Pubdate: Sun, 02 Jul 2017
Source: Province, The (CN BC)
Copyright: 2017 Postmedia Network Inc.
Author: Dr. Diane McIntosh
Page: 21


We're in the midst of an unprecedented health crisis, with
fentanyl-related overdoses causing the death of thousands of
Canadians. I believe this crisis is due, to a great extent, to the
wilful blindness of all levels of government through the inadequate
resourcing of mental health care.

Whether blamed on stigma, poor insight, hopelessness or lack of access
to care, many people who are mentally ill suffer in silence, sometimes
for years.

For some, this leads to a reliance on self-medication to cope with
their symptoms. This term refers to the use of inappropriate or
unhealthy measures to relieve the distress and pain of a mental
illness. Self-medication can take many forms: alcohol and cannabis are
most common, but other illicit substances, food or other forms of
escape are also common.

Dual-diagnosis is the term commonly used to describe those diagnosed
with a mental illness and an addiction.

Not everyone who has an addiction has a dual-diagnosis, but a
substantial proportion do and many are unable to access timely,
appropriate mental health and addiction treatment.

Untreated mental illness drives addiction and addiction drives mental
illness, creating a vicious cycle that too often is broken by death,
not recovery.

Why are so many people falling through the cracks? Well, we don't have
mental health care "cracks," we have a mental health care "Grand
Canyon" resulting from the negligence and/or ignorance of governments,
health care providers and society.

Ultimately, the most vulnerable members of society pay the highest

The barriers to timely and appropriate mental health care particularly
relevant for those with a dual-diagnosis include:

Lack of adequate funding

Inadequate mental health care funding is a national embarrassment.
Funding reductions have resulted in hospital and bed closures,
bolstering the homeless mentally ill population. Publicly funded
dual-diagnosis programs are nearly non-existent. There are months-long
waits for hospital outpatient programs and intensive addiction
programs. And provincial Pharmacare is reluctant to fund drugs
approved by Health Canada and recommended by their advisers.

Seriously mentally ill patients are routinely discharged from
hospitals or mental health teams to overburdened, unsupported family
doctors because of the lack of appropriate community resources -
that's if they're lucky, since many don't have a family doctor.

Police services are also picking up the mental health slack, costing
taxpayers millions in unproductive policing time, such as waiting for
hours in an ER for a psychiatric assessment. Law-enforcement agencies
have become some of the greatest advocates for improved mental health
and addictions funding.

Lack of access to high quality addiction treatment

Most addiction services aren't delivered, or even led, by
knowledgeable mental health professionals. Many of my patients, while
in addiction treatment, have been urged to stop their psychiatric
medication because those treatments were portrayed by their addiction
treatment provider, including physicians, as "mind-altering."

Equating psychiatric medications with drugs of abuse is inaccurate and
dangerous. Peer-support programs, such as Alcoholics Anonymous, are
invaluable for some people, but many peer-supporters don't understand
the devastating impact of untreated mental illness.

Resistance to innovative addiction programs

Here too, we must follow the science and improve access to
evidence-based treatments and services. Research evidence demonstrates
the life-saving value of supervised injection sites. These programs
save lives, improve social functioning, reduce illicit drug-related
health issues, reduce crime and link vulnerable people to health care
professionals who can treat them.


The stigma associated with mental illness remains a powerful barrier
to change and it exists even among health care providers. Mental
illnesses are medical illnesses that cause measurable changes in brain
structure and function, and have a massive negative impact on physical

Until psychiatrists confront this stigma personally, how can we expect
others in society to view mental illness as a priority?

Political correctness

The Canadian Mental Health Commission followed nearly 600 homeless
people over two years and found 67 per cent had two or more mental
illnesses or addictions. Clearly, housing is an essential focus when
supporting people with a dual-diagnosis. However, political
correctness can sometimes completely overwhelm common sense.

Vancouver city council is spending millions of tax dollars to build
social-housing developments on some of the most expensive property in
Canada. The city could use the funds from the sale of the many bed
bug-ridden, drug-infested hellholes where human beings live now to
create safe, affordable housing outside the downtown core - which
would include a substantial investment in mental health and addiction
services available where people live.

While food and shelter are basic human rights, none of us has the
right to live wherever we want. Canadians should also have the right
to adequate health care, yet many of the most vulnerable members of
our community don't have access to any of those basic rights. But
demanding that those rights be delivered wherever you see fit isn't

I've heard repeatedly: "Who cares if the drug addicts kill themselves
off with fentanyl?" One in five Canadians will suffer from a mental
illness in their lifetime and all of us will love someone who is
mentally ill, so this is everyone's problem.

It might not feel like it's your problem until it's your child or
grandchild. Having repeatedly witnessed the agony of a parent grieving
their dead child, I can think of a few better ways to spend my tax

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Dr. Diane McIntosh is a psychiatrist and clinical assistant professor in 
the department of psychiatry at the University of B.C.
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