Mental illness is not a special-interest issue. It affects everyone in some way or another.
About 20 per cent of the population suffers from a mental illness during their lifetime. Sometimes it’s temporary, but for others it’s for life. The emotional and financial and cost to society, families and individuals is massive. In pure economic terms, the cost of mental illness to the B.C. economy exceeds $6 billion per year.
The parents and spouses of loved ones with mental-health challenges experience the good, the bad and the ugly of the province’s mental-health system, which often begins with the police, followed by emergency psychiatric services, case managers, psychiatrists and non-governmental community-service providers.
Fortunately, we are increasingly being included by those service providers as they review their programs and explore options for improvement. However, progress is slow; meanwhile, in the absence of psychosocial therapy, the quality of life for people with mental illness continues to degrade. In some cases, lives are being lost.
The February 2017 announcement of a 10-year $655-million contribution from Health Canada to the B.C. government for mental-health services is very encouraging. The question is, how should it be invested? To help inform that conversation, given that a new government is about to be formed, I offer the following observations:
• Responsibility for mental-health service delivery is distributed across the multiple programs operating within each regional health authority. There are no publicly observable quality-assurance or accountability mechanisms and little, if any, cohesion or continuity across jurisdictions.
• Police are the default responders to a mental-health crisis. A significant number of police calls for service involve a mental-health situation, and those numbers continue to rise. So begins the criminalization of mental illness.
• The province’s residential-treatment centres were closed decades ago. B.C. Corrections now operates the province’s de facto residential facilities for many people with mental illness, who are being jailed, not treated.
• Non-governmental community-based programs are chronically underfunded, frequently geographically out of reach and poorly co-ordinated. They can be very difficult for people with mental illness to access and navigate during an acute episode.
• There are numerous private and public residential rehabilitation facilities on Vancouver Island with programs that focus primarily on recovering from addictions. There are none that focus primarily on recovering from a mental illness.
• Young people aging out of the mental-health programs delivered by the Ministry of Children and Family Development must shift to their regional health authority, a completely different bureaucracy, at a particularly vulnerable time of life.
• In the absence of adequate capacity to deliver evidence-based therapy, doctors must rely on medications, many of which have unpleasant side-effects that lead to chronic non-prescription substance abuse. Substance abuse is a common consequence of anti-psychotic medications not being complemented by therapy.
• Psychiatric emergency services can dehumanize a person who is seeking help. In Victoria, people with acute mental illness must commune in a room full of recliners while waiting for a psychiatrist, which can take days.
• While many people with a mental illness endure isolation, stigma and unemployment, the research confirms that early intervention, social support and psychosocial therapy are effective in promoting a successful recovery.
A 2015 study by experts in psychosocial rehabilitation, commissioned by Island Health, concluded that Greater Victoria needs “social gathering places” for people with mental illness.
The study’s authors reported that such places serve the unique social and peer-support needs by providing community engagement and recovery coaching for persons with mental illness. Social gathering places operate in some B.C. communities. Victoria is not one of them.
By making recovery a mental-health priority in the B.C. Ministry of Health’s services plan, the 10-year funding program announced in February could correct some of these deficiencies. Doing so requires political will, effective leadership, and a ministerial directive that the health authorities fund capacity and employ evidence-based approaches.
Peter Evans is a volunteer member of Family Voices for Mental Wellness, a group of parent advocates striving to improve the delivery of mental-health services throughout Greater Victoria.
