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Thursday, December 09, 2010

Culture shift needed in society, system

December 9, 2010

In the end, who failed Howard Hyde?

Perhaps, to some degree, we all did.

There is really no way to dress up the realities of mental illness. It is not pretty, and it can be a very tough challenge to support people in crisis. The people who live closest to those who suffer from mental illnesses are victims of the illnesses, too.

There is also no way to disguise or excuse how our society has continued to respond to people who experience mental illnesses. The stigmas are clear and well understood, even by young children in our schools. The branding begins early.

Hyde is the Dartmouth man who died in custody in 2007. He suffered from schizophrenia. The police were told of his mental illness when he was taken into custody over allegations of domestic abuse. He later died after an intense struggle with prison guards.

Provincial court Judge Anne Derrick released the fatal inquiry report into Hyde’s death on Wednesday. She firmly rejected a previous finding by a pathologist that he had died due to a condition termed "excited delirium."

Derrick dismissed that finding as a "red herring" that did not exist in Hyde’s case.

She also found that while the repeated use of a Taser on Hyde during his time in police custody "worsened the situation," it was not the cause of his death. She did, however, remind justice officials that so-called stun guns are to be used as an alternative to lethal force rather than as a front-line option to subdue suspects who are emotionally disturbed.

His death was accidental, Derrick found, but it came as a direct result of his struggle with prison guards.

In the comprehensive list of 80 recommendations, Derrick tossed the ball firmly into the hands of the provincial government.

She begins by calling for the establishment of a long-promised, but still absent, mental health strategy. It is clearly not by accident that this basic framework is at the top of the list as a necessary building block from which other improvements would naturally evolve.

The judge also calls on the province to increase funding for mental health, but not to do it by reallocating funds from within the existing envelope of health-care funding. This reflects the fact that mental health issues have for too long languished on the list of health-care priorities.

We are left with a fractured, often inaccessible mental health system where vanishing waiting lists are proudly waved around by government as proof of treatment for patients. Improvements are being made, and Derrick’s report makes note of policy changes that have already occurred in the justice system in the wake of Hyde’s death.

But it is hard to comprehend that none of the guards involved in the struggle with Hyde minutes before he died had any training to help them deal with prisoners who suffer from mental illness.

One seemingly innocuous recommendation, No. 49 on Derrick’s list, speaks volumes. Directed at justice system staff and other front-line officials who are in contact with prisoners who suffer from mental illness, it is brief and to the point:

"Training should have, as its overarching purpose, the development of a culture of respect and empathy for persons with mental illness in the justice system."

This is a statement that reaches beyond the justice system and into our society as a whole. While mountains have been moved in reducing the acceptance of stereotypes linked to mental illnesses, many of the most basic government services — justice and health among them — are still handcuffed by systemic ignorance.

The judge called for alternatives for people with mental illness who come in conflict with the law, and says the responsibility reaches well beyond the justice system.

"As the evidence before the inquiry has vividly illustrated, grasping this nettle is not just the responsibility of the justice system; creativity and commitment to change are required of the health system and the community, too."

The principles of respect and empathy provide a good place from which to start.

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