Saturday, August 26, 2006

No more stalling on addiction

So now the head of the region’s new psychiatric emergency service has quit. In a funny sort of way, that’s almost good news.
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.

Monday, August 21, 2006

Addiction misread
Aug. 18, 2006

The trouble with drugs is that most of us can use them just fine. The majority of people who try drugs - even street drugs - can quit using them fairly easily if they need to.
I’ve come to suspect that fact is why we’re still so damn hopeless at dealing with addiction. We just don’t get it. We’re a nation of enthusiastic users that really struggles with the concept that not everybody has such an easy relationship with drugs and alcohol.
Most of us will drink, drop, smoke or swallow various drugs over our lifetimes with little incident. We’ll go hard as teenagers and less hard as adults, and we’ll quit when the time seems right, for reasons ranging from the kids getting old enough to notice, the mornings getting harder to bear, or just the embarrassment of being 40 and having to buy marijuana from the kid on the corner.
For those of us so blessed, our drug use remains within our control. When we want to stop using, we do. We understand addiction exists on a theoretical level - thousands of university papers have explored the various aspects of addiction for decades now, and why people end up addicted is no real surprise anymore. But to the great detriment of the poor sods who are among that group, we still can’t shake the feeling that people with addictions simply aren’t trying hard enough.
Such lingering and misguided beliefs clearly drive our clumsy and conflicted actions around addiction. Otherwise, why would we even be having this ridiculous conversation about closing Vancouver’s highly successful safe-injection site? Why else would treatment and support remain so elusive throughout B.C.? What else would be the explanation for leaving profoundly ill people to live - and die - on the streets?
I’m a big believer in democracy, but some things can’t be left up to public whim. Issues that will have an impact on the health and happiness of the population as a whole and on generations to come cannot be decided on the basis of a political platform.
Stephen Harper’s government may want to believe that providing a safe, clean place for addicted people to use drugs is wrong. But it isn’t. Our drug-addiction strategy can’t be about anybody’s belief system, but needs to focus instead on what are the smart and effective things we need to be doing on any number of levels.
Public health. Compassion. Keeping the peace. Happy neighbourhoods. The building of relationships. Take your pick from a couple dozen good reasons for having a safe-injection site, for instance. With Vancouver’s site having operated for three years, there are now even more reasons: Less death; fewer needles lying around; more people taking part in daily conversations about getting clean. It’s working.
Admittedly, the need for safe-injection sites in our cities’ cores is something of a tragic reminder of our failure as a society. In a connected and healthy world, we would have responded to the issues underlying addiction long before it got to the point of herding people into big clinics to inject drugs.
But what’s done is done. Now we’re dealing with a new world order that includes large quantities of cheap drugs and a growing underclass being primed by their unhappy lives and family genetics to develop an addiction to them.
Step one in the plan: Get the politics out of the picture. Whether the Tories or the Liberals are in power shouldn’t make a whit of difference in how we manage the issues of addiction. If a safe injection site is accomplishing what it set out to do, then we ought to consider it a step in the right direction and move on to the next challenge. With so much still going wrong on the addiction front, we don’t need to waste any time tearing apart successful health services for irrelevant ideological reasons.
The argument against safe injection sites generally boils down to one of not wanting to “encourage” drug use. It’s a peculiar position to take in a nation that saturates itself with alcohol, prescription drugs and gambling, and makes even less sense in the context of the sad souls who frequent Vancouver’s safe-injection site.
A clinical, brightly lit room where sick and suffering people are injecting drugs isn’t as grim as a grubby little squat full of sleeping, crying, moaning addicts, but it’s still far from an appealing place to be. Just ask one of the hurting people lined up waiting for their turn. In terms of setting youngsters straight, it would be hard to envisage a better intervention than a visit to the local safe-injection site to see the skinny, abscessed clientele searching for a vein somewhere on their tired old bodies capable of withstanding yet another needle
Most of us will never know what that’s like, and that’s a lucky development. But we owe it to those who struggle with a very different reality to put aside our opinions for once and get on with doing the right thing.

Friday, August 11, 2006

Here's a thoughtful piece from today's Vancouver Sun opinion pages that sums up so much of what's wrong with the federal and provincial governments' approach to health.
Development in B.C. parks
Aug. 11, 2006

Parks are important places. They’re gifts from the taxpayers of today to every generation that follows, in perpetuity. Any change to the way we use our parks is potential cause for alarm, because one bad policy shift is all it takes to betray the public trust that our parks represent.
With that in mind, here’s hoping that British Columbians think long and hard about what it will mean in the long-term to open up more development in B.C. parks. A call for proposals went out this week for construction in six provincial parks, and six more will be put on the list at the end of August. We have mere months to decide if this is what we want for our parks.
The wonderfully isolated Cape Scott Provincial Park was on this week’s list, and thus could be the future site of a small lodge, cabins or yurts. As Parks Minister Barry Penner noted, that would make things much nicer for Cape Scott visitors who didn’t like to tent. But is it true to the park legacy entrusted to us?
I hiked the park seven years ago with my youngest daughter, 14 at the time. We backpacked and tented for six days, and emerged at least five pounds slimmer from the hard work of it. The experience was all about doing for ourselves, in a wild environment that at times was quite daunting.
The park is perched at the northernmost tip of Vancouver Island, 16 kilometres away from teeniest, tiniest Holberg and a jouncy 70 kilometres away, on a gravel road, from Port Hardy, the nearest community of any size. The trails are rough, sparse, and snarled with tree roots. When it rains - and it often does - the mud can be thigh-deep in some spots.
There’s no water supply beyond that of the local creek system, nor any guarantee that you won’t get sick from drinking it should you forget to bleach, boil or otherwise treat it. Campers quickly learn to stake their tents well above the tide line, and to scramble like the dickens to uproot camp when the tide rolls in even higher regardless. Were you to hurt yourself along the way, help would come eventually, but not easily.
Add in a six-hour drive to Port Hardy from Victoria, the many months of the year when the hiking trails are almost impassable, and the fact that you’ll be carrying all your supplies and equipment on your back, and you get the picture. Nothing about experiencing Cape Scott park is about ease and convenience.
Nor was it in 1973 when the park was created. Then as now, part of what made Cape Scott a special place was that you really had to put some effort into it to visit the park. B.C. has any number of accessible and spectacular beaches and misty forests. What distinguishes Cape Scott is its sense of splendid isolation.
I can understand an aversion to tenting. I prefer a motorhome myself. But parks are preserved for reasons beyond a person’s immediate need to get a more comfy night’s sleep. So while Parks Minister Penner may indeed be right that more people would visit Cape Scott if they didn’t have to sleep in a tent, that has nothing to do with why Cape Scott was designated a provincial park.
The north Island has suffered immensely from the shifting fortunes of the forest and fishing industries. An influx of bigger crowds to Cape Scott would be a wonderful development for the struggling merchants and retailers who are hanging on for their lives in Port Hardy. But that mustn’t come at the cost of the park itself.
Holberg and Port Hardy are ideally situated for the kind of development the government is touting. Sprawling backpack supply stores, end-of-trip accommodation for hikers preparing for or wrapping up their trip, strings of restaurants for the ravenous hordes emerging from the culinary disciplines of backpacking with an urge to eat and drink just about anything - it could all unfold a mere 15 minutes’ drive from the park’s border.
Visitors who wanted to stay inside the park without having to tent would still be out of luck under such a plan. But that group isn’t going to like the rugged muck of the trails beyond San Josef Bay anyway (or is the next phase of the plan to pave the path?). If you can’t bear to tent, chances are that the whole rough-and-ready trip through Cape Scott park won’t be too appealing.
Each of the 12 parks now listed for development were set aside for different reasons by the various governments of the day. Some might dovetail quite nicely with the current government’s commercial interests. A big new lodge or a string of cabins might be exactly what’s needed at a more urban park.
But not Cape Scott. It was given to us to keep wild. Thirty-three years into the legacy, we don’t have the right to change our minds.

Friday, August 04, 2006

RCMP and crime in the media
Aug. 4, 2006

Having experienced the challenge many times of trying to squeeze information out of the RCMP in the course of chasing a news story, I can’t imagine how much tougher the task will get if B.C.’s Mounties take the advice of their communications department and clam up further.
People in B.C. are much more fearful of being a victim of crime than they need to be, the department found in an internal report last year, made public this week after the Vancouver Sun got hold of a copy. The report speculates that the problem might be the volume of crime stories in the media.
If RCMP media officers weren’t quite so open and prompt in their dealings with the media, the report wonders, is it possible the media would fixate less on crime and people would calm down a little?
Two-thirds of the British Columbians surveyed as part of the report said they were fearful of being a crime victim sometime in the next year. Not even close to that many actually will be. These days, the fear of crime is considerably more prevalent than crime itself, the report notes.
I can see how you might conclude that the media had something to do with that. A month-long survey of undisclosed B.C. newspapers done as part of the report found that 67 per cent of all front-page stories in that period were about crime. While it’s hard to know what to make of that finding - what’s the “right” amount of crime news, anyway? - it’s still a significant statistic.
I wouldn’t want to see RCMP restricting crime information in an attempt to change that, however. This is our province. These are the police officers who we pay. We have a right to know what’s going on.
Beyond that, the media would simply dig up other sources to fill the void if RCMP became more reticent - sources that would almost certainly be less accurate, more speculative, and even more likely to frighten the uninformed reader or viewer. Crime reporting without access to accurate police information is truly a scary prospect.
But that’s not to cast aspersions on the main point of the report. The public perception of the likelihood of being a crime victim is seriously out of whack with the reality. We are scaring ourselves well beyond what’s actually necessary for our safety.
The front pages of B.C.’s newspapers certainly aren’t the only places where crime and violence take up a disproportionate amount of space. The most popular TV series these days feature epic levels of violence and crime, and unnecessarily grisly images aired at completely inappropriate times of day. Even cooking and home reno shows are filled with menace.
News of war pours into our homes every day as well. We need to know about them - in this global age, even the most distant wars hit home in one way or another.
But we also need to know what to do about it, rather than simply be left to grow ever more fearful. And the media have to assume some responsibility for that. Context needs to be put into stories of crime and conflict, to help us understand the reasons, the patterns, and the genuine risks to our communities.
Police themselves, however - and politicians - also have to answer for the culture of fear we find ourselves in. Crime is a powerful political tool that both groups have used as needed to scare voters into doing what they want.
Perhaps the cause at hand is more money for the police department, or the election of a law-and-order man. Convince the public to be very afraid, and all of a sudden the voters are on your side. But when interest groups and politicians scare up voters by conjuring the spectre of crime, the level of public anxiety increases.
What’s the truth of the matter? According to the RCMP report, British Columbians have a 14 per cent chance of being burgled in the next two years. Five per cent will be assaulted.
Those are still striking numbers, and of no comfort to the people who do end up the victims of crime. But it’s heartening news for the 85 to 95 per cent of us who aren’t affected in a typical year. We still live in a country where most of us do not routinely experience crime. If only we could allow ourselves to believe that.
The information must continue to flow from our police departments to the media. As tempting as it might be for the RCMP to believe that too much information is the primary problem in terms of perception of public safety, the issue is much more complex than that.
But maybe the leaked police report will finally get us talking about why we’re more worried than we need to be, and what we can do about it. This old world has troubles enough without us imagining it any worse.