Silence.  Even as I hear the slushy snow-turned-freezing-rain pattering at my window, even as I can still make out the CBC news jingle in the next room, all I can think of is silence – the silence that is killing us, the things unsaid: important things; life-changing, perhaps even life-saving, things.

Almost one year ago I got a call from a friend to help someone we both know and care about to receive mental health care.  I attempted to get involved, but a family member stepped in and prevented this from happening – all with the best of intentions.  My dear friend’s mother knew how much my friend disliked being in hospital, or being on medication of any kind, and because of her love for her daughter, and because she wanted to respect her wishes, she let sleeping dogs lie.  But no dog sleeps forever.  And psychosis rarely rectifies itself when someone is left to live in their own delusional world without specific attempts at helping the person to move through it.  Whether it be medication, or alternative therapies or through various spiritual paradigms – I have come to feel strongly that people need to overcome the notion that mental health problems go away on their own.  My friend, one year later, is still struggling.

I have lost several people I care about to mental health crises, because of either a lack of treatment or inappropriate or poorly monitored treatment.  They have been lost because no one knows exactly what the best thing is to do, and sometimes we err on the side of social, not medical, caution.   Instead of risking a friendship by undermining a friend’s right to make their own decisions, we allow them to risk their own lives.  I, among many, am guilty of this.

I now have come to the conclusion that help – even unwanted – is a better option during major mental health crises than worrying about hurting someone’s feelings, or going against their preferences for how it should be done.  I have had friends come out of psychotic episodes and thank the people in their lives later for making sure they got help, even if they protested it at the time.  I know that everyone should have the right to the best treatment possible, and theoretically to refuse it – but when you know that in many cases, the earlier the treatment is administered (and progress carefully monitored), the earlier you bring your loved one out of harm’s way – it becomes a much more complicated picture.  I am not a die-hard supporter of hospitalizations for major mental health crises – our psych wards in this country are largely un-therapeutic environments in which to heal – but if someone will not agree to any type of treatment outside of a hospital environment, and they are at risk of deterioration or at risk of harm to themselves, the situation becomes a lot more dicey.  Although a part of me feels it is a human right to refuse treatment, a part of me also supports the camp of psychiatry that advocates for early intervention, even when it may be contrary to a person’s wishes, given what we know about how disruptive some severe forms of mental illness can be when left unaddressed.  I’m not saying that this treatment need always be medication, but in our culture it is largely what we’ve decided to pay for.  We haven’t exactly provided many options.  Though psychotropic drugs can be incredibly useful, they are not fool-proof, and should be administered with caution and regular follow-ups, especially early in the treatment process.  I have known people whose lives have been saved by psychiatric medications, and those for whom they have been very dangerous.

But if we could talk about these sorts of things more openly, if we could make sure to be the village of support that it takes to help some of us through difficult times, and to think of long term visioning for our friends in trouble – not just how comfortable they will be with the decisions we make on their behalf in the short term – we might see a very different picture.  Talking about mental illness isn’t enough.  When our loved ones are deteriorating, we need to go further.  We need to risk discomfort, and momentary resentment sent in our direction by the person we care about.  We need to muster our courage, keep our own supports online, and to get our hands dirty.  We need to be respectful, but to surpass the inertia of politeness.  Silence is killing us.  We need to care, loudly and with the determination that our loved one will get the best help our communities have to offer.  Caring is not an adjective; it’s a verb.   Thoughts?