- 注册
- 2002-10-07
- 消息
- 402,187
- 荣誉分数
- 76
- 声望点数
- 0
Marc Rivest was surrounded by police offers, their guns drawn.
“Drop your weapon,” yelled one big cop.
Rivest looked at the steel pipe in his hand, then started to walk toward the officer.
“Drop your weapon, Marc. You need to drop it now.”
Rivest gave the officer a quizzical look and kept walking.
“Drop it, Marc.”
He stopped and stared behind him. As if to see whether there might be another “Marc,” standing there.
But he saw no one. Just the half dozen cars he had vandalized in Smiths Falls that night.
“You need to drop the pipe now, Marc. Right now.”
The pipe? No longer a weapon? A pipe? As if comprehending what the officer was saying for the first time, Rivest opened his clenched fist and let the pipe roll from his hand.
In the crisp, cold air of the January evening you could hear the sound of breath exhaling. So loud and pronounced it seemed for a moment as though a small gust of wind was passing over the men huddled on the residential street in Smiths Falls.
Ontario Ombudsman Paul Dubé released a report this summer titled Nowhere to Turn. It came with the sub-title: “Investigation into the Ministry of Community and Social Services response to situations of crisis involving adults with developmental disabilities.”
Ontario ombudsman Paul Dube detailed a litany of problems.
The report was filled with stories of what it called “gaps” in care for people with developmental disabilities. Stories such as that Joe, a 55-year-old man with both a developmental disability and a psychiatric disorder who, because of inadequate community support, had spent “considerable time” in jail. (The report did not use last names.)
Developmental disability (also called learning disability or intellectual disability) is a cognitive impairment, often present at birth. Cerebral palsy and autism are two examples of a developmental disability.
Mental disability (also called a psychiatric disorder) is any illness found in the Diagnostic and Statistical Manual of Mental Disorders (DSM.) Depression, post-traumatic-stress-disorder and schizophrenia are examples of a mental disability.
There was Patrick, a 24-year-old with cerebral palsy, who was placed in a nursing home for seniors. Later, “in a fit of frustration,” Patrick broke the ankle of one of those seniors. His punishment was to have his wheelchair taken away. For four months Patrick crawled to get where he needed.
Layla was placed in 22 group homes and shelters in the span of 34 days. Cindy waited seven years for a community placement. Guy drowned in a cistern while living with a “host family” in Ancaster.
Marc Rivest was not featured in the ombudsman’s report. He could have been.
Rivest was born with a developmental disability and his confrontation with Smiths Falls police in the winter of 2006 was national news. It happened less than a year after he had been released from a long-term-care hospital for people with developmental disabilities.
Family photo of Marc Rivest.
The hospital was the Rideau Regional Centre in Smiths Falls, where Rivest had lived for 24 years. It was permanently closed by the provincial government in May 2009, on the same day as two other long-term-care facilities were closed.
With the three closures, Ontario was left without a long-term-care hospital — what the government called an institution — for people with developmental disabilities.
This was by design. Four years after shuttering Rideau Regional, Ontario Premier Kathleen Wynne rose in the legislature and apologized to former patients. At the same time she announced $20.6 million in compensation.
Institutional care was bad. Without equivocation or exception. That was the message the premier delivered that day.
Even as she was delivering her historic apology, however, some in the medical community were beginning to wonder if closing the facilities had been a tragic mistake.
If you lived in Smiths Falls in the 1980s or ’90s, there is a good chance you remember Marc Rivest. You used to see him everywhere. At Smiths Falls Bears Junior A hockey games. At Alexander Park, cheering on whatever baseball team was playing. At restaurants and diners up and down Beckwith Street.
“When I took Marc out for dinner, I was always be amazed at how many people in Smiths Falls knew him,” remembers his older brother, Paul Rivest. “People would come up and talk to us about how the Bears did that weekend. Or how the Blue Jays did. You would think he was running for mayor or something.”
Rivest was often taken on escorted trips to the village and, by all accounts, he was a charmer — animated and gregarious. Always laughing at some joke or prank. (He was especially fond of talking nurses and waitresses out of their pens, going on to amass a collection of more than 4,000 Bics and Sharpies.)
Marc Rivest was known around Smiths Falls, as was his passion for sports.
He lived at Rideau Regional for 24 years; about the same length of time he lived with his family before arriving. Born with a profound learning disability (as an adult, Rivest functioned at the level of a six-year-old) he was also diagnosed with a psychiatric disability when in his early 20s.
The mental illness caused sudden mood swings that sometimes ended in what his brother calls “one of Marc’s blind rage episodes.” His parents had divorced by then and Rivest’ mother soon found herself unable to take care of her youngest son.
He was committed to the Rideau Regional Centre in 1981. His brother remembers the next 24 years as a period of calm for the family.
“For us, Rideau Regional was everything you could have wanted,” he says. “Marc seemed happy there, the staff seemed caring and professional. We couldn’t believe it when the government announced they were shutting the place down.”
The announcement came in September 2004, when Sandra Pupatello, then the minister of community and social services, announced the province would be closing all the long-term-care facilities. She promised to have the job done in five years.
Marc Rivest was one of the first to leave Rideau Regional, placed in a group home in Smiths Falls in the summer of 2005. On his second night in the group home, Paul Rivest got a phone call from the night counsellor at the home, telling him his brother had just run away.
Bruce McCreary is a psychiatrist and professor emeritus with Queen’s University in Kingston. He is also a pioneer in the treatment of people with dual diagnoses — those with both a developmental and a psychiatric disability. He was not as surprised as the Rivest family when Pupatello made her announcement.
“De-institutionalization has been rather in vogue for decades,” he says. “Just say the word ‘institution’ and most people will have a negative impression of a place. Certainly they do when you’re talking about long-term-care facilities for the mentally ill, or those with developmental disabilities.”
It’s not hard to understand the antipathy. The first long-term care hospital in Ontario for people with developmental disabilities was opened in Orillia in 1867. It was called the Orillia Asylum for Idiots.
Related
It was not uncommon back then for people with low-grade learning disabilities to be committed to such institutions for life. Once there, many suffered physical and sexual abuse. Neglect. Forced labour. In the early ‘60s Pierre Berton wrote a story about one such man for the Toronto Star and the ensuing scandal nearly brought down the provincial government of the day.
The class action lawsuit filed against the Rideau Regional Centre had David McKillop as the lead plaintiff, a man who was beaten at the facility and suffered permanent brain damage as a result.
David McKillop, with his wife Eileen in their Gananoque home. McKillop sued the Ontario government for $1 billion for his treatment at the Rideau Regional Centre in Smiths Falls. Michael Lea/Postmedia Network
There were similar lawsuits filed across the province after the facilities were closed (at its peak, in 1974, there were approximately 8,000 people living in 16 long-term-care facilities in the province.)
McCreary does not deny the historical record, but he insists the decision to close the long term-care hospitals created more problems than it solved. He says this was particularly true for dual diagnosis patients such as Marc Rivest, who were most of the residents at Rideau Regional when Pupatello announced the closures.
“The people who didn’t belong in the institutions were long gone,” he says. “The people still living there were the people most likely to end up in crisis. A lot of us had concerns about what would happen to those people when Rideau Regional was closed. I still do.”
Jean Chouinard is chief of medical services, complex care, at St. Vincent Hospital in Ottawa, the only long-term-care health facility in the nation’s capital. Although St. Vincent’s is primarily for seniors, Chouinard believes he knows exactly what happened to many of those former residents.
“I see them just about every day,” says Chouinard. “People who used to be in the long-term-care hospitals, or should be in one today. I also read about them. Even though I’ll be reading a news story about something else.”
Dr. Jean Chouinard, medical chief of complex continuing care, at Bruyere Continuing Care within St. Vincent Hospital in Ottawa.
Chouinard says the closing of Rideau Regional, coupled with the downsizing of long-term care psychiatric facilities such as the Brockville Psychiatric Hospital — which is down to roughly 300 long-term care beds from a high of nearly 1700 — has had a ripple effect throughout Ottawa.
Not just the medical community. The entire city.
Chouinard says the effects of de-institutionalization can be seen every day in courtrooms and street corners, emergency shelters and jails. Just how many news stories are out there, he asks, that have some mental health component to them? Everything from shootings in front of the National War Memorial to overcrowding at the Innes Road jail?
? By the Numbers
70,000 – Adults in Ontario with a developmental disability –
40% – of those adults believed to also have a mental disability –
18,000 – Living in group homes and other supported living:
9,700 – On waiting list for supported living:
360 – Developmental service agencies funded by the Ontario government –
1,525 – Complaints about developmental services received by the Ontario Ombudsman between November 2012 and August 2016.
Source: Ontario Ministry of Community and Social Services; Ontario Ombudsman
?
He is not the only one beginning to wonder. Ottawa police say 20 per cent of a patrol officer’s work day is now taken up with “calls related to mental health.” Overcrowding at the Ottawa-Carleton Detention Centre has been partially blamed on inmates with psychiatric and developmental disabilities (a phenomenon the ombudsman called “institutional care by default.”)
At the city’s homeless shelters, some studies have found the percentage of long-term residents with a mental or developmental disability is as high as 70 per cent. Peter Tilley, executive director of the Ottawa Mission, thinks that estimate may actually be low.
“From my personal experience, being at the shelter every day, I think it is higher than that,” says Tilley. “There is really no way you can overestimate the problem and the impact it has on our work here.”
Peter Tilley, executive director of The Ottawa Mission says he sees the consequences of long-term-care facilities being shut down regularly.
Korey Earle is president of People First of Canada, an advocacy and support group for people with developmental disabilities. While Earle has only a developmental disability, his twin brother is has a dual diagnosis and in past years could easily have been sent to a long-term-care hospital such as Rideau Regional.
It is a health care option he says the family will never consider.
“My brother came to me the other day and said he was worried about what was going to happen to him when our father couldn’t take care of him anymore,” says Earle. “He said he was worried about being sent away to an institution. That’s what frightens my brother. I’m very glad that can never happen in Ontario.”
Kory Earle, 31, sits amidst a clutter of books at a used book outlet in Carleton Place where he works now and again. He is also president of People First Canada – an advocacy group for people with developmental disabilities.
Earle lives in Carleton Place and is an eloquent and passionate advocate for the rights of the disabled. He became involved in People First in 2006, first becoming head of his local chapter, then Ontario president and finally elected to a three-year term as national president in 2014.
He was consulted by Ombudsman Dube, when Nowhere to Turn was being written, and was in attendance at the news conference when the report was released. He calls it a sad day for Ontario.
“You read the stories in that report and how can you not feel shame?” he asks. “The system is letting the disabled down in this province. People are not getting proper care. People are dying. The report makes that very clear. People are dying.”
The solution to the problem, he says, is more resources and funding for the Ministry of Community and Social Services. A centrally orchestrated approach to providing care, instead of the patchwork system of more than 300 service providers that the province has today. Better training for support workers.
One option he will not consider is bringing back the long-term-care facilities.
“We are never going back to those days,” he says. “We need to have the disabled living in our community. We need to make that system work.”
Marc Rivest kept walking away from his group home. Getting angrier and angrier each time he was picked up by Smiths Falls police and brought back. Until finally, one January night he threatened workers at the home with a knife and went on to vandalize several cars parked nearby. The police found him in a rage when they arrived on the scene.
“I have always been thankful to the Smiths Falls police, for how they handled themselves that night,” says Paul Rivest. “It could have turned out so tragic.”
Instead, it turned out merely absurd. Rivest was charged with five criminal offenses, the most serious being possession of a weapon dangerous to the public peace. The Crown attorney’s office in Brockville then proceeded with the criminal indictment.
“I was really startled by the decision to prosecute my brother,” says Paul Rivest. “It turns out the test for going ahead with a criminal charge is whether a person understands they did something wrong. And Marc did understand that — the way a child would understand it.”
Rivest spent a week in the Napanee jail, made several court appearances but in the end a plea bargain was struck. He avoided more jail time and was placed on two years’ probation. Then he was sent to another group home, this one in Ottawa run by Christian Horizons, a support agency for people with developmental disabilities.
Family photo of Marc Rivest, who ended up with a criminal record after a episode in Smiths Falls.
Paul Rivest would go on to tease his younger brother about his criminal record, although never around their mother, who remained dumbfounded until her death in 2011 at the age of 76, at what had happened to her youngest son.
“My mother spent most of her adult life worrying about Marc, about what sort of life he was going to have,” says Paul Rivest. “I don’t think she once thought he was going to end up a convicted criminal.”
Marc Rivest went on to become a model for community integration after his short-lived stint at a group home in Smiths Falls, a turn in the story that shows just how difficult it is to find black and white answers in the de-institutionalization debate.
For the next decade, Rivest lived at the Christian Horizons group home and, by all accounts, flourished. Before long he was going to sporting events again. Ottawa Champions baseball games. Ottawa 67s hockey games. He even got a chance to finally play a sport, becoming an outfielder for a baseball team run by a church near his group home.
So is Rivest’s life story a cautionary tale about the perils of closing down long-term-care facilities, or a press release for community integration? It depends who you ask.
McCreary, who knew Rivest when he was a resident at Rideau Regional, gives this as his answer: “There are many successful stories out there about community integration. For many people who were in long-term care, it is a viable option. It is a preferred option.
“You do have to think, though, that (Rivest) was pretty lucky that night in Smiths Falls. That it didn’t turn out much worse for him. The question I am left with is whether medical care for people like Marc should be based on us getting lucky.”
The same question — cautionary tale or ringing endorsement — gets a different response from Korey Earle.
“You telling me that he played on a baseball team is all I need to know,” says the president of People First of Canada. “That never would have happened if he had been in institutional care. That is quality of life right there.
“You can’t remove all the danger in life. That’s not what community integration is all about. It’s about being treated like everyone else.”
Should the Ontario government at least re-consider the decision to close all the long-term-care facilities? The ombudsman investigated 1,436 complaints of inadequate care for people with developmental disabilities, yet did not make this one of his 60 recommendations.
Turns out he couldn’t.
“The ombudsman’s role is not to intervene in matters of broad public policy, which governments are elected to set,” says ombudsman spokeswoman Linda Williamson. “The ombudsman’s role is to investigate and propose solutions to problems arising from the administration of such policies.”
So will the government consider bringing back the long-term-care facilities, as both McCreary and Chouinard say it should? After apologizing and offering compensation, that one is also a little tricky.
“Our goal now is to continue to create a more inclusive Ontario,” says Lyndsay Miller, spokeswoman for Helena Jaczek, the minister of community and social services. “To accomplish this, we need to think about how we deliver developmental services. In addition to closing the institutions, we put in place new legislation, introduced new direct funding through Passport and introduced a new entry point for the adult system — Developmental Services.
“While we have made significant progress, we recognize that we have more to do. There are still many people waiting for services so we are not only committed to providing funding to individuals, we are also committed to finding unique, creative ways of providing services and supports.”
When told of the response from the minister and the ombudsman, the chief of medical services for St. Vincent Hospital gets noticeably agitated. Then angry. Then apologizes and says: “I am sorry, but that is such BS.”
Jean Chouinard goes on to say he is one of three triage doctors at St. Vincent. As a triage doctor it is his job to admit people brought to the hospital by ambulance. That usually happens after someone with a disability has not been seen or heard from in a few days and a landlord or neighbour has called police to investigate.
Once there, police find someone passed out on the floor that hasn’t eaten for days; huddled in a corner, trying to get the voices to stop; lying in bed, unresponsive and uncommunicative.
The paramedics will be called. Not knowing where exactly to take the person, the ambulance will arrive at St. Vincent’s, the only long-term-care hospital in the city. Chouinard will give immediate medical care, but in a few days must discharge the patient.
“With virtually every ambulance call, the person being admitted should be going to a long-term-care hospital,” says Chouinard. “But I will have to release them back into the community. I’m a doctor and I can’t do my job properly. This is what is happening right now in Ontario.”
Chouinard says the number of ambulance calls has been increasing each year since Rideau Regional closed. Last year, St. Vincent’s received around 200.
Marc Rivest passed away one month before the release of the ombudsman’s report.
His death was described in his obituary as a “tragic accident,” the sort that leaves you thinking about the fragility of life, the quality and purpose of life, the many themes and questions swirling around the decision to close the long-term-care facilities for the developmentally disabled in Ontario.
The accident happened the day before Rivest’s 57th birthday. He had been on his way to an Ottawa Champions baseball game, a birthday surprise from some workers at his group home.
He was taken to dinner before the game. As was his habit, he talked the server into giving him her pen.
What happened next came out of the blue. Such an incongruent end to the story McCreary gasps when he first hears what happened. Seeming to sense the question he is about to be asked, he says:
“So did it make any difference? That’s a good question. Would anything have been different if Marc had stayed at Rideau Regional? We’ll never know, will we?
“I don’t think that means you give up, though. You try to do your best for the people who need your help. That’s all you can do. You can’t control all the outcomes. What saddens me right now is I don’t think that’s what we’re doing.”
You could argue the narrative lines of Rivest’s life had nothing to do with his death. You could argue they had everything to do with it.
After the many struggles in his life, Marc Rivest choked while eating a sandwich. He had been so excited about going to the baseball game he forgot to chew his food properly — that small thing people had been telling him to do for most of his adult life.
He had a heart attack while choking and that cut off oxygen to his brain. He never regained consciousness. Four days later, his family by his bedside, he was disconnected from life support.
“He’s at peace,” says his older brother. “I think Marc had more struggles than he needed to have in his life, but he’s at peace now.”
—
Ron Corbett is an author, broadcaster and journalist.
查看原文...
“Drop your weapon,” yelled one big cop.
Rivest looked at the steel pipe in his hand, then started to walk toward the officer.
“Drop your weapon, Marc. You need to drop it now.”
Rivest gave the officer a quizzical look and kept walking.
“Drop it, Marc.”
He stopped and stared behind him. As if to see whether there might be another “Marc,” standing there.
But he saw no one. Just the half dozen cars he had vandalized in Smiths Falls that night.
“You need to drop the pipe now, Marc. Right now.”
The pipe? No longer a weapon? A pipe? As if comprehending what the officer was saying for the first time, Rivest opened his clenched fist and let the pipe roll from his hand.
In the crisp, cold air of the January evening you could hear the sound of breath exhaling. So loud and pronounced it seemed for a moment as though a small gust of wind was passing over the men huddled on the residential street in Smiths Falls.
•
Ontario Ombudsman Paul Dubé released a report this summer titled Nowhere to Turn. It came with the sub-title: “Investigation into the Ministry of Community and Social Services response to situations of crisis involving adults with developmental disabilities.”
Ontario ombudsman Paul Dube detailed a litany of problems.
The report was filled with stories of what it called “gaps” in care for people with developmental disabilities. Stories such as that Joe, a 55-year-old man with both a developmental disability and a psychiatric disorder who, because of inadequate community support, had spent “considerable time” in jail. (The report did not use last names.)
Developmental disability (also called learning disability or intellectual disability) is a cognitive impairment, often present at birth. Cerebral palsy and autism are two examples of a developmental disability.
Mental disability (also called a psychiatric disorder) is any illness found in the Diagnostic and Statistical Manual of Mental Disorders (DSM.) Depression, post-traumatic-stress-disorder and schizophrenia are examples of a mental disability.
There was Patrick, a 24-year-old with cerebral palsy, who was placed in a nursing home for seniors. Later, “in a fit of frustration,” Patrick broke the ankle of one of those seniors. His punishment was to have his wheelchair taken away. For four months Patrick crawled to get where he needed.
Layla was placed in 22 group homes and shelters in the span of 34 days. Cindy waited seven years for a community placement. Guy drowned in a cistern while living with a “host family” in Ancaster.
Marc Rivest was not featured in the ombudsman’s report. He could have been.
Rivest was born with a developmental disability and his confrontation with Smiths Falls police in the winter of 2006 was national news. It happened less than a year after he had been released from a long-term-care hospital for people with developmental disabilities.
Family photo of Marc Rivest.
The hospital was the Rideau Regional Centre in Smiths Falls, where Rivest had lived for 24 years. It was permanently closed by the provincial government in May 2009, on the same day as two other long-term-care facilities were closed.
With the three closures, Ontario was left without a long-term-care hospital — what the government called an institution — for people with developmental disabilities.
This was by design. Four years after shuttering Rideau Regional, Ontario Premier Kathleen Wynne rose in the legislature and apologized to former patients. At the same time she announced $20.6 million in compensation.
Institutional care was bad. Without equivocation or exception. That was the message the premier delivered that day.
Even as she was delivering her historic apology, however, some in the medical community were beginning to wonder if closing the facilities had been a tragic mistake.
•
If you lived in Smiths Falls in the 1980s or ’90s, there is a good chance you remember Marc Rivest. You used to see him everywhere. At Smiths Falls Bears Junior A hockey games. At Alexander Park, cheering on whatever baseball team was playing. At restaurants and diners up and down Beckwith Street.
“When I took Marc out for dinner, I was always be amazed at how many people in Smiths Falls knew him,” remembers his older brother, Paul Rivest. “People would come up and talk to us about how the Bears did that weekend. Or how the Blue Jays did. You would think he was running for mayor or something.”
Rivest was often taken on escorted trips to the village and, by all accounts, he was a charmer — animated and gregarious. Always laughing at some joke or prank. (He was especially fond of talking nurses and waitresses out of their pens, going on to amass a collection of more than 4,000 Bics and Sharpies.)
Marc Rivest was known around Smiths Falls, as was his passion for sports.
He lived at Rideau Regional for 24 years; about the same length of time he lived with his family before arriving. Born with a profound learning disability (as an adult, Rivest functioned at the level of a six-year-old) he was also diagnosed with a psychiatric disability when in his early 20s.
The mental illness caused sudden mood swings that sometimes ended in what his brother calls “one of Marc’s blind rage episodes.” His parents had divorced by then and Rivest’ mother soon found herself unable to take care of her youngest son.
He was committed to the Rideau Regional Centre in 1981. His brother remembers the next 24 years as a period of calm for the family.
“For us, Rideau Regional was everything you could have wanted,” he says. “Marc seemed happy there, the staff seemed caring and professional. We couldn’t believe it when the government announced they were shutting the place down.”
The announcement came in September 2004, when Sandra Pupatello, then the minister of community and social services, announced the province would be closing all the long-term-care facilities. She promised to have the job done in five years.
Marc Rivest was one of the first to leave Rideau Regional, placed in a group home in Smiths Falls in the summer of 2005. On his second night in the group home, Paul Rivest got a phone call from the night counsellor at the home, telling him his brother had just run away.
•
Bruce McCreary is a psychiatrist and professor emeritus with Queen’s University in Kingston. He is also a pioneer in the treatment of people with dual diagnoses — those with both a developmental and a psychiatric disability. He was not as surprised as the Rivest family when Pupatello made her announcement.
“De-institutionalization has been rather in vogue for decades,” he says. “Just say the word ‘institution’ and most people will have a negative impression of a place. Certainly they do when you’re talking about long-term-care facilities for the mentally ill, or those with developmental disabilities.”
It’s not hard to understand the antipathy. The first long-term care hospital in Ontario for people with developmental disabilities was opened in Orillia in 1867. It was called the Orillia Asylum for Idiots.
Related
- Revealed in photos: Take a tour inside Ottawa's notorious jail
- Inmate alleges he was put in segregation over his lawsuit against jail
- Inmates told ministry they were stripped naked and put into solitary confinement: documents
It was not uncommon back then for people with low-grade learning disabilities to be committed to such institutions for life. Once there, many suffered physical and sexual abuse. Neglect. Forced labour. In the early ‘60s Pierre Berton wrote a story about one such man for the Toronto Star and the ensuing scandal nearly brought down the provincial government of the day.
The class action lawsuit filed against the Rideau Regional Centre had David McKillop as the lead plaintiff, a man who was beaten at the facility and suffered permanent brain damage as a result.
David McKillop, with his wife Eileen in their Gananoque home. McKillop sued the Ontario government for $1 billion for his treatment at the Rideau Regional Centre in Smiths Falls. Michael Lea/Postmedia Network
There were similar lawsuits filed across the province after the facilities were closed (at its peak, in 1974, there were approximately 8,000 people living in 16 long-term-care facilities in the province.)
McCreary does not deny the historical record, but he insists the decision to close the long term-care hospitals created more problems than it solved. He says this was particularly true for dual diagnosis patients such as Marc Rivest, who were most of the residents at Rideau Regional when Pupatello announced the closures.
“The people who didn’t belong in the institutions were long gone,” he says. “The people still living there were the people most likely to end up in crisis. A lot of us had concerns about what would happen to those people when Rideau Regional was closed. I still do.”
•
Jean Chouinard is chief of medical services, complex care, at St. Vincent Hospital in Ottawa, the only long-term-care health facility in the nation’s capital. Although St. Vincent’s is primarily for seniors, Chouinard believes he knows exactly what happened to many of those former residents.
“I see them just about every day,” says Chouinard. “People who used to be in the long-term-care hospitals, or should be in one today. I also read about them. Even though I’ll be reading a news story about something else.”
Dr. Jean Chouinard, medical chief of complex continuing care, at Bruyere Continuing Care within St. Vincent Hospital in Ottawa.
Chouinard says the closing of Rideau Regional, coupled with the downsizing of long-term care psychiatric facilities such as the Brockville Psychiatric Hospital — which is down to roughly 300 long-term care beds from a high of nearly 1700 — has had a ripple effect throughout Ottawa.
Not just the medical community. The entire city.
Chouinard says the effects of de-institutionalization can be seen every day in courtrooms and street corners, emergency shelters and jails. Just how many news stories are out there, he asks, that have some mental health component to them? Everything from shootings in front of the National War Memorial to overcrowding at the Innes Road jail?
? By the Numbers
70,000 – Adults in Ontario with a developmental disability –
40% – of those adults believed to also have a mental disability –
18,000 – Living in group homes and other supported living:
9,700 – On waiting list for supported living:
360 – Developmental service agencies funded by the Ontario government –
1,525 – Complaints about developmental services received by the Ontario Ombudsman between November 2012 and August 2016.
Source: Ontario Ministry of Community and Social Services; Ontario Ombudsman
?
He is not the only one beginning to wonder. Ottawa police say 20 per cent of a patrol officer’s work day is now taken up with “calls related to mental health.” Overcrowding at the Ottawa-Carleton Detention Centre has been partially blamed on inmates with psychiatric and developmental disabilities (a phenomenon the ombudsman called “institutional care by default.”)
At the city’s homeless shelters, some studies have found the percentage of long-term residents with a mental or developmental disability is as high as 70 per cent. Peter Tilley, executive director of the Ottawa Mission, thinks that estimate may actually be low.
“From my personal experience, being at the shelter every day, I think it is higher than that,” says Tilley. “There is really no way you can overestimate the problem and the impact it has on our work here.”
Peter Tilley, executive director of The Ottawa Mission says he sees the consequences of long-term-care facilities being shut down regularly.
•
Korey Earle is president of People First of Canada, an advocacy and support group for people with developmental disabilities. While Earle has only a developmental disability, his twin brother is has a dual diagnosis and in past years could easily have been sent to a long-term-care hospital such as Rideau Regional.
It is a health care option he says the family will never consider.
“My brother came to me the other day and said he was worried about what was going to happen to him when our father couldn’t take care of him anymore,” says Earle. “He said he was worried about being sent away to an institution. That’s what frightens my brother. I’m very glad that can never happen in Ontario.”
Kory Earle, 31, sits amidst a clutter of books at a used book outlet in Carleton Place where he works now and again. He is also president of People First Canada – an advocacy group for people with developmental disabilities.
Earle lives in Carleton Place and is an eloquent and passionate advocate for the rights of the disabled. He became involved in People First in 2006, first becoming head of his local chapter, then Ontario president and finally elected to a three-year term as national president in 2014.
He was consulted by Ombudsman Dube, when Nowhere to Turn was being written, and was in attendance at the news conference when the report was released. He calls it a sad day for Ontario.
“You read the stories in that report and how can you not feel shame?” he asks. “The system is letting the disabled down in this province. People are not getting proper care. People are dying. The report makes that very clear. People are dying.”
The solution to the problem, he says, is more resources and funding for the Ministry of Community and Social Services. A centrally orchestrated approach to providing care, instead of the patchwork system of more than 300 service providers that the province has today. Better training for support workers.
One option he will not consider is bringing back the long-term-care facilities.
“We are never going back to those days,” he says. “We need to have the disabled living in our community. We need to make that system work.”
•
Marc Rivest kept walking away from his group home. Getting angrier and angrier each time he was picked up by Smiths Falls police and brought back. Until finally, one January night he threatened workers at the home with a knife and went on to vandalize several cars parked nearby. The police found him in a rage when they arrived on the scene.
“I have always been thankful to the Smiths Falls police, for how they handled themselves that night,” says Paul Rivest. “It could have turned out so tragic.”
Instead, it turned out merely absurd. Rivest was charged with five criminal offenses, the most serious being possession of a weapon dangerous to the public peace. The Crown attorney’s office in Brockville then proceeded with the criminal indictment.
“I was really startled by the decision to prosecute my brother,” says Paul Rivest. “It turns out the test for going ahead with a criminal charge is whether a person understands they did something wrong. And Marc did understand that — the way a child would understand it.”
Rivest spent a week in the Napanee jail, made several court appearances but in the end a plea bargain was struck. He avoided more jail time and was placed on two years’ probation. Then he was sent to another group home, this one in Ottawa run by Christian Horizons, a support agency for people with developmental disabilities.
Family photo of Marc Rivest, who ended up with a criminal record after a episode in Smiths Falls.
Paul Rivest would go on to tease his younger brother about his criminal record, although never around their mother, who remained dumbfounded until her death in 2011 at the age of 76, at what had happened to her youngest son.
“My mother spent most of her adult life worrying about Marc, about what sort of life he was going to have,” says Paul Rivest. “I don’t think she once thought he was going to end up a convicted criminal.”
•
Marc Rivest went on to become a model for community integration after his short-lived stint at a group home in Smiths Falls, a turn in the story that shows just how difficult it is to find black and white answers in the de-institutionalization debate.
For the next decade, Rivest lived at the Christian Horizons group home and, by all accounts, flourished. Before long he was going to sporting events again. Ottawa Champions baseball games. Ottawa 67s hockey games. He even got a chance to finally play a sport, becoming an outfielder for a baseball team run by a church near his group home.
So is Rivest’s life story a cautionary tale about the perils of closing down long-term-care facilities, or a press release for community integration? It depends who you ask.
McCreary, who knew Rivest when he was a resident at Rideau Regional, gives this as his answer: “There are many successful stories out there about community integration. For many people who were in long-term care, it is a viable option. It is a preferred option.
“You do have to think, though, that (Rivest) was pretty lucky that night in Smiths Falls. That it didn’t turn out much worse for him. The question I am left with is whether medical care for people like Marc should be based on us getting lucky.”
The same question — cautionary tale or ringing endorsement — gets a different response from Korey Earle.
“You telling me that he played on a baseball team is all I need to know,” says the president of People First of Canada. “That never would have happened if he had been in institutional care. That is quality of life right there.
“You can’t remove all the danger in life. That’s not what community integration is all about. It’s about being treated like everyone else.”
•
Should the Ontario government at least re-consider the decision to close all the long-term-care facilities? The ombudsman investigated 1,436 complaints of inadequate care for people with developmental disabilities, yet did not make this one of his 60 recommendations.
Turns out he couldn’t.
“The ombudsman’s role is not to intervene in matters of broad public policy, which governments are elected to set,” says ombudsman spokeswoman Linda Williamson. “The ombudsman’s role is to investigate and propose solutions to problems arising from the administration of such policies.”
So will the government consider bringing back the long-term-care facilities, as both McCreary and Chouinard say it should? After apologizing and offering compensation, that one is also a little tricky.
“Our goal now is to continue to create a more inclusive Ontario,” says Lyndsay Miller, spokeswoman for Helena Jaczek, the minister of community and social services. “To accomplish this, we need to think about how we deliver developmental services. In addition to closing the institutions, we put in place new legislation, introduced new direct funding through Passport and introduced a new entry point for the adult system — Developmental Services.
“While we have made significant progress, we recognize that we have more to do. There are still many people waiting for services so we are not only committed to providing funding to individuals, we are also committed to finding unique, creative ways of providing services and supports.”
•
When told of the response from the minister and the ombudsman, the chief of medical services for St. Vincent Hospital gets noticeably agitated. Then angry. Then apologizes and says: “I am sorry, but that is such BS.”
Jean Chouinard goes on to say he is one of three triage doctors at St. Vincent. As a triage doctor it is his job to admit people brought to the hospital by ambulance. That usually happens after someone with a disability has not been seen or heard from in a few days and a landlord or neighbour has called police to investigate.
Once there, police find someone passed out on the floor that hasn’t eaten for days; huddled in a corner, trying to get the voices to stop; lying in bed, unresponsive and uncommunicative.
The paramedics will be called. Not knowing where exactly to take the person, the ambulance will arrive at St. Vincent’s, the only long-term-care hospital in the city. Chouinard will give immediate medical care, but in a few days must discharge the patient.
“With virtually every ambulance call, the person being admitted should be going to a long-term-care hospital,” says Chouinard. “But I will have to release them back into the community. I’m a doctor and I can’t do my job properly. This is what is happening right now in Ontario.”
Chouinard says the number of ambulance calls has been increasing each year since Rideau Regional closed. Last year, St. Vincent’s received around 200.
•
Marc Rivest passed away one month before the release of the ombudsman’s report.
His death was described in his obituary as a “tragic accident,” the sort that leaves you thinking about the fragility of life, the quality and purpose of life, the many themes and questions swirling around the decision to close the long-term-care facilities for the developmentally disabled in Ontario.
The accident happened the day before Rivest’s 57th birthday. He had been on his way to an Ottawa Champions baseball game, a birthday surprise from some workers at his group home.
He was taken to dinner before the game. As was his habit, he talked the server into giving him her pen.
What happened next came out of the blue. Such an incongruent end to the story McCreary gasps when he first hears what happened. Seeming to sense the question he is about to be asked, he says:
“So did it make any difference? That’s a good question. Would anything have been different if Marc had stayed at Rideau Regional? We’ll never know, will we?
“I don’t think that means you give up, though. You try to do your best for the people who need your help. That’s all you can do. You can’t control all the outcomes. What saddens me right now is I don’t think that’s what we’re doing.”
You could argue the narrative lines of Rivest’s life had nothing to do with his death. You could argue they had everything to do with it.
After the many struggles in his life, Marc Rivest choked while eating a sandwich. He had been so excited about going to the baseball game he forgot to chew his food properly — that small thing people had been telling him to do for most of his adult life.
He had a heart attack while choking and that cut off oxygen to his brain. He never regained consciousness. Four days later, his family by his bedside, he was disconnected from life support.
“He’s at peace,” says his older brother. “I think Marc had more struggles than he needed to have in his life, but he’s at peace now.”
—
Ron Corbett is an author, broadcaster and journalist.
查看原文...
