RESIGNATION MIGHT FINALLY BRING NEEDED TREATMENT

So now the head of the region's new psychiatric emergency service has
quit. In a funny sort of way, that's almost good news.

Dr. Anthony Barale's passion and rare candour around the crappy way
we're managing addiction and mental illness will be missed. I don't
like to think of people like him getting squeezed out of the Vancouver
Island Health Authority, because we desperately need them to guide
change. And boy, do we need change.

All will not be lost along with Barale, however, if his high-profile
resignation this week wakes people up. Finally, it's not just the
social groups sounding the alarm about dwindling community services
and support, but the clinical director of a barely two-year-old VIHA
service intended as a leading-edge response to people with mental illness.

Archie Courtnall Centre, at Royal Jubilee Hospital, has instead become
the "default processing centre for addicted individuals seeking
treatment," complained Barale. Apparently, nobody at the centre
contemplated dealing with that much addiction. (What's with that,
anyway?) Worse still, there's no other place to send people with
addictions, meaning they end up the centre's problem even though it
wasn't built to deal with them.

"The staff of the psychiatric emergency service struggle daily to
provide even the most basic medical and psychiatric care for his
suffering population," said Barale. "And they do so with little
support and the pitiful resources provided by VIHA -- resources which,
even by so-called Third World standards, are entirely
inadequate."

You go, Dr. Barale. Use that influence to get this beast in motion.
Social groups are viewed as serving their own interests whenever they
try to get the same message across, and business groups are still too
caught up in the "lazy bum" theory of homelessness and addiction to
move this issue forward. But the good doctor knows his stuff, and
maybe his can be the resignation that transcends the divide.

That addiction and mental health are so tightly linked should hardly
be a surprise in a province that has relentlessly cut back
mental-health services for more than 20 years. What might you do if
you were bouncing around homeless, broke and lost for long enough?
Might you not look for something to make it all go away for a little
while?

It's a potent mix, mental health and addiction. Each makes the other
worse, as Barale can no doubt attest. Each can lead to the other. The
pain of mental illness can lead someone to look for relief from drugs,
and the long-term or toxic use of street drugs can shatter people into
a million pieces.

It shouldn't matter which comes first, the addiction or the mental
illness. But it does in terms of trying to find health services.

Heaven help the addict who is going crazy from the drugs, because
that's the wrong order as far as our health services are concerned. It
is, however, a common problem. Almost half of the people admitted to
the Archie Courtnall Centre's three-day beds since it opened in 2004
had a primary diagnosis of addiction.

Allow me to share a story from the front lines, of a woman in her late
40s connected to the social agency where I work full-time. One day she
was going crazy, rattled to the core by the drugs she'd been using.

Her body movements were jerky and unpredictable, the result of brain
chemistry so out of whack that the violence of her body very nearly
tipped over the chair where she sat. We finally called for help when
she started hitting herself repeatedly in the face.

VIHA's emergency mental-health team responded, but left within
minutes. A VIHA worker familiar with the woman had declared her to be
not mentally ill, but in a drug-induced psychosis. The team said they
were unable to help. Her options at that point were a few hours at the
sobering centre or the streets.

What does any of this mean to the average citizen? Sadly, almost
nothing. Wrong-headed as it might be, addiction and mental health too
often conjure up sloth and weak character in the public's mind.

But that needn't stop action. We don't solicit public input on how our
health system deals with the problems that we bring to it. If the
issue was cancer treatment, for instance, we would bring in the
experts and figure out the best possible strategy. There's more than
enough expertise in B.C. to figure out how we can be effective around
addiction and mental health. We need only begin.

With any luck, the resignation of Dr. Anthony Barale will shake us
from our tragic stupor. People who wrongly assume they know everything
may briefly be prepared to listen to a psychiatrist-manager who
witnessed the problems firsthand. What Barale saw was nothing new, but
his voice ought to carry well.

Shout it from the rooftops, doc. We've been messing this one up for
long enough.