We are 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 willful 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 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 as a whole. Ultimately, the most vulnerable members of society pay the highest price.
Inadequate mental health care funding is a national embarrassment.
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 out-patient programs and intensive addiction programs, and provincial pharmacare's reluctance 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 do not 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. The mental health care funding cuts continue, despite the scientific evidence clearly demonstrating that adequately funded, comprehensive mental health care ultimately saves money and lives.
2. Lack of access to high-quality addiction treatment
Most addiction services are not delivered or even lead 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 do not 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. The science supporting access to unadulterated illicit drugs, such as heroin, is also strong. These programs are now a social necessity: they save lives, improve social functioning in all realms, reduce illicit drug-related chronic health issues (like the spread of HIV and hepatitis), reduce crime, and expose vulnerable people to healthcare professionals who can offer them mental health and addiction support and treatment (so long as it's available- see points 1 and 2).
The science is clear: mental illnesses are medical illnesses.
4. Stigma
The stigma associated with mental illness remains a powerful barrier to change and it exists even among physicians and other health care providers. This must change. The science is clear: 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 stand up and confront this stigma, personally and amongst our peers, how can we expect our fellow citizens, allied health professionals, and governments to view mental illness as a priority?
5. Political correctness
The Canadian Mental Health Commission followed nearly 600 homeless people over two years and projected that 67 per cent have two or more mental illnesses or addiction. 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.
Gentrification -- renovating dangerous and unhealthy urban areas -- is viewed by some as a social evil. However, the city could use the funds from the sale of the many bed-bug ridden, drug-infested hell-holes where human beings currently live to create safe, affordable housing outside the downtown core that includes 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 do not have access to any of those basic rights. However, demanding that those rights be delivered wherever you see fit isn't reasonable.
I have 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. Having repeatedly witnessed the agony of a parent grieving their dead child, I can think of few better ways to spend my tax dollars.
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