By: A Toronto Mother
We started noticing a change in our son at 14. The checkboxes for mental health red flags we are instructed to look for in our children were all there:
- School refusal? Check.
- Self-isolation? Check.
- Excessive sleeping? Check.
- Decline in academic performance? Check.
- Weight loss? Check.
- Expressions of hopelessness or worthlessness? Check.
- Poor physical hygiene? Check.
- Drug use? Check.
Our son had started using cocaine, opioids, and other drugs. He agreed to go to treatment at Pine River Institute, a year-long program for minors in Ontario. Unfortunately, the waiting list for a government subsidized bed at Pine River was 16 months long. He couldn’t wait that long, so we sold our house to pay for a private bed at a cost of $475 per day ($173,375 for the year long program). Sadly, the waiting list for a privately funded bed was 3 months long, which would turn out to be too long for our son.
There are few treatment options for minors in Ontario.
In the 3 month wait for the treatment bed, our son was running away and spending time at a flop house well known to police. This house was rented by an adult and filled with minors who had run away from home. He quit school, began stealing, and continuing to engage in polysubstance use. He was unhygienic, skinny, and going days without sleep. He started making superficial cuts into his arms. We called the police for help but they said there was nothing they could do. By the time the rehab bed at Pine River was available, he was in too deep and was no longer willing to go.
We reached out to multiple resources for help. They all acknowledged that they could help ME learn how to manage my emotions as they relate to my son, but there was nothing they could do for my son unless he was willing to accept help. The help I received for myself was great, but my son — who was only 15 and in way over his head — was on his own.
We took our son to Sick Kids at 15 when he came home from a drug binge with lips swollen three times their natural size as a result of him chewing on his lips in a drug-fueled state. We asked the ER if they would be willing to detox him as there are no detox beds for minors under 16 in Ontario. They declined to keep him, sending us home with a list of instructions of what to look for as he detoxes at home.
Why are there no detox beds for people under 16?
Although it would have been illegal for us to kick our son out of the house as he was under 16 (suggesting that our son still required protection due to his age), surprisingly it was not possible to mandate treatment for him for the same reason.
A few months later, we petitioned the Justice of the Peace for a Form 2 after receiving a hopeless, quasi-suicidal text from our son in a park. The Form 2, which would allow us to have our son taken to a hospital for a mental health assessment, was approved. I found my son on the streets, took him to the police to facilitate the transfer to a local ER to be assessed. I wanted to take him to the CAMH ER as they are the only hospital in Ontario where minors can be treated involuntarily for substance use disorder, provided they are under a Form 1. That form is issued by a physician when a person has a mental disorder and they are a harm to themselves or others. However, the CAMH ER does not accept minors under 16! It didn’t make sense. Ultimately, the local ER my son was admitted to held my son for 2 days and then discharged him, saying he was capable of making the decision to refuse treatment.
Our son began dating a 27-year-old IV drug user when he turned 16. Within weeks he began using drugs intravenously. She injected him for the first time. We sought help again but was told that the relationship was legal, despite our son being only 16. We had to ask our son to leave home as he would not accept treatment, and the next two years saw him sleeping in stairwells, on friends’ couches, and eventually in a room they were able to sublet. The relationship with this older woman eventually became physically abusive.
By the time our son was 17, he was injecting meth, cocaine, and ketamine. At 17, he collapsed and fell down a staircase while injecting cocaine at the top of a parking lot staircase, alone, in downtown Toronto at 3am. He woke up at the bottom of the stairs in a pool of blood. He sustained a concussion, tore his retina, and required stitches on his forehead. He walked to the ER alone for help as strangers were frightened by him in the streets. The doctors and nurses would not speak with me as our son was considered capable of making treatment decisions independently and he declined to allow them to share information with us.
Our son developed an IV-related infection when he was 17 years old. He was diagnosed with a blood infection, severe cellulitis, and a large abscess requiring surgical debridement. He was hospitalized at Sick Kids for 10 days after surgery where he was treated with IV antibiotics. At 5"10, he weighed only 91lbs at the time. The surgeon informed me that he is lucky he still has his arm, let alone his life. Despite this, I was told he was able to leave the hospital against medical advice at any time, even at just 17 years old, with a life-threatening infection caused by IV drug use. I also required his approval for the doctors to provide me any information at all. At Sick Kids, a parent requires their child’s permission to access their medical records if they are over 12 years old.
Our son was a regular user of harm reduction services. He had access to clean needles and other harm reduction supplies. Though I am grateful for the availability of these services, they can reduce harm — but they don’t eliminate it. In the presence of life-threatening self-harm in a minor, despite the use of harm reduction services, we were told there was nothing we could do but watch our son self-harm himself to death. He needed to accept help voluntarily, despite the fact that he was a minor with a mental illness under the influence of powerful mind-altering substances.
Despite this experience, our son continued using drugs intravenously and started experiencing bouts of drug-induced psychosis that same year. This is the nature of untreated mental illness and substance use. The turning point was last summer when concerned strangers called 911 after finding him in the streets in a psychotic state. He was hospitalized in the psych unit under a Form 1. Our son believed that the nurses were conspiring to kill him, and that the sunburn he obtained while walking through the streets in a psychotic state were the result of the doctors "poisoning him with ricin." The psychiatrist admitted there was little she could do to keep him once the psychosis lifted; however, she stuck her neck out and threatened to keep him unless he went to rehab voluntarily. Luckily, we were able to secure a privately paid bed within a few days — an option not available to those who cannot afford to pay $30,000 for a treatment bed quickly. The waiting list for a government subsidized bed was 4 months at the time.
Our son eventually agreed to treatment under threat of remaining in the psych unit. He completed treatment. He relapsed a few times after treatment which we were expecting. Substance use disorder is a chronic illness for which there are no quick fixes. However, he now has insight into his illness. He’s living at home again, and he is attending college as a mature student. He’s trying really hard. We do not expect treatment to "cure" him, but rather to give him the tools he needs to help himself. Statistically, it may take a few attempts to achieve long term recovery. If that’s the case, the first treatment is just as important as the last.
I wonder if some of these harms could have been avoided if a bed had been available when he was first open to treatment at 15 years old, not to mention potential savings to the healthcare system.
We are forever grateful to the psychiatrist who stuck her neck out for him and didn’t discharge him back to the streets, which she could have done once the psychosis lifted. We are also grateful that we had the money to pay for a private rehab bed quickly which is not the case for many families. We know that our son has a long road ahead of him. Where we were once prepared to bury him, we now have hope that he can live a life with meaning and purpose. Treatment WORKED for him, I just wish we didn’t have to wait until he almost lost his life and his mind to get it.