Vancouver's ill and addicted lost in a mental-health care maze

Patients and service providers describe B.C.'s mental-health care system as a byzantine bureaucracy that's losing too many people through its cracks.

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      When Adam was 17 years old, he travelled from Vancouver to New Mexico to visit his father. Upon returning to B.C., his mother recalled, he appeared to have lost his ability to maintain eye contact. His posture had changed and he stopped sleeping at night; he became fastidiously attentive to litter, and he began to wander, seemingly without direction.

      “He was popular, a self-taught musician, a self-taught artist, and then he got sick,” Angel Strehlen said at a coffee shop on Main Street. “At the worst of it, he was raving, running down the streets with a baseball bat. And at that time, I found it extremely difficult to get him help.”

      At first, doctors accused Adam of taking drugs. After two years of trips to the emergency room, he was finally diagnosed with schizophrenia.

      Almost 15 years later, last October, Strehlen told the Straight her son remained lost in a byzantine system, at risk of falling through its cracks. He was living in an East Hastings Street hotel infested with bedbugs, on supportive-housing waiting lists that never showed signs of moving.

      “The maze and the quagmire of forms and bureaucracies and phone numbers—I can hardly deal with it,” said Strehlen, herself a mental-health support worker. “Can you imagine someone who is sick filling out these forms? In his paranoid state, I had to convince him to let me do it for him. That took a year, just to convince him to trust me, his mother.”

      Service providers readily concede that B.C.’s mental-health-care system is overburdened and excessively complicated in ways that prevent many severely mentally ill people from receiving care.

      “It’s confusing to even know where to begin,” said Dr. Carol-Ann Saari, president of the B.C. Psychiatric Association. “There is just no good way of navigating everything, as far as I can see.”

      Jonny Morris, public-policy director for the Canadian Mental Health Association (CMHA)’s B.C. division, described mental-health care as a “patchwork” of services “not well connected”.

      “Even for those who do have strong family networks, the system can be very difficult to navigate,” he said.

      Years on waiting lists

      Once one begins to figure the system out, there are often long waits for services, especially for supportive housing.

      For months, health authorities and B.C. Housing refused to disclose waiting-list data. Statistics obtained from Vancouver Coastal Health (VCH) and B.C. Housing through freedom of information legislation reveal the extent to which those agencies are overwhelmed.

      During the first half of 2014, the median time an individual waited for their first meeting with a VCH Community Mental Health team usually fluctuated between 10 and 20 days. The wait for VCH’s outpatient psychiatry team was 20 to 40 days (down from a high of 91 days in early 2013).

      Waits for VCH supportive housing are substantially longer. For the period January 2012 to November 2014, the average number of days an individual waited for placement in a licensed care home was 532. For an enhanced-housing service, the wait was 385 days; for supported-independent-living sites, it was 271 days; for supported apartment blocks, the wait was 219 days; for group homes, it was 85.

      In recent years, B.C. Housing’s waiting list for supportive housing has more than quadrupled, from 1,165 names in January 2011 to 5,642 in November 2014.

      According to a September 2014 City of Vancouver report, there are an estimated 2,000 single-room-occupancy-hotel tenants who are “severely ill” and receiving no care for mental-health issues or problems related to addiction. In addition, two-thirds of the city’s 536 homeless people are “in urgent need of adequate mental health and addictions supports”.

      Recent police shootings involving people experiencing mental distress have attracted attention to what can happen when someone who needs help doesn’t get it. On December 28, 23-year-old Naverone Woods was shot by transit police at a Safeway in Surrey; he died later in hospital. Reportedly, Woods was wielding a knife and inflicting self-harm. On November 22, Phuong Na (Tony) Du, 51, whose family has said was in treatment for schizophrenia, was killed during an encounter with police at Knight Street and East 41 Avenue.

      The Vancouver Police Department has made a public plea for help from the province. “We need a shift from dealing with the crisis to preventing the crisis from occurring in the first place," said chief Jim Chu speaking alongside Mayor Gregor Robertson in September 2013. More than one year later, it continues to push for more resources to focus on mental-health care.

      Lost filling out forms

      Adam’s story has a happy ending. In November, he was finally placed in a supportive-housing site on Powell Street. Despite having spent time homeless in the Downtown Eastside, he is not a drug user and has stayed out of trouble with police. Interviewed again alongside Adam in December, Strehlen said she was always aware a positive outcome was far from certain.

      “I had to go get him welfare and then I had to go through the process of getting him disability status,” she recounted. “They required an essay. It took me three days to fill that thing out.”

      After years on waiting lists that he spent in dingy hotels, Adam Strehlen was finally accepted into a supportive housing development where he now enjoys a clean and private room.
      MPA Society

      For housing, Strehlen said Adam was on “six or seven” waiting lists. She noted that every one requires its own application, involves different eligibility requirements, and carries distinct rules for how one both stays in and moves up the queue. Matters were further complicated when in 2010 they moved from Burnaby (which is serviced by Fraser Health Authority) to Vancouver (which is under the jurisdiction of VCH).

      “He has had many nurses, too numerous to count,” Strehlen said. “And all that time, I’m dealing with Adam and he’s raving mad, he’s not bathing—it was a nightmare.”

      Government aware there's a problem

      The Ministry of Health, B.C. Housing, and Vancouver Coastal Health did not make representatives available for interviews. An email supplied by Health Ministry spokesperson Kristy Anderson states that in 2013-14, the province spent $1.38 billion on mental-health and substance-use services.

      In November 2014, a bipartisan committee chaired by Jane Thornthwaite, parliamentary secretary for child mental health and anti-bullying, published an interim report on youth mental health in B.C.

      “Oral and written submissions characterized the provincial mental health system as a fragmented set of services provided by different ministries and agencies,” it states. “Youth can be required to move between multiple facilities, health authorities, and communities from initial assessment to actual treatment. All of these transition points, it was noted, are fraught with gaps and barriers.”

      The report also mentions a “persistence of long waitlists for diagnosis and treatment of mental health issues”.

      Pockets of success

      Ted Bruce is interim executive director of the Portland Hotel Society (PHS), a nonprofit that operates 16 housing sites in the Downtown Eastside. He told a success story that underscores the extent of the problem.

      In mid-November, PHS opened Alexander Street Community, one of 14 supportive-housing sites the City of Vancouver is funding in partnership with B.C. Housing. The building, at 111 Princess Street, provides 139 people with what Bruce described as “wraparound services” that address mental illness and addiction as concurrent disorders.

      “The wait list for people applying to get into that building was unbelievable,” he said. “It was over a thousand people.”

      Bruce argued the city needs more buildings that offer mental-health support alongside addiction services, harm reduction initiatives such as managed alcohol programs, and employment opportunities. But housing first, Bruce added. “Folks are getting discharged from hospitals into shelters. That is really problematic.”

      Darrell Burnham, CEO of Coast Mental Health, which operates more than 30 supportive-housing sites throughout Metro Vancouver, also called attention to waiting lists.

      “For housing, it’s outrageous,” he said. “It’s longer than people can imagine. There are several hundred on the wait lists for mental-health housing alone, and they only get to four or five or 10 a year.”

      Burnham noted wait times are usually longest for people who are doing relatively well, since priority is often given to people exiting hospitals with nowhere to go but the streets or a shelter. “We could double in size tomorrow and still have a wait list,” he emphasized.

      To minimize confusion while on those waiting lists, Burnham recommended people with a serious mental illness stay in touch with a general practitioner as opposed to relying on drop-in clinics. Failing that, he suggested people try and maintain a relationship with one mental-health case worker for an extended period of time. (A case worker can be assigned at an intake centre such as the Raven Song Community Health Centre at Ontario Street and 9th Avenue, where Adam was partnered with the service provider who finally secured him a space in supportive housing.)

      Change at a systematic level

      Dr. Carol-Ann Saari, who specializes in youth concurrent disorders at B.C. Children’s Hospital and Surrey Memorial Hospital, told the Straight the B.C. Psychiatric Association is calling for children and youth programs to be reassigned from the Ministry of Children and Family Development to the Ministry of Health.

      “Part of the problem for youth mental-health services is that the responsibility is split between two ministries,” she said. “If you go to the hospital, all hospital-based services are through the Ministry of Health….When you then transition to the community, those are all run through the Ministry of Children and Family development. Why is that a problem? We have different leadership that have different priorities and these two ministries don’t necessarily work together to plan together.”

      In a telephone interview, Thornthwaite, Liberal MLA for North Vancouver-Seymour, said the youth mental health committee “heard a lot about problems in the system with regards to the fragmentation of services, but we also about where places were working".

      She told the Straight B.C. is looking at other jurisdictions such as New Brunswick, which recently consolidated mental-health services for children and youth previously spread across four ministries into the public school system. Thornthwaite said the next step might be launching a pilot project in B.C. schools that follows that example.

      “We’ve got social workers who work in all of these different ministries,” she continued. “But are those social workers talking to each other about that one child? That’s what I would like to see.”

      The CMHA's Jonny Morris likewise said that addressing barriers to mental-health services requires change from the top down.

      “I think to really improve things, we really need to look at a systematic level,” he added. “What would a collective approach, a collective impact around mental health look like in British Columbia?”

      Chasing a crisis
      This article is the fifth in a six-part series.
      Part one: Vancouver police still seeking help to prevent a mental-health crisis
      Part two: Amid a mental-health crisis, Vancouver care providers revisit the debate on institutionalization
      Part three: Vancouver service providers fail to get ahead of a mental-health crisis
      Part four: B.C. prisons lock mentally-ill offenders in isolation
      Part five: Vancouver's ill and addicted lost in a mental-health care maze
      Part six: Deaths involving police reveal a long pattern of mental illness and addiction

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      4 Comments

      sicntired

      Jan 9, 2015 at 3:17am

      Vancouver has had problems with addiction and mental health as long as I can remember.We just used to hide it behind asylum doors and the prison system.The closing of riverview and other such places put the most vulnerable among us to fend for themselves.You only have to watch a person have a long argument with no one you can see,for hours,to realize how foolish this is.BC has been uncaring and unfunding health care and the homeless issue as long as it's existed.Addiction used to be left to the police until it was realised that it was doing nothing but ruin the addicts lives.Now,with a very tiny heroin program,there is nowhere in Vancouver to buy heroin unless you know someone who's importing small amounts.There is nothing on the street but pharmaceuticals and Fentanyl.At the exact same time,the methadone that was once given to addicts has been replaced with a compound of unknown drugs including methadone hydrochloride but not exclusively that drug.Patients are complaining at over 50% with serious side effects.As so many people were put on methadone for pain.These addicts are now left with a cut down,concoction that vanishes without reason and is useful for pain for 4 hours.They give small booster doses that used to help with methadone but do very little to nothing with the methadose.Our whole health care system is a mess.Ideologues with opiate bias run the college and the 129 people that get the heroin are the only people in Vancouver that have access to that drug.It's suspicious that the heroin disappeared at the same time as a heroin program started and that the methadone was discontinued and replaced with a very poor and harmful substitute.All this at the same time that big pharma is being forced to put additives into opiate drugs to reduce their effectiveness and alter the way they are manufactured to try to stop the OD's that we are seeing on oxycontin.Of course just changing the oxy would be too simple for our prohibitionist society.Especially here,in BC.Our college rules through threats and intimidation.My doctor won't even discuss opiates.He was so scared he refused to take over the prescribing of drugs which had already been prescribed by another doctor.He said it wasn't worth his liscense.What does that mean to you?

      Eveline

      Jan 9, 2015 at 10:02am

      I am sorry to say, but even if people who need help for their mental health issues do finally receive the help, the system has predators in it. In my personal experience, I have received both good help and "help" that nearly killed me. Some time has passed since I escaped what I describe as a cult (a clandestine psychoanalysis practice that was billed to MSP) I have done an enormous amount of research on the mind control that I was subjected to. This "doctor" is highly trained in manipulation of the same type used by totalitarian societies, the CIA, and for torturing prisoners. I believe this doctor makes good money exploiting vulnerable people and enjoys making them suffer. Clients are sitting ducks, and because there is no informed consent or information about psychoanalysis (or code of ethics!)clients have no way to defend themselves. And even more unfortunate, I can't seem to get anyone in the system to acknowledge this problem and properly regulate these private practices. But I won't stop trying.

      @Eveline

      Jan 9, 2015 at 6:58pm

      If they're a real doctor file a malpractice suit. We have courts for a reason.

      healer

      Jan 9, 2015 at 9:31pm

      Travis, thank you for this excellent and well researched piece. I have worked in BC's mental health system in a variety of ways and what no-one seems to get is that a lot of this is administrative and operational. Systems are designed and built by people, and by governments with ideologies. There is also a great deal of administrative incompetence within the Health Authorities too. How many CEO's have come and gone? How much taxpayer money been spent on audits and internal reviews? An FOI about the cuts to mental health services within the Health Authorities would turn up some interesting numbers.

      Social workers speak to each other across different systems as part of ongoing case management, planning and discharge planning. That is part of their work, to bridge clients from one place, or system, to the next, if there are resources. Social work jobs in mental health, in particular. are being axed and re-classified within the health care system. MCFD has never had enough child and youth mental health clinicians.

      Health Authorities have also cut a swath through community-based programs that used to keep people stable, or intervened early for those with chronic mental illnesses. Case management services have also been completely slashed in some areas. There are simply not enough staff (psychiatrists, nurses, social workers, therapists, psychologists and support workers) and programs to serve the numbers of people who need the assessment, treatment and ongoing case management. This is by the decisions and design of Health Authority administrations and bureaucracies.

      While so many people like Adam and Angel struggle to find help, dignity and a light in the darkness as far as I can see, there is no-one, not one single person, or entity, including the BC government, that is taking leadership, responsibility, or has any accountability for the state of BC's mental health system for any age group.

      When we have our next election, we need to remember who created this situation (and it will be worse by then) and stop allowing them to create new generations of marginalized, vulnerable people who can't get the help they deserve.