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Mark, currently 59 years old, was admitted to The Salvation Army Toronto Grace Health Centre (TGHC) from St. Michael’s Hospital (SMH). His primary health issue on admission was “Charcot’s Foot” and pain secondary to his non-compliant diabetic status. He had previous misuse of pain medication and was prescribed Methadone. (Methadone reduces withdrawal symptoms in individuals addicted to narcotics. It is used as part of drug addiction detoxification and maintenance treatment).

Mark’s social situation was quite complicated, as he had no contact with family members including his four children, all of whom reside outside of the GTA. Mark was unemployed and on disability benefits because of a history of depression and increasing deterioration in his physical health.

Shortly after admission he was noted to have very distressing visual and auditory hallucinations, and was assessed as an outpatient by psychiatry in 2014. He was delusional and paranoid and felt that staff and patients were conspiring against him. Psychotropic medications eased his delusions and he continued treatment for a major depressive episode. It was noted that he had a dysthymic mood disorder and his low mood had been perpetuated by numerous stressors in his life, particularly the multiple medical complications and the deterioration of his social relationships. He had no further psychiatry involvement until the new Mental Health Services were initiated in the spring of 2015.

In March 2015, the social worker met Mark in her office. His initial request was “get me out of here, I am going crazy”. At this time, he was no longer delusional but his physical health was not stable, he suffered several health crises, and he had frequent acute care transfers and admissions. Mark wanted to find affordable housing but he had little insight into his physical limitations that required a supportive environment. Alternative housing options were explored but the care team recognized that housing options were very specific. Mark had ongoing meetings with the social worker to discuss his family issues and mood. The social worker attempted to reconnect him with family members with no success. Mental health and addictions closed many doors for Mark. A Housing Connections application was submitted in March 2015 but the wait for a single adult unit is currently approximately ten years. Mark was despondent with this news and thought the social worker could try a rooming house. He expressed loneliness and boredom but denied suicidal ideation.

Mark responded well to counselling but continued to show little insight into how his past lifestyle and spontaneous decision-making impacted on his family and friends. He is seen regularly in follow-up sessions through the mental health videoconferencing clinic held by SMH. Mark finds this a very positive intervention, and his mood has improved greatly and he is feeling positive about his future.

In June, Mark turned 59 and became a candidate for seniors’ housing options. His Housing Connections application was updated and he recently received a small apartment in a building with community supports. He was elated at this turn of events. Arrangements were made with the Furniture Bank for his furniture delivery. Upon realization of the reality of these events, he expressed that he was both happy and very worried about reintegration into the community. He is linked to the Community Care Access Centre and various community agencies to ensure he receives continued support and is safely integrated back into the community. Outpatient psychiatry support will continue for Mark.

Mark was successfully discharged on Monday, August 8, 2016 to begin a new life.

Mark seen above with Suzanne, his social worker, and Paula, his chaplain.