Pubdate: Sat, 28 Dec 2013
Source: Globe and Mail (Canada)
Copyright: 2013 The Globe and Mail Company
Contact:  http://www.theglobeandmail.com/
Details: http://www.mapinc.org/media/168
Author: Vivian Luk
Page: 5

MENTAL-HEALTH CRISIS LINKED WITH ADDICTION

Imagine this: Every day, you can feel people looking at you warily.
They want to hurt you. Even the police are out to get you. You try to
rid your mind of all the ill intentioned people, but you can't ignore
the other thing that is gnawing at you. Those bugs on your arm won't
leave you alone, no matter how often you gouge at them.

Such are the hallucinations and paranoia felt by those with a
stimulant drug addiction. Sometimes the substance abuse is so severe
it causes neurological damage and psychosis becomes a chronic condition.

Combine untreated addiction with homelessness and physical health
problems and you get a health emergency. Vancouver police and the
region's health authorities are desperately trying to figure out how
to help the most vulnerable of mentally ill drug addicts.

The province estimates that roughly 130,000 people in British Columbia
suffer from a severe addiction and/or mental-health illness. But
police and emergency workers are increasingly dealing with a much
smaller group of people whose brains have been damaged by their
stimulant addiction and who appear to be responsible for random
violent acts on Vancouver's streets.

Dr. Nader Sharifi, addiction medicine lead with the Fraser Health
Authority, said there are few good treatment options for those people.

"It's a bit of a challenging question, because what we have available
isn't necessarily structured for this patient sub-type. It's either
structured for addiction, or structured for mental health illness, but
not necessarily the two together."

Drugs such as cocaine and crystal meth can both damage the brain, but
Dr. Sharifi says the effects of crystal meth can be
irreversible.

"In chronic crystal meth users, somewhere between 3 to 6 per cent will
have persistent psychosis that won't go away even after they stop using."

Earlier this year, Vancouver's police chief and the mayor pleaded for
help from the B.C. government to deal with what they call a
mental-health crisis comparable in scope to the HIV/ AIDS epidemic
that swept Vancouver's impoverished Downtown Eastside 20 years ago.

It was the third time in five years that the police asked for help,
even though the province pours millions of dollars into mental health
and addiction services and supportive housing every year.

Police Chief Jim Chu said officers are taking more people into custody
than ever under the provincial Mental Health Act. St. Paul's Hospital
in downtown Vancouver has also seen an alarming spike in mentally ill
patients in its emergency department.

It's often uncertain which came first, the mental illness or the
substance abuse, or whether one caused the other, said Michael Krausz,
professor of psychiatry at the University of British Columbia.

"It's a level of complexity where the cognitive impairment, the
substance use, the psychological trauma are just so entangled that you
can't say this is causing that," he said.

The public plea from the police and the city prompted B.C. Health
Minister Terry Lake to announce a series of measures last month.

They include adding a nine-to-12 bed psychiatric assessment and
stabilization unit at St. Paul's. There will also be two more
Assertive Community Treatment teams - or ACT teams - which include
social workers, psychiatrists, nurses, addiction counsellors, police
and outreach workers to help people discharged from emergency.

"So they would have experienced their crisis, they would have ended up
in [emergency rooms] for whatever reason they had been brought in,
sometimes substance abuse, sometimes mental illness," said Andrew
MacFarlane, mental health and addictions director for Vancouver
Coastal Health.

"If they are not known to our system, or they're waiting for a more
intensive service, we have a new team that we're developing which
would go out and see those clients post-discharge."

There are currently 14 ACT teams across the province. Police say the
three in Vancouver have led to a 50-per-cent reduction in difficult
encounters with police and a 70-per-cent decrease in non-urgent
emergency department visits.

Dr. Krausz said the two more ACT teams announced by Mr. Lake are a
significant step. However, the last piece of the puzzle remains
long-term care beds.

"We can only effectively work in the community if you have =C2=85 a
specialized institution that is stepping in to help you if there is a
crisis, if people are really getting sick."
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