Thursday, May 1, 2008

'Treatment works,' city-sponsored conference told

VANCOUVER - Treatment works for homeless, mentally ill drug addicts, despite many public myths that it doesn't, a senior public health authority said Tuesday.

It often seems that it fails because the treatment available in B.C. is sporadic, underfunded and a patchwork, Dr. Patrick Smith, a vice-president of the Provincial Health Services Authority of B.C., said at a conference on mental illness and addiction.

Smith said the evidence that treatment works for mental illness and drug addiction is stronger than the evidence for treatments for other diseases like cancer and diabetes.

"There are many things we don't understand about mental health and addiction, but there are many things we do understand," Smith told about 150 people at the conference. "Treatment works. I can't emphasize this enough. It's no longer okay for our leaders to believe there are not evidence-based approaches."

Afterwards, he said the reason people think treatment isn't effective is that the kind of treatment most mentally ill and addicted people get is so limited and erratic that it's bound to fail, the same way that giving someone a tenth of the dose of penicillin they need for an infection is also bound to fail.

"When you look at treatment that's applied with scarce resources, there's more failure," he said.

He pointed to the difference in the way cancer is treated in B.C., compared to addiction. The province has a comprehensive and aggressive system of care, which means people everywhere in the province have good access to the same standards of care.

As a result, B.C. has the best health outcomes in Canada for people with cancer.

The same could happen with addiction if the same resources and standards were applied, he suggested.

Smith and others emphasized that people have to stop seeing addiction, especially when it's combined with mental illness, as some kind of problem that can be cured with a magic-bullet, one-time-only miracle cure.

That's not realistic because it's an ongoing health problem, like diabetes, and needs to be treated that way.

"We are talking about chronic-disease management," said Soma Ganesan, the medical director of the psychiatric wards at the University of B.C. and Vancouver General Hospital. Ganesan said there needs to be a national strategy that comes with real money.

Others throughout the day agreed with Smith and Ganesan that the problem is not a lack of effective treatment, which they saw as including everything from early intervention and prevention to harm reduction to full-scale detoxification and recovery services.

But there are all kinds of gaps and dysfunctions in the system, particularly for the homeless mentally ill and addicted.

For years, mental illness and addiction treatments were run separately. That changed in 2003, but many speakers still talked about the fact that mental-health counsellors will often demand that clients get off drugs before getting help for their psychiatric problems.

As well, there are all kinds of barriers to communication. The drug-policy coordinator for Vancouver police, Insp. Scott Thompson, said his officers spend hours with mentally ill clients, picking them up and taking them to emergency rooms. Then they're told they can't have any follow-up information because it's a privacy violation.

The one-day conference was organized by the City of Vancouver as a way of focusing attention and building momentum to get system changes and more resources for people who have both psychiatric and addiction problems, a group that is a big part of the city's rising homelessness population.
source: © The Vancouver Sun 2008

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