Saturday, March 07, 2009

Understanding Why NCR Laws Do Not Need To Change

In recent weeks, there has been a certain amount of "why isn't Vincent Li accountable for his actions"? being bandied about.

The Globe and Mail does a great job of explaining just how things failed at every step of the way where Mr. Li was concerned.

“The stigma around the illness is so severe,” said Mary Alberti, executive director of the Schizophrenic Society of Ontario, “that people are afraid to talk about it, afraid to come forward because they are afraid of how they will be treated by society.”

That's an understatement - especially for a condition as severe as schizophrenia, which most can only guess at how it affects its victims.

He was picked up by police and taken to William Osler Health Centre in Etobicoke. “He was vague, seemed to be hallucinating, staring into space,” a doctor there noted. “He has not slept or eaten for three days.”

He was diagnosed with schizophrenia and given medications that he refused to take.

Believing Mr. Li was at risk of harming himself or others, doctors placed him on two involuntary admission certificates and could have legally detained him for 14 days. For reasons still unclear, he walked away from the hospital after just 10 days.

There's a significant point here. We need to recognize that Mr. Li probably didn't understand that anything was really wrong with him. The disruption in thought that schizophrenia creates is sufficiently severe that from within, it can seem normal.

This is one of the reasons why we cannot ethically hold him liable for those actions. They took place under circumstances which the person we know as Mr. Li was "not in the building" so to speak. If we treat Mr. Li, and manage to restore him to a modestly stable condition, are we in fact punishing the same person that committed those crimes? In such a situation, it's extremely hard to say yes or no.

In his mind, he and his trusty buck knife had just slain a demon. With blood smeared across his face and three of the demon's body parts stuffed in his pocket, he couldn't understand why police surrounded him as soon as he landed, or why they “put cuffs on my hand and then they took me to the police station and treated me like a murderer,” he later told a psychiatrist.

It took weeks of treatment before Mr. Li realized the extent of his actions the night of July 30, 2008: that a major psychotic disorder had compelled him to stab, dismember and disembowel a 22-year-old stranger aboard a Greyhound bus bound for Winnipeg.

It sounds like he's aware of what he was did now (in which case, I pity the man, for he will remember both the incident and the process of digging out his role in it for the rest of his life, and he will have to find a way to understand, and accept, his role in that event - a punishment far worse for most than any prison cell).

The whole story around this man is one of a series of failures - on the part of Mr. Li, the medical system, those around him and society. Society probably holds the biggest weight here, for collectively, we continue to treat mental illness with a mixture of fear and contempt. Fear because we do not adequately understand it, and contempt because it is so difficult to empathize with someone whose illness is not physical.

Our medical institutions are woefully inadequate when it comes to treating mental health conditions, and we continue to underfund the area, meaning that treatment beds are at a premium; and the ability to track patients with severe, long term treatment needs is virtually non-existent.

When incidents like that of July 2008 occur, we should be cognizant of the fact that they represent more than a failure of an individual. They often represent a systemic failure that could well have begun years before.


Anonymous said...

What you discount is that by your own admission he remains a danger to society. He should be segregated from law abiding citizens in something known as a prison, or jail as others put it so to protect the safety of the rest of the law abiding citizens. Period.

MgS said...

No, I do not discount that at all. The point is that under NCR he is subject to indefinite detainment until such times as treatment has been successful.

In this situation, I suspect that could be a very long time indeed. Especially since it looks like he would have very limited social support outside of the clinical setting.

A locked psychiatric facility is, in essence, a prison. This man will not be walking the streets. (and by the sounds of it, not for quite some time)

Anonymous said...

Who told him to listen to God's words?

Who cut government funding for the treatment and housing of mentally ill people?

and: Who voted for these heartless politicians who don't give a rat's ass for immigrants, the mentally ill and the homeless?


MgS said...

And, at the end of the day, it is very much a matter of the ignorance of the voters, isn't it?

More seriously, I don't think anybody told him to listen to those voices - those are auditory hallucinations, and to those that experience them seem as real as if they were having a conversation with someone over coffee.

The mental health system in Canada is in a shambles, and unfortunately, that has allowed some very old, messy and dangerous stigmas to be propagated instead of educating people. Most people still fear mental illness rather than understand it.