Frequently Asked Questions:
Home on the Hill is in the process of developing supportive housing for those with serious mental illness. While fighting for housing, the organization has filled a niche in our community by educating the public regarding serious mental illness through our public education series, and thereby reducing stigma. Home on the Hill also offers advocacy and support to families supporting loved ones with serious mental illness through its family support program.
Here is a list of topics that frequently come up in conversations about serious mental illness. If we can speak about these topics clearly and objectively, people will be much more likely to support our cause.
Anosognosia: A prominent feature of schizophrenia and bipolar disorder is anosognosia, a person’s unawareness that he or she has a mental illness. This is not to be confused with denial which is a psychological defense mechanism. It is not helpful to say to an individual with this symptom “you have a mental illness” as it could cause anguish for the person as he or she does not believe that has an illness. This is a brain based symptom. According to the Treatment Advocacy Centre in the United States, fifty percent of people with schizophrenia and forty percent of people with bipolar disorder have this symptom. Community mental health agencies only serve those who are “voluntary” clients, so much of the support given to those with this symptom is given by the family.
Causes: Serious mental illness such as schizophrenia or bi-polar disorders are genetic illnesses. Unfortunately, people often explain serious mental illness in terms of pet theories (e.g. bad parenting).
Chronic care: The (funded) mental health system is focused on acute care, and discharges seriously mentally ill patients as soon as the current incident is resolved. Serious mental illness is chronic, and the burden falls on (unfunded) families. Burnout and symptoms of Post Traumatic Stress Disorder are not uncommon among family members.
Diagnosis and Treatment: The behaviours of those with serious mental illness can be caused by the illness or by side-effects of the medications. They can also be the result of repeated episodes of stigma, shaming, and social alienation. Prescribing appropriate medication is therefore only one component of successful treatment.
Symptoms of psychotic illnesses are:
- anosognosia or lack of insight about the illness
- cognitve deficits such as memory problems
- impaired problem solving and goal setting
- perseverative activity (repeated dwelling on a past grievance)
- difficulty concentrating
- depressed mood
- sleeping too much or not enough
- withdrawal from family and friends
- disorganized speech, such as switching topics erratically
- suicidal thoughts or actions
Independent Living: With appropriate supports, some adults with serious mental illness can live independently. Neighbours and other members of the community may agree to be part of a “natural support” network.
Stigma and Discrimination: Continuing efforts to educate the public about serious mental illness will help overcome stigma. (Editor’s note: A 2012 Report from the Ontario Human Rights Tribunal stated that much of the discrimination experienced by those with mental illness came from the health care system).
Violence: Most people with serious mental illness are not likely to become violent, especially if they are taking appropriate medication. Violence is usually a result of feeling threatened. Factors which contribute to violence are physical (architecture, lighting, narrow corridors), mental (disorientation and confusion), or emotional (abrupt invasion of personal space).
Privacy Legislation: The current privacy legislation is a little unrealistic when it concerns those with serious mental illness. Balance between the physical safety of the individual, or the family, or members of the community must take precedence over the rights of the individual to privacy. Too many innocent people have died because the person with the illness has not allowed health information to be shared to the family. (Steve Mesic, Hamilton, 2013) Often the person with the serious mental illness is psychotic and not able to make rational decisions about his or her right to keep health information private from family. Please see Recommendation 14.4 of the 2013 Mental Health Commission of Canada Family Guidelines which states “Where a relative chooses not to involve the family caregivers, ensure that the reasons are explored, discussed and documented and that the service providers provide (to the family) basic information required to support the family member……” Hopefully, this recommendation will be implemented soon as it could save lives.