We call 911 on a rainy night in October. Kevin’s in our yard again, though he promised us he wouldn’t be. He shouts that he’s alone with Blueberry Panda (his cat) on the surface of a giant sun, and nothing else exists in time or space and only he, almighty, can harness the power of this sun for the purposes of destruction.
The paramedics arrive after five minutes, and the first police car a couple of minutes after that. Others follow. Just like two weeks ago.
Six officers, all with flashlights, tromp along the narrow, overgrown path that leads to the back of the yard at our house in the east end of Toronto. Kevin’s hunkered down with his sodden sleeping bag over his head, rocking, looping, round and round.
“Kevin—let’s get you up,” one of the officers says. “Let’s get you somewhere dry.”
“No,” he snaps, briefly free of the loop. Then he resumes: “You are not speaking English. Blueberry Panda and I are in an unknown location because we are the only creatures in all of time and space. Blueberry Panda and I are in an unknown—”
He’s standing now. His wild, curly hair and beard look even wilder in the glow of the flashlights; his brown skin looks grey.
In the end he goes with the officers quietly.
Kevin started sleeping in the ravine behind our house four months ago. After a while, when it got rainy and buggy, my husband, Peter, and I decided to give him a tent. We got to know him: Grew up in Trinidad. Graduated from the University of Toronto in the ’90s with a degree in philosophy and chemistry. Is in his mid-40s. Had an apartment until things went south. Had been on meds and thought maybe he should get his prescription refilled. When he walked past our porch, he’d call out “Hi, neighbours! Hi, sweeties!”
It took a while for us to get a good look at Blueberry Panda: she was skittish and quick, a plump black and white blur streaking across our backyard and disappearing under our fence. One day, he brought her to the porch to meet us. “She’s been with me for seven years,” he said as she wriggled indignantly in his arms. “She was a feral kitten. She fit in my hand when I got her.”
Kevin asked to use our bathroom, but only a couple of times. We gave him money when he wanted to visit the bathhouse on Church Street with the Jacuzzis and cheap rooms. We gave him subway tokens. Once, we gave him breakfast. He sat at our table, plucking at the cigarette butts he’d picked up near the subway station and saying over and over: “I have nowhere to go.”
A few months later, when the nights started getting colder, we told him to go to a shelter. “No,” he said. “I itch at shelters. And there are no pets allowed, and Blueberry Panda needs me.”
At 3 a.m., long after Kevin leaves with the cops, the phone rings. It’s a frontline worker from the Centre for Addiction and Mental Health; she tells us Kevin has just been sent away in a taxi, having not been assessed or medicated. He was lucid again by the time someone at the ER had spoken to him. He answered their questions. He got in the cab. He’s supposed to end up at a shelter.
He’s back at our place six hours later, calling for Blueberry Panda.
* * *
The first time Kevin was taken away, I thought everything was going to get better—I was convinced that professional and qualified people would be looking after him from then on. That was before I learned about Ontario’s rules for involuntary admission.
It works like this: Someone (typically a police officer) sees a person exhibiting signs of mental illness and decides they should be taken to hospital. At hospital, that person is examined and assessed. If various criteria are satisfied, the examining doctor can fill out a Form 1—that is, an application for psychiatric assessment—which allows the hospital to hold the person for up to 72 hours, without legal review.
Those “various criteria” are where things get tricky—and they explain why Kevin returned to the ravine just hours after he’d left.
Under the Mental Health Act, a physician can apply for a psychiatric assessment if they believe an individual might harm themselves or others, or is unable to take care of themselves. The physician must also believe the person has a “mental disorder” that will result in “serious bodily harm to the person,” “serious bodily harm to another person,” or “serious physical impairment of the person.” (The case law says that such harm must be expected to occur within a reasonable period of time.) The physician can also fill out a Form 1 if they believe the individual has a pre-existing mental disorder that, when not treated, “is of a nature or quality that likely will result in serious bodily harm to the person or to another person or substantial mental or physical deterioration of the person or serious physical impairment of the person.”
The first time Kevin was taken away, I was convinced that professionals would be looking after him from then on. That was before I learned about Ontario’s rules for involuntary admission.
But what constitutes a reasonable period of time? What about substantial mental or physical deterioration? What about harm?
“There is sometimes a misconception that psychological or emotional harm does not justify committal and that the person must be physically dangerous to himself or herself or others,” reads a 2013 report by Gail Czukar, now CEO of Addictions and Mental Health Ontario, and the law firm Dykeman Dewhirst O’Brien. “This is simply untrue. However, the authors acknowledge that this fact may not be readily known by health practitioners.” A 1991 Supreme Court of Canada finding interpreted “harm” to mean psychological and physical, but this is not made clear in the Mental Health Act.
Nor is it clear on the Form 1 template. Multiple checkboxes have the word “harm” beside them—and in front of each one, the word “bodily.” As Jean Buie, an adjudicator with the Social Justice Tribunal of Ontario and formerly in-house counsel at CAMH, told me, “The definition of psychological harm is in the case law, but it’s possible that many psychiatrists aren’t aware of it.”
“The forms are very specific about the harm having to be physical,” says a social worker who has worked in the emergency room at CAMH, and who spoke to TVO on condition of anonymity. He adds that the forms are less specific when it comes to deterioration and impairment. “If people are on the street because they see demons everywhere,” he says, “that’s impairment, and a physician might decide to do a Form 1.” But ERs feature a rotating cast of physicians, some of whom will see impairment where others won’t: “The vagueness of the category allows for some inconsistency, while still adhering to the law.”
(Of course, even if a person is involuntarily admitted, that doesn’t mean they’ll receive medication or therapy. According to a 2013 report from the Schizophrenia Society of Ontario, “Whereas in some other provinces an individual who is involuntarily admitted would necessarily receive treatment, in Ontario, an involuntary patient could still refuse treatment if they were found capable of making such a decision.”)
Then there’s the fact that a physician has only a limited period of time in which to assess a patient: “It can be really challenging to grasp a person’s level of impairment during this time—so if the patient’s lucid, it’s difficult to make the case for impairment. There are definitely folks who fall through the cracks. Someone can be not sick enough to warrant committal, but sick enough that you know it’s not right to send them back onto the street.”
* * *
Back in September, Kevin started shouting in the middle of the night. He explained later that he could see the demons most clearly after dark. Shouting was how he banished them. So we’d lie in bed, listening to him shout the demons away.
One night, he sang instead: first Whitney Houston’s “Greatest Love of All,” then Madonna’s “Like a Prayer.” Another night, we looked out the window and saw flames: Kevin had made a fire. For a few moments the flames leapt high, toward the rain-soaked trees.
We didn’t call the police; we wanted to avoid involving law enforcement, if at all possible, as we’d read too many stories about Toronto cops and their sometimes violent interactions with mentally ill people. So who were we supposed to contact?
I sent our city councillor a long, wordy email that boiled down to: Help. We don’t want anything bad to happen to this man, but he’s mentally ill and now he’s making fires in our yard and he won’t go anywhere without his cat and please help. I got a response from a staffer a few minutes later: she said she’d refer the issue to someone from the city’s Streets to Homes program. She thanked Peter and me for being such caring people.
Five days later, I’d heard nothing more, so I emailed our councillor again, and again I received a quick reply: she’d follow up with the city. She’d keep me in the loop. Thanks again for all we were doing.
I didn’t hear from the councillor’s office again, and I never heard from the city.
We emailed the Salvation Army to ask what could be done to get Kevin somewhere with walls and a roof and heat and showers and mental-health support. They came by and talked to him. They offered him a shelter bed, but he refused. So they left him a sleeping bag (because after he was taken away the first time, the city staffers had thrown away what remained of his tent). They said they’d check on him from time to time, but there was nothing else they could do.
I found out about a shelter in the city that accepted homeless people and their pets: Fred Victor Bethlehem United. I called. “We’re full,” the shelter staffer said. “We’re almost always full. But keep calling. Something will open up.”
* * *
At last official count, in 2013, there were more than 5,200 homeless people in Toronto on any given night. There are roughly 4,600 permanent emergency and transitional shelter beds in 62 shelters across Toronto, 10 of which are run by the city. Toronto’s approved shelter occupancy rate is 90 per cent, but its facilities regularly exceed that—on December 6, for example, the daily shelter census indicated that every sector had climbed above it: co-ed, 96 per cent; men, 94 per cent; women, 98 per cent; youth, 97 per cent; family (shelters), 100 per cent; and family (motels), 92 per cent.
The Out of the Cold program, an inter-faith initiative run by volunteers, provides additional beds in winter, but it’s also stretched to the limit. As the Toronto Star reports, a 2016 study from the Ontario Coalition Against Poverty found that “55 per cent of respondents said they’d been denied overnight access to Out of the Cold programs at some point because a particular facility was full.” Members of the research team were also told that, because of the lack of resources, people sometimes had to sleep “on the bare floor or in chairs.”
Seaton House—the city’s largest shelter, with more than 600 beds—was supposed to close this year, but the project has been delayed because the city has not yet come up with sufficient funding for alternate locations. The city’s 2018 Shelter Infrastructure Plan and Progress Report (which council adopted, with amendments, last week) lays out a strategy for finding sites that will replace Seaton House, and addresses general capacity issues. There are six pilot site addresses on the list, and seven TBDs. Community consultation will be required before those seven are confirmed, and communities aren’t usually eager to welcome homeless populations.
Kevin shouted in the middle of the night. He said he could see the demons most clearly after dark, and shouting was how he banished them. So we’d lie in bed, listening to him shout the demons away.
If a shelter bed is available, there’s still the question of what a person might have to give up in order to take it. Only one Toronto shelter—YMCA’s Sprott House, which opened in 2015—is dedicated to the LGBTQ homeless community. Only six of the city’s shelters accept homeless families. Only Bethlehem United offers services to homeless people with pets. The numbers (upwards of 900 at Seaton House, when it’s over capacity) can be overwhelming, both to individuals with mental-health issues and those without. There are lice and bedbugs. There is theft and illness.
Even with available beds and appropriate services, many homeless people simply will not go to shelters. “You have people who don’t like the shelter system,” a mental-health worker at CAMH told me. (He also asked to be kept anonymous, citing the “incredibly political” nature of mental-health care.) “People who say, ‘Last time I was in a shelter, I was assaulted and I won’t go back to one.’ That’s a fair statement to make.”
And if they do choose to go, and are assigned case workers to help them transition to permanent housing, more often than not, there’s no housing available; as of last year, the wait for Toronto Community Housing was almost four years. Yes, the federal government just announced its first National Housing Strategy, which aims to cut homelessness across the country by 50 per cent over the next 10 years, but it isn’t set to be implemented until 2019. Meanwhile, so far this year, at least 70 homeless people have died in Toronto.
“We have been talking for decades about the crisis of homelessness in Toronto,” a spokesperson for the Toronto Alliance to End Homelessness wrote in a November 20 deputation to city council, “and it is still a crisis and a disaster.”
* * *
After calling every couple of hours for days, as shelter staff had instructed me to, it happened: a bed had opened up for Kevin and Blueberry Panda at the Bethlehem United shelter.
I was at work when I got the news. It was my husband who rushed to the ravine and told Kevin, then rushed to pick up a rental car. When Peter got back, Kevin was starting little fires. There was no Blueberry Panda in the carrier. “She got upset,” Kevin told him. “She ran away. I can’t go without her.”
Peter yelled something along the lines of “Enough. This is what we’ve all been wanting. This place will take you and Blueberry Panda—now get in the car. We’ll bring her to you as soon as we can catch her. But get in the car. Now.” He picked up Kevin’s knapsack and sleeping bag and put them in the car. After a few more protestations, Kevin got in, too.
We couldn’t catch Blueberry Panda that day or the morning of the next. Kevin came back on the afternoon of that second day. As he set his sleeping bag and knapsack on our porch, he swore he was going to get her into the carrier this time. He swore he’d be on his way back to the shelter in a couple of hours.
A couple of hours later, his stuff was gone. The cat carrier was gone. Shelter staff said, yes: Kevin had showed up, Blueberry Panda in tow.
There was obviously no guarantee that this would take: he had left shelters before. So we called for Blueberry Panda one more time that night, as we put out some kibble. Just in case.
* * *
Kevin had left shelters before, because no one could make him stay if he didn’t want to. That was his right—and it’s completely understandable that the mental-health system is geared toward protecting individual rights. “The history of the involuntary hospitalization of the mentally ill is marked by ignorance and cruelty,” wrote psychiatrist Frances Frankenberg in a 1982 paper on the Mental Health Act, which had been amended just four years earlier to include the right to refuse treatment. And psychiatric hospitals, according to the Canadian Psychiatric Association, “have a long history of functioning as quasi-jails for persons who have had to be admitted involuntarily.” When the state has unrestrained power to decide who gets committed and who doesn’t, that can lead—has led—to abuse.
Still. Kevin had to get out of our yard. He needed help. He wasn’t well. Someone needed to make him get help.
“We talk about protection of rights,” says Sandy Simpson, chief of forensic psychiatry at CAMH, “but these are generally negative rights—including the right to refuse. Not positive rights, which include the right to work, to be a member of society, to have a family. Positive rights can wither away while your right to refuse is respected.”
Civil liberties matter. It should be hard to keep someone in hospital against their will. But people will get sick on the streets this winter; some of them will freeze to death because they don’t want to leave their dogs.
Buie agrees that we need to think about positive rights. But, she says, “When ‘gaining’ such rights is through hospital detention and/or forced treatment, we have to be very careful who gets to determine which right prevails for a person, the negative or the positive, when that person is not making the decision for themselves.”
This makes sense to me: Civil liberties matter. Autonomy matters. It should be really, really hard to keep someone in hospital against their will. And yet people will get sick on the streets this winter; some of them will freeze to death because they don’t want to leave their dogs.
What isn’t clear to me is who should get to make that decision for Kevin if Kevin can’t make it for himself. All the obvious options—doctors, justices of the peace, cops—could be motivated by interests other than his.
And what about my motivations?
One October morning near dawn, days after our 911 call, Kevin woke us again with his coughing and mumbling. When I finally drifted back to sleep, I had a dream: A woman comes to pick him up in a car, and she’s a friend, and he’s suddenly clean and smiling and clear-eyed, saying goodbye to us. Because this is the fairy tale I want, of course. Maybe we don’t see him for a few months. Maybe he rings the doorbell sometime in 2018 and we don’t recognize him at first, but as soon as he says our names we exclaim and maybe even hug him—and he’ll smell like soap, of course, and his clothes won’t smell at all. He’ll tell us about his new apartment. He’ll show us photos of Blueberry Panda on his new phone. He’ll say he just wanted to tell us how well he was doing, and to thank us again for being there when he was hitting bottom.
It’s not an entirely altruistic narrative. What other story is there that’s as self-satisfied and self-satisfying as this one? The redemption story in which you get to play the most important of the supporting roles. The happy ending you wrote.
* * *
Bethlehem United celebrates its 10th birthday on a mild night in November. The shelter manager has invited Peter and me to attend. Balloons bob up against the ceiling of the large room in which the event is held. Strings of clear beads hang above the heads of the people gathered here: members of the Bethlehem United Church congregation; Fred Victor staff; shelter residents.
After dinner, and after speeches from staff and testimonials from residents—people with pets, people like Kevin—we finally spot him. I wave madly. He waves uncertainly. He looks confused. He also looks exactly the same as he did four weeks ago.
“What are you guys doing here?” he asks after we make our way over to him. (We find out later that no one told him we were coming; they wanted it to be a surprise.) He puts his hands to his head and shakes it slowly: “I was just thinking about you guys! Like, just five minutes ago! I was just thinking about you, and here you are.”
“So how are you, Kevin?”
“How’s Blueberry Panda?”
“Have you heard from the Salvation Army guys about that housing wait list you’re on?”
“No. I guess I should call them.”
“Do you have another cellphone yet?”
“But you still have your laptop.”
“No. It broke.”
We’re sitting at a table by now. Kevin’s dessert plate is piled high with cake and strawberry halves and bits of pineapple. He eats hardly any of it. When we ask him again about the housing list, he says he’s afraid that he’s been prioritized only because he was living rough; now that he’s in a shelter, he might end up back on another, longer list. A little after that he laughs to himself; he’s gazing at the tablecloth, or maybe at something we can’t see.
We say goodbye to him a little while later. He tells us he’ll try to call sometime. We hug him. He’s bulky with layers of clothing but also slight somehow. His jacket smells dirty but his hair doesn’t.
Then we head back to our house and our yard and the ravine, where we know Kevin and Blueberry Panda won’t be tonight. But although he is where he needs to be for now, the cracks he fell through before are still gaping. The city is full of Kevins, and there aren’t enough supports in place to help them—if they want help at all.
This story has no ending.
Caitlin Sweet is a communications coordinator with the Ministry of the Attorney General. She’s also a novelist and a creative writing instructor at the University of Toronto’s School of Continuing Studies.
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