Pubdate: Wed, 05 Jul 2017
Source: Sun Times, The (Owen Sound, CN ON)
Copyright: 2017 Owen Sound Sun Times
Author: Dr. Diane McIntosh
Page: A5


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 to the inadequate
resourcing of mental-health care.

Whether due to 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? Actually, we don't
have mental-healthcare "cracks." We have a mental-health-care "Grand
Canyon," resulting from the negligence and/or ignorance of
governments, health-care providers and society as a whole. Ultimately,
the most vulnerable members of society pay the highest price.

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

1. 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,
nearly non-existent publicly funded "dual-diagnosis" programs,
months-long waits for hospital outpatient programs and intensive
addiction programs.

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 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.

2. 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.

3. 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 lifesaving 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

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

5. Political correctness: The Canadian Mental Health Commission
followed nearly 600 homeless people over two years and found that 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.

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. However, it might not
feel like it's your problem until it's your child or grandchild.

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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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