The Royal Ottawa Mental Health Centre English Literature Essay

That he is, says his mother, Cindy Johnston, but it is the thoughts inside his head that make him a really scary fellow. She thinks he is ready to explode.

If Kelvin doesn’t get the help he needs soon – and she thinks it has to be in a psychiatric hospital so he can be treated for his schizophrenia and substance abuse – Johnston says she is certain Kelvin, 22, will either kill someone or end up dead himself. Johnston says Kelvin has attempted suicide several times and hears voices, including those from demons who have said things that were “too bad to tell” his mother.

Recently, says Johnston,”he’s talked of throwing himself in front of a bus.”

Kelvin was diagnosed with paranoid schizophrenia when he was 18. But he suffers from a number of other mental-health disorders, some going back to age 4, when he came increasingly aggressive with fellow students at a Montessori school. Johnston was forced to pull him out.

He was first diagnosed as having anxiety distress disorder, then obsessive compulsive disorder, and by age 12, it was determined he was bipolar as well. Johnston says when he was placed into a program at age 5 to deal with his aggression and anxiety, he was, at that time, the youngest patient ever to receive treatment at the Royal Ottawa Hospital – now the Royal Ottawa Mental Health Centre.

Johnston says Kelvin’s condition is so bad that he, too, now realizes he needs hospital care. She says he recently tried on four separate occasions to have himself admitted through emergency to the psychiatric wing of the Civic campus of The Ottawa Hospital. While she keeps fighting to get her son back into the Royal Ottawa, she’s hoping that in the meantime, he can begin rehabilitation for his substance abuse. But that doesn’t seem likely. He hedges back and forth on entering a program. And he isn’t abstaining from drugs and alcohol. Abstinence is a typical requirement for people seeking treatment, according to a case manager at the Ottawa Mission, where Kelvin sometimes stays and could get help.

Not long before he was diagnosed with schizophrenia, Johnston says Kelvin’s aggressiveness and anger got to the point where she had to move him into his own apartment on Lorry Greenberg Drive. He was 17. She says she feared his constant mood swings endangered the rest of her family, including his older brother, younger half-brother and adoptive father. There had been assaults on family members and numerous occasions when he damaged the house and furniture. Often, police had to be called to the house. It is horrifying when Kelvin flies into a rage, his mother says. Family occasions were very strained when he lived at home, but they can also be pretty nerve-racking when he’s alone with his mother.

Last fall, Kelvin became so incensed while Johnston was driving him to the Montfort Hospital that he put this fist through the front passenger window of her car. About five years ago, he suddenly lunged for the steering wheel as Johnston was driving and forced the car into a farmer’s field.

Kelvin had a driver’s licence for a very short period. It was permanently revoked when he was 18 by a review board at the Royal Ottawa following a number of incidents involving road rage and careless driving. In what his mother believes was one of his suicide attempts, Kelvin was involved in a high-speed single-car crash. His vehicle flipped three times, front end to back end. He suffered permanent injuries to his back.

Johnston says her son often doesn’t take his medication and further aggravates his condition with alcohol and drugs, including crack cocaine. His substance abuse goes back years. When he does take his medication these days, his mother says he crushes it into a powder and snorts it as it apparently gives him a quick high.

Kelvin now spends his time shuffling between shelters for the homeless in Lowertown. He moves about because his behaviour – threats, fights, putting his fists through walls – gets him into trouble. He’s usually told to take a time out and go to another shelter. It was the same behaviour that got him kicked out of three group homes in the last year and eventually landed him on the street. His mother says drug dealers use him as “an enforcer or protector” whenever there is a problem with buyers.

When I saw him this week, one day at the Salvation Army men’s shelter on George Street and the next day outside the Ottawa Mission on Waller, he was anxious and tired. Kelvin doesn’t want his story in the paper. He says everything is fine and he’s “doing OK.” He says he doesn’t want people to know “my s–t.” He says he would return to hospital if he could.

His mother wants her son’s story told in the hope that someone in authority at the Royal Ottawa reacts positively to her son’s situation. She understands there is a bed shortage at the Royal Ottawa, but says one has to be found for Kelvin so he can be stabilized.

Johnston says her son’s doctors don’t see Kelvin in any immediate danger and think he can manage with the support they are giving him. She says his Royal Ottawa psychiatrist has more or less dismissed her as an “overbearing parent.”

That psychiatrist refused a request to be interviewed. The psychiatrist heading the Assertive Community Treatment Team (ACTT) – which provides rehabilitation support to Kelvin and others in the community with severe mental illnesses – did not answer any of my requests for an interview.

But Mary Alberti, chief executive of the Schizophrenia Society of Ontario, says it sounds as if the mother in this case needs to calm down and let her son’s doctors and support team do their work.

“Being connected with an ACTT team, this individual has a lot more support than many other people have in terms of being in the system, in being connected.”

Alberti suggests that parents with schizophrenic children turn to support groups to help them cope and come to a better understanding of the mental-health system. As well, says Alberti, it is important for parents “to continue letting the care team and psychiatrist know what the family viewpoint is, what they are seeing, what they are experiencing and what their concerns are.”

Johnston says she often updates Kelvin’s doctors and support team about what is happening to her son. But all she sees is Kelvin sinking deeper into his psychosis and drug abuse.

It was an assault on a neighbour at the Lorry Greenberg apartment building in 2008 that led doctors to finally determine he had schizophrenia. He was charged by police, but following his diagnosis, he was deemed not criminally responsible for the assault and spent the next 13 months at the Royal Ottawa. Though his psychiatrist decided after three months that Kelvin was ready to leave the hospital, Johnston took the matter to the Royal Ottawa’s review board and convinced members that her son should not be released.

Once he was allowed to leave in June 2009 – against his mother’s wishes – Johnston placed Kelvin in a Rothwell Heights residence, which primarily accommodates seniors. He was there a year before doctors determined he was ready to live on his own

Johnston found an apartment for Kelvin on Walkley Road in June 2010. His mother would visit to help him with groceries, cleaning and laundry. But the visits became less frequent as he made it clear he wasn’t keen having her in his apartment. His mother says her son fell in with a bad crowd. In June 2011, he was attacked in his unit by three men – Johnston believes it was over drugs – and his head was bashed with a beer bottle. He suffered a severe cut to an ear and nerve damage to an eye and his mouth.

He was released from the Civic the day after the attack. Johnston picked him up. But on his way back to the apartment, Johnston says her son talked about revenge and that he planned to catch his attackers and “eat their faces.” Alarmed, Johnston called police after she dropped him off. Police took him back to the Civic and had him admitted to the psychiatric ward.

Johnston says an ACTT worker got in touch to tell her the team would be recommending that Kelvin be readmitted to the Royal Ottawa.

Buoyed, Johnston says she got Kelvin out of what was left on his lease, but not before she spent $600 having the apartment professionally cleaned. She says what she found in the unit was shocking. Besides blood-stained walls, floors and mattress as a result of the attack, Johnston found filth everywhere. The stench in the unit made her gag. His fridge and cupboards were bare. There were beer bottles and drug paraphernalia that indicated he was drinking and doing drugs, and as such, contravening the rules of the community treatment order he was under. That alone could have been enough to force his return to the Royal Ottawa, says Johnston. How could the ACTT members have missed so much stuff during their visits, she asks.

When Kelvin phoned her to say he was being released from the Civic and going home, she was caught off guard because she thought he was being readmitted to the Royal Ottawa. There was no apartment to return to, she told her son, who reacted by putting his fist through a plate-glass door. He was kept at the Civic for another couple of days before his psychiatrist from the Royal Ottawa determined he was OK to leave.

His release had Johnston scrambling to find a place for him to stay. The Rothwell Heights’ residence agreed to take him, but he was kicked out after a few months because of bad behaviour. He ended up in a group home in Limoges last November, but was forced to leave in April, again because of his behaviour. That’s when he ended up homeless for the first time and started staying at the Ottawa Mission. He moved to a group home in Vanier in June, but, by the end of July, he was kicked out of there, too. He has been staying at the Lowertown shelters since then.

Says Ottawa Mission spokeswoman Shirley Roy: “I saw someone quoted recently about how our jails are becoming the new mental-health institutions. I would argue that shelters are starting to equal that, too … we’re seeing a lot of people who are in crisis.”

Question: In this case, a clear causal link is presumed between mental disorder and violence. The purpose of this assignment is to provide a critical -and complementary- view of this man’s “dangerousness”. Using concepts and theories learned in class so far, discuss the following points: 1) limitations of the concept of “mental disorder” as a predictor or risk factor for violence and 2) the difficulties of intervening with this individual as well as potential solutions.

Unfortunately like many others, Kelvin Johnston is a young individual who suffers from having a mental disorder and who is violent. With the concepts and theories learned from class, I will try to explain the limitations of the concept of “mental disorder” as a predictor or risk factor for violence and the difficulties of intervening with this individual as well as potential solution. According to Stuart (2003), the main risk factors related to mental illness and violence are young, male, single; lower socio-economic status and substance abuse, which Kelvin fits perfectly. For the public eye « the link between mental illness and violence are central to stigma and discrimination as people are more likely to condone forced legal action and coerced treatment when violence is at issue » (Stuart, 2003). « Further, the presumption of violence may also provide a justification for bullying and otherwise victimizing the mentally ill » (Stuart, 2003). In Kelvins case there has been many interventions that have been forced upon him in order to reduce his risk to the public. For example, the police were called at many occasions and were forced to intervene because there were many assaults on the family members and lots of material damage done (for example, damaged furniture). Furthermore, at the age of five he was placed in a program at the Royal Ottawa Hospital to deal with his aggression and anxiety. The problem with this is that he was the youngest patient to ever get help from this Hospital and at such a young age he was labeled as having many different types of mental disorders. In other words he was labeled as mentally ill. Once an individual is labeled as aggressive or as having a mental disorder it is very hard for this person to be seen as something other than their label (CRM 3311). For example, the mother Cindy constantly saw her son as a threat to society and as dangerous. She said: « it is the thoughts inside his head that make him a really scary fellow (…) he is ready to explode ». The fact that she thinks that he is ready to explode is because of the label of violent and aggressive. « Not long before he was diagnosed with schizophrenia, Johnston says Kelvin’s aggressiveness and anger got to the point where she had to move him into his own apartment (…) He was 17. She says she feared his constant mood swings endangered the rest of her family ». It could be that he is violent and aggressive but what makes it that this behaviour is considered as a mental disorder? Could this behaviour be a result of child development, a learned behaviour, life habits or problems in perception? In other words, it might be related to psychological theories. If it is a learned behaviour he might have seen someone being aggressive towards another individual or it was reinforced (CRM 3311). Perhaps it was just regular childhood behaviour and with a little bit of punishment it would have been learned that being aggressive is not good. Could there be stressors or moderators (anything that can influence the impact of stress) that triggered the disorder like the social stress model (CRM 3311). Perhaps he had an extreme event or trauma happen that might have caused him to act out aggressively. Instead of bringing him to a the Royal Ottawa Hospital at such a young age, perhaps Cindy could have tried a cognitive-behavioural therapy where she could have taught him what to think, how to think so that he can learn that the aggressive behaviour is a danger to society and that he is not supposed to act this way (CRM 3311). This way, instead of being labeled as mentally ill it would be a whole process of learning the right way to act and the mother would not see her son as aggressive and dangerous or as his label. In addition, « [it] was an assault on a neighbour at the Lorry Greenberg apartment building in 2008 that led doctors to finally determine he had schizophrenia (…) Though his psychiatrist decided after three months that Kelvin was ready to leave the hospital, Johnston took the matter to the Royal Ottawa’s review board and convinced members that her son should not be released ». Here the mother only sees her son as dangerous; she does not see him as anything else but as a label. Instead of Cindy only seeing Kelvin as his mental disorder, violent and schizophrenic, maybe she should have been thinking about what is best for her son. Maybe getting out of the Hospital, leading him to make the right choices, being supportive and being there for Kelvin would have helped him. In this case we see that it is the mother’s goals and intentions that are taken in consideration (pragmatic values) (CRM 3311). The mother’s intentions are to influence the Royal Ottawa to react positively to her son’s mental illness.

Moreover, once the person is labeled, the individual will start to see themself as the mental illness. Especially, when it comes to identifying themself, the individual will start to alienate from place (CRM 3311). For example, Kelvin will act differently than the way he sees himself (act out of place), like being aggressive towards fellow students. This different behaviour creates violations between place and interactions (CRM 3311). Additionally, Kelvin starts to recognize his symptoms (CRM 3311), for example « Johnston says Kelvin’s condition is so bad that he, too, now realizes he needs hospital care ». This example proves that he is seeing himself as the label and is alienating from self. He knows that something is not right with his behaviour and he is drifting even further away from himself. Moreover, Kelvin tries to change his method of reasoning (CRM 3311). For example, « [he] hedges back and forth on entering a program. And he isn’t abstaining from drugs and alcohol », he often doesn’t take his medication and abuses substances such as alcohol, crack and cocaine and sometimes he even crushes his medication and snorts it to get a quick high. It is clear that Kelvin is trying to cope with his mental disorder by trying to do the programs offered to him. Unfortunately he is also coping with this by drinking alcohol and doing drugs which causes even more risk to society. One of his logics might be that by not finishing the programs and by not abstaining from drugs and alcohol he is also not giving in to the disorder, which means he is fighting the label, in literal terms. By doing so, he is going against what everyone else wants for him and he is creating his own way of coping with his madness. Here the definitive outburst (CRM 3311) is present, the environment (his mother, the psychiatrists, society) is unable to understand him which leaves Kelvin discouraged and he alienates himself from others. We see this when he lives on his own, his mother unable to cope with her sons madness leaves him to live alone. « He’s usually told to take a time out and go to another shelter. It was the same behaviour that got him kicked out of three group homes in the last year and eventually landed him on the street », here it is clear that the workers at the shelters are unable to cope with his madness either. Here, Kelvin blames the environment for not understanding him, also called negative account (CRM 3311). Finally, throughout the case, it is clear that there is the paradox of normalcy where disorder is recognized by Kelvin, his mother, his family, psychiatrists and society, and then it becomes normalized (CRM 3311). The whole idea of labeling is that he is labeled as aggressive, paranoid schizophrenic, anxious and he then is only seen as those characteristics. In Cindy’s case, it is very hard for her to see her son as something besides his mental disorder. « Mental disorder becomes the “Master Status” » (CRM 3311) and creates a paradox where « abnormal state becomes a normal state for someone » (CRM 3311). In other words, his disorder became normal for the mother and for society, he is his label. In result, he is removed from place; he is labeled so he cannot have the same place as he used to have before his mental disorder (CRM 3311). In conclusion, there are many limitations to the word mental disorder such as labeling, psychological theories, identity, stigma and the social stress model. There are also many ways to try to intervene and try and reduce his risk by being supportive, trying the cognitive-behavioural therapy, having police and hospitals to help him, different programs to offer to him, giving him a home to live in and giving him medications to help keep his mood stable.

Mental Illness and Violence

Case 1 Kelvin Johnston

Chantal Labrecque

5657684

CRM 3311 A – Mental Disorder and Justice

Professor David Joubert

November 5th 2012

University of Ottawa