But many face hurdles in getting the services they need
By Cindy Chan
Epoch Times Staff Dec 23, 2008
‘SAFE HAVEN’: The Fraser Street facility run by RainCity Housing in Vancouver provides a successful transitional housing program for people with both mental
illness and substance use disorder. (Courtesy of RainCity Housing)
Mike Pratt, 51, has suffered depression all his life. After losing his wife to cancer in 1999, he fell into using cocaine.
“My addiction was masking my grief, because I couldn’t deal with it and I sort of snapped. I went on a suicide mission for a few years,” said the Vancouver
Mr. Pratt maintained his addiction with his truck driver job until the government garnished his wages for money he owed. He lost his job and could hardly
afford to eat. After living on the streets for nearly three years, he ended up with pneumonia and almost died in a hospital.
He is one of the many people with concurrent disorders—having both a mental illness and a drug or alcohol addiction—who have suffered because of a disconnection
between mental health and addictions services.
Mr. Pratt now receives help from a transitional housing and support program for people with concurrent disorders. He also volunteers and works part time
to help others in need.
But before that, he experienced firsthand what it’s like when these services are not integrated.
Even after 90 days in a treatment centre, Mr. Pratt continued having suicidal thoughts and was on the verge of slipping back into depression and drugs.
When he sought help at a mental health service in Vancouver, “they told me they couldn’t help me because I didn’t quite fit their criteria.”
“It made me feel lost … They’ll help you if you had [a diagnosis] of mental illness before addiction, but not if you had mental illness after addiction.
That’s a grey area that a lot of people fall into, and that’s where concurrent disorders [services] can catch them.”
Coping with mental illness alone is challenging enough. But coupled with alcohol and drug abuse, the problem becomes much more complicated, said Dr. Brian
Rush, senior scientist at the Toronto-based Centre for Addiction and Mental Health (CAMH),
Dr. Rush is principal researcher on two recent studies on Canadians who suffer from both mental illness and substance use disorder. The studies call for
system-wide planning and better integration of mental health and addictions services.
These services are typically quite separate, funded by different parts of the ministry of health, and operated independently, said Dr. Rush. Yet “problems
tend to be together in people.”
Mr. Pratt can attest to the importance of integrated addictions and mental health services. He is one of about 30 residents in a substance-free supported-housing
facility that opened in August 2007 in Vancouver.
“It’s the first time in many years that I have had a place to call my home,” he said.
With funding from Vancouver Coastal Health (VCH), RainCity Housing and Support Society provides two years of housing at its Fraser Street facility for people
Through VCH’s Centre for Concurrent Disorders, Mr. Pratt sees a psychiatrist regularly, takes medication, and attends courses to help manage his depression
Right now he’s almost finished a peer support course that’s training him to help people who are dealing with addictions and mental illness. The course includes
a part-time job, and he also volunteers at a homeless shelter.
With the “double trouble” of having co-occurring mental and substance use disorders, Dr. Rush said the individual faces additional challenges with managing
medications and participating in treatment.
In addition, one disorder may make the symptoms of another disorder worse, such as an addiction to alcohol—a depressant which exacerbates depression. Meanwhile,
depression can make someone fall into an addiction, as in Mr. Pratt’s case.
And sometimes an addiction creates symptoms that can be misunderstood for mental illness. With cocaine or crystal meth, it’s often paranoia, said Dr. Rush.
Stopping drinking or drugs can help a person with depression do better, but for other disorders, like schizophrenia, it will not change the disorder.
There are many different combinations of addictions and mental disorders. And “if you picture a knot in a rope, it takes time to untangle this knot because
the mental illness and substance abuse get so entangled. It [also] takes a lot of training to be able to work with a person [in a treatment setting.]”
Negative attitudes add to the problem. “People tend to think, why don’t they just stop and get their act together? It’s not so easy. So it’s kind of a double
stigma to have both sets of problems,” Dr. Rush said.
Of the two studies, one focused on the general Canadian population while the other looked at people already receiving treatment under the Ontario mental
The Ontario study showed that one in five Ontarians being treated for mental disorders has a co-occurring substance use disorder. Co-occurring disorders
were highest in the younger adults’ subgroup, at 55 per cent.
The Canada-wide study indicated that about 435,000 adults have concurrent disorders, and about one in five people with a mental disorder also had a co-occurring
substance use problem. The rate of co-occurring disorders was found to be highest in British Columbia and lowest in Quebec.
The Canada-wide study was based on a 2002 Statistics Canada mental health survey. Dr. Rush said the problem may be much larger than the numbers indicate.
The survey did not cover all mental disorders, children under 18, and several known high-risk populations for co-occurring disorders, such as on-reserve
Aboriginal people, the homeless, and those who are institutionalized.
There’s no one-size-fits-all solution but many different ways to integrate services, said Dr. Rush.
“[Integration] can occur within the government when [departments] work more closely together. It can occur in organizations in broad structural mergers.
It can occur with community partnerships between different organizations, and it can occur within integrated services and integrated clinical teams.”
For example, CAMH is a merger between two organizations dealing with mental health and two dealing with addictions.
And some treatment centres or mental health programs where substance abuse is common have an integrated clinical team comprised of a physician, mental health
worker, and drug addiction worker.
Dr. Rush urged every community, planning authority, and funding body involved in mental health and addictions to try to get these services working more
closely together and develop more holistic and flexible strategies.
People with addictions and mental illness are also finding their way into other systems, such as justice, corrections, welfare, primary healthcare, and
emergency services, he said.
Giving Back by Helping Others
Mr. Pratt has lived in his apartment at Fraser Street for a year now. The program will help him find the right place to live when it’s time to leave.
He hopes his part-time job as a peer support worker with VCH will lead to full time eventually.
Along with his volunteer work with homeless people, he says, “There is just something about giving back and not forgetting where you came from that really
is a powerful reality check. Fraser Street, like many things happening to me, seems to have a purpose that only inspires me to be all that I didn’t believe
I could be.”