Joy MacPhail, in her recent opinion piece, makes clear how pleased she is with the new provincial plan to improve mental health and addiction services. She believes that this plan, called A Pathway to Hope, can help “improve the well-being of all citizens.”
As the mother of a daughter living with schizophrenia, I disagree. Many unmet needs of adults living with the most severe psychotic disorders are not addressed.
MacPhail focuses on the high rate of hospitalization as evidence of the failure of the current mental health system. It is disappointing that she doesn’t acknowledge the many people with untreated psychotic disorders whose suffering is very visible on the streets of cities and towns throughout the province. Lack of treatment for this population leads to homelessness, victimization, addictions and incarceration.
The article seems to argue that all mental illnesses arise from negative social factors. It is unclear if MacPhail knows that psychotic disorders like schizophrenia and bipolar disorder cannot be prevented. It is also unclear if she knows about anosognosia, the brain-based inability of many people in psychosis to understand that they are ill. This symptom leads people to reject treatment when they most need it.
It is good that increased funding will probably be used to expand B.C.’s too few Early Psychosis Intervention programs. These time-limited programs, unlike much of the rest of the mental health system, are known for educating clients and their families about the illnesses they are living with. I have seen how people who receive adequate psycho-education have a much better chance of understanding, accepting and learning to manage their illnesses.
Most people with schizophrenia can have their psychotic symptoms alleviated by anti-psychotic medications. However, there is widespread and ongoing disability in this population because psychotic disorders often involve significant cognitive losses. B.C.’s many influential anti-psychiatry/anti-medication activists should learn that these losses often appear before the use of any medications.
These cognitive losses include difficulties with concentration, short term and working memory, problem solving, judgement and social skills. These problems can make many of the tasks of daily living, including remembering to take medications and attend medical appointments, very difficult.
All clients and families need, but currently do not have, the chance to learn about these cognitive losses. As well, clients deserve access to the evidence-based cognitive remediation programs that exist in many other countries.
A coalition of representatives from the B.C. Schizophrenia Society, B.C.’s Early Psychosis Intervention programs, the B.C. Psychosis Program and B.C. Psychosocial Rehabilitation put on a sold-out conference in 2017 on Bringing Cognitive Remediation to British Columbia. This group has gone on to submit several proposals for training staff in implementing evidence-based cognitive remediation programs. So far, this government has chosen not to provide necessary funding.
As someone who has always voted for the NDP, I am concerned about some of this government’s approaches to severe mental illnesses. The recent recommendations from the B.C. Ombudsperson, for example, will embed the Community Legal Assistance Society in hospitals to provide advice to all involuntary inpatients. This is an organization fighting to abolish access to involuntary treatments.
Currently, nurses and social workers inform involuntary patients about their rights and about ways to access review panels to ensure that people are not receiving unnecessary treatments. Patients will soon receive advice and legal assistance from an organization that publicly doubts the value of anti-psychotic medications.
Hopefully, the NDP can be persuaded to better meet the needs of people with the most severe mental illnesses. Rather than spending millions of dollars on lawyers, the right kinds of services for this disadvantaged population could be implemented.
A lot of money is about to be spent on various mental wellness programs. Some of these funds should be used to improve mental illness literacy programs. Educating the public about psychotic disorders can increase their ability to help people access and stay engaged in essential services.
Susan Inman was an English and drama teacher at Windermere Secondary School for 24 years. She has a daughter living with schizophrenia.
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