Don’t isolate mental health

Provincial health officer Perry Kendall has warned that creating a new Ministry of Mental Health and Addictions would be unwise. He was responding to a proposal by the NDP-Green alliance. John Horgan and Andrew Weaver, who lead the two parties, have said a separate ministry is required to deal with the escalating challenge of overdose deaths and untreated mental illness.

That we are facing an addiction crisis is unquestioned. In the first four months of 2017 alone, there were 488 overdose fatalities, province-wide.

Likewise, our mental-health programs are inadequate. The provincial auditor general reported in 2016 that the government does not have a comprehensive strategy for treating serious mental illness in adults.

But the solution proposed by Horgan and Weaver will only make things worse. On its face, it appears seductive. Why not tackle the problem with a stand-alone ministry unencumbered with other issues?

But Kendall gives the answer. First, you would have to change the reporting relationship of several dozen programs located in the Health Ministry, health authorities and dedicated facilities such as Island Health’s Eric Martin Pavilion and the forensic psychiatric program at the Provincial Health Services Agency.

Staffing units would be pulled apart and duplicate teams of managers hired at considerable cost. Service agreements with the Yukon government and Ottawa would have to be renegotiated, and numerous provincial statutes recast.

The effort required to make these changes would drive attention away from the pressing job of improving services now.

But a more critical issue is at stake. Modern healthcare delivery is based on treating each patient as a whole person, not as an unconnected assemblage of maladies.

In the case of mental illness, many patients have coexisting physical ailments that contribute to their overall condition. If they are to receive seamless care, the treatment of these ailments must be integrated.

At present, this is accomplished by preserving a database that records each interaction between every patient and caregiver in B.C. It is through access to this archive, which the Health Ministry manages, that caregivers can track a patient’s complete medical history, including drug interventions, hospital admissions, etc.

So will the new ministry create its own patient database? On the one hand, how can it operate and meet audit standards, if it doesn’t?

But on the other hand, the process would be a logistical nightmare. According to the Mental Health Commission of Canada, one in two Canadians will have had some form of mental illness by age 40. That’s a lot of files to create.

There is an additional matter to consider. While progress has been made in recent years, mental illness still bears a social stigma. We should be welcoming these patients into the mainstream, not treating them as a group apart.

There is also a lesson from history here. In 2001, the incoming Liberal administration created a new Ministry of Health Planning. The result was an attractive sound bite but an operational failure.

Ministers squabbled, officials squabbled and the project was eventually abandoned. But this was far less of an operational challenge than setting up a ministry for mental illness and addictions.

So what is the answer? In 2011, the provincial government announced a 10-year strategy for mental-health services in B.C. Yet the current service plan has only one performance target for the programs involved.

The correct response is to demand a vastly enhanced plan, with appropriate reporting and a major infusion of funds.

We don’t need a separate ministry, with all the confusion and bureaucratic infighting that will cause.

We need a serious reinforcement of existing services, and a recommitment, from the premier on down, to addressing these critical health issues head on.