Pubdate: Sat, 28 Dec 2013
Source: Vancouver Sun (CN BC)
Copyright: 2013 The Vancouver Sun
Contact: http://www.canada.com/vancouversun/letters.html
Website: http://www.canada.com/vancouversun/
Details: http://www.mapinc.org/media/477
Author: Vivian Luk
Page: A9

B.C. STRUGGLES TO TREAT MOST VULNERABLE OF MENTALLY ILL ADDICTS

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 B. C. 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
Sharifi says the effects of crystal meth can be irreversible.

"In chronic crystal meth users, somewhere between three to six 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 which
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 B. C.

"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.

"It's all contributing to a very complicated situation for those
clients."

Many people with severe mental illnesses and drug addictions are
socially marginalized and homeless, making it harder for them to get
treatment, Krausz said. Delivering continuous care remains the
toughest task.

For example, said Sharifi, those with neurological damage caused by
crystal meth may well have to take anti-psychosis medication for the
rest of their lives. They will need help with housing and will need
more thorough follow up in the community.

Such services are intensive, said Sharifi, and a treatment team will
generally include a psychiatrist, family physician, social worker,
case manager, nurse, occupational therapist and psychologist.

"It really requires a team-based approach and will take
months."

The public plea from the police and the city prompted B. C.' s 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.

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

Only one facility in the province serves mentally ill drug addicts.
The Burnaby Centre for Mental Health and Addiction has 100 beds, but
an estimated 300 people are in need.

Even the Health Ministry acknowledged the centre is not "optimally
equipped" to meet the needs of "the small subset of aggressive clients
with severe addiction and/ or mental illness."

Lake is reluctant to add many more beds immediately, but he did say a
new facility linked to the Burnaby centre will provide stabilization,
assessment and individual case planning services. It will boast six
beds, but eight overflow beds will be available.

It's not the 300 beds that Vancouver Mayor Gregor Robertson and Chu
have asked for, but Krausz said the new measures are a start while the
province figures out - yet again - what more it must do for its most
vulnerable citizens.
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MAP posted-by: Matt