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Breakdown: Canada's mental-health crisis

When mental illness tarnishes your golden years

Members of an older generation struggle to overcome not only their own biases against seeking care for mental disorders, but the lack of services perpetuated by the 'therapeutic nihilism' of a health-care system that sees them as beyond saving. But on Vancouver Island, researchers and support workers are trying to rejuvenate geriatric psychiatry

From Wednesday's Globe and Mail

VICTORIA — When Laura Baldwin, three months pregnant, began washing clean household linen and fussily ironing what didn't need ironing, her husband, Barry, shrugged it off as the elation of pregnancy.

When she began running compulsively on the beach and couldn't sleep, she went to see her doctor. "He also said I was just excited," she recalls.

It was 1969 and Mrs. Baldwin was in fact heading into her first major experience with bipolar disorder. That first event would result in her being hauled into a mental institution by five burly men and heavily medicated to get her to sleep.

Now 73, she has endured 13 such episodes. Each one takes her longer to bounce back. And like many seniors with mental-health issues, she faces mounting challenges to get the care she needs.

Mrs. Baldwin is more likely to get adequate care for her diabetes than for her bipolar disorder, according to a new study by the Centre on Aging at the University of Victoria. The survey of caregivers and service agencies found fragmented and inflexible care for seniors with mental illness or addiction, and inequitable treatment, compared with other seniors' health problems.

Even if the services were there, Mrs. Baldwin's generation often carries a bias against seeking help for mental health.

"This is the first time I've heard her willing to talk about it," said her daughter, Karen Baldwin. "She was too ashamed."

Society has its share of prejudices, too. There are no major "runs for the cure" or gala fundraisers in this field. The very few health-care professionals who understand both geriatric and mental-health care are stretched thin.

"There is a stunning shortfall of specialized services," said Penny MacCourt, president of the B.C. Psychogeriatric Association, a group of nurses, doctors, psychiatrists and other professionals in the field. "This is a marginalized population."

Mrs. Baldwin lives an hour's drive from Victoria, a community well attuned to the needs of seniors. It has Canada's highest concentration of people 80 and older.

And it's a growing cohort. Within the next 10 years in B.C., there will be fewer school-age children than seniors, and Vancouver Island's retirement communities will be the destination for many.

But even here on Vancouver Island, programs and supports for the elderly are largely designed for cognitive impairment or physical frailty, not the complex needs of depression, bipolar disorder, schizophrenia or addictions.

Open a Victoria phonebook and out tumbles a multitude of services catering to the elderly.

There are social clubs and meal deliveries, a bereavement helpline and bathing programs. There's Dial-a-Daughter Solutions Ltd. to make up for distant children, and volunteers who offer cheering visits with a pet.

But finding services that cater to seniors with addictions or mental-health issues is harder. When UVic researchers went looking for them, they could find only five seniors' programs aimed at mental-health issues, and three for seniors' addictions.

There are roughly 130,000 seniors on Vancouver Island, and experts estimate 5 per cent will require care for acute depression or other psychiatric disorders.

Michael Cooper is the head of geriatric psychiatry for the Vancouver Island Health Authority. For the more populous south island region, his unit will get about 1,000 referrals each year for psychiatric disorders.

Others will get care from their family physicians. "And a significant number are not getting recognized and treated," he said. The group with Canada's highest suicide rate per capita is men over 80.

Dr. Cooper has a team of geriatric psychiatrists who attend all the complex-care nursing homes in Victoria to try to identify problems, especially depression. For seniors living on their own, such illnesses are harder to detect.

To reach out, Dr. Cooper enlists people in the community who work with seniors to help spot the signs of mental illness.

Once a month, he sits down in a room full of nurses, physiotherapists, social workers and others to discuss individual cases.

The program is still in its infancy but he'd like to expand it, to overcome the bias he sees in the medical profession against the older mental-health patient.

"I'd like to work with family physicians to overcome what I call therapeutic nihilism," he said. Many need to be persuaded that "we can do something for seniors with mental-health issues."

That said, Dr. Cooper does believe the island offers leading-edge services in his field, including a rapid-response mental-health team.

Treatment ranges from hospitalization and electric shock therapy to an outreach program that offers specialized counselling.

But when Karen Baldwin, who lives in Ontario, realized that her mother was quickly descending into another episode on a long weekend last year, she found it wasn't easy to track down help from her home.

Eventually, the local police were dispatched to fetch her mother to the hospital. They arrived to find Mrs. Baldwin locked in her bedroom.

An officer patiently stood at the locked door for half an hour, coaxing her out. She was in a heightened religious state. When she demanded he provide the "magic password," he responded: "Jesus Christ."

It worked. She opened the door and allowed him to escort her to the Eric Martin Pavilion, a mental-health facility, where she would remain for two months.

"I've learned after 13 episodes, I've learned to say, 'Yes, I have a mental illness and this is who I am,' " Mrs. Baldwin said.

Karen Baldwin sees progress after a long, arduous journey. But she knows her mother cannot be relied on to tell people when an episode is coming - her manic energy proves seductive.

"That's the beast," she said.

And she's concerned that each one is harder on both her parents: "I worry how if it were to happen again, could she survive it? I worry about what happens if Dad has another stroke."

'THEY CALLED ME GRANDPA'

In the 1980s, Joe Scaletta was one of the few social workers in Victoria focused on seniors and mental health. His caseload - about 120 people - was overwhelming. When he saw a funding opportunity, he jumped at it with a proposal for an outreach program.

Today, Victoria's Elderly Outreach Service sees close to 1,000 clients with late-onset mental-health problems each year. Staff are so overloaded they are working on an exit plan the moment a new client walks in the front door.

Clients find their way to the program a number of ways.

"We get a call from police, there's a woman who calls police repeatedly because someone is in her house leaving her notes," Mr. Scaletta said. "We find out the notes were in her handwriting but she can't remember writing them."

A typical case, however, looks like this: A man in his mid-eighties, recently widowed, starts showing up at the wrong house, appears dishevelled or underfed. He would receive a psychiatric assessment, and the team would decide what he needs. Sometimes it means getting a warm meal delivered regularly, sometimes it means getting him hospitalized.

Next door is the Victoria Innovative Seniors Treatment Approach program, an arm of the same agency. It is one of the few programs where seniors with addictions can get counselling with peers.

"At Elderly Outreach, we're doing a jitterbug. At VISTA we are doing the slow dance," Mr. Scaletta explained. Clients here often don't want to be here. "A lot of the cases are picked up because people have done enough damage to themselves that they end up in the emergency ward."

Ron Thompson, 65, found himself in the VISTA program recently after a rapid slide into depression and alcoholism.

After a lengthy career as a television news cameraman - earlier this year he became the first cameraman to be named a life member of the Victoria Press Gallery - Mr. Thompson found himself sidelined from the physically demanding job following a bout with prostate cancer six years ago.

"I had no strength for the work, I just got more and more depressed," he said.

He was put on antidepressants but began to "self-medicate" with alcohol. Since he left work, he's ended up in hospital four times because of alcohol abuse.

He's now separated from his wife of 40 years, estranged from the son he is so proud of. He's had a stroke, lost his driver's licence and handed over control of his finances.

But he doesn't fit in the mainstream addiction programs. Last spring, he found himself in a detox centre surrounded by youth who were being treated for addictions to street drugs.

"They called me grandpa," he said. "There was no one there my age."

These days, he's been sober for six months and he takes the bus up to the VISTA meetings every week.

But separated from friends, much of his family and his colleagues, he admits he is sometimes lonely. "As you get older, so many things hit you," he said.

Hazel Meredith, executive director of the Victoria branch of the B.C. Schizophrenia Society, has watched the stress of mental illness tear many families apart. For aging couples, caregivers are often taxed by their own growing frailty. She was once called from her office by a counsellor who had been meeting next door with an elderly client and his wife. The woman had slipped into a catatonic state.

"I thought she was going to die right in the office," Ms. Meredith recalled.

THE SPOUSE'S CHALLENGE

As a caregiver, Barry Baldwin, 77, has faced more challenges than most. Each time Mrs. Baldwin has had a psychotic episode, he becomes her target.

It's difficult to imagine, watching the two of them sitting close together as Mrs. Baldwin shared her story. Married now for 42 years, they shared a gentle intimacy even as she recounted her treatment of him when she is in the grip of psychosis.

When she is sick, she hates Mr. Baldwin. She's run away, called the police and made terrible allegations against him; she's told friends and neighbours she's divorcing him.

It's a trauma to recall the way she behaves toward her good husband when she is ill. "Unfortunately, I do remember," she said.

Mr. Baldwin has not always understood her illness - as they raised their two children, and then buried their son David, it was sometimes easier to avoid it. But he can separate the illness from his wife.

During the last episode, he was unable to drive because of a recent stroke. So he would take the long journey by bus from Sooke to Oak Bay to visit her in hospital. Knowing that once he was there, she would refuse to speak to him.

"When you go through deep waters like that, you get stronger as a couple," Mrs. Baldwin said, speaking more to him than to the reporter.

"It's less draining every time," he replied. "Now I know you'll get better."

HEALTH CARE // UVIC STUDY

When Rhonda Goldberg rushed to Rockyview General Hospital in Calgary last November, it was to attend to her father, who needed emergency care.

As he lay in the intensive-care unit on life support, her mother needed help, too. Ms. Goldberg was shocked to see how little understanding the highly trained medical staff displayed for her mentally ill mother.

Shirley Goldberg, 65, has been diagnosed with bipolar disorder and has suffered from depression all her adult life. "We were trying to deal with my father dying and my mother wanting to end her life and she didn't want to leave his side," Rhonda said. "And this was a problem for the staff."

When Rhonda's father died in January of this year, the role of caregiver for her mother fell to the daughter. "His life revolved around whether my mom was feeling okay or not, whether he could work or not," she said. "And now my life revolves around my mother."

A new report from the University of Victoria's Centre on Aging shows the Goldberg family's experience is not unusual.

Seniors with addictions or mental illness are shortchanged when it comes to resources and treatment, said Holly Tuokko, one of the authors of the report. The study centred on caregivers of seniors with acute mental illness and addictions. It concluded there is a lack of housing and treatment facilities. As a result, the challenges are offloaded to caregivers who themselves have nowhere to turn.

Ms. Goldberg said there are programs available to help her mother, but only if she is willing to reach out for assistance. "There needs to be more outreach at the home; that's where it starts, that's where it ends," she said.

Justine Hunter

THE SERIES

Saturday

Children and mental illness,

by Erin Anderssen

and André Picard

Monday

A last resort for violent teens,

by Dawn Walton

Yesterday

How doctors discriminate

against mental illness,

by Carolyn Abraham

Today

Growing old with bipolar

disorder, by Justine Hunter

Tomorrow

Lonely lives in the institution,

by Erin Anderssen

Friday

Forcing adults into treatment,

by André Picard

Saturday

Faces of the breakdown,

a photo gallery by Charla Jones

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