ST. CATHARINES, Ont. - Katey Campbell couldn't cut deep enough.
No blade could pierce her flesh to excise the darkness that gnawed her soul.
When blades failed to kill the pain, she tried to numb it. Alcohol. Drugs. There was no particular preference. Whatever was at hand would suffice.
Katey was bright, beautiful and talented. She was a school teacher. Children were drawn to her. She was an artist. Her family and friends coveted her paintings and pencils drawings. She spoke Spanish. She was a skydiver.
There were moments of clarity. A handful of years of untainted happiness. But for all her brightness, Katey could not outrun the shadows that followed her since that one, horrifying moment three decades ago.
On July 18, after the poisonous cocktail of mental illness and addiction drove her into the Niagara River — the churning current washing away everything she was or could have been — her family was left asking "why?"
Why couldn't Katey help herself? Why wasn't their love and support enough? Why couldn't the health care system heal her mind?
"This is where she spent her last day," says Katey's mother Helga Campbell, sitting poolside in the back yard of her Niagara Falls home. The yard smells of sweet flowers. The pool framed by a thick wall of tall plants and trees. It has long been the family's oasis.
"She looked happy. She played with her niece and nephew," Helga says. "It was the last time we saw her."
Hours later, after neatly putting her purse and sandals aside at Dufferin Islands on the shore of the Niagara River she texted a friend.
"I'm going to kill myself."
She got no reply.
"I don't think she wanted to die. She wanted help. I think in that moment it was another way to numb the pain," Helga says. "The police told us that when she was swept away she was calling out for help. I think she had second thoughts, but by then it was too late to turn back."
For years Katey struggled with the echoes of a sexual assault she suffered at the hands of a boy staying with her grand parents. She was three years old. By the time Katey was a teenager, she had serious behavioral issues, including bulimia.
Eventually a diagnosis of borderline personality disorder was reached.
"Borderline personality disorder is very difficult to treat," says Dr. Edgardo Perez, head of mental health services at the Niagara Health System.
Katey was treated more than once at the NHS, but due to privacy regulations Perez cannot speak about her case. However, he said borderline personality disorder is often triggered by extreme trauma, and once manifested it is difficult to treat.
"Someone with borderline personality disorder has a very difficult time managing their emotions," Perez says. "It is often at one extreme or another. They can be very impulsive."
The inability to regulate their emotional response makes it extraordinarily difficult for people with the disorder to "live in the real world," Perez says. Many will attempt to self-medicate using drugs or alcohol, making treatment more problematic. Suicide attempts are common.
"This is a problem we are seeing more and more often, particularly among younger people," Perez says. "About 20% of the psychiatric patients we see coming into the emergency department have concurrent disorders. (Both addiction and a diagnosed mental illness)."
In the past, Perez says the rule of thumb was to tackle one issue at a time. But since one is often directly connected to the other the current trend is to try and deal with both simultaneously.
That was not the Campbells' experience in the health care system.
"They often just treated her like a Saturday night drunk," says her father. "They would never look at what was at the root of the addiction. All they saw was the addiction itself."
Wayne says it was hard to predict what might disturb her equilibrium and trigger a self-destructive rampage. A news story. An argument. A failure.
Helga said Katey once locked herself in a bathroom and, in her anguish, started cutting herself.
"She kept saying she couldn't cut deep enough," Helga says. "Not deep enough to hurt herself, but not deep enough to make the pain go away."
That pain deepened with each retelling of her story of abuse to a succession of doctors and therapists.
"There is a thing they talk about in mental health called continuity of care and it's very important," says Helga. "She didn't have that. Every time she saw a new therapist she had to retell the story. Instead of her information being shared, she had to retell that story and it was hell for her every time."
Katey was hospitalized more than once. She spent time in detox programs. The family even traveled to the United States to work through these issues together at a clinic. But none of it seemed to stick.
The Campbells say they were left feeling like no one would help their daughter. No matter how hard they advocated for her, or where they turned, the fundamental reasons for Katey's troubles were not addressed.
Perez said improving continuity of care is a critical step in improving the mental health system in Canada. Patients cannot feel like they are hitting the reset button on their care every time they change doctors or therapists. Information from one therapist or service should travel with a patient, he says. But at present the mental health system in Canada is too fragmented. Standards of care, unlike in other areas of medicine like cancer care, are less uniform. However, he said it is something that can be changed.
"You know, if you look back, cancer treatment was like mental health is now," Perez said. "But over time they advocated for a better system and better patient care. We need to advocate like they did to transform the system to produce better outcomes for patients."
Despite her troubles, there were years of normalcy for Katey — five years when was she was clean. She got her masters degree and worked as a supply teacher with the District School Board of Niagara. Her natural inclination toward art and creativity won the hearts of her students.
But it wouldn't last.
She responded to an abusive relationship by turning back to alcohol and drugs. Her parents wanted her at home so they could help, but she became increasingly difficult to live with. Wayne put a pad lock on the wine cellar door. Katey got to the bottles with a crow bar.
"You can't live with a person when they are in full addict mode," Helga says.
She had a choice — start changing or leave. Katey left.
In a 2012 letter written to a local agency requesting transitional housing, Katey said her parents "love me dearly" and that she had made bad choices been a "disrespectful house-guest" to them. She wrote that her attempts to cope with her mental health issues by self medicating had created a life she could no longer tolerate.
"I knew I needed to get my act together," she wrote. "Although I knew it, I had yet to feel it. I hit many bottoms. I lived a double life. One was amongst others on the streets and addicts and the other was with family and friends."
Saying she could no longer continue on as she was, Katey ended the letter with a simple plea for help: "Please do not let me fall through the cracks like so many others."
When the appeal for transitional housing failed, Helga intervened. She could not stomach the idea of her daughter living on the street. So Katey moved into the third floor apartment in the house owned by her parents, next door to their Armoury Street home in Niagara Falls.
"She wanted help," Helga says. "She wanted to move forward and get her life back together. On the last day we saw her, she was excited to go on a family trip with us."
Katey's funeral was attended by hundreds of friends and family. Her artwork lined the walls of the church. Her parents and her sister all spoke, choosing to focus on Katey's essential light rather than her struggles with the darkness.
"Staff condolences from FJ Rutland (where Katey worked as a supply teacher) said she was light and energy in the halls; other staff said she was the only one who could control a class with the flare of her nostrils," Helga said during the funeral. "Staff also wrote that they overheard some grade 8 students say that she was the best teacher they had ever had. Katey always hoped and planned to return to teaching. We mourn the loss of a talent that could have brought many positive contributions to the lives of young people. Katey touched her students, as does our daughter, Leigh, because she liked them and she understood them and she did her best for them."
No one knows what triggered Katey's worst impulses after that last afternoon with her family around the pool. But if her parents can never find out why, they at least want to see the system changed so that other parents don't have to watch their children suffer as they did.
They call it a concurrent disorder. It's a term to describe one of the most difficult and vexing problems in mental health — a patient with a diagnosed mental health disorder and addiction issues.
Dr. Edguardo Perez, head of mental health services at the Niagara Health System, says it is a growing problem and one that is difficult to treat. Patients will often use drugs or alcohol to cope with their mental health disorders. But the addiction exacerbates the mental health issues, impeding treatment.
Perez said treatment is difficult because, as in any case, a person with an addiction has to want to recover and be willing to work to overcome their addiction. However, a concurrent mental health issue can directly impact a persons ability to combat their addiction.
According to the Centre for Addictions and Mental Health, mental health disorders and substance abuse addictions often walk hand-in-hand:
30% of people with a mental health disorder will also have a substance abuse disorder at some point in their lives, which is twice the rate of people without a mental health issue.
37% of alcoholics will be diagnosed with a mental health disorder, which is close to twice that of those without an alcohol addiction.
53% of those with drug addictions will also have a mental health disorder, which is nearly four times the rate in people who are not addicted to drugs.
Helga Campbell lived a mother's nightmare for 33 years. She watched her beloved daughter destroy herself. Driven by a mental illness and addiction, Katey Campbell ended her life on July 18.
But Campbell refuses to allow her daughter's death to be an empty one.
Campbell, along with her husband Wayne Campbell, is working to ensure her family's experience will improve the mental health system.
"I'm a member of the board of Healthy Living Niagara (a community group working to improve the safety and health of Niagara), and one of the things we are working on is a mental health charter," Campbell says.
For decades, the Campbells advocated for their daughter, making connections with support groups, finding therapists and doctors and, when necessary, taking her to the emergency room.
"Navigating the system isn't easy. It wasn't easy for us and Helga and I are both intelligent, educated people," Wayne Campbell says. "I have no idea, none, how someone without a person to advocate for them could get through the system. Someone who suffered like my Katey couldn't have done it on her own."
A mental health charter would layout exactly how those suffering from a mental health problem will be treated by the health care system and the quality of care they should receive. Helga Campbell believes that if such a charter existed, the kind of care her daughter received could have been better.
Her effort to see a charter created is being supported by Dr. Edgardo Perez, the head of mental health services at the Niagara Health System.
"They developed one in Australia that has been quite successful and I think it is a model we should be looking at," Perez said.
To be effective, however, Perez and Campbell said the charter cannot just be a document that collects dust on a shelf. It has to become the defining mission statement for the mental health system itself.
"It is something that has to become the law of the land," Perez said. "It is something that we can adopt locally, but we will have to bring pressure on the provincial minister to accept it and adopt for the province."
Information about the Australian charter can be found online at http://health.act.gov.au/health-services/mental-health-act/charter-of-rights
Are you in distress?
If you or someone you know is attempting suicide or imminently a risk to themselves, phone 911.
For other crisis and distress situations, call COAST (Crisis Outreach and Support Team) at 1-800-263-4944. The operators will direct the caller to the appropriate agency. For children and youth, that agency is Pathstone Mental Health.
There is also the Kids Help Phone, a 24-hour crisis hotline and website to connect young people to a counsellor. Pathstone Crisis Services/Crisis Ourtreach and Support Team. www.pathstonementalhealth. Call 1-800-263-4944