The Revolving Door: Mental Illness Aftercare

When a person living with a mental illness reaches the point of hospitalization, those who care sigh a breath of relief.

“Thank goodness,” we say to ourselves, “our loved one is in good hands.”

And that is true. The mental health professionals both inside and outside the hospital setting do their jobs well and ensure that within the structure of our health care system the most vulnerable and unwell receive the attention they need.

But once outside the institutional system, mental health patients fall off a cliff and enter a revolving door of inside-outside. Allow me to give you an example, from personal experience.

Someone I care about deeply lives with bipolar disorder, a devastating illness that requires constant monitoring and assertive treatment.

Hospitalization has been a frequent feature of this person’s life, but beds on the psychiatric unit are scarce. Six beds serve the whole of the Sunshine Coast. So, when acute medical needs were deemed to have been addressed, this loved one was let out  – without a formal discharge plan or follow-up.

The inevitable happened.

Still unwell with her mood cycling dramatically, and with new medications not yet having their effect (psychiatric meds typically take weeks to work), my friend entered the twilight zone between care and chaos.

Homeless, because her landlord did not want her around, and without social support because her behaviour estranged her friends, this incredibly bright and caring woman fell into life on the streets, bush, beaches, and dark alleyways of Sechelt.

In through the out door.

Predictably, after causing a rumpus, she was arrested and again taken to hospital. Released again, she is back on the street – unwell, and vulnerable to the predations of (mainly) men with unfriendly intentions. It’s only a matter of time when the revolving door will once again deliver her into care, eventual release, and back into the cycle.

One does not have to read this sad story all that closely to realize that there is a large and perilous gap between structured, acute care and outpatient well being.

Vancouver Coastal Health funds mental health services. As few as eight years ago, there were several mental health social/outreach workers who attended to the needs of recently discharged patients. Now, I think there is one for the entire Sunshine Coast, though I hear this may change for the better.

Until a few years ago, the Homelessness Project (modestly funded) connected with patients while in hospital to help them find stable housing upon discharge.  Yes, the organization that now runs the Upper Deck homeless shelter has, in its remit, the task of finding homes for the homeless. It is a daunting task, as there is no affordable housing on the Coast.

As a caring community, we must do what we can to address the bottom, most fundamental level of Maslow’s Hierarchy Of Needs, which is safe and stable shelter and the basic elements of comfort.

Perhaps you have a spare bedroom you can let out to a person in need. I did, and I did.

If there is anything you can do to help bridge the gap between care and nothingness, then drop by the Arrowhead Clubhouse in Sechelt and talk with staff. Shelter. Clothing. Camping equipment for folks living rough. Anything.

Caring for those in need is our moral imperative.


Note: This regular column on mental health and social issues will appear 11 May at www.coastreporter.net







  1. Hi Again Hugh,

    I’ve been up since 5:00 am after an argument with my housemates regarding why I’m upset when they leave two bags of garbage outside my townhouse door because they “forgot” they had planned to go and sneak them into a neighbouring dumpster last night (the reason they can’t fit them in the proper garbage can here, is they are too lazy to separate out the obvious recyclables and take them to the depot once a week, the way I do with my own). I’m a “bitch” for making this an issue.

    This morning I had an idea for your next column! You have already told us that the people who work at Mental Health–the nurses, social workers, and psychiatrists–are doing their best. You’ve written several columns praising them. How about a column about the families, usually the mothers, who are often the last to give up on their children? Two of these mothers have been murdered by their psychotic sons in this community in the past few years (and the mental health establishment does its best to hush this up lest it contribute to “stigma”!). There are also the caring neighbours, even the landlords who put up with it all until their place gets trashed (and are then criticized by do-gooders for kicking the person out). How about those whom you appeal to to provide their “spare bedroom” to a person with a mental illness–how about a pat on the back for them–if they do that– in one of your columns? None of us have training to handle this. None of us know how to reason with a person whose illness impacts their ability to reason. None of us are paid. And the paid workers at Mental Health don’t offer a whole lot of help! I’ve locked horns at the local office with both a rude receptionist and a smug, complacent, smarmy, patronizing so-called “counselor” who offered zero compassion when I asked him what the hell I was supposed to do!

    My loved one’s psychiatrist has told me what a good person I am for taking him in. That’s nice. (He’s a step up from the last psychiatrist, who didn’t have time to talk to me–and it’s not like I even called him often!) But I don’t feel “good”–I feel resentful, angry, unloving, fearful and alone! I feel like I’ve been duped by the system to do their work for them. Their only answer would be that I should go talk to one of their counselors–thus wasting even more of the system’s money than is wasted on ineffectual treatment for my ill relative!

    Another column idea: agnosognosia. It is people with this problem that cause most of the stigma, because they don’t know they are ill, refuse medication, and act out–but even with medication behaviour can be an issue that we, in the general public, are not qualified to deal with.

  2. Thanks for a heartbreakingly accurate description of what my husband and I experienced with a close friend of ours.
    The awful thing is that our experience with a longtime friend going in and out of the hospital was thirty years ago, and shockingly the relentless revolving door still flips patients back out into the unready- or all too ready- world.
    Hate to have to agree with Anne on one thing:
    as in most professions, there are those who are callous and uncaring, even negligent. The occasional predator can also be found on ‘the inside’.

  3. I know better than to “breathe a sigh of relief” when my loved one is hospitalized.

    Mental health professionals do not always do their jobs well. Sometimes this is because they are spread too thin in an under-funded system. Other times it’s because, as with every job or profession, mental health includes some people who are less caring than others. I, and my family member with a mental illness, have not always been treated well by mental health professionals either here or in the lower mainland.

    Tell it like it is, Hugh, because those of us with experience know that not all the people in the system do their jobs well. The system is broken despite the efforts of those who DO try. There is no excuse for the revolving door–ask the police who have to repeatedly bring the same person back to the hospital, only to have them released the next morning with no plan and in no shape to stay in someone’s spare room either.

    I am currently providing housing to a couple of people who have mental illnesses–but only because one of them is my ill relative. This isn’t something just anyone can bring themselves to do–we are not trained mental health workers.

    • Thanks, Anne, for your comments. Yes, it is true that not all workers in the system are as good as we might like them to be, or who have become jaded. If the system is broken, it is because of a lack of funding. The mental health professionals I know – nurses, social workers, and psychiatrists – are doing their best with scant resources.

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