Trouble inside VIHA?

Check out this intriguing series of letters and opinion pieces from doctors and VIHA directors, all published in the Times Colonist in the past month. I've started with the June 9 editorial that got things rolling, followed by the three letters that have run so far revealing a whole lot of internal dissent about the cuts to mental-health services this past year. I'll be writing about this issue in my column on Friday, June 25.


A terrible failure on mental illness
Times Colonist (Victoria)
Wed Jun 9 2010

A terrible failure on mental illness

There is no worry greater than being the parent of a child with a serious mental illness or addiction. Any illness suffered by a family member is, of course, traumatic.

But for most ailments and injuries, especially critical ones, there is support and help. If your child has cancer, the health care system provides remarkable care; support services help the family; friends and neighbours pitch in. Parents know that even after they are gone, their child will be supported.

None of those things is true for people suffering with mental illness. We would not turn someone away requiring critical cancer care; we routinely tell people dealing with serious -- potentially fatal -- mental illness that there just isn't space to provide care. Patients are stigmatized and families isolated.

The consequences are terrible for individuals, families and society.

The tragic stabbing death of 15-year-old Justin Wendland has refocused attention. The man charged with murder has a long history of mental illness and addiction.

But it should hardly take such a case to remind us of this health care failure. Look at downtown streets and the people camped along Pandora Avenue most nights.

Most are not well. Of some 1,400 homeless people in the city, about 40 per cent have a mental illness; 50 per cent have an addiction. Many are dealing with both.

That means that some 800 sick people are warehoused on the streets with little or no support or treatment. Often, they lurch from crisis to crisis. When things get bad enough, there is a brief, expensive response from the system, in the form of acute care or jail time. Then they are left on their own until the next crisis.

It's not easy to provide treatment. Some patients reject help; others shun medication that could assist in managing their illnesses (sometimes with good reason). Others are just terribly difficult. Involuntary treatment is sometimes necessary.

But we are a long, long way from having to worry about finding ways to persuade the recalcitrant to accept care.

Even when people want care -- when their families are desperate -- there are likely no beds available and little support. The Vancouver Island Health Authority cut mental health services in the capital region, both psychiatric beds and community support. Patients who should be in the hospital, according to their doctors, aren't. Some 350 patients lost the support of mental health caseworkers.

VIHA is simply balancing priorities against inadequate funding. Mental illness is a lesser priority.

But the health system's savings are offset by the extra costs for policing, shelters and crisis response.

It must be noted that mental illness, like many other diseases, can be managed. Millions of people live happy, productive lives. Even those seriously ill are rarely -- almost never -- a danger to anyone but themselves.

But the extreme cases are a reminder of the high price we pay every day for failing to provide adequate mental health care.

Services increased to the mentally ill
Times Colonist (Victoria)
Sat Jun 12 2010

Re: "A terrible failure on mental illness," June 9.

Over the past three years, VIHA has greatly increased funding in Victoria for services to the homeless, mentally ill and addicted. This includes an increase of more than $6 million every year toward enhancing services for those who suffer from mental illnesses or addiction, including those living on the streets, and we are seeing excellent results.

In Victoria, the establishment of four Assertive Community Treatment outreach teams proactively connects individuals who suffer from serious mental illnesses and-or addictions, particularly those who are homeless or poorly housed in the downtown, with the services they need and has reduced the number of individuals coming to emergency rooms. Clients are now better able to manage their mental illnesses long term with the ongoing contact and support from these teams.

We have tripled the number of medical detox beds and tripled stabilization and supportive recovery beds for those in long-term recovery from addictions.

Services provided at a number of supported housing apartments for mental-health clients continue to help them transition into wellness and reintegrate into the community.

This past year, we have shifted some of our funding in order to provide services to those communities in the Central and North Island communities that have been significantly underserved. This meant a reduction in services in the Greater Victoria area.

We can and will do more. We all recognize that it will take the combined and determined efforts of many agencies, and the support of all citizens, to ensure that everyone has a safe place to live, their basic needs met and a valued role in our community.

Alan Campbell
Director, Mental health and addictions services Vancouver Island Health Authority

No confidence in VIHA's mental-health efforts
Thu Jun 17 2010
Page: A14
Source: Special to Times Colonist

The letter from Alan Campbell, Vancouver Island Health Authority director of mental health, suggests he must be living on a different planet than the majority of front-line psychiatrists and case managers who are trying to deal with cuts to services for their chronically ill mental health patients in Victoria ("Services increased to the mentally ill," June 9).

On my planet, the following facts are the reality:

- A motion passed at the Nov. 10, 2009, meeting of the department of psychiatry, south Island, condemned the unacceptable way in which budget reductions in mental health took place, the lack of clinical consultation, the significant failure of managers and co-ordinators to share information and the resulting low morale, despondency and mistrust that had ensued.

- A draft e-mail in November 2009 from one of Campbell's managers stated, "With the reduction of six case management staff in early December, the case management program will need to discharge a total of over 300 individuals in the next few weeks." Case managers are afraid to speak out about this, or any other matter affecting their patients, for fear of retribution by senior management. This is not a healthy state of affairs.

- On Nov. 30, 2009, and because of continued frustration with management, a group of nine psychiatrists signed a letter of complaint about a situation in the Mental Health Centre that also referred to low morale affecting staff. Nothing was done to address the complaints; the reply from Campbell on Dec. 3 said he was directly involved in the decisions made and was accountable.

- On April 22, 2010, we received notice that Dr. Anthony Barale was closing his outpatient neuropsychiatry practice at Victoria General Hospital. He complained about the lack of concern by VIHA for brain-injured patients, who are amongst the most complex in the system. He said they have organic brain conditions, addictions, concurrent psychiatric disorders and multiple medical conditions, yet mental health is currently putting up as many barriers as possible to this patient group. He is no longer prepared to support a system that is failing patients and their families.

- Dr. Adam Gunn has tendered his resignation from the Schizophrenia Clinic and Affective Disorders Clinic in Victoria effective June 26. He referred to difficulty with the profoundly negative effects that VIHA cuts have had on patient care, causing serious concerns about safety and the expectation that there will be dangerous consequences, with patients' lives at stake.

He said he could no longer be a part of it. He went on to state that the quality of care has already been severely eroded, and accessing treatment services for quite ill patients is now extremely difficult and in some cases impossible. As well, he felt that VIHA has now become an unhealthy workplace, with patients, their families and his colleagues deserving better and believed that bad things will follow from this in the coming months. Other VIHA psychiatrists are considering resigning because of similar concerns.

Meanwhile, VIHA funds programs for patients to do yoga, Qigong and power walking. Not much use to the patients of Barale and Gunn, nor to the 194 patients I saw in 2009 who suffer from schizophrenia, bipolar mood disorder and serious depression. Not much use to the 300 Mental Health Clinic patients who have been disenfranchised with the loss of six of their case managers.

Mental health management continues to bury its head in the sand and ignore a very large group of chronically mentally ill patients. They and their families rarely speak out; they do not cause problems downtown, and are no more likely to commit crime than the general population. Indeed most of my patients have been afraid to go downtown or near Our Place because of the presence of the drug abusers who present a threat and are most likely to commit crimes, from theft to serious assaults.

The problems downtown have been erroneously blamed on the mentally ill. Their incidence in the population has remained static, but there has been a totally unacceptable explosion in the numbers of drug addicts who have been allowed to take over our city.

Repeatedly, I have called for an audit of actions taken by mental health management in the last three years, but this has fallen on deaf ears.

André Masters is a psychiatrist who has worked in mental health for 49 years in the United Kingdom, Saskatchewan and Victoria. He recently retired from a position as a consultant in general psychiatry at the Victoria Mental Health Centre, but continues to do part-time consultations for the Mental Health Service in Victoria.

Mental-health improvements up to us
Times Colonist (Victoria)
Sat Jun 19 2010

Re: "No confidence in VIHA's mental health efforts," June 17.

There are, to be sure, profound differences in the perspectives of Dr. André Masters and Alan Campbell, who retires next month after a lifetime serving the needs of the mentally ill in B.C.

These differences go some way to explain their differing views of the progress made in serving the mentally ill on Vancouver Island over the past several years.

As Vancouver Island Health Authority director of mental health, Campbell has to support the needs of all those who live on Vancouver Island who are mentally disordered. He cannot favour those with mental illnesses judged as respectable or unavoidable and neglect those whose impairments are secondary to a lifestyle that might have been prevented.

He must seek to provide fair funding for all communities, redressing the gross imbalance that has favoured the south island. VIHA now spends $6 million more annually in new mental health and addictions funding in Victoria. So, despite reductions to service in Victoria totalling about $1.5 million last year, there has been a net increase of nearly $4.5 million over the past few years.

Masters has been an exceptional advocate for his own patients; but he has not had to be concerned that continuing to favour some continues to disadvantage many.

We are, fundamentally, on the same side. We recognize that mental illness is the cause of the greatest loss to our quality of life and the largest economic burden to our society.

The answer lies with our population, who must decide how much value to attribute to mental health and addiction care compared to other health care. Canada has traditionally spent a smaller proportion of its health-care dollars on mental health and addiction care than other western nations.

If we are to increase this proportion to amounts that match other countries, it must mean reductions or funding changes in other areas. Are we as a population ready to bite that bullet?

Dr. Robert Miller
Head of department of psychiatry
Medical director, Mental Health and Addictions Services
Vancouver Island Health Authority

B.C. families need to fight for group homes

I remember the exact moment I started to look at people with mental handicaps in a completely different way.
It was 1985, not long after the province had closed the huge institution for “retarded” people at Tranquille, an old tuberculosis sanatorium outside Kamloops. I was working at a Kamloops newspaper at the time and the closure was big news, so I’d been part of documenting the hope, fear, anger and anticipation that the closure had sparked.
Families had been working for long, long lifetimes by then to move things forward for their mentally handicapped children, who were all ages. They had few choices in those years when it came to finding services or schooling for their children in their own home towns, and often had no option but to send their children hundreds of kilometres away to institutions such as Tranquille, Woodlands and Glendale.
The families were mostly over the moon at the thought that Tranquille’s closure would allow them to bring their children home to get all the support they needed in their own communities, which is what the government was promising. But they were terrified, too, because it’s very hard to give up a sure thing for a promise when it’s your child’s life at stake.
As for how I felt personally about the closure of Tranquille - well, I hadn’t really wondered to ask myself about that.
But then came the day when I happened to be stopped on a Kamloops street waiting for a young mentally handicapped boy to cross at the crosswalk. He appeared to be on his way home from school, walking along in the sunshine with a schoolmate and swinging his lunch kit in that big-armed way that every kid in the world is probably familiar with.
And it was all so normal. A 30-second scene, yet it clarified for me in an instant why we had to put the days of giant institutions behind us. Normal is a pretty nice place to be.
All these years on, much has changed for people with mental handicaps. They have the right to go to school. To live a real life in a real community, near to friends and family. To be paid a fair wage for a job well done. To have some say over their own lives. Those are meaningful achievements.
As for the families - well, let’s just say it’s been an interesting 25 years.
Their children’s basic needs haven’t changed in that time, because a mental handicap is forever. But everything about the way the government operates its services has been in a near-constant state of flux. Sometimes that was due to shifting philosophies or new research, but more often it was because somebody in government thought there were savings to be had by doing things differently.
The language changed: mental handicaps became developmental disabilities, and the associations and programs serving that population took to referring to their services as “community living.” When the government created Community Living BC in 2005, a new governance authority that would give families more say over services, many of those families felt they were realizing a dream.
But it’s the year of broken dreams. CLBC is now preparing to shut down group homes - the four- and five-bedroom staffed homes that people were moved into after the institutions closed. The move has been portrayed as being about choice for families, but it’s mostly about saving $22 million a year.
Many families have lobbied hard to give their adult children more housing options beyond just moving into a group home. Independent living is one more step toward normal, and I’m all for it, too.
But everything changes when the primary goal is cost savings. If families aren’t yet alarmed by what they’re hearing from CLBC, they might want to ponder what it would really mean to eliminate the only designated housing supports in B.C. for people with developmental disabilities.
Once all the group homes are gone, families will be left to fight it out with everybody else for low-income housing for their adult children. The support to help people find and keep housing will be there initially, because government needs to make the changes palatable. But for how long? And then what?
This government in particular has a history of being deceptive, ruthlessly ideological and dangerously ill-informed around social spending. CLBC may have honourable intentions, but it’s a good soldier. It’s no more likely than the health authorities to challenge government demands for cuts.
Families, you’ve been here before. It’s wrong that they’re coming for you again, but so it goes in this often unjust world. Fight.

Lessons from BP tragedy: Trust is not an option

As barrel after barrel of oil pours into the Gulf of Mexico, poisoning every living creature that comes in contact with it, I feel again a creeping dread at how little we know about the things we say yes to.
I know almost nothing about deep-sea oil drilling. And I see now that I have made a terrible error in not knowing more, because one of the greatest environmental disasters of our time is unfolding and all I can do is stand here bewildered at how this can possibly be happening.
As with all things I don’t know enough about, I just thought somebody was taking care of things. I thought people with a lot more smarts than me were considering everything carefully and proceeding with the utmost caution, because it’s in nobody’s interest to kill off our oceans.
I presumed - and isn’t that just the saddest word? - that a company drilling an oil well reaching 17,000 feet below the surface of the ocean would have had a backup plan for every eventuality. And that certainly would have included what to do in the event of an explosion tearing the drilling equipment away from the underwater wellhead, as happened April 20 in the gulf.
We know the horrible truth of that all too well now. But it’s just a little late. As always, we are learning the hard way what we never thought to wonder about up until things suddenly blew up.
In the case of the oil spill, perhaps the most disturbing revelation is that neither the company nor any of the regulatory bodies has any idea of how to cap the ruptured well.
Think about that. BP Global has been spending $1 million a day for the last nine years to drill for what it hopes will be three billion barrels of oil deep in the sea, but it doesn’t have a workable contingency plan for capping the hole it has made in the ocean floor. It’s working in water more than a kilometre and a half deep to drill a well that will reach a further four kilometres into the seabed, but it had no tested strategy for turning that massive gusher off in the event of equipment failure.
BP spokesmen are now saying it will probably be August before it gets the spill under control.
In the meantime, the oil pours into the gulf, at a rate of 5,000 barrels a day. An estimated 80 to 170 million litres of oil have poured into the gulf to date, dwarfing the 42 million litres spilled in the Valdez accident. By August, the gulf will be awash in 10 times the amount of oil spilled by the Valdez, and that’s presuming that BP is even successful in stopping it then.
How could this have happened? Point the finger in a dozen different directions. Like the sub-prime mortgage crisis that has ended up devastating the world economy, there are many reasons why.
The U.S. pundits and bloggers paint a picture of a compromised federal government, and an industry used to getting its own way. The inspection process was obviously flawed as well, seeing as the Deepwater Horizon passed every one of its monthly safety inspections this year right up until it blew up in April.
What’s scary about both the mortgage crisis and the oil spill is that they were years in the making, yet no one behind all the fateful policy decisions and bad choices foresaw the disaster being wrought.
Until hundreds of thousands of Americans started losing their homes in the sub-prime mortgage crisis, we all thought somebody was tending to things like that. Until it exploded, the oil rig Deepwater Horizon barely got a mention in the U.S. press, and the world slept well at night in the naive belief that somebody would know what to do were the worst to happen.
We know better now. But what’s to be done about it?
One thing seems obvious: No more presuming that anyone has your back. If you want your children and grandchildren to enjoy a lifetime on this Earth that’s at least as good as the one you’re having, let go of the comforting fallacy that government is tending to all the big stuff.
A rich country. Thousands of brilliant minds. A thick stack of long-standing environmental regulations. And none of it can stop the oil pouring into the Gulf of Mexico.
That’s a lesson we can’t let ourselves forget.

Link to the live feed from one of the remote operating vehicles near the wellhead.

Can Trackside Gallery be reborn?
(Here's a link to a Barry Barr photo of Trackside art)

Not so long ago, Esquimalt’s Trackside Art Gallery was being feted far and wide as an extraordinary achievement.
A dark and crime-filled little lane transformed into an urban art gallery that was turning around young, troubled lives - well, that was a story that everybody wanted to tell. There were raves all round for Tom Woods and the non-profit Rock Solid Foundation when the outdoor gallery launched in 2001.
But that was then.
Today, painting graffiti on the warehouse walls in the 800-block of Hereward Road is once again prohibited, and volunteers with an unlimited amount of beige spray paint work very, very diligently to keep it that way. The ever-changing art that adorned the walls in years past is long gone, as is the dream of an artsy public space where young graffiti artists and the community could happily co-exist.
All that remains of the bold experiment are the 48 large murals that were painted in the first three years of the project and hung up high on the walls at Trackside, named for the E&N railway that runs alongside it.
The colourful and transient art that once dotted the lower wall has been painted over. The street lights in the area are off now that Rock Solid’s no longer paying the hydro bill. The youth who Woods envisaged a brighter future for have scattered around the region, along with their tagging.
Woods has been so wounded by three years of skirmishes with Esquimalt municipality that Rock Solid has now removed itself from the Trackside project. A new group of supporters under local businessman Jason Guille has taken shape, but they’ll be against a determined group of residents that doesn’t want to see graffiti return to the area.
Woods knew it was time to let go of Trackside the day an angry resident dumped a garbage bag filled with used spray-paint cans on the steps of the Rock Solid office. “Rock Solid had suddenly turned into the one being blamed for the problem,” he says in bewilderment.
Few people feel neutral about graffiti. Some appreciate it as a vehicle for artistic and teenage self- expression. Others see it as an offensive, unwanted and costly blight on the urban landscape. Both Woods and Guille respect the arguments of those who hate the stuff, but they also see much potential in having a spot where young outdoor artists can cut loose.
“Boundary creep” is a big problem for anyone making an argument for a legitimate graffiti space. Give youth a designated place to express themselves with a can of spray paint, and the next thing you know some of them are expressing themselves on all the nearby buildings for six blocks around.
More challenging still is the fact that flouting authority is part of graffiti-art culture. So it’s not like you can just lecture everybody about sticking to the rules and that’s that. Guille was reminded of that while talking to a young artist about the need for a firm graffiti boundary at Trackside. “He told me, ‘You don’t understand - I’m against all private property.’”
Guile came to the Trackside revival project through his Herald Street art and music space, the Sunset Room. He wasn’t familiar with Trackside, but artists exhibiting and selling at Sunset always seemed to be mentioning it.
“It kept coming up, mostly as, ‘I sure miss that place,’” recalls Guille. “So we brought together everyone who was interested to see if we could find a solution.”
Municipal staff didn’t respond to my requests for an interview, but Guille confirms he has met with the head of facilities operations, Mike Reed. What’s clear is that nothing’s going to happen on the lower wall without a management plan establishing responsibility, says Guille. “That’s the question. How is it sustained? Who controls it?”
Guille wants a solution that keeps everybody happy. He tosses out some ideas: A twice-yearly urban arts festival in which artists volunteered to do a general cleanup of the surrounding neighbourhoods in exchange for the right to paint the wall. A SWAT team of young volunteers tasked with cleaning up any graffiti outside the zone.
Or maybe the artists’ group just pays Esquimalt every year to cover the costs of graffiti removal - “like carbon offsetting,” says Guille. He’s got calls in to Mayor Barb Desjardins to talk further.
“The dream from my artistic side is to have a free wall again. From my community side, it’s to have one without much cost,” he says.
“It’s not going to be easy. But we’ve got some good people involved. We’ve got people who understand the difference between vandalism and art.”

Living dark in a white world

It’s a weird feeling to be travelling in countries where virtually every face is dark-skinned, yet all the images on billboards and TV advertising are resolutely white.
Even the storefront mannequins and baby dolls are blond-haired and blue-eyed in Vietnam, where I recently travelled. If dolls are the way a little girl begins to imagine the adult world, what does it mean to an Asian child when no doll looks anything like her?
In Hoi An, on the central coast of Vietnam, many of the young women now cover themselves from head to toe to prevent the sun from darkening their skin. Wearing jazzed-up face masks that have become a fashion staple in the country, the girls sweat it out in 35-degree heat wearing jeans, long-sleeved jackets, winter gloves and masks to shield their skin.
“It’s very hot!” one young woman told me from behind her flannel face mask. She was working the tourist beach at Hoi An on a scorcher of a day, running out onto the sand every few minutes to try to convince sun-seeking foreigners to rent beach chairs from her for the day (a highly competitive business, as it turns out).
“But I don’t want to get dark,” she added. “In Vietnam, we think it’s more beautiful to have white skin.”
Hey, we’ve all got our dreams. Vanity, thy name is woman.
But there’s a reason for being brown. Darker skin is less susceptible to sunburn, which is why people native to hot countries like Vietnam are generally darker than those from cold countries like Sweden. The basic biology of skin colour has little to do with the cruel realities of racism, but count it as a very disturbing development when any race learns to hate its own skin colour.
Women the world over have long engaged in acts of self-hatred in their quest for “beauty,” of course; nothing new about that. But for a whole nation of young women to have defined beauty as a skin colour that isn’t theirs - that’s just plain sad.
Go into the cosmetics section of any Vietnamese store and you’ll find row upon row of skin-whitening products for women. The bigger stores have whole sections devoted to “anti-melanin” creams and lotions, each promising whiter, brighter skin.
Pond’s, L’Oreal, Clinique, Nivea - all the big names in global cosmetics are selling extensive lines of whitening products in Vietnam. Here in Canada, the dream marketed in our cosmetics aisles is of eternal youth, but in Vietnam it’s all about being whiter.
More brilliant minds than mine have dissected the issues of power, race, sexism, colonialism and all those other heavy hitters that you’d probably find at the root of all this. No doubt the series of events leading to the phenomenon of the modern-day Vietnamese cosmetics counter were decades in the making, and complex in their origins.
But some of it is easy enough to understand, even for us average thinkers.
Maybe the reason that all the dolls and mannequins are Caucasian is simply because that’s what the big Vietnamese factories are manufacturing for export to the developed world, so that’s what’s most affordable to sell locally. Maybe the truth is that almost all the dolls and mannequins being manufactured anywhere in the world are white ones.
The giant store billboards in places like Ho Chi Minh City, with their ubiquitous images of languid white-European models looking great in clothes - they’re the identical ads we see over here. What motivation is there for a big fashion company to change its models to better suit a Vietnamese market, when everywhere else in the world accepts those same white-centric images without question?
That’s ultimately the grand revelation, I suppose: That we’re all being sold an ideal of white skin.
It’s more noticeable in a place like Vietnam, because the contrast between the ads overhead and the people on the street is just too ludicrous to go unnoticed.
Then again, try to recall ever seeing an Asian or aboriginal face in a major fashion campaign in Canada. Or a dark-skinned doll in a toy store that didn’t just look like a token brown-plastic version of a white doll. And that’s right here in Canada, where almost a third of the population isn’t white.
If I ever decide to launch a campaign for the right of every little girl to have an alternative to blonde-haired, blue-eyed dolls, at least I’ll be able to start close to home.