West Island Crisis Centre A day in the lives of lifesavers By Charlie Fidelman

Photos & video by Dario Ayala

Dan says his beautiful wife doesn’t deserve a man like him, broken, weak and without a future. Dan, 31, speaks slowly between stretches of silence. He knows an awful lot about finances but that career is over, and life for the both of them will never be the same. Hannah is nodding, tucked into a black couch next to Dan in a matching sofa chair. Hannah says she knows guilt. She’s feeling real bad about being forced to place her cat in a temporary home and her fiancé is sleeping on the floor at his mother’s flat. She’s 41 and looks 25. The words tumble out of her – they were evicted from their apartment, plus she’s not working and maybe everything would be easier if she’d just put her cat down and went away herself. It’s not clear if she means away forever, as in suicide. As Wednesday lengthened into evening at the West Island Crisis Centre, Dan and Hannah chatted spontaneously in a spacious living room with comfy chairs, a widescreen TV and a music system. But Dan and Hannah are not ordinary house guests. They were told that a reporter and a photographer from The Gazette would be in the background, shadowing the “human relations agents,” the mobile unit workers and any clients who gave their permission for an insider’s view of their world – a portrait of 24 hours at a crisis centre. “Can you forgive someone that does that to you?” Dan and Hannah just met as recent clients of the centre where more than 40 per cent of calls for help involve suicide threats. Phone lines here are open for business 24/7. Clients came to stay at the centre’s shelter for a few days to recover from the storms buffeting their lives. Dan and Hannah are keen to be part of the story, but on condition that their real names are not published. For confidentiality reasons, names of clients, past and present, are pseudonyms. More than privacy, it’s also a matter of dignity in the face of lingering stigma and discrimination. In 1987, the centre was barred from opening in another West Island neighbourhood because local residents objected — saying they believed patients would be chained to their beds and the noise of rattling chains would be disturbingly audible, especially during summer when windows are open. Many still mistakenly believe the mentally ill are psychotic bombs ready to explode in violence. “You should have come yesterday,” Hannah added. Another woman here talked about feeling guilty for leaving her live-in boyfriend behind to pay the bills even though he cut off one of her nipples. “Can you forgive someone that does that to you? That was years ago. Then she met this other guy and he didn’t treat her well, either.” The woman Hannah was talking about turned out to be Luanne, a smiling woman in pink slippers and a history of abusive relationships, who let us in first thing in the morning. “I don’t actually work here,” she says with a giggle. “Maybe I should.” The crisis centre doesn’t advertise its location; it looks like any other spacious two-storey house with a bay window and a stone facade on a quiet Pierrefonds street near a strip mall. A car-size canopy shelters smokers by the back door. Our boots lined up with others near the entrance. A list of house rules on a hallway table suggested this place is no vacation spa: no lolling in bed past 8 a.m., no Internet access and no TV during the day, either. Clients are expected to work on resolving whatever situation brought them here in the first place. Dan started his day meeting with his case worker, while Hannah went looking for apartments for rent, and the pink-slippered Luanne left the centre, dropping off a sweet letter of thanks to the staff. Straight ahead through a pair of French doors is the nub of the house where most of the hotline calls are handled. Day staff Caroline Senecal and Danielle Seguin had taped Luanne’s thank-you love letter to the window between their desks. Executive director François Ste-Marie, a slightly built psychologist with a smoker’s cough, offered a tour of the house. He led the way to the mobile unit next door, a room slightly bigger than a walk-in closet and painted a tart lime green. It also has the only coffee pot on the floor. That’s because coffee is a stimulant — not good for some psychiatric conditions, he says. Nearly $400,000 in fundraising paid for an extensive facelift in 2000, redesigning the kitchen and seven minuscule bedrooms upstairs for a total capacity of eight residents. One bedroom has two single cots, because it’s much easier to keep an eye on things, Ste-Marie says, with a roommate to alert staff if there’s a suicide attempt. A spare bedroom in the basement is available for tired night staffers. Human relations agent Monique Caissie, left, speaks on the phone as fellow HRA Marie-Michèle Thibault looks on in the West Island Crisis Centre’s green room. But the highlight is the archive room. Every call was logged by hand until the centre went digital in April. A mountain of papers stashed in metal classifiers trace the mending of potential fissures: more than 51,000 crisis calls fielded, thousands more services rendered and hundreds of clients sheltered since the centre’s inception. How many suicides avoided? Ste-Marie couldn’t say. Sadly, not everyone makes it. But many clients do and Ste-Marie is comforted by his deep conviction that the work his staff does is crucial. Just this week, he says, a man now living on the West Coast dropped by for a visit, a man who credits the centre for having saved his life a decade ago. Ste-Marie shivers thinking about it. He was categorically suicidal. The hospital ER referred him to the centre for support. He’d lost his job, separated from his wife and had difficulties with his children. What do you do for a man who is on the verge of suicide? No one could fix his problems, find him a new mate, a job or repair his caustic relationship with his children, Ste-Marie says. A generous dose of kindness changed his perception that everything was lost. Now the psychologist worries about growing needs: more personality disorders, homelessness and an aging population, challenges that didn’t exist in the suburbs when Quebec started these centres 26 years ago to relieve emergency rooms of congestion. Mentally ill patients not sick enough to stay in a hospital yet not well enough to go home, transitioned here. Today, clients also come from various community health organizations. But Ste-Marie laments that he’s losing good people to CLSCs and other health agencies that offer higher pay. Either the government believes in crisis centres and funds them properly – or not, he says.

Early Morning “Hi, Kira, what’s going on? Did the police come? And the money you were gambling yesterday was money for what? ...You didn’t like jail the last time.” Human relations agent Danielle Seguin is in the hub of the house, a sunny room with French doors, periwinkle-coloured walls, and a vintage wood floor with copper rivets the size of pennies. She is listening to a woman railing against house arrest, the rent money she lost gambling and drinking and the bad fight she had with her aging father who has dementia. “And then they called the cops. What are we going to do, Kira, eh? Things are tight since the bankruptcy. We talked last week about changes that need to happen. ... I’m not talking about your dad, but about you. Your dad is 85 years old … sorry, 84, he has ailing health, he’s not going to be making the changes.” Seguin grew up during the 1970s Front de libération du Québec era, living under threat of violence with soldiers guarding her house, floodlights in the backyard and emergency evacuations at night while the military searched her house for bombs. As a pro-Canadian provincial, her father was under military protection from threats linked to the FLQ. Having lived through such terror, Seguin’s heart has been with the underdog ever since. “Kira, robbing a store is not a good idea.” Kira agreed to lie low in her room until her next appointment with Seguin. The call lasted 21 minutes. “Richards suggested a client write her feelings of guilt on a piece of paper, and in a symbolic gesture, they burnt it.” play

pause When people ask Seguin, a grandmother of five, how she can stomach a job dealing with constant problems, she says they’ve got it wrong. It’s the best job in the world. Clients are the real heroes here, she says, for surviving. Like the woman whose six-month-old baby died, followed by her husband abandoning her with the mortgage unpaid and then her mother became ill. “And you say to yourself: Oh, my God, how would I deal with that?” It’s a win-win situation, Seguin says, that renews her faith in human resilience. Seguin’s eyes glisten with tears when asked if there’s a case she’ll never forget. For a few seconds, she can’t speak. She’d just started working at the centre when a young man in his early 20s, the spitting image of her son, was discharged from a hospital ER with severe depression and came to stay at the centre for a while. He had his whole life ahead of him, she said. But he didn’t see it that way. He was convinced no one would miss him, or would even remember him. Three weeks after he left, the head nurse of psychiatry at Lakeshore General Hospital called: he had hanged himself. Ten years have since gone by and at every anniversary Seguin thinks of him: “You never forget someone who let you into their lives. You just don’t.” Staff would love to wave away everyone’s pain with a magic wand. But that’s not how it works. About three years ago, Caroline Senecal became the case worker for an immigrant woman whose husband went missing. She caught him watching her daughter undressing on a webcam rigged at home. She got upset. They argued. He said he would go and kill himself. Then he vanished. She panicked, she had no family in the area and called the centre. Days later, police found his body in a wooded area near Repentigny. “Just one argument and he went out and hung himself,” Senecal says. As a child, Senecal said she loved her mother’s stories about being a nurse in a hospital psychiatric ward. “I always found it fascinating and cool and interesting. It’s why I went into psychology.” But none of her training prepared her for the saddest case she has ever handled so far. Police called after midnight to request shelter for a distraught mother. Investigators were done speaking with the mother and she had nowhere to go. She had discovered the body of her younger child, stabbed to death by an older sibling. This mother had lost two of her children, Senecal says, wiping her eyes: the younger child to death and the older one to the penal system. “I had to tell this grieving mother that she could not use the house for the funeral. It broke her heart and it broke mine.” Senecal talked to a counsellor after that. It was too much emotional pain to handle and she needed perspective: “It really disturbed me because I’d just had a child.” Senecal turned to her desk to take a call from long-term client with paranoia: “Just called to let us know that her bad thoughts were going away.”

The Mobile Unit After four years at the centre, Alex Richards, 27, still likes to recall how he got the scare of his life when he was hired for the night shift. It was his first night on the job and he heard a deafening bang upstairs. Sure someone was in deep trouble, he vaulted up the stairs. “But it was only the wind slamming a heavy door.” Now he’s with the mobile team on days and when a caller in crisis needs an evaluation, someone from his team is dispatched, within two hours for urgent cases. “We never have wait lists.” A devout Christian, Richards says helping others is simply what he does. He also has a degree in psychology. All of the centre’s human relations agents have degrees in psychology or social work. Once, in a spark of intuition, Richards suggested a client write her feelings of guilt and sadness on a piece of paper, and then in a symbolic gesture, they burnt it. It helped the client move forward. You don’t find that in the training manuals, he says. Today, he has a 1:30 p.m. meeting with a client, a single mother of three young children. She can’t stay at the centre, so Richards will go to her home. But usually meetings are held in eateries or coffee shops. Many clients are battling depression, so it’s good for them to get out of the house, he says. Mobile-unit staff also monitor the hotline at the centre. The phone rings simultaneously in the main and the green rooms. Whoever is free, answers. “Chopped meat?” Richards says into the phone. “I think it’s still in the freezer.” On the line was an evening human relations agent checking whether she needed to shop for tonight’s main supper ingredient on her way in. There’s no answering machine here. You can’t send a person in crisis to voice mail, he says. And you never know, he says, whether the voice on the line will be a colleague on dinner duty wondering whether the meat is defrosting or someone with a grim situation. Richards says he believes that mental illness strikes with equal opportunity. “If you end up with a psychotic disorder or depression, chances are you didn’t choose that any more than you chose to have a cold or flu. Mental illness doesn’t discriminate.” At least half the clients are also looking for housing. During most weeks, every bed at the shelter is occupied. This week, there are only two names listed on the board in the main room: Dan and Hannah. It was midafternoon when staff gathered around Seguin’s and Senecal’s desks for the handover from day and to evening shifts. “Barnaby demanded a scan of his brain, then threatened to kill himself when he was refused. Police confiscated his gun collection and the hospital sent him to the centre.” play

pause Curiously, no one had seen the client with pink slippers, Luanne, leave in the morning. But there’s a note from her to the staff, says Monique Caissie, who read it aloud. Luanne had underscored a few words: “I came in here so broken … you welcomed me, made me feel safe, loved, respected and gave me hope. No thank-you’s are enough … You are my heroes.” “This is what gives meaning to our job,” Caissie says taping the letter to the window again. Meanwhile, in the green room, someone from the mobile team answered a call for help from a desperate woman. She was crying: Her son had threatened to go to school the next day and shoot everyone. Marie-Michèle Thibault handled the call. “Does he have a gun? ... Did something happen to make your son angry?” The woman explained that there had been a death in the family in the summer, but she couldn’t get grief counselling for her son — he was getting angrier and the aggression was mounting. She’d seen the centre’s number on the Web, but the centre only serves adults in crisis. So Thibault put the woman on hold, called the CAF, an emergency aid program specific for families with children, and transferred the case. One of their workers is expected go to the family’s home tonight, Thibault says. The teen didn’t have a gun, but such threats are always taken very seriously. “If, for any reason, they say they can’t help you, call back and I’ll find another resource for you,” Thibault told the caller.

Evening The centre once admitted a chef from one of Montreal’s swankiest hotels. Residents are responsible for making dinner for the house, a therapeutic tactic aimed at improving self-esteem through acts of creation for someone else. The chef wowed. He made such gourmet feasts from ordinary ingredients in the fridge – three course meals complete with dessert — that the centre was almost sorry to see him go. Tonight’s menu, Shepherd’s Pie, called for hamburger with canned and creamed corn as well as reconstituted mashed potatoes from a box. Human relations agent Marie-Michèle Thibault looks in a refrigerator as she prepares dinner at the West Island Crisis Centre. “I thought it would be faster than from scratch,” Caissie says about the potatoes, bought on her way in to work. Notice, Hannah says, that the person who bought the “gluey” fake potatoes isn’t eating them. Caissie laughed. She can only eat gluten-free food. The hotline rang and Caissie left the kitchen. It was Barnaby, again, his fourth call in less than two hours and Caissie is his case worker. Barnaby recently demanded a scan of his brain at the emergency room, and then threatened to kill himself with a gun when he was refused. He went to the hospital to get his head examined after getting scammed out of his life savings in a telemarketing deal. Police confiscated his antique gun collection and the hospital sent him to the centre. He left within two days, however, claiming people were stealing from him. “He may be delusional. If so, that’s a brain disorder,” says Caissie, while waiting for a call back from a social worker at the CLSC about the case. Barnaby hasn’t been assessed and doesn’t have a diagnosis. “What we can do is help him find resources," Caissie says. "At one point, we’ll have to stop him from calling. We have to be here for people who are truly in crisis. But until then, we have to go on the assumption that he is in need.” Caissie answered another call and it was not Barnaby. Her voice, as soft as a caress, murmured to the receiver: “And you’re feeling sad?" By the time Caissie returned to the kitchen, Hannah and Dan were clearing the table. Hannah wanted to know how we’d rate the dish. Haute-cuisine? “What would you give it, out of 10?” she asks. Dan took a pencil to a napkin. By his calculations, the individual ratings average at 5.8, he says. So not haute-cuisine. “Numbers are easy for me,” says the financial adviser who until two weeks ago was managing millions of dollars in investments. “[The psychiatrist] looked me in the eye and he said: ‘Kid, you have two choices. Either you stay here, or you kick your ass and go back into reality.’” The good thing about the centre, says Hannah who is filling the dishwasher with plates, is that it gives clients structure and routine. Dan nodded his agreement. “I came here five years ago,” she says, to recover after trying to kill herself with pills. Her father had died. Her brother had a stroke. She had a breakdown. Feeling nervous after dinner, Hannah went for a tête-a-tête with one of the staff. Dan went to his room write in his journal. In the green room, where the mobile unit stays open for clients until midnight, Alex Richards’s replacement had arrived. “Good luck,” he told me earlier. “Don’t forget, if you hear a big crash in the night, it’s just a door banging shut.”

Dan and Hannah Like the kitchen, the living room is where residents connect while swapping scenes from their life stories. With an hour before 11 p.m. curfew, I asked Dan and Hannah if I can sit with them for a while. Hannah tapped the couch next to her, an invitation to join the conversation. Dan had a meltdown about seven years ago. Hannah says that’s typical as mental health problems tend to recur. Dan broke up with his girlfriend (now his wife). Despite good grades that made the dean’s honour list at university, he couldn’t land a job. His best option was welfare. His breakdown landed him in a closed unit in the hospital because he was a danger to himself. It was awful, Dan says. He was prescribed strong anti-anxiety drugs and they turned him into a zombie; he couldn’t see sunlight through the hospital’s dull windows. “You’re with the mentally ill, many much worse than you are. Staff interact with you like you’re contagious. They don’t want you to approach; they’re scared you’re going to attack them.” One day the psychiatrist took him to the eighth floor, which is reserved for long-term, serious cases. “You know, (patients) balancing in their rocking chairs. He looked me in the eye and he said: ‘Kid, you have two choices. Either you stay here, or you kick your ass and go back into reality.’ ” Hannah nodded. She had the same trip to the same hospital floor during her breakdown. A thank you note from a past resident is taped to the window. Dan was shaken. But his girlfriend took him back, and then he was offered a job for which he interviewed before going to the hospital. “And the problems that caused me to break down fixed themselves,” he says What brought him to the crisis centre now is his new house, Dan says. He traded his compact downtown condo for a big West Island home, but it was an overpriced and needed renovations – a financial mistake. He knew it as soon as they moved in. Dan couldn’t sleep for the thought of it. He couldn’t sleep for four nights straight. Hannah’s only family is her cat and her fiancé. Their landlord evicted them illegally, which she found out after they’d left. Now her furniture is in storage and she’s staying with strangers. “I have a roof over my head, but my family was taken away.” How come other people can deal with things and we can’t? she asks. People have different levels of tolerance, Dan says. “My wife is in the same boat, but she’s functioning. I had to leave work.” He easily managed to earn an MBA degree while working full time, but buying this house made him crack. Now he can’t think of anything else; the more he thinks of it, the larger it gets. But he can’t stay in the house that he hates. “If I stay at home looking at the ceiling, I get crazy.” It’s hard to be productive when your brain is going in circles, Hannah says. “You know the expression, ‘like a hamster on a wheel?’ ” “Yeah, that’s how I see it. A hamster on a wheel,” Dan says. play

pause You can’t shut it off. And the anxiety builds up like an electric storm. Just getting out of bed in the morning is an effort for Dan. If it wasn’t for the centre’s rules, he would lie all day on this couch, he says. Mornings are exhausting, Hannah says. After doing the supper dishes, Hannah turned to case worker Monica Gurcha about her panic. “I was telling Monica, that I feel I wasn’t doing enough. I’m feeling panicky because we’re not doing anything. While everyone else is going about living their lives and being successful, we’re sitting here. Monica said I was putting too much pressure on myself.” Gurcha reminded Hannah that asking for help provides strength. “She said: ‘We are doing what we're supposed to be doing.’ And that made me feel better.” She spoke too fast and Dan didn’t catch it all. “Could you repeat, please?” “That we’re trying, you know what I mean? Because if you give up, you’d kill yourself, right? But you’re fighting it.” Dan says that if a genie in a bottle were to give him three wishes, he’d give two away. He only needs one: “I want to turn the clock back six months.” Hannah worries that her days at the centre are going by too fast. “How long will you be staying?” Dan asks “As far as I know until Friday.” Dan closed his eyes a moment. “I’ll miss you,” he says.

Night Shift Marie-Michèle Thibault was on tenterhooks, hoping her last call wouldn’t be among those the centre couldn’t save. She surged through the French doors at midnight, after a long conversation with a man bent on killing himself. There’s no magic wand. No genie in a bottle. Every staffer here knows of a client who slipped away. The client, Eric (not his real name), had stopped taking medication that controls his schizophrenia. He was feeling better so he stopped when his court-ordered obligation to get injections had expired two months ago. Besides, he said, the meds were messing with his head. Human relations agent Marie-Michèle Thibault talks to Eric, who threatens to commit suicide. Now his paranoia was back. But he didn’t think it was paranoia. He knew, as he told Thibault, that people were controlling him, trying to make him do things he didn’t want to do. He was feeling really bad, alone in the world, and no one could help him. He threatened to kill himself — tonight. After an intense exchange, he calmed down. But Thibault wasn’t convinced. “He has a knife,” she told the night staff in her debriefing. Hugging her coat to her chest, she explained that this is a long-term client. His name is on a whiteboard called “the consistency board,” for uniformity in dealing with difficult clients requiring frequent interventions. For Eric, the board had this advice: No shelter unless urgent (verify last stay). Eric didn’t want to go to the hospital on his own. He didn’t want an ambulance sent to his home. So Thibault negotiated a promise that he wouldn’t do anything for at least an hour – and then he’d call the centre to let them know how he’s doing. Maude Pilon and Chad Caterson took over as hotline guardians. Eric delivered on his promise. But Caterson’s deep voice threw him off and he hung up immediately. play

pause He called again within seconds. Pilon’s turn. Pilon asked him to rate his suicidal tendencies on a scale of one to 10. “Is it better or worse than when you spoke with Marie-Michèle?” Eric was sticking to his plan. He’s going to cut himself. “Have you thought about going to the hospital?” But Eric dismissed that option. He’s scared doctors are going to manipulate him. Pilon tried to get Eric to negotiate a way through the night. “So for tonight, we’ll make a plan? Do you think you are okay to stay at home alone with your roommate without hurting yourself? I have to make sure you’re okay, otherwise you know what my job is, right?” Eric knows. He’s been down this route before. He knows Pilon will have to call an ambulance if he escalates. “I don’t want to call the ambulance because I know you don’t like that, so maybe you can decide to go to the hospital on your own. Or, you can tell me that you feel depressed and everything, but that you’ll be okay for the night.” Or, if you want, she tells him, you can call back in hour. But he’s worse; he hangs up. Calls to his cellphone go to voice mail. What to do? Eric was in deep trouble, the team reasoned, showing signs of unraveling. He would not be calling unless he was desperate for help, Caterson says. This is the moment to alert police. But Eric had moved recently and the centre did not have his new address, only his cell number and his parent’s address. As Caterson gave the police this information, the telephone rang again. Pilon pounced on the receiver. It might be him, ask the police to trace the call, he’s on Line 4, Pilon tells Caterson. “Centre de crise bonsoir … Hi, Eric.” Pilon tells him he scared her. “You said you wanted to end it all and you just hung up.” She reminded him that before he stopped taking his medication, he had hopes and dreams; he wasn’t talking about killing himself and to his credit, he had almost completed his law studies. Doesn’t he see the relationship between stopping the meds and to his current feelings of paranoia? Pilon tells him he needs to go to the hospital. Eric is exhausted, he says he just wants to go to sleep now, but he won’t promise Pilon he'll keep safe and not do anything dangerous tonight. She put him on hold for a few seconds to consult with Caterson. “He must be in such a bad state that he’s not thinking clearly,” Caterson says. “Will he give us his address?” Pilon asked again. Eric refused again. “He doesn’t want us to call the police, either.” Caterson and Pilon think it’s best to be frank with Eric about alerting police. But that made him angrier. Pilon banged the receiver down. Eric had hung up again. They wouldn’t hear from him again. “We want to control him and we’re full of shit and fuck you. That’s how it ended.” When police called back at 3 a.m. – they know the family, it has a history of distress calls to 911 – it was to say they couldn’t trace Eric’s call. The team wondered whether they did the right thing. “I don’t know. Will the police get to him in time?” Pilon says.