Dr. Anthony Barale’s passion and rare candour around the crappy way we’re managing addiction and mental illness will be missed. I don’t like to think of people like him getting squeezed out of the Vancouver Island Health Authority, because we desperately need them to guide change. And boy, do we need change.
All will not be lost along with Barale, however, if his high-profile resignation this week finally wakes people up. Finally, it’s not just the social groups sounding the alarm about dwindling community services and support, but the clinical director of a barely two-year-old VIHA service intended as a leading-edge response to people with mental illness.
Archie Courtnall Centre, at Royal Jubilee Hospital, has instead become the “default processing centre for addicted individuals seeking treatment,” complains Barale. Apparently, nobody at the centre contemplated dealing with that much addiction. (What’s with that, anyway?). Worse still, there’s no other place to send people with addictions, meaning they end up the centre’s problem even though it wasn’t built to deal with them.
“The staff of the psychiatric emergency service struggle daily to provide even the most basic medical and psychiatric care for his suffering population,” said Barale. “And they do so with little support and the pitiful resources provided by VIHA - resources which, even by so-called Third World standards, are entirely inadequate.”
You go, Dr. Barale. Use that influence to get this beast in motion. Social groups are viewed as serving their own interests whenever they try to get the same message across, and business groups are still too caught up in the “lazy bum” theory of homelessness and addiction to move this issue forward. But the good doctor knows his stuff, and maybe his can be the resignation that transcends the divide.
That addiction and mental health are so tightly linked should hardly be a surprise in a province that has relentlessly cut back mental-health services for more than 20 years. What might you do if you were bouncing around homeless, broke and lost for long enough? Mightn’t you look for something to make it all go away for a little while?
It’s a potent mix, mental health and addiction. Each make the other worse, as Barale can no doubt attest. Each can lead to the other. The pain of mental illness can lead someone to look for relief from drugs, and the long-term or toxic use of street drugs can shatter people into a million pieces.
It shouldn’t matter which comes first, the addiction or the mental illness. But it does in terms of trying to find health services.
Heaven help the addict who is going crazy from the drugs, because that’s the wrong order as far as our health services are concerned. It is, however, a common problem. Almost half of the people admitted to the Archie Courtnall Centre’s three-day beds since it opened in 2004 had a primary diagnosis of addiction.
Allow me to share a story from the front lines, of a woman in her late 40s connected to the social agency where I work full-time. One day she was going crazy, rattled to the core by the drugs she’d been using. Her body movements were jerky and unpredictable, the result of brain chemistry so out of whack that the violence of her body very nearly tipped over the chair where she sat. We finally called for help when she started hitting herself repeatedly in the face.
VIHA’s emergency mental health team responded, but left within minutes. A VIHA worker familiar with the woman had declared her to be not mentally ill, but in a drug-induced psychosis. The team said they were unable to help. Her options at that point were a few hours at the sobering centre or the streets.
What does any of this mean to the average citizen? Sadly, almost nothing. The public doesn’t like this issue. Wrong-headed as it may be, addiction and mental health too often conjure up sloth and weak character in the public’s mind.
But that needn’t stop action. We don’t solicit public input on how our health system deals with the problems that we bring to it. If the issue was cancer treatment, for instance, we would bring in the experts and figure out the best possible strategy. There’s more than enough expertise in B.C. to figure out how we can be effective around addiction and mental health. We need only begin.
With any luck, the resignation of Dr. Anthony Barale will shake us from our tragic stupor. People who wrongly assume they know everything may briefly be prepared to listen to a psychiatrist-manager who witnessed the problems firsthand. What Barale saw was nothing new, but his voice ought to carry well.
Shout it from the roof tops, doc. We’ve been messing this one up for long enough.