NOWHERE ELSE TO SEND ADDICTS: MD

Departing Head of Psychiatric Emergency Unit Says He Had No Choice
but to Accept Them As Patients

Strung out on cocaine or crystal meth, they pile up in the comfortable
waiting room chairs of the new Archie Courtnall psychiatric facility
and wait for help.

Psychiatrists say they aren't qualified to deal with these patients'
addictions, homelessness or diseases, and can't cope with their
numbers. But they don't know what else to do.

"It's unethical to discharge them," Dr. Anthony Barale, departing
clinical director of the Archie Courtnall Centre said Wednesday.

With only seven Victoria adult detox beds, which often have a waiting
list, Barale said psychiatrists don't have anywhere to send the
unexpected flood of addicted people.

When social workers and nurses can't find facilities in town to place
the addicted patients, Barale said he just breaks the rules and lets
them stay.

"We let them detox here, spend five, six, seven days even though the
[four] beds are three-day placements [intended for the mentally ill]."

Sometimes these individuals just sleep or "wear it off" while sitting
in the waiting room. Some are put in the facility's two secure rooms
designed for mentally ill people who may harm themselves or others.

Barale is quitting the nearly two-year-old $2.2-million psychiatric
emergency facility at the end of this week. He is taking a new job at
Victoria General Hospital.

"I leave with a lot of anger and reluctance," Barale said. "I don't
want to leave. But the team here feels unsupported and
unrecognized."

He said he's leaving because he has found that the Vancouver Island
Health Authority administration has its own agenda "and they're not
prepared to listen to people on the front lines."

The 48-year-old doctor was instrumental in planning and running the
facility paid for mostly through money raised by Victoria's Courtnall
brothers -- Bruce and former NHL stars Russ and Geoff. Their father,
Archie, committed suicide after a battle with mental illness.

The emergency psychiatric facility was intended to provide a calm and
caring atmosphere and provide for mentally ill individuals requiring
short-term stays and to take pressure off Royal Jubilee's ER
department and Eric Martin Pavilion, with 80 beds for the mentally
ill.

"We don't want to flood Eric Martin," Barale said. "My partner and I
were hired to do the opposite."

Alan Campbell, director for VIHA's mental health and addiction
services, says the health authority recognizes the need for more
services for addicted and mentally ill patients and has a plan to
address many of the inadequacies in mental-health care services
Island-wide.

But Barale said without proper resources, all VIHA's plans are just
that. Plans.

"I cannot think of a single psychiatrist who doesn't support me,"
Barale said.

Psychiatrist Dr. Andre Masters works out of the Mental Health Centre
and the Archie Courtnall Centre when he's on call evenings and
weekends. "Colleagues in the department of psychiatry share [Barale's]
frustration and concerns," he said.

"At least 60 per cent of the cases I see, on average, have addiction
problems," Masters said. "There's nowhere for them to go, those who
want to get help."

So psychiatrists cater to primarily addicted people, "shortchanging
the primarily mentally ill," Masters said.

At least 20 residential detoxification beds are needed, he said. "We
need halfway houses; there is no long-term residential treatment
available; and time spent dealing with this mess affects the care of
those with primary psychiatric illnesses."

Masters said there will be more problems if Victoria provides
supervised injection sites but doesn't also supply equal resources and
community facilities for people who want to quit.