by Dr. Richard O’Reilly

My heartfelt congratulations to Ms. Marlene Bryenton who, against all the odds, forced the provinces of Ontario and Prince Edward Island do the right thing. Just five years ago Marlene’s son Andrew was working as an assistant bank manager and living in his own home with his wife and children. Then, due to the sudden onset of a psychotic illness, he lost everything, wandered off and ended up living on the streets in Toronto. Paranoid delusions prevented Andrew from accepting shelter and other support services so his mother mobilized an expanding group of volunteers to check on his wellbeing and provide him with food, clean water and clothes.

Marlene was less successful, initially, in mobilizing mental health services to provide the care her son needed. But this was not for want of trying. Three times she made the arrangements for her son to be assessed in the emergency rooms of Toronto hospitals. Despite the fact that Andrew Bryenton was severely ill, sleeping on the streets and had walked against traffic on a highway off-ramp, he was discharged back to the streets without treatment or provisions for follow-up care. But Marlene refused to accept the callous absurdity of the system. She relentlessly lobbied doctors, hospitals and the governments in Ontario and PEI, eventually flying from PEI to Ontario to pressure Ontario’s mental health system to provide the care and treatment that her son needed. Only then was Andrew admitted to Humber River Hospital and the necessary treatment for his illness finally started. Last week, at Ms. Bryenton’s request, her son was flown back to a hospital in PEI, on a rarely used ministerial order.

While she was working to get appropriate treatment for her son, Marlene Bryenton also successfully lobbied the government of PEI to develop and introduce legislation to support community treatment orders. Treatment for psychosis sometimes alleviates hallucinations and delusions but the patient fails to develop an understanding that they have a serious illness and need to stay on medication to prevent relapse. This outcome is especially common when the initiation of treatment is delayed, as it was in Andrew’s case. The availability of a community treatment order means that Andrew, and others like him, who lack an awareness of their severe mental illness, can be legally required to continue treatment and follow-up after discharge from hospital. Without Marlene’s determination, persistence and innate political smarts her son would still be profoundly ill and languishing on the streets of Toronto 

While this is an uplifting story of a mother’s success in securing essential care and treatment for her son, is this really what it takes to get standard medical treatment for an individual suffering from a psychotic illness? There are thousands of Andrews out there. Many do not have families. When they do, those families are often exhausted due to the effort needed to look after someone with a severe mental illness: particularly the effort sometimes required to ensure that a loved one stays on treatment. Family caregivers repeatedly tell me that they feel shunned and defeated by the system.

It is in these situations that the state must exercise its parens patriae duty, i.e. the responsibility to look after vulnerable citizens who cannot look after themselves. But note how the institutions in Ontario abysmally failed to provide Andrew the care he needed until they were forced to do so by Ms. Bryenton. 

Our society’s reluctance to provide individuals like Andrew Bryenton essential care is epitomized in comments by Roxie Danielson, identified as a street nurse, in this CP24 article: https://tinyurl.com/2snb7srf . Respectfully I disagree with Roxie Danielson’s conclusion that Ms. Bryenton violated her son’s privacy rights by sharing photographs of him with the volunteers who checked on him and provided him with the essentials of life. Roxie Danielson speculated that these photos of Mr. Bryenton, destitute and disheveled on the streets of Toronto, could adversely affect his future employment opportunities. Again, with due respect, the possibility of future employment was surely the least of Mr. Bryenton’s concerns when he was walking against traffic on a motorway off- ramp or sleeping on the streets of Toronto in the middle of winter.

Here is what I take away from Andrew’s story. Families can make a difference …but to do so they must be both vocal and persistent. They must also be confident about what is right and what is not. Marlene Bryenton knew that her son needed treatment, knew that he deserved treatment, knew that he had a right to receive that treatment. She knew that her son’s lack of understanding about the nature of his condition and the need for treatment did not justify leaving him to languish on the streets to face an inevitable early death. Marlene Bryenton should not have had to work 10 hours every day for almost a year to get her son the treatment he needed. Ontario should have provided that treatment, but it didn’t until forced to do so by Ms. Bryenton. The story of Andrew Bryenton demonstrates what I have always believed – that the mental health system will not meet its duty to provide appropriate care and treatment to people with severe mental illness until family caregivers come together and force it to do so.

Richard O’Reilly
Emeritus Professor of Psychiatry
Western University, London, Ontario