ONCE, THERE WAS NOWHERE TO GO

For those who are addicted and mentally ill, Burnaby has a haven - but
beds are limited

Cancer patients would not be discharged and denied medical treatment
because they smoke cigarettes, says Dr. Michael Krausz.

But it's that attitude, one of denying care to difficult and complex
patients, that many of the clients he sees at the Burnaby Centre for
Mental Health and Addiction have come up against.

"They are banned from treatment due to bad behaviours. It's seen as a
moral issue. They are thrown out of their housing. They are thrown out
of emergency rooms," said Krausz, the centre's medical director.

"If you look at the clients we see in here, more than 50 per cent have
psychotic symptoms and 20 per cent have bipolar symptoms. We are
talking about people who are facing major, major problems in their
life and severe, persistent mental illness."

Opened in June 2008 and operated at an annual cost of $14 million, the
centre provides longterm treatment for those whose lives have been
virtually destroyed by mental illness, addiction and other problems.
At least 72 per cent of the 201 people admitted so far have also been
homeless.

About 45 per cent of the first 400 clients referred to the centre had
experienced trauma and abuse, a major factor in developing severe
addiction issues.

"Often substance use is part of their coping mechanisms. If you live
in a single-occupancy room in the Downtown Eastside with a bipolar
disease, you would start to use stimulants in a week," said Krausz.
"And there is no psychiatrist to see them there. There is no hope; no
light at the end of the tunnel.

"Our main philosophy is to serve people, to understand what their
needs are and then reorganize ourselves along their needs instead of
forcing people to meet the needs of the health-care system."

So the made-in-B.C. approach is to find the strengths in each person
and to treat the illnesses and the person at the same time. And that
has meant a wholesale change in the way the 140 staff perceive the
clients. It's a far cry from the typical medical model.

Krausz said even if someone is hearing voices or having delusions,
it's important to his recovery to maintain connection to peers and
family, to build relationships and to restore lost
self-esteem.

"A lot of the treatment we are providing . . . has nothing to do with
addiction or with psychosis or with bipolar," he said.

Obviously those are treated, he said, but a key part of recovery is
stabilization of the person and reintegrating them into the community.
The centre provides acupuncture services, art therapy, music classes,
yoga and outings to the local library and swimming pool. Clients are
helped in learning how to structure their days, a skill they will need
upon "transitioning" out of the centre.

More than 60 per cent of the current clients are enrolled in education
programs. The average stay is from nine months to a year.

"It becomes unique . . . that we are ready to commit ourselves to the
most challenged clients instead of excluding them, being really
committed to work with them on a long term," said Krausz.

"People come here with a chaotic life - fights every day, a lot of
threats, nearly no income and involved in all kinds of deviant
behaviours - and to adapt and really change direction takes time."
Unlike most treatment centres, this one tolerates relapses into drug
use. It's seen as a part of recovery and as an opportunity to explore
the triggers that led to using.

All of this comes at a cost of $340 per person per day. The per diem
at an acute-care hospital is more than $1,000 a day, while supported
housing in the Downtown Eastside averages between $50 and $70.

Heather Hay, Vancouver Coastal Health's regional director for complex
mental health and addiction populations, said the cost is equivalent
to that of a seniors' residential-care home and is far cheaper than
treating people on the streets.

"When this client population is left untreated on the street, we're
using policing resources, ambulance resources. [There's] inappropriate
use of our emergency department, inappropriate use of our inpatients'
beds in acute care and many of the clients . . . have been 30-,
40-time visitors per year to our emergency department," said Hay.

"So, from a health-care perspective, $14 million is a drop in the
bucket compared to the overall cost to the system of this client
group, which is huge."

A 2008 Simon Fraser University study found that the average homeless
person - more than half of this group also suffer from mental illness
and drug addiction - uses nearly $55,000 a year in services.

On the day the Burnaby centre opened, staff found someone waiting at
the door to get a bed. Ever since, demand for the 100 beds has far
outweighed capacity. There are 600 people on a "referral list" waiting
to get in, a number that isn't acceptable to Dr. Krausz.

The first assertive community treatment (ACT ) team to be struck in
Vancouver is responsible, along with the centre's outreach team, for
supporting those waiting to get in and those already discharged. At
least 113 clients have left the centre, all with community care
supports in place.

St. Paul's Hospital psychiatrist Dr. Bill MacEwan, who also provides
outreach psychiatric services in the Downtown Eastside, said it's
great to see the combination of mental illness and drug addiction
become inclusionary criteria.

"The difficulty we've had is that anyone who has a major drug problem
often doesn't get the appropriate treatment at a psychiatric ward -
and anyone who's got a major psychiatric problem has not been able to
get the appropriate intensive treatment at a recovery facility," said
MacEwan.

He is pleased that staff at the centre are willing to alter the
program, for example when policy was changed to restrict movement in
and out of the firstphase treatment area, where clients are often
detoxifying.

No one sees the centre as the "whole answer," he said, but his hope is
that spin-offs from the facility, such as the ACT team, lead to the
complete integration of mental-health and addiction services in the
community so that people don't lose touch with treatment options.