Pubdate: Wed, 05 Jul 2017 Source: Sun Times, The (Owen Sound, CN ON) Copyright: 2017 Owen Sound Sun Times Contact: http://www.owensoundsuntimes.com/letters Website: http://www.owensoundsuntimes.com/ Details: http://www.mapinc.org/media/1544 Author: Dr. Diane McIntosh Page: A5 MENTAL HEALTH WOES PLAY ROLE IN FENTANYL CRISIS 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 them. 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 reasonable. 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. - ---------------------------------------------------------------- Dr. Diane McIntosh is a psychiatrist and clinical assistant professor in the department of psychiatry at the University of B.C. - --- MAP posted-by: Matt