Sometimes the most effective innovation is the most obvious one. For health-care providers struggling to help B.C.’s most severely troubled citizens in the Downtown Eastside, that light bulb idea was simple: instead of dealing with each health problem separately, why not create a centre where patients could access integrated treatment for addiction, mental health and other significant health problems under one roof?
Before the June 2008 opening of the Burnaby Centre for Mental Health and Addiction, there was no treatment specifically for those with such a mix of serious health problems. “What we have been doing for the last decade is just keeping them alive,” says Heather Hay, who worked for Vancouver Coastal Health in the Downtown Eastside for years as a regional director of complex mental health and addiction before becoming director of the centre. “We were making contact but had no long-term solutions.” Hay, who was also involved in establishing the Insite safe injection service, pushed for a dedicated centre that would allow health-care providers to better reach these challenging clients, and Premier Gordon Campbell announced funding in February 2008. Vancouver Coastal Health, the Provincial Health Services Authority and the Ministry of Health partnered to open the centre: a 100-bed facility that provides long-term care specifically designed for people with a complex combination of addiction, mental illness and other health problems such as HIV/AIDS and tuberculosis.
“In the current climate, the focus has been very much on pushing people into the community and accessing a collection of community resources that are all spread out,” says Douglas Saunders, a clinical psychologist and assistant professor at the University of Toronto. “[The centre in Burnaby] is innovative in that it bucks this trend.”
Most addiction services typically offer 30- to 60-day programs while programs offered at the centre last between nine and 12 months. This allows staff to build trusting relationships with clients, fully address their health issues and help them prepare to resume normal life. Instead of the focus being solely on fixing their problems, clients are encouraged to develop their strengths. “People usually talk about these clients as addicts or the homeless, but they all have another face. Are they a good parent? A poet? Musician? It changes their identity,” Hay explains.
While other programs that concurrently treat addiction and mental illness exist in Canada, the centre in Burnaby is bringing integrated treatment to the next level. “As soon as you throw in homelessness, you’re into a whole different ball game,” says Saunders. The holistic model of treatment extends even past health-specific issues, with wide-reaching collaboration between the justice system, Ministry of Housing and Social Development and Ministry of Children and Families. Although it’s too early for comprehensive statistics, anecdotes abound of patients achieving the ability to live in independent housing, care for their children and pursue higher education. Nearly 150 patients have completed the program thus far.
BCB’s panel believes there is also an economic benefit to society as a whole in treating these people more effectively. As one panellist argues, “The enormous cost to public safety, enforcement, emergency departments and the cost to the health-care system overall through secondary medical conditions is another reason the national and international communities are interested in the success of the Burnaby centre.”
There is still much work to be done. With more than 700 referrals to date, the centre’s waiting list is long. Five per cent of potential patients die while waiting for treatment. But it is continuing to grow and search for innovative models of care. In January, 22 new beds opened for female patients who need additional support after completing the program, and 22 beds for young adults (between the ages of 19 and 24) will be available in May.
