Barbara Cleary, a 76-year-old from Cornwall, Ontario, reflects a growing sentiment that mental health treatment must change. Her case has exposed the controversy, incompetence and injury that these practices have forced onto our healthcare and legal systems. Over the years, she has faced numerous obstacles and hardships as a result of her mental illness. More precisely, she fights bipolar I disorder, which makes her experience extreme manic, emotional highs, followed by dark waves of depression. Cleary’s situation raises important questions about the adequacy of mental health care and the resources available to individuals in crisis.
From an early age, Barbara Cleary has traveled the stormy path of addiction. She has spent time in psychiatric wards, sheltered emergency rooms, and even lock-ups. Today, she is unhoused and lives in a tent encampment in Cornwall—a harsh reminder of her ordeal. Since 2018, she has incarcerated approximately 347 days in jail. Its costs to the system have exceeded $121,000 in inflation-adjusted dollars. Beyond the financial impact, her experience underscores larger systemic problems within mental health care and the lack of permanent supportive housing.
In recent years Cleary’s story has shone a spotlight on the ongoing lack of mental health services in Cornwall. After exiting the assisted living facility last year, she told us about her wish to have a permanent place to live. Her concern is if she can keep that stability given her history of relapses. Her experiences have started conversations on how to better support people like her who need more holistic care.
The Burden of Mental Health on Public Resources
Barbara Cleary’s story is an extreme example of the burden that people with serious mental health conditions often put on our public systems. The policing costs related to her case have ballooned to nearly $364,000. This figure assumes an average of 32 police calls per year. This figure doesn’t even take into consideration the extra costs associated with emergency room visits and hospital admissions.
According to Dr. Karen Shin, a mental health expert and a youth advocate for ending gun violence, untreated mental illness takes an enormous financial toll.
“It is an extremely high cost to the system when people are unwell.” – Dr. Karen Shin
This cost also falls heavily on emergency services. We found that giving Cleary a bed in a short-term crisis housing program for only seven weeks was approximately $14,600. That’s a huge cost for such a short visit. These statistics raise troubling questions about our ability to respond to mental health emergencies. More importantly, they call into question whether we’re using our limited resources in the most effective ways.
Cleary is still bouncing through different types of care without finding permanent stabilization. Dr. Shin notes that many individuals in similar situations experience repetitive cycles of hospitalization and incarceration without meaningful support to address their underlying issues.
“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.” – Dr. Karen Shin
The Need for Comprehensive Care
As Barbara Cleary’s story illustrates, we have to do better by millions of Americans who need mental health care that puts treatment over punishment. Many experts advocate for systems that emphasize access to effective treatment options rather than relying on incarceration as a solution.
Jennifer Chambers, an advocate for mental health reform, emphasizes the need for evidence-based approaches.
“Why not exhaust providing the services that evidence shows help people, rather than spending a half a million dollars on your more carceral responses?” – Jennifer Chambers
Chambers reminisces about the harmful revolving door that people like Cleary enter when they lack the proper resources.
“Instead, people are just in and out, in and out, and it makes no sense.” – Jennifer Chambers
A central part of this conversation is all about knowing what people are opting out of and why. Dr. Shin discusses her advocacy for patient autonomy and shared decision-making. She argues that patients need to know the risks of rejecting treatment in order to provide truly informed consent.
“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.’” – Dr. Karen Shin
The following story about Barbara Cleary illustrates this sentiment perfectly. After receiving care from a nearby facility after a crisis, she was discharged back onto the streets within a matter of days.
“Then they admitted me for 12 days. The doctor released me onto the street again.” – Barbara Cleary
Advocating for Systemic Change
Barbara Cleary’s struggles continue to drive advocates to call for a systemic change in our mental health care. Her story has turned into a rallying point for this vital movement. We all know that solving root cause problems instead of just responding to emergencies will produce better results.
Cleary is an unabashed proponent for more psychiatrists in Cornwall. She highlights the need for help with activities of daily living. Her experiences demonstrate the clear and immediate need for more customized support networks. These systems have to serve mental health needs as well as general living needs.
“So much has changed with our knowledge of mental health care, the importance of access to treatment,” an unnamed expert stated regarding evolving perspectives on mental health services.
As advocates and stakeholders help shape discussions on mental health policy nationally and locally, experts are still stressing the need for proactive measures.
“Most jurisdictions consider the potential risks and harms related to treatment refusal. They have legislative safeguards to ensure involuntary admission is with treatment,” an unnamed source noted.
This new viewpoint shows a deepening realization that mental health issues call for caring support instead of judgmental punishment.
Peer support in community-based environments can help to create supportive spaces that center recovery and connection without pushing people into premature engagement they aren’t ready for.
“Peers can be really creative and supportive with just where people are,” Dr. Shin explained.
