa McMurray, manager of mental health and addictions services for the hospital, says a recent expansion — financed in part with a donation from a member of the community — has allowed Ridge Meadows to improve its psychiatric emergency services.

In June the hospital opened a new 20-bed emergency psychiatric care unit with increased working hours for psychiatric liaison nurses and a policy of more collaboration across all hospital services. McMurray says this has helped educate and inform the regular emergency room staff about the best approach for patients with mental illness.

“The collaboration also means that we’re all aware of other services and we’re all talking to each other about what’s the best spot for a particular individual,” she says.

It has even addressed the problem of stigma throughout the hospital.

“We can see some big changes in how psychiatric patients are treated while they’re in hospital generally since we started this,” McMurray says.

Ridge Meadows isn’t the only hospital that has these services, but it’s one of a small number.

The MHCC wants to spark this kind of transformation across the country.

Bradley says it will take decades to reform the mental health system in Canada, but the momentum for change is growing.

“If we are making progress — and I like to think that we are — then now is the time to work even harder than ever,” she says. “Because for every one story that we may get that’s positive, there are 10 others that aren't.”

Laying the blame on mental illness

When Lisa Duncan was rushed to the emergency room with the left side of her body paralyzed she didn't understand why the doctors weren't taking her physical problem seriously. But then she realized they were distracted by an unrelated issue — her mental illness.