"Safe" Injection and "Reduced" Harm good for society? Don't think so

[Booter]

And how much treatment are addicts getting for their addictions in jail compared to how much is needed there, right (happy to hear from corrections folks on this)? Then again, throwing more people in jail is something that can be done relatively quickly, easily and visibly, whereas other solutions may be less concrete and (to the right demographic) sexy.

Found this as a meme-ish explanation of how rooting out addiction and its destructive side effects (individual and societal) is so hard ...
View attachment 78947

People aren’t going to jail in Canada for being drug addicts. It hasn’t been that way in decades.

So while their drug use is a medical issue that needs assistance. They are there for multiple or violent crimes and have spent half a dozen chances to do anything different before being there.

I wish there was a demonstrate how hard you have to try to go to jail in Canada. Like the severity or the amount of crime you have to do.

Correctional programming for addictions, when I worked in corrections, was driven by the inmate. If they don’t care they don’t go. Mark the calendar and then leave.

 

[Kirkhill]

I get that man I really do, and I wasn't trying to be flippant. But I can see how that could be the perception. I have no doubt you have to deal with this and clean up the messes at a ridiculous volume.

My point is purely resource based. And at some point we have to take a long hard look and see if the juice is worth the squeeze.

I can honestly think a lots of other things our outrageous level of taxation could be better redirected towards. To me this is a problem for charity, unless we decide to go back to and reopen institutions.

The "juice" is a safe, pleasant society for all. Cleaning up the tent cities and the human excrement (and I am referring to the inhabitants' leavings not the inhabitants) is worth it to me. And I don't live exposed to those areas. But I have lived and worked where those areas now are.

Between 25,000 and 35,000 people are homeless on any given night in Canada. Toronto has the largest number of homeless people in Canada. 62% of homeless people in Canada are males. 30% of Canadian homeless come from Indigenous communities.

1 in 3. 1 in 3 Canadians (about 9.1 million people) will be affected by a mental illness during their lifetime

30,000 homeless in 200 person units = 150 homes for the whole of Canada or 1 home for every 250,000 Canadians.
I suggest that that proportion may be fixed and that it will track with a growing population so everytime the population grows by 250,000 a new home needs to be built.

With respect to 9.1 million Canadians - to be blunt, as one of their number, that is a pretty useless formulation. It effectively covers so much of the population as be close to the norm. A tighter definition needs to be those that can't function and that need close supervision and support. And those exist in my extended family. They need assisted living rather than confinement.

 

[Humphrey Bogart]

I get that man I really do, and I wasn't trying to be flippant. But I can see how that could be the perception. I have no doubt you have to deal with this and clean up the messes at a ridiculous volume.

My point is purely resource based. And at some point we have to take a long hard look and see if the juice is worth the squeeze.

I can honestly think a lots of other things our outrageous level of taxation could be better redirected towards. To me this is a problem for charity, unless we decide to go back to and reopen institutions.

The only way I think social assistance provided by tax dollars is a valuable investment is if I don't have to deal with continued bullshit from the people taking advantage of the charity from the money being spent.

When the problems become magnified as a result of the money spent, I seriously question the value of the investment.

 

[Infanteer]

The smart thing to do is to view substance abuse as a health problem and not a criminal one. The not-so-smart thing is to fail to follow up that view with imposed treatment on those who need it, leaving them to fend for themselves with their safe supply and safe-injection sites.

 

[Kirkhill]

The only way I think social assistance provided by tax dollars is a valuable investment is if I don't have to deal with continued bullshit from the people taking advantage of the charity from the money being spent.

When the problems become magnified as a result of the money spent, I seriously question the value of the investment.

I sympathize with the sentiment but as a wiser man than me said about the poor... they will always be with us. They have to be managed in exactly the same way that storm waters have to be managed. They are both facts of nature.

 

[Kirkhill]

The smart thing to do is to view substance abuse as a health problem and not a criminal one. The not-so-smart thing is to fail to follow up that view with imposed treatment on those who need it, leaving them to fend for themselves with their safe supply and safe-injection sites.

View attachment 78958

In 1934 out of every 100,000 people 750 people were under close supervision - 150 for criminal reasons and 600 for mental reasons.
Now out of every 100,000 people only 600 people are under close supervision - 600 for criminality and 0 for mental reasons.

My non-progressive view of the world suggests to me that the nature of the population has not changed that drastically in 100 years.

450 people are under the wrong kind of supervision and have clogged up the courts and the legal system, while 150 people that should be under close supervision are not being supervised at all.

600 people of every 100,000, at 200 people per home using that metric, means 3 homes instead of 3 prisons and 600 people getting close supervision and social assistance. And I would sooner see my tax dollars going to that than building German car companies battery factories.

I would also support national service credits for the staff just as I would support national service credits the armed services.

 

[The Bread Guy]

In 1934 out of every 100,000 people 750 people were under close supervision - 150 for criminal reasons and 600 for mental reasons.
Now out of every 100,000 people only 600 people are under close supervision - 600 for criminality and 0 for mental reasons ...

You have a source for this? I only ask because I heard prison officials tell me, first person, into a microphone more than 30 years ago, that easily 1/4 to 1/3 of their "guests" needed a mental health bed, not a prison cell. And I keep hearing a lot of different voices on all sides of the issue STILL saying a number of current "guests" need a mental health bed and not a prison cell. That suggests to me the root causes needing to be wrestled with still remain an issue on the "how do we treat the addicted?" side.

 

[rmc_wannabe]

I heard prison officials tell me, first person, into a microphone more than 30 years ago, that easily 1/4 to 1/3 of their "guests" needed a mental health bed, not a prison cell. And I keep hearing a lot of different voices on all sides of the issue STILL saying a number of current "guests" need a mental health bed and not a prison cell. That suggests to me the root causes needing to be wrestled with still remain an issue on the "how do we treat the addicted?" side.

This is a massive part of the problem.

Talk to any addict and they will tell you it's not free will that led them to substances, but a lack of supports. There's also a huge backlash against asking for help because of remaining attitudes that view addiction as a moral failing. A lot of times, folks are self medicating because they have no other option.

One of the majority problems addicts (saying this as one in recovery) face are those of impluse control and brain chemistry imbalance; usually due to previous trauma, neurodivergence, or insufficent coping skills. Both need to be treated with a combination of meds and Behavioral Therapy (CBT or DBT).

That meds/therapy combination allows folks to a) balance out the deficiency in brain chemistry, b) learn and develop coping skills to control impulsivity, and c) help start the healing process for the trauma that caused all this.

That said, the price tags are very different between medically supervised therapy and street drugs. We defunded a lot of psychiatric care in the early 90s because it was easy. Unless you were one of the minority of society needing it, it didn't affect you personally, so let's make it privatized.

Well, someone facing homelessness doesn't have $200 a session or $75 for 30 Zoloft; but they do have thr ability to beg, scrounge, steal, and rob $5, 10, 20 bucks to numb things for a while. That leads to this "Mental Illness to Prison" pipeline we see.

Now as for government monitored safe consumption sites, we already have them across Canada and you all have frequented them at some point in time, even on our bases. The substance? Alcohol, cannabis, and cigarettes. The site? Pubs, bars, messes, patios, convenience stores, dispensaries. The safe consumption? Ensuring the substance consumed is safe, regulated, quality controlled and is consumed safely.

Been cut off at a bar? Harm reduction. Someone grabbing your keys and calling you a cab? Harm reduction. The second you cross the line into addiction, there's a program for that. That said, every time I drank to excess, it was either due to poor impulse control or I was running away from life for a night. Once I was able to get support and therapy, I didn't need to. That said, I can afford to be sober. The homeless and poor cannot.

Until we resume funding care for those that need it most, the spin cycle continues and are left wondering why someone would ever "choose" to take heroin.

 

[Dana381]

You have a source for this? I only ask because I heard prison officials tell me, first person, into a microphone more than 30 years ago, that easily 1/4 to 1/3 of their "guests" needed a mental health bed, not a prison cell. And I keep hearing a lot of different voices on all sides of the issue STILL saying a number of current "guests" need a mental health bed and not a prison cell. That suggests to me the root causes needing to be wrestled with still remain an issue on the "how do we treat the addicted?" side.

When I think of a mental health bed the only image I get is an asylum type setting. Even mental health wings I have seen in hospitals have an asylum type feel and who is going to want to enter that system. If there are other types than I have not seen them. I have had ocassion to visit people staying in the hospital mental heath wing a few times over the years.

Growing up my family owned a bed and breakfast where we took college students in the winter months. When my mother could no longer run the bed and breakfast she made it a rooming house. Almost all our tenants were single men with addiction issues who were on social assistance. Most of them were in a better place when they left than when they arrived, with some of them making great strides.

It became a community of sorts with these guys helping each other often. There were problems sometimes but nothing too serious. My mother spent time with them and listened to them. She truly cared about their well being. She had house rules and for the most part they were obeyed. I think The guys didn't want to disappoint her. She did have to kick people out a couple tines but it was rare.

The structure and freedom and accountability that our house provided seemed to work well. These men would see their roommates succeed or fail based on their choices. They had to look after themselves. Some (most) had assistance send their rent money direct to mom so they wouldnt drink it, it was their choice as we werent allow to demand it. If they blew their whole cheque on booze and didnt buy enough food and had to ask for help it was humbling. They had to live with consequences in a relatively safe environment.

One guy who had a pretty bad drinking problem discovered he had bad ADD and got on Ritalin. It helped him tremendously and he was able to work again and moved out a while later. He once told me he drank to shut his mind off so he could sleep. He wouldn't touch alcohol unless there was enough to knock him out.

This thread has made me realize mom inadvertently ran a successful treatment program while just trying to pay the bills. Maybe that is a model that could be scaled up some (we had 6 rooms) and add in some more support options.

I believe as people we all need somone to care about us, freedom of choice, consequences, community, support without enabling and a sense of purpose. If we are missing one or more of these we become disfunctional and addiction is how we deal with that disfunction. I think often mental heath efforts get these ratios wrong and that's why their largely ineffective.

 

[Kirkhill]

You have a source for this? I only ask because I heard prison officials tell me, first person, into a microphone more than 30 years ago, that easily 1/4 to 1/3 of their "guests" needed a mental health bed, not a prison cell. And I keep hearing a lot of different voices on all sides of the issue STILL saying a number of current "guests" need a mental health bed and not a prison cell. That suggests to me the root causes needing to be wrestled with still remain an issue on the "how do we treat the addicted?" side.

I was drawing on the graphic supplied by Infanteer and interpolating from that information.

 

[Brad Sallows]

The more charity is taken up by government, the more disconnected people become from problems which do not immediately affect them.

 

[YZT580]

When I think of a mental health bed the only image I get is an asylum type setting. Even mental health wings I have seen in hospitals have an asylum type feel and who is going to want to enter that system. If there are other types than I have not seen them. I have had ocassion to visit people staying in the hospital mental heath wing a few times over the years.

Growing up my family owned a bed and breakfast where we took college students in the winter months. When my mother could no longer run the bed and breakfast she made it a rooming house. Almost all our tenants were single men with addiction issues who were on social assistance. Most of them were in a better place when they left than when they arrived, with some of them making great strides.

It became a community of sorts with these guys helping each other often. There were problems sometimes but nothing too serious. My mother spent time with them and listened to them. She truly cared about their well being. She had house rules and for the most part they were obeyed. I think The guys didn't want to disappoint her. She did have to kick people out a couple tines but it was rare.

The structure and freedom and accountability that our house provided seemed to work well. These men would see their roommates succeed or fail based on their choices. They had to look after themselves. Some (most) had assistance send their rent money direct to mom so they wouldnt drink it, it was their choice as we werent allow to demand it. If they blew their whole cheque on booze and didnt buy enough food and had to ask for help it was humbling. They had to live with consequences in a relatively safe environment.

One guy who had a pretty bad drinking problem discovered he had bad ADD and got on Ritalin. It helped him tremendously and he was able to work again and moved out a while later. He once told me he drank to shut his mind off so he could sleep. He wouldn't touch alcohol unless there was enough to knock him out.

This thread has made me realize mom inadvertently ran a successful treatment program while just trying to pay the bills. Maybe that is a model that could be scaled up some (we had 6 rooms) and add in some more support options.

I believe as people we all need somone to care about us, freedom of choice, consequences, community, support without enabling and a sense of purpose. If we are missing one or more of these we become disfunctional and addiction is how we deal with that disfunction. I think often mental heath efforts get these ratios wrong and that's why their largely ineffective.

Did you ever see one of the chain of Ontario hospitals when they were up and running with a decent budget. They were really well designed and welcoming structures, single story in a country setting on a very large chunk of real estate. They did not in any way resemble the notorious Queen str. that every one in the Toronto area associated with mental health

 

[Kat Stevens]

Did you ever see one of the chain of Ontario hospitals when they were up and running with a decent budget. They were really well designed and welcoming structures, single story in a country setting on a very large chunk of real estate. They did not in any way resemble the notorious Queen str. that every one in the Toronto area associated with mental health

I'm pretty sure DC Comics based Arkham Asylum on the old Riverview Mental Hospital in Coquitlam.

 

[mariomike]

Did you ever see one of the chain of Ontario hospitals when they were up and running with a decent budget. They were really well designed and welcoming structures, single story in a country setting on a very large chunk of real estate. They did not in any way resemble the notorious Queen str. that every one in the Toronto area associated with mental health

My first station was 500 metres from 999. Didn't know any better at the time, or have a choice. GTFO ASAP.

 

[KevinB]

When I think of a mental health bed the only image I get is an asylum type setting. Even mental health wings I have seen in hospitals have an asylum type feel and who is going to want to enter that system.

A lot of that was the ease of throwing people ‘away’ into those sorts of facilities

There needs to be some sort of balance.
Clearly some people do need ‘the rubber room’ type of facility as they are an extreme danger to themselves and others.

However the vast majority of persons do not, and the old dump them in the sewer method clogged and backed up with resulted in what exists now.

I’ve picked up 2 ‘customers’ from MH facilities, for transportation elsewhere. Neither was a good person, and I doubt they where every either going to get their needed help, nor are they going to be out in public anytime before the next century…

I have seen many people who did need help, that were not yet far gone, but the best one could do was slap bracelets on and take them to the Country Detention center.

I’m far from a MH professional, and I’m not a big fan of public spending, but I’m also a human being who sees others who need help, that if not given help will be a re-occurring problem or worse, and so in this case on can be humanitarian and financial prudent.

 

[Kirkhill]

The more charity is taken up by government, the more disconnected people become from problems which do not immediately affect them.

That is exactly why I introduced the concept of National Service credits and equating such service to military service. In both cases the participants are performing a service to the nation that needs to be done and needs to be rewarded.

I think it likely that the biggest problem the old asylums and sanitariums experienced was burn out on the part of the staff followed by burnt out staff trying to hire new staff and only finding unsuitable candidates that couldn't find other jobs.

Even the most compassionate individual has their limits. There is a limited ability to be altruistic. That means that the staff needs to be regularly refreshed with new, keen, energetic help. Kind of like the need to constantly find new, keen, energetic Privates. Both groups need to be regularly turned over. Potential leaders and specialists can be sorted from the intakes.

@Dana381 's mother is not alone. There are many people that want to help. But society shouldn't just dump the problem on the shoulders of people like her and pretend it has been solved.

Politicians like capital costs. They hate operating costs. Finding National Service Volunteers to work in government supplied facilities would be little different to finding National Service Volunteers to work in government supplied tanks. Both sets of volunteers would be contributing to society (labour instead of taxes) and both would be building a sense of national community. And the afflicted would be getting fresh faced youngsters engaged in their work.

 

[rmc_wannabe]

@KevinB your last bit kind of hits the nail on the head. We often are penny wise and pound foolish when it comes to social spending.

We cut the legs out of MH systems, people in crisis have no place to turn to, people self medicate, we develop a societal epidemic of substance abuse and the crime that fuels it, the judicial and correctional systems get overloaded, and it all costs a lot more to fix and maintain than if we just helped people help themselves in the first place.

But sadly, unless something affects a taxpayer personally (be it defence or MH funding)... it's a superfluous line item on a ledger ripe for the picking to lower the costs of running our society.

 

[The Bread Guy]

... mom inadvertently ran a successful treatment program while just trying to pay the bills. Maybe that is a model that could be scaled up some (we had 6 rooms) and add in some more support options ...

Well done on your mom! This is one of the kinds of out-of-hospital care that can be offered, as well as other types of supported housing or drop-in help for people living "on the economy". That's all the kind of help that wasn't set up (or not enough of it quickly enough) when de-institutionalization happened, which is one element of the problem of getting the right help to the right people.

... Politicians like capital costs. They hate operating costs ...

That's exactly why it's politically cooler to put up buildings than to spend money on staffing them - also easier as one-time capital funding, too.

 

[Brad Sallows]

That means that the staff needs to be regularly refreshed with new, keen, energetic help.

Not the staff. Most of "society". "I sent my 20 dollars to Live Aid; I paid my guilty conscience to go away."

 

[Kirkhill]

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About AHS | Alberta Health Services

About Us - Overview of Alberta Health Services (AHS).

www.albertahealthservices.ca

Whitby Psychiatric Hospital - Wikipedia

en.wikipedia.org

We know what to do. We're just not doing enough of it.