It's still the back of the bus for mental health services

Alan Campbell couldn’t believe the kind of care and support his wife received after being diagnosed with breast cancer five years ago.

The speedy treatment. The kind words. The follow-up calls and offers of support. It was an amazing experience, says Campbell - and all the more striking when compared to the level of care his own clients typically see.

Campbell has spent the last 34 years working in B.C.’s mental-health system, most recently as director of mental health and addictions for the Vancouver Island Health Authority.

I’m sure he would have liked to have been finishing off his career this week reflecting on the tremendous gains made around mental-health care in his time. That’s certainly been the case for breast cancer and for many other major health concerns that we’ve tackled with fervour in the last three decades.

Alas, Campbell retired Wednesday from a field that is very nearly as underfunded, misunderstood and stigmatized as it was when he got into it in 1976. Had his wife been diagnosed with bipolar disorder or schizophrenia instead of breast cancer, her family’s journey through a fractured and overwhelmed mental-health system would have been very, very different from the experience they had at the tender hands of the B.C. Cancer Agency.

Why is that? Why does one disease get the resources it needs to do things exactly right, and another have to beg for leftovers at the back of the line?

 Mental illness accounts or 20 per cent of all illness, yet its share of health-care spending on Vancouver Island is a mere eight per cent. Make that six per cent in B.C. overall.  

“We haven’t figured out how to get behind mental health as a country,” says Campbell. “It’s not just a problem here. In other regions, other provinces, the same dynamic exists. When we compare ourselves to other countries, we don’t look good.”

Campbell’s final months at VIHA can’t have been fun, what with the outrage building in the local psychiatric community over the loss of even more mental-health services.

In recent weeks, a doctor with the Schizophrenia Affective Disorders Clinic, Dr. Adam Gunn, resigned over the cuts. Dr. Anthony Barale has closed his outpatient service at Victoria General Hospital for people with brain injuries, saying he can’t support a system that’s failing patients and their families.

Dr. Andre Masters noted those resignations in a letter to the editor last month, and says more are likely coming. VIHA’s Department of Psychiatry passed a motion last fall condemning everything about the way budget deliberations were handled at VIHA.

Yes, there’s an urgent need for more spending on mental-health services, says Campbell. But when his department takes that message forward, the answer is usually “no,” he adds.

“For every one of the five years I’ve been doing this job, we’ve put forward strong, well-reasoned cases for more funding,” he says of his department. “The only time we were successful was in getting money for the Mayor’s Task Force on Homelessness. My understanding is that our requests are given real consideration, but they just don’t fare well in the end.”

Nor does it go well when VIHA starts moving money around on the Island, taking funding away from places like Victoria and Nanaimo in order to provide more services in places like Port Hardy and Duncan. Mental-health services may be insufficient in Greater Victoria, but they’re downright dismal elsewhere on the Island, says Campbell. 

The economy will eventually improve, of course, and brighter days will dawn for many of the health, education and social services under the knife right now.

But that won’t get to the fundamental problem plaguing mental-health services, which is that it’s buried at the bottom of the priority list for health spending even in the best of economic times.

Once upon a time, cancer treatment was poorly funded and misunderstood as well. But brilliant minds as far back as 1938 saw a way to address that problem, and the foundations of what would eventually become the B.C. Cancer Agency were put in place.

Its mandate and practices are everything that health care should be: Consistent and thorough; well-resourced; research-based; thoughtful. It’s a made-in-B.C. blueprint for doing things differently around mental health. So is the province’s new 10-year mental-health plan, if it’s able to become something more than just words on paper.

What can you do in the meantime? Write B.C. Health Minister Kevin Falcon and Health Canada Minister Leona Aglukkaq and tell them that mental-health care matters (kevin.falcon.mla@leg.bc.ca, aglukkaq.l@parl.gc.ca.). Governments won’t change unless we make them.  

An eye-opening study out of Vancouver that clearly shows how much of B.C.'s homelessness problem is about people with mental illness falling through the massive gaps in the health-care system.

A heartfelt plea from the father of a young woman who could lose her group home if "home share" becomes the only option in B.C. for people with mental handicaps.

Mental-health cuts take aim at those unable to fight back

Please don’t tell me that the people in charge of services on the Island for people with mental illness really think that it’s us to blame for the sad condition of mental-health services.
Dr. Robert Miller, medical director for mental health and addiction services at Vancouver Island Health Authority, wrote in a letter to the editor last week that the reason mental health and addiction services are inadequate is because the public makes that choice.
Really? I can’t recall a time when the health-care system has ever consulted Canadians around funding decisions of any kind. I take Miller’s point that our country underspends on mental health services, but I don’t remember a public conversation in which we agreed to that.
Miller, who’s also head of psychiatry for VIHA, rightly raises in his letter the fact that Canada spends a smaller proportion of its health-care dollars on mental health and addiction care than other western nations. Just eight per cent of the health-care budget for Vancouver Island goes to mental health and addiction services. Countries like Australia and the United Kingdom are spending 12-15 per cent.
We did elect the governments who have brought us to this point, it’s true. Maybe that’s what Miller means. But I can’t recall an election when any of the major political parties even put forward a platform around mental health services, let alone worked it as an election issue.
I suppose we taxpayers do deserve the blame for tolerating political parties that can’t even be bothered to talk about mental health. But it’s a pretty big stretch to translate that as meaning the public has made a choice to deny better care to those with mental illness. (Or that we’d ever want public opinion to dictate something as important as who gets good health care.)
And we couldn’t be party to any of the decision-making around health care even if we wanted to. VIHA and B.C.’s other four health authorities have no public accountability, or meaningful public access to their meetings.
Miller’s June 19 letter was the latest in a trio of missives that have appeared in the paper over the past month from doctors and directors at VIHA.
The first letter - from outgoing VIHA mental-health director Alan Campbell - was prompted by a Times Colonist editorial June 9 headlined “A terrible failure on mental illness,” written after the tragic stabbing death of 15-year-old Justin Wendland. Campbell wrote that the health authority had for the last three years increased funding for mental health and addiction services by $6 million a year in Greater Victoria.
His letter brought a shot across the bow from Dr. Andre Masters, a psychiatrist and outspoken critic of cuts to mental health services. Masters took considerable exception to Campbell’s assertion that spending was up.
Then came Miller’s letter, which seemed to be an attempt to make peace between the two sides by shifting the blame for cuts off of VIHA and onto the public.
I’m not buying it. This has nothing to do with the public making a choice. It’s all about the health authority looking for savings in the same old places, and a budget so tight that improving wretched services on one part of the Island can only be done by taking valued services away somewhere else.
Mental-health services are chronically underfunded and the first to be cut because governments know they can get away with it. For all kinds of reasons, mental illness has never had the political cachet and sophisticated lobby of physical illnesses, and was deliberately segregated from the rest of the Canada’s health-care system from the start.
Mental illness can’t be “cured” in that nice, clean way that we prefer, like a broken leg or an ailing heart. Even diagnosing it can be tricky, and the results of treatment unpredictable.
It’s stigmatized and poorly understood. It generates just enough scary media stories of unexpected violence to leave the public with the gross misconception that to be mentally ill is to be dangerous and out of control.
Mental illness knocks the wind out of the best of families in no time flat. Even friends and family members tend to take a step back when the diagnosis is mental illness, instead of stepping up to help the way they would have had the diagnosis been breast cancer or hip surgery.
So when cuts come, they hit a group of people that already feels ashamed, hopeless and unworthy. The axe falls, and nobody has the strength to scream.
Who’s to blame? The decision-makers who take advantage of that helplessness to reduce care to people too broken to fight back.

I've been hearing from lots of concerned family members around B.C. responding to my June 11 column on the major changes afoot for British Columbians with developmental disabilities.

The push is on for an end to the group-home model for people with mental handicaps, a change that pleases the families who like the idea of a more independent living situation for their loved ones, but terrifies those who have had bad experiences with private homes (increased isolation, more risk of abuse going undetected, less stable as a "permanent" housing solution, etc).

It seems like a good time to post the
United Nations Convention on the Rights of the Disabled. Take a look at Article 3, which notes that giving people the right to choose what happens to them is a basic principle in the Convention.