By GARY MASON
02/09/10

Bill MacEwan has a perspective of mental illness in Vancouver few have.

He is one of the leading psychiatrists in the country and director of the University of B.C.'s schizophrenia program. He also runs an acclaimed psych wing at Vancouver's St. Paul's hospital called Ward 9a, and a psychosis intervention program at Surrey's Peach Arch Hospital. Dr. MacEwan regularly ventures down to the city's Downtown Eastside to work with some of the most troubled people you'd find anywhere.

In other words, when it comes to mental illness and our failure to grapple effectively with its burgeoning presence in this city, few have his bona fides.

That failure is so multifaceted it's hard to know where to begin. And frankly, there is no way to chronicle all the problems in one short column. But let me highlight a couple of Dr. MacEwan's biggest concerns.

For starters, he says, there are no productive treatment options for so-called dual-diagnosed or concurrent disorder patients. These are people with a drug or alcohol addiction as well as a mental illness. This constitutes a staggeringly large percentage of mentally ill people in the city.

Dr. MacEwan said that two-thirds of the people he sees at St. Paul's have substance abuse problems and 80 per cent of those have a major psychosis. Of those, about 70 per cent have no fixed address.

Community programs to help these people have a critical design flaw: They insist they show up clean and sober.

“That might be okay for a few,” says Dr. MacEwan. “But for the vast majority in the Downtown Eastside, they have no interest in coming off drugs. This is the problem. We now say if you are going to get treated you have to want to get treated. If not, you're left to your own devices.

“Well, that's exactly the group we're trying to deal with here. Some just can't meet the criteria we've set because of the ravages of psychiatric illness, demons, voices they hear, whatever. They don't have the freedom of choice.”

Drugs, in particular crack cocaine and methamphetamines, play a big role in this ongoing tragedy. These drugs are often the cause of mental illness. Any number of people, in the Downtown Eastside particularly, are willing to supply the sick with these drugs. They even sneak into hospitals to find customers. Dr. MacEwan says hospital staff caught one drug seller in Ward 9a posing as a pizza delivery person.

This is why we'll never truly deal with the growing problem of mental illness in this city as long as the Downtown Eastside exists in its present state. It is just too easy to prey on the sick and vulnerable there.

For now, Dr. MacEwan believes the Downtown Eastside needs a program to deal with the concurrent disorder problem, using health teams that go out and find people suffering from this problem and getting them into acute triage beds.

“There should not be a referral system or any reason for turning people away like many programs in the Downtown Eastside do,” he says.

Dr. MacEwan believes another big problem is the B.C. Mental Health Act.

The act, he believes, is not being used to its full potential. We are not certifying people as mentally ill when they should be. And those who are being certified are not being put away long enough to do them any good. Blame it on One Flew Over the Cuckoo's Nest.

People still associate forced psychiatric care with images from decades past of zonked-out looking people with lobotomy scars being pushed in wheelchairs by an unsmiling Nurse Ratched. Consequently, mental health care professionals have gone overboard to make sure the treatment of mental illnesses is as non-intrusive as possible.

“The Mental Health Act is being very narrowly and strictly interpreted,” says Dr. MacEwan. “Locking people up and leaving them there isn't going to work. But there are definitely some who need to be put away for a long time. That's the only chance they have of getting better.

“More people need to be certified [as mentally ill] than is currently the case. Now people are being released from hospital and sometimes [committing suicide] very soon after. Many get right back into drugs.”

Brain disorders caused by crack cocaine and methamphetamines can last up to nine months after a person stops using the drugs, says Dr. MacEwan. That's another reason certain people need longer stays in a hospital or mental health care institution.

B.C. Health Minister George Abbott is promising a new psychiatric hospital for those with extreme cases of mental illness – a number in Vancouver he estimates to be between 100 to 150. Unfortunately, as measures go, it will not be nearly enough to deal with what the Vancouver Police Department is calling an all-out crisis.

Mr. Abbott needs to convene a roundtable on the problem immediately. Dr. MacEwan should be the first person he calls.