Yet despite Barbara Cleary’s dozens of stints in hospital psychiatric wards, emergency housing, jail cells and living rough<\/a> \u2014 as well as brief periods of stability and several months in an assisted living facility last year<\/a> \u2014 today the 76-year-old is again unhoused, living in a tent encampment in Cornwall, Ont., continuing the cycle.<\/p>\n ‘An extremely high cost to the system’<\/p>\n “It is an extremely high cost to the system when people are unwell,”\u00a0said Dr. Karen Shin, chief of psychiatry at St. Michael’s Hospital for Unity Health Toronto and chair of the Ontario Psychiatric Association.<\/p>\n “And you have to remember, she’s one person. If you went in and reached out to any psychiatrists in the system that are working in a hospital, they can tell you numerous people they care for that have a similar story.”<\/p>\n Cornwall police say they’re dealing with 20 people like Cleary on a daily basis. The force picked five individuals from that group and found each averaged 53\u00a0occurrences requiring police response in 2024.\u00a0<\/p>\n So, what to do?<\/p>\n Shin founded and co-leads the Ontario Psychiatric Association’s mental health and law reform task force, which is\u00a0calling on the province to expand forced treatment in certain circumstances. From her organization’s perspective, some\u00a0forced care protects the right\u00a0to health for vulnerable people whose illnesses can cause delusional thinking.<\/p>\n “Choice is extremely important, but that choice has to be a capable choice, and a capable choice needs to include that there’s an understanding of the symptoms of the illness and the consequences of saying, ‘No, I don’t want treatment,'” Shin said.<\/p>\n The task force wants\u00a0the province\u00a0to:<\/p>\n Permit\u00a0treatment\u00a0during a patient’s court appeal after the\u00a0Consent and Capacity Board upholds a finding that\u00a0they’re incapable of making a decision. Remove\u00a0the requirement that people have had to respond to treatment in the past from involuntary admission criteria under the Mental Health Act. Extend\u00a0a first involuntary admission from 14 days to up to 30 days. An organization called the Empowerment Council takes an\u00a0opposing\u00a0view. It says\u00a0medication comes with risks that not every patient can tolerate, including the possibility of neurological damage, and that the trauma of having something forced into the body and mind can interrupt therapeutic relationships and scare people into avoiding it altogether.<\/p>\n “Why not exhaust providing the services that evidence shows help people, rather than spending a half a million dollars on\u00a0your more carceral responses?” said Jennifer Chambers, the council’s executive director.<\/p>\n “Instead, people are just in and out, in and out, and it makes no sense.”<\/p>\n Cleary\u00a0spent a few months in an assisted living facility last year after CBC\u00a0first covered her story. She was removed\u00a0last August by police after\u00a0her illness deteriorated. In late October she was arrested and charged by Cornwall police for the 23rd time, according to court records \u2014 this time for breaching probation and trespassing at her former apartment building.<\/p>\n She spent a month and a half in jail getting back on medication before she pleaded guilty in December. She was sentenced to the time she had already served, bringing\u00a0her total time in jail since 2018 to about 347 days.<\/p>\n Near her tent encampment on Wednesday, she recalled being removed from the assisted living facility\u00a0and being strapped down on a bed in an anteroom of the hospital’s emergency department for half a day.<\/p>\n “Then they admitted me for 12 days. The doctor released me onto the street again,” she said.<\/p>\n Asked what she thinks she needs, Cleary said Cornwall has only one psychiatrist and requires\u00a0more, and that she needs to live with someone who can help her with things like getting around and getting dressed. Many people in the unhoused community\u00a0help her out on a daily basis, she said, though in the past\u00a0she has\u00a0been taken advantage of by some. She wants housing, but in light of her history since 2018 it’s\u00a0unclear how long it would last.<\/p>\n Chambers\u00a0said Ontario used to be a leader in peer support, but that it’s been first on the chopping block with funding constraints. And a\u00a0transitional support system would help people adjust after being released from institutions like hospital\u00a0and jail.<\/p>\n “Peers can be really creative and supportive with just where people are, rather than concentrating so much on wrenching them into a different space against their will,” she said.<\/p>\n Shin agrees that more wrap-around social supports and services are necessary. But she also thinks Ontario’s Mental Health Act needs beefing\u00a0up.<\/p>\n “So much has changed with our knowledge of mental health care, the importance of access to treatment, the concerns around repeated episodes of illness and how that leads to more intractable illness, how it can lead to medications not working as well,” she said.<\/p>\n “Most jurisdictions consider the potential risks and harms related to treatment refusal. They have legislative safeguards to ensure involuntary admission is with treatment, so that people get the treatment they need and are not indefinitely detained untreated.”<\/p>\n The\u00a0provincial ministries of health and the attorney general, which oversees the justice system, have not responded to repeated requests for comment.<\/p>\n Where our\u00a0numbers come from According to a patient cost estimator run by the Canadian Institute for Health Information<\/a>, which the Cornwall Community Hospital said was the best data to use, it has cost about\u00a0$210,000 to hospitalize her on an inpatient basis\u00a0for a total of 120 days since 2018. The estimate includes overhead costs as well as direct billing for treatment. It does not include her dozens of emergency room visits. According to figures provided by the Cornwall hospital about how much it costs to run its short-term crisis housing\u00a0program ($100,000 per bed, per year), it cost about\u00a0$14,600 to fund her bed\u00a0for seven weeks this past winter. The Ministry of the Solicitor General said it cost about $349 per day in 2024 to house someone in an Ontario\u00a0jail. Adjusted to inflation, it has cost an estimated\u00a0$121,000 to keep Cleary\u00a0in jail for a total of 347 days, according to a\u00a0complete criminal history obtained by CBC. (Statistics Canada’s daily average cost for Ontario<\/a> is higher, resulting in\u00a0an estimated total of about $127,000). The Ministry of the Attorney General does not keep track of or estimate costs on a case-by-case basis. Using estimated granular data from a small number of studies contained in a 2016 report on the costs of crime and criminal justice responses for Public Safety Canada<\/a>, it has cost about $90,000 to shepherd her criminal cases through the Ontario Court of Justice,\u00a0adjusted to inflation. The ministry said the 2016 report is the latest data available. According to statistics kept by the Department of Justice<\/a>, which show Legal Aid has cost an average of about $1,200 per case from 2017 to 2023, it’s cost an\u00a0estimated $12,000 to pay for her defence. Policing costs, such as\u00a0costs for time in court,\u00a0are hard to nail down on an individual basis. Cornwall police say the lowest number of calls per year among\u00a0its frequent fliers\u00a0was 32 in 2024, and the highest was 88 calls.\u00a0The force doesn’t track costs per call or person, and said calls vary so widely in complexity and length that any estimate would be a wild guess.\u00a0Using estimated granular data from a small number of studies contained in the\u00a02016 report\u00a0for Public Safety Canada<\/a>, which pegs the average cost of a single police contact at about $1,400 in 2014 Canadian dollars, and using the lowest number of calls per person per year in Cornwall\u00a0among its folks in\u00a0Cleary’s situation (32), it has cost about $364,000 to police her, adjusted to inflation. Mental health resources<\/p>\n Do you need help, or does someone you know need help? Here are some mental health resources in the province, which differ depending on where you are:<\/p>\n 211 Ontario<\/a>\u00a0maintains a database of services. You can search by topic (mental health\/addictions) and your specific location. Live chat is available Monday to Friday from 7 a.m. to 9 p.m. ET, and a chatbot is available 24\/7. You can also text 211, call 211 or email gethelp@211ontario.ca.<\/p>\n![\"A](\"https:\/\/www.newsbeep.com\/us\/wp-content\/uploads\/2025\/07\/jennifer-chambers-empowerment-council-camh-july-15-2025.jpg\")
Jennifer Chambers, executive director of the Empowerment Council, says forced treatment comes with risks. She believes giving people the care they ask for is a better approach. (Mathieu Deroy\/CBC)<\/p>\n![\"Two](\"https:\/\/www.newsbeep.com\/us\/wp-content\/uploads\/2025\/07\/barbara-cleary-peer-support-july-16-2025.jpg\")
A friend helps Cleary walk from her encampment to a food bank in Cornwall, Ont., on July 16, 2025. Chambers says peer support can help people learn to trust and seek help. (Francis Ferland\/CBC)<\/p>\n![\"A](\"https:\/\/www.newsbeep.com\/us\/wp-content\/uploads\/2025\/07\/dr-karen-shin-psychiatrist-ontario-psychiatric-association.jpg\")
Dr. Karen Shin, chair of the Ontario Psychiatric Association, says patients need to have a fulsome understanding of the negative consequences that can result from deciding not to accept treatment for mental illness. (Kyle Bernardo)’So much has changed’<\/p>\n