Client-Centred, or Client-Shaming? My Experience with CAMH’s Emergency Medication Services

As a BSW student we have heard of plenty of cases and experiences of collaborative and oppressive services at the structural level. Anti-oppressive practice is an approach that is constantly talked about and we are encouraged to apply to our placement and theoretical experience. I have been fortunate enough to receive a placement that I believe skillfully demonstrates what anti-oppressive practice can be in the practical setting, However, placement has recently had me encounter a service that claims to practice many of the characteristics of Anti-Oppressive Practice such as collaboration and advocacy, yet in reality provides extremely problematic client services.

A few weeks ago at my placement I went with a client with mental health struggles to access the emergency medication services at CAMH. As a result of a previous conflict between the client and their psychiatrist they have been unable to refill the prescription for their medication, and has been off of them for over a month. A staff member at my organization called CAMH after this information was disclosed to make sure they still had emergency medication services. After we received a confirmation and the paperwork we needed, we made our way over in the hopes of getting a small amount that could help until they obtained a new psychiatrist or even get a temporary one through CAMH.

Once we arrived, the client had to fill out a form while a person behind a giant glass divider pressed their forehead against the partition and yelled for her to change something if she did it incorrectly. At one point a doctor placed a form on the counter and the client picked it up thinking it was theirs (it had their first name on it) where it was snatched out of their hand from under the glass. The client was already extremely emotional from the decision to come here and was also prone to be distracted due to their increased symptoms. These actions made them feel they were being penalized for a mistake and already heavily surveyed in a building that claims to enforce a client-centre approach.

From there the client was given an initial assessment which I was not permitted to accompany even though the client asked for my presence. We then were led to a waiting room where at least three other people at a time were also awaiting services. We waited for approximately an hour where two other people waiting far longer than us were asked to leave without receiving any care. I began to wonder how many people are actually seen per day and how many end up leaving despite the fact that they required an emergency assessment. Eventually, we were seen by a second worker and were led to a small grey room that can only be described as something from a cop show.

There were four chairs separated by a long granite table and a surveillance camera installed just above where the worker sat so it was angled directly at the client. I sat at the same side as the client in case I was needed as well as general support. The client was posed several in-depth questions:

“What exactly are your symptoms?”                                                                                                                       “Can you give examples?”                                                                                                                                     “Can you be more specific?”                               “Any others you can think of?”                                                                                                                                 “Are you sure?”                                                                           “How many times a day?”                                                                                                                                “Can you give a more accurate number?”  

Every time the staff member asked a question, she would first look at me to answer for the client. The worker proceeded to condescend the client, telling her to, “Stop fidgeting and look up.” She asked invasive questions, made assumptions about their concurrent disorder, and made wildly inappropriate judgement about their sexual activity and then made a vague conclusion that they would see what they would do and left us for another hour in this room.

After waiting yet again, a third staff member came in and asked the client many of the same questions that were previously asked by the two previous staff members. It was at this point that I wondered what would happen if a client had symptoms that made them unable to endure this long of a wait or could not fully answer many of these in-depth questions. If people are unable to answer all these, are they forced to go untreated like the people we saw in the waiting room?


lonelyAfter waiting another hour after the third line of questioning, a staff member came to inform us that because the client would not be given medication because they were not considering self-harm or harming others. The client was redirected to their general physician instead.

This completely goes against the notion of preventative care that could often assist clients so that they never get to this point. Instead, a neoliberal Band-Aid solution is used so clients with only severe symptoms can be treated. This complex system is unaccessible and difficult for clients seeking services in it’s effort to weed out the less severe cases and is disempowering to those in crisis.

We left CAMH feeling defeated, my client wasted half their day, shaken by the heavy questioning and judgement, and still coming home empty handed. I left feeling earful of organizations like CAMH, organizations that receive most of the funding by presenting themselves as a collaborative client-centred space yet continue to practice the archaic neoliberal policies that have made mental health services near impossible to access.


Anonymous

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