Issue 3: Addictions and Mental Health Care

  • Addictions and substance use often accompany mental illness, increasing individual’s vulnerabilities, risk to illness and poverty, and barriers to receiving care.
  • Substance is reported by some as a form of self-medication when they are unable to receive mental health care.
  • Individuals who experience the co-occurrence of addiction and mental illness “often experience poorer physical health and greater psychological distress.

DEFINITION

Substance Use

A pattern of using psychoactive substance, including but not limited to alcohol and illegal substances. Psychoactive substance use often lead to dependence.

  • Addiction and mental health correlate to heightened stress and impairment of cognitive functioning, which may result in a range of illnesses.
  • Mental illness and addictions have been associated with the reduction of life expectancy by up to 20 years, as well as premature death, most individuals impacted by a dual diagnosis will recover if they receive the “appropriate treatment and support.”

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Housing and homelessness

  • Substance use and homelessness has a complex relationship
  • Someone with unstable housing has an increased risk of losing their housing if they use substances.
  • Once homeless, access to healthcare, which includes specific substance use supports, such as recovery and treatment services, becomes much harder.
  • Without treatment, after discharge from a hospital or centre without treatment, there is a lack of housing options which can jeopardize their recovery process.
  • Transitional housing is one approach to “addressing substance use problems,” however, many do not qualify for facilities that require abstinence.
  • In 2014, it was approximated that at least 235,000 Canadians would be homeless by the end of the year.
  • A study defined hidden homelessness:  “ever having had to live temporarily with family, friends or in their care because they had nowhere else to live”
  • A tenth of Canadians “have experienced hidden homelessness.”
  • Those with a disability are  more likely to experience hidden homelessness.
  • Hidden homelessness is more likely experienced by those with a weak social network due to moving multiple times within a five year period, and those who are non-heterosexual.

The Child Welfare System and Vulnerable Youth

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  • In 2016, a national survey indicated two of every five youth respondents became homeless due to aging out of care, thus losing supportive housing access.
  • Foster care has repeatedly been linked to homelessness later in life, which impacts Indigenous youth who are overrepresented in our child welfare system.

Opioid crisis

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  • Opioids are a class of drugs that are primarily prescribed to treat severe pain, which can lead to “fatal overdose, along with other medical, legal and social problems.
  • Tolerance to opioids builds up quickly, thus increased amounts are needed to experience euphoric effects, which can lead to physical and psychological dependence.
  • A majority of substance-related deaths were male victims, and individuals between the ages of 30-39, however, these categories vary across territories and provinces.

DEFINITION

Opioid Crisis

The rapid increase in the use of prescription and non-prescription opioid drugs, beginning in the late 1990s and continuing to today. The potency and availability have made opioid a popular medical treatment and recreational use, despite their high risks of addition and overdose.

  • A breakdown of opioid-related deaths in 2016-2017
  • Canadian Addiction Treatment Centre:  “opioid addiction epidemic is fueled by prescription addiction, synthetic drugs, and the extremely addictive heroin drug.”
  • Synthetic fentanyl has been reported to sometimes contain a higher potency level than regular fentanyl. Fentanyl is potent, deadly, versatile, and highly profitable due to the ease and low costs of producing it in relation to heroin.

According to Michael Heitshu, chairman of the Coalition for Safe and Effective Pain Management, rising rates of addiction and opioid overreliance is due in part to a lack of affordable alternatives.

  • “Canada’s first supervised injection site (SIS)” was opened in the Downtown Eastside in Vancouver 15 years ago. Despite the SISs, local health officials conceded that Insight doesn’t-or simply can’t- provide enough service to satisfy local harm reduction needs, and that the current budgets allocated to their operation are too low.
  • In addition to promoting public health and safe use, SIS also has a detox and and opportunity for individuals to connect with other services and support. The current treatments available are: substitution drug therapies, and addiction treatment counseling.

Criminal Justice System/Incarceration/Corrections

  • Those experiencing mental illness do not have a relationship with the criminal justice system and are never incarcerated
  • Those with illnesses such as “psychosis, depression, anxiety, and substance-use disorders are over-represented in Canada’s correctional facilities.”
  • In 2010, a report reviewed the capacity of Canada’s correctional system to respond and address mental illness.
  • The majority of offenders suffering from mental illness in prison do not generally meet the admission criteria that would allow them to benefit from services in the regional treatment centres.
  • They stay in general institutions, and their illnesses are portrayed as behavioural problems or are labelled as disciplinary as opposed to health issues.
  • Correctional officers who work with federally sentenced offenders on a daily basis cannot recognize the symptoms of mental health problems and illness
  • Corrections officers at Regional Treatment Centres do not receive specialized training.
  • The Globe and Mail: A letter summarized 33 prisoner’s experiences in Canada’s federal corrections system in the Pacific region.
  • Many of the prisoners were unable to access basic treatment for the addictive drugs that includes fentanyl and oxycodone
  • They stated opiate substitution therapy waiting times fluctuated from months to years.
  • Don Head: one tenth of male offenders and one fifth of female offenders admitted to detention have serious mental health issues, which known as an underestimation because the CSC only recently started “tracking mental illness upon admission.”
  • Mental disorders in federal prison are three times more common than in the general population, which contributes to an increased likeliness of offenders with mental health issues to self-harm.
  • Four fifths of offenders “admitted to CSC correctional institutions have serious drug or alcohol abuse problems.”
  • Indigenous populations: are overrepresented among segregated offenders, have higher rates of mental disorders and addiction issues, are younger upon admission, serve more of their sentences before release (than non- Indigenous populations).
  • Indigenous communities are more likely to feel the effects of lack of mental health care in the  federal correctional system.
  • Mental health courts, like Ontario for example, offer a promising solution. You can read more here and here.

Stigma

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  • Stigma: can impact individuals “willingness to attend treatment and access to healthcare, harm reduction, self-esteem and mental health.”
  • Those with substance use disorders face barriers seeking treatment, which has significant “economic, social, and medical costs.”
  • Perceived stigma also has detrimental impacts, which include chronic stress, discrimination, exclusion, and in some cases, can cause an increase in drug use.

Stephanie Knaak, Ed Mantler & Andrew Szeto argue that stigma also exists within the healthcare system,  amongst healthcare providers, which create barriers toinadequate care for individuals with mental illnesses. Within the mental health care profession, Knaak et al. argue that healthcare staff see the illness rather than the person when it comes to certain disorders, a lack of awareness, therapeutic pessimism, lack of skills, and stigma in workplace culture. Stigma is systemic and structural within our society.

The research of Clarke, states racial minorities have historically suffered from what they term stratified biomedicalization, it is argued that inequality is structural. There is unequal medicalization in part due to media portrayals which associate “genetic determinism and genetically based racism”. The medicalization of mental illness and substance use disorder has roots in racial stereotypes, which exists within society in the form of intensified stigma towards people of colour.

DEFINITION

Structural Inequality

A condition where categories of people are attributed to an unequal status in relation to other categories of people. This relationship is perpetuated and reinforced by unequal relations in roles, functions, decisions, rights, and opportunities. 

For an overview of the racist criminalization of opiates and cocaine in the United States, click here.

Key Stakeholders

Affected Groups:

  • First Responders, those experiencing mental illness and substance abuse, the families and loved ones experiencing mental illness and addiction, the Canadian Correction Services, service providers.

Other Key Players:

  • Centre for Addictions and Mental Health
  • Canadian Mental Health Association
  • Mental Health Commission of Canada
  • Canadian Centre for Substance Abuse
  • Canadian Centre on Substance Use and Addictions
  • Health Authorities
  • Health Canada

Who is doing something now?

Party Platforms and Positions:

Liberal Party of Canada:

Conservative Party of Canada

New Democratic Party of Canada

Bloq Quebecois:

Green Party

Provincial/Territorial Parties

What is being done now?

Federal Government of Canada:

  • In 2017, the Minister of Health announced an increasing in federal funding for the Centre of Excellence for Women’s Health in BC’s ‘Trauma- and Gender- Informed Approaches in Substance Use Practice and Policy project.’
    • This project will now include opioid use, and will continue to take gender and trauma into account when creating resources for substance abuse
  • The Government’s approach to the Opioid crisis can be found here

Provincial/Territorial Governments:

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