ADDICTION, SUBSTANCE ABUSE OFTEN PLAGUE MENTALLY ILL

Mental health issues must be high on the agenda of any plans to save
Vancouver's downtown eastside. Otherwise, the battle cannot succeed.

As publicized recently, the primary focus of the initial plan is to
mobilize federal, provincial and municipal resources in a concerted
campaign to heal the ugly wound of Vancouver's drug trade, centered at
Main and Hastings.

This area originated as "skid road," where loggers came in from the
bush to live it up. The action was confined to seedy hotels and pubs.
But now it's on the streets, wide-open for drug dealers, prostitutes,
pimps and fences supporting property crimes.

Behind this scene are the dangerous demons of untreated mental
illness. That's what pushes or drags many of these people to this port
in a storm, and leaves them stranded in the closed loop of the drug
scene. Vancouver/Richmond Health Board and associated agencies do
their best but are hobbled by funding/housing shortages, treatment
issues, and frequent shuffles in provincial responsibility.

To banish these demons along with street drugs, the ministry of health
will have to be involved. The Mental Health Plan will needs to be
upgraded and spending increased. We will also need to: break the
gridlock in hospital emergency psychiatric beds; build/rent dedicated
dual diagnosis treatment beds and centers; train and hire more
psychiatric and specialized health professionals.

Similar recommendations have been urged by Lower Mainland mental
health administrators, and inquest juries. The growing impact of
downtown eastside issues demands integrated management of mental
health at all levels.

Most of us in the mental health community would likely agree with key
elements of Mayor Philip Owen's new plan: drug dealers are criminals
and should be strongly prosecuted; addiction is not criminal behavior;
addiction is a medical condition and needs medical treatment.

But addiction is not easily treatable -- especially when workers
average 59 cases each. Addiction or substance abuse seldom exists by
itself; it is frequently linked to mental illness. Together in the
same person, it is called dual diagnosis (DD).

The new plan does list mental illness among categories with special
needs, but goes no further. Special needs, indeed. In the present
mental health system, DD is nobody's child. That's because untreated
DD people are hard to house and likely to become known to police.

They migrate from B.C. and Canada into downtown eastside streets. Too
many end up in jail or in the morgue -- poor substitutes for the
safety and diligent treatment such people used to receive in
Riverview's 5,000 beds (now 730).

Serious mental illnesses (schizophrenia and major mood disorders) are
prevalent in less than five per cent of the general population. But
are far more common in the Lower Mainland's 12,000 injection drug
users. Counting congenital and other mental disorders, the DD ratio is
at least 50 per cent. Alcoholism pushes it even higher.

Whether DD or not, serious mental illness is disabling under stressful
conditions. But modern medications can control it, especially in the
early stages, enabling many to live safely in the community or return
to work.

Untreated victims tend to require hospitalization to become stabilized
on anti-psychotics, and to address their basic health needs
(malnutrition, low immune resistance, etc).

Without diligent follow-up, stabilization becomes more difficult.
Repeated relapses tend to consume their victims. Many attempt suicide:
ten to 15 per cent succeed.

All untreated mental disorders can make their hosts vulnerable to
stress, unable to function normally, and place them -- or others -- in
harm's way. Lacking community care and support, many find it in drugs
or alcohol: comfort, security, release from stress or pain, and a
connection to someone or something.

Without integrated and comprehensive treatment of serious mental
illness, there can be no long-term cleanup of the slippery slopes
leading to Main and Hastings.

Veterans of the hospital revolving-door syndrome will just keep
drifting into the street scene. New young victims of mental illness,
rejected by community or peers, will continue to drop out of the
overloaded support system, stop taking medications and start wandering
the streets, looking for pain relief.

They have a right to receive treatment. And society has a duty to
provide it.