Pubdate: Sat, 28 Dec 2013
Source: Prince George Citizen (CN BC)
Copyright: 2013 Prince George Citizen
Contact:  http://www.princegeorgecitizen.com/
Details: http://www.mapinc.org/media/350
Author: Vivian Luk

B.C. STRUGGLES WITH HOW TO TREAT THE MOST SEVERE OF MENTALLY ILL ADDICTS

The Province Estimates That Roughly 130,000 People in British 
Columbia Suffer From a Severe Addiction And/or Mental Health Illness.

VANCOUVER - 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 
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.
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MAP posted-by: Jay Bergstrom