Note: this is the third of a series expanding on FASMI’s position statements. This blog post is concerned with our position statement called Restoring the Distinction between Mental Illness and Addiction.
More and more, it is becoming the new normal to see provincial governments combining budgets for the treatment of those with mental illness and addictions. Some provincial governments have plans to expand current mental health legislation to include those with severe substance use disorders (SUDs), as was recently discussed in B.C. Recently, other provinces have attempted bring in new legislation, as in Alberta and New Brunswick’s proposed Compassionate Intervention Act. This has been the latest in a last ditch attempt to try and stop the surge of overdose deaths that are becoming rampant in our Canadian cities and towns.
Time will ultimately reveal the path Canada’s provinces decide to take with these prospective legislative reforms, but one thing is clear: combining mental health and addictions, in the health care sector has so far proven to be both an exercise in sustained, insufficient funding and a statistical failure.
The treatment and care of those with severe mental illnesses (SMIs) have consistently been underfunded in both research and resources, particularly when contrasted to physical illnesses. By combining SUDs and mental illnesses within the same budgetary line number, governments continue to downplay the seriousness of each and underfund both.
The rate of SUDs has escalated since the pandemic but even prior to that, an industry of privately run rehabilitation facilities had become a profitable venture for some. Ironically, some of these rehabs prove to be both expensive and ineffective, owing to the lack of provincial legislation which would regulate and enforce industry accreditation standards. With no regulatory body in place to enforce such standards, some of these sites employ staff members with questionable training and credentials, programming which may be less than evidence-based, and feature post-treatment support that is either lacking or non-existent.
Desperate families are left to their own devices to choose one of these typically expensive and privately run facilities, or, run the risk of rolling the dice for a wait-listed slot within inpatient addiction programming in the public system. Some of these have limited duration (7 to 30 days), may only be available during daytime clinic hours and have little to no follow-up support. Additionally, publicly available inpatient addiction programs are wait-listed as demand consistently outpaces supply.
As parents of an adult child with co-occurring illness we have watched in disbelief as we were told by a clinician that our son would need to have his SUD treated first. Then, after he was in rehab for 10 days, we were asked to pick him up and told that he needed to be in hospital for treatment and stabilization of his SMI. In the meantime, he refused further care due to deciding “there was nothing wrong” with him. This is the conundrum many families are faced with.
The additional difficulty of trying to get someone with “lack of insight”/anosognosia, who doesn’t believe they are ill, the emergent care they need when co-occurring illness is present, brings an added layer of complexity that can be very difficult to navigate. Conflicting messaging such as:” You’ll have to let him hit rock bottom”, and “He’s an adult and as long as he isn’t harming self or others he can make his own decisions,” and, “He may be making impulsive or risky decisions that you or I would not, but it is his right to do so” bring with them a whole new level of confusion and dread. These kinds of statements are hard for parents and family caregivers to hear particularly when impulsivity is a clinical feature in both bipolar disorder and schizophrenia.
By now, government and policy makers have had access to research that clearly shows mental illnesses and SUDs as very separate and serious entities that need to be treated as such.
Whatever benefits that may be had by combining programming and resources for mental illness and addictions: i.e., reduction in the overall economic burden at the system level, IE: (parallel management and administrative structures that can be combined rather than operated independently), do not necessarily translate into success from a statistical perspective.
Barriers to care whether through a lack of resources due to underfunding, or legislation which makes accessing services inaccessible to those who need them most, are the hallmarks of our time.
FASMI’s Position Statement on Restoring the Distinction between Mental Illness and Addictions is:
Mental illness and addiction are two quite different conditions, with different origins and requiring distinct treatment methods. By recognizing and addressing these issues independently, we can pave the way for more effective, targeted, and compassionate support for individuals grappling with severe mental illness in Canada.
There must be separation of mental illness and substance use disorder in the realms of treatment, resource allocation, and legislation within the Canadian healthcare system. Everyone living with a mental illness, a substance use disorder, or both, must be given treatment that is appropriate to their situation.
We know that those with SMIs are vulnerable to self- medicating with illicit drugs therefore, it makes sense that in treatment as well as in community residential housing, they remain separate from those with SUDs or co-occurring illness.
The Transtheoretical Model Stages of Change which talks about “pre-contemplation and contemplation” regarding treatment resistance for those with SUDs, is dangerous to apply to those with SMIs or co-occurring illnesses who may have a lack of insight/anosognosia (cognitive damage to the frontal lobe which causes individuals to not understand they are ill).
For these reasons, three streams of independent treatment – (1) for those with SMIs, (2) for those with SUDs, and (3) for those with co-occurring illness - would provide individualized care and prioritizes the safety and needs of each demographic.
For the sake of those with SMIs, SUDs, or both, and the parent and family caregivers who support them, we must insist our governments do better and are held accountable to provide safe, accessible and evidence-based treatment and services.
The opinions expressed in blog posts are those of the author and do not necessarily reflect the opinions and beliefs of FASMI. To join FASMI, visit our Sign Up page.
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