Dan: This is a factory. In the factory, we have somewhere between 1100 and 2000 review board hearings a year—most of them, they try to squish into a hearing that is an hour an twenty minutes to an hour and a half long, and there is a real resistance for the scheduling people at the review board or the review board themselves to deal with any issue that takes the tribunal outside of 90 minutes. If the issue is going to take longer than 90 minutes, there is huge resistance to dealing with it whether it be cultural, whether it be class-they don’t’ want to have longer hearings because it bogs the system down.From an interview with a seasoned “Community Mental Health Worker” on the nature of “services in the community"
Bonnie: It is a bureaucratic process.
Dan: It is a factory. A successful day would be to go along with what the hospital wants, to have the person moving through the system is a reasonable way, and to go on to the next case and the next day.
Bonnie: And the alleged “reasonable way” in fact is often leaving them in the system?
Dan: Well, it is hard to move the person through the system if the person complains that they are not being treated okay and then God forbid they appeal; and it slows everything down. (laughter).
Bonnie: So processing cases is what that the system is about.
Dan: The system is about processing cases. And the system is about the system. Therapy can be having lunch with the nurse and discussing for 5 minutes your case before you spend the rest of the hour, you know, talking about the weather. But as long as you can say that there has been some therapy, then there is a justification for keeping a person in the system. So the system is about the system.
Dora: I am an in-the-moment kind of person. I mean clearly in the mental health system as it is now what we are seeing is that, I mean, you have to remember, community mental health was a reaction. It was quite reactionary, when it started out, right?From an interview with a Survivor/Educator on the use of “Crazy” as Opposed to Medical Model Language
Bonnie: Yeh, let’s control people in the community given that we can’t afford to have them in hospital.
Dora: Precisely. So then now, where we’ve gone is…but it looked different, you know, it kind of looked different. Now it’s not looking that much different.
Bonnie: It looked different from what?
Dora: Than institutions that are all located in one massive building.
Bonnie: So unlike earlier, today you are saying it does not look so different?
Dora: It doesn’t look different in that we fetishize the paperwork so much, right? That we act like it’s an institution. Essentially, we imprison people with the paperwork, with the files.
Bonnie: Tell me how the files imprison people?
Dora: Axis points and seventeen pages to fill out.
Bonnie: Slow down if you could. All of these things I need to understand. What are axis points? What is the paperwork that you have to fill out?
Dora: So if you want to get supportive housing, you have to go through what is called the CASH. Coordinated Access to Supportive Housing.
Bonnie: That’s in Ontario.
Bonnie: Toronto is different from other jurisdictions.
Dora: Yes. So then you’ll see when you look at it yourself, there is a 17 page application.
Bonnie: 17 pages to get supportive housing.
Dora: No, to get on the waiting list. To get on the waiting list for supportive housing. So all this data, and I fought tooth and nail to stop this, and but they say, “we need the data.” But there are 5000 people on the waiting list. So what’s the justification for having that 17 pages of information because 5 years from now, it is not even going to be relevant to the person’s life. And I tried to come at that through PHIPA and I lost that fight.
Bonnie: And PHIPA is what?
Dora: The Personal Health Information Protection Act. I tried to use that to stop people from collecting so much information.
Bonnie: Gotchya. So you are filling out the 17 page application. Then what happens?
Dora: Yes, so and now we have coordinated all the case management in the city into this access point called Axis 1.
Bonnie: Axis 1. Axis 1 is for what?
Dora: Case management.
Bonnie: Case management of anyone who…fill in the blank.
Dora: Who wants case management or some worker feels that they need case management, who has been identified as mental health issues.
Bonnie: Been identified with mental health issues. Now that phrase, you’ve used a couple of times. Does someone have to sign a form saying that someone has “mental health issues”?
Bonnie: All right. Who signs this form? And what form is this?
Dora: Well most of the time the person has to have their diagnosis verified by a doctor or a psychiatrist.
Bonnie: They have to have a diagnosis?
Bonnie: So almost anything. But using a diagnosis, some psychiatrist has to identify this person as having a mental health problem.
Bonnie: Okay. Go ahead.
Dora: So we create these gatekeeping functions, and paper is the operating mechanism of all of these functions. So it becomes so laborious that even if the person is asking for some kind of service that you know, well the paper serves to keep people out.
Bonnie: Out of what?
Dora: Out of services—people who are considered troublesome, or marginalized or so, and to let other people in.
Bonnie: So that the paperwork not only slows everything down but serves a gating function? Is that what you are saying?
Bonnie: And to keep some out and others in, and the ones that get in would be easier to serve? Less onerous?
Bonnie: Tell me in your own words. In your experience—and I know that you have been at this for decades—who does it try to keep out?
Dora: Well, people who are troublesome.
Bonnie: So you are suggesting that such people in particular get bogged down in the paperwork. But I thought that it was exactly people who are “troublesome” that it was supposed to serve.
Dora: I know. That’s what everyone says. But that’s not the case.
Irit: In regard to terminology, I’m really happy that I called my book “Call Me Crazy.” I was just in Israel visiting family, and I kept talking about when I was crazy, and people cringed and objected, saying, “We don’t use those terms. We don’t say that any more”—letting me know, out of kindness, that I was really wrong to be using the word “crazy.” But because these people love me, they did hear me when I told them why. The last day that I was there, I had an hour with a fifteen-year-old cousin. My brother had dropped me off there, and he had said something about some synagogue. This cousin knew that I wasn’t religious, so she asked what that was about. I took the opportunity to tell her the story of how I got locked up in Bellevue, and that afterwards my brother hooked me up with a synagogue and with Jewish Family Services, who were very helpful, and with the Housing Foundation of B.C., which got me some really good housing.
Bonnie: Good services.
Irit: So I was telling her the story of me being bonkers, just the way I always talk about it to anybody who will listen. And she was just riveted. This has happened with a couple of the teenaged daughters of my friends, too. Kids who maybe never thought about this stuff, or had the standard view about this stuff. I am good at telling stories, and it is entertaining. I don’t feel like I make it entertaining; I think the things that have happened to me are hilarious at the same time that they are sad—and it’s opening up possibilities of understanding in people who have not yet been entrenched in the establishment view. It’s wonderful. And it’s also been important to me when I get into conversations that random strangers on the bus, which happens a lot in Vancouver.
Bonnie: That overhear you?
Irit: No—people who ask me some question that results in my talking about “crazy,” in reference to myself. Initially, people are startled and maybe offended:
Bonnie: I see what you’re saying. That’s a great and gutsy thing for you to do, Irit.
Irit: But I feel like that it’s a huge thing that justifies my existence on the planet—not that one should have to think about justifying one’s existence on the planet.
Bonnie: So it is like your role or your mission?
Irit: Yeah. It is something I do that I think is important, and which I do automatically—I don’t think about it. I will talk to anybody who will give me the time of day about all of this stuff, and about it being about me. And I think that the terminology really does matter. And that’s why I’m so glad that I titled my book “Call Me Crazy.”