Anne Norris case: What services do mental health patients receive after treatment at the Waterford?

After the death of Marcel Reardon earlier this month, more details have begun to emerge about the woman charged with his murder, Anne Norris.

Norris, 28, suffers from bipolar disorder. She was discharged from the Waterford Hospital just days before moving into the Harbour View Apartments complex, where Norrislived.

According to other tenants of the building, she lacked basic necessities like furniture and bedding, among other things. One neighbor claims to have given her personal hygiene supplies including shampoo and tissues.

This new information has raised questions about what happens to patients with mental health concerns after they are released from medical care.

Lawyer and mental health advocate Mark Gruchy spoke to Anthony Germain on CBC Radio's St. John's Morning Showabout his concerns regarding that post-treatment care that patients receive in Newfoundland and Labrador.

Q. What's your reaction when you hear some of the details surrounding the life of the accused in this case?

My reaction, generally speaking, to any story which indicates that an individual with a serious mental health concern, who's recently been to the healthcare system, finding themselves out in the world with nothing, is to think that's not particularly unusual. We have a lot of supportive services that try to address that and try to assist people in their transition. But, the reality is mental illness and serious mental health concerns have a very major impact on homelessness, semi-homelessness, the capacity of a person to find help in the community. I am not, sadly, terribly surprised... at all.

Q. In this case it would seem that this person went to an empty apartment and had nothing.

The reality of it is, when people are going in and out of the psychiatric system... firstly, you can sometimes have people who have little to start with. Secondly, when you're in and out of the system, the system is not really designed to get you back on your feet in an integrated society [environment]. It's designed to deal with a rather simple issue... that is to say the legal definition of certifiability and immediate medical treatment.

Housing is more than fourwalls. People need safe and supportive housing.- Mark Gruchy

We have a very huge disconnect between the medical components of an individual with a mental health concern in the system, and the social determinants of health, which are required. A major concern right now for instance is housing and supportive living. We have been clamouring for community supports, for housing supports, at a greater and enhanced level for many years. Though it has improved, it has really not materialized and there's a great number of extremely frustrated advocates.

People need to realize that there are lots of people with mental illnesses in this community, in St. John's and elsewhere, who are spending their days, quite frankly, bouncing in and out of systems and wandering around the streets in between hospitals and slum-land conditions and various services trying to get a bite to eat.

Q. What support is there for someone after they've been released from the Waterford?

It depends on the individual and it depends on their good fortune to be able to access relevant services and qualify for them or to interact with certain not-for-profits who are doing exactly that. So it can vary dramatically. You can have some people get quite fortunate and find themselves in a place of an organization, like let's say, Choices for Youth, which helps young people and so on. But people can slip right through that, and they are bounced in and out of the system with virtually nothing.

People get lost all the time and it's particularly troubling considering that all of the data tells us that people with mental health concerns are far more likely to be victims of violence and fall through other cracks as well. So, we really need housing. The saying is "that if a person needs a home, a friend, and a job, and if you don't have a home and that support in the community the likelihood of finding stability and help is low."

Q. In the case of the accused,it would seem as though she did have a place to live but not much else.

Housing is more than four walls. People need safe and supportive housing, and they will need assistance sometimes finding employment. They may need assistance having basics and necessities, and so on. A lot of what's happening in practice is people's families are footing it. There's all kinds of people that are bouncing in and out of this and finding themselves shuffling around, wondering where they are going.

It's not consistent with health, and we need a major governmental investment in insuring that people are protected and supported that way. Particularly given that our society has been going through major transitional change. This problem is only going to get worse and frankly it's been dealt with in a patchwork fashion that is unacceptable.

Q. What kind of supports, and checks and balances should there be in place for people as they are discharged from the Waterford?

We should have a far more comprehensive system in place to minimize the likelihood that somebody is going to slip outside of the safety net, so that we know where they're going to go, what they're going to be eating, and ideally what they're going to be doing to try to support themselves. As I say, some of these services exist, but it's entirely possible for people to fall in and out of it.

The previous Waterford Hospital project, which is currently in an ambiguous state, was supposed to have enhanced transitional support even for people who are hospitalized in the long term sense. It was supposed to have units which simulated a returned living to the community and trained people in doing things like cooking, cleaning and basic stuff like that. There is some of that in the current hospital, but there was supposed to be a lot more.

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We need a lot more money invested in housing. We need a lot more money invested in entities which coordinate placement of people, wherein they actually have the basic things you need to not find yourself being a victim of violence or otherwise having a repeat of your mental health concern, or having commit suicide or developing a substance problem, or what have you. We are completely failing in that regard. That's why people are ending up homeless. That's why people are ending up in prisons. And that's why people are ending up back in the hospital over, and over, and over again. We need places for people to live where they are safe and supported.

This interview was edited for length and clarity.