Part four of Toward Peace of Mind: Mental Health in B.C., our four-part series on the state of the mental health system. Part three, on a work program helping those with mental-health issues find employment, can be read here.
The psychiatrist sees right away that there is reason to be concerned for the young occupant of a tiny, eastside SRO. Dirty clothes and used needles litter its 100 square feet and the pungent smell of human waste wafts through the doorway.
"The reason I look at rooms," Bill MacEwan says, peering into his patient's unit in Vancouver's Downtown Eastside, "is because it's a picture of their brains."
Moments earlier, the doctor had confronted the room's occupant in the hallway, asking about a meeting, chasing her down a flight of stairs and out on to the street when she refused to stop and talk. For the past decade, the silver-haired psychiatrist has taken the unconventional approach of going out to the patients who refuse to go to him.
Dr. MacEwan's roles are plenty: He does outreach work in the Downtown Eastside, he is physician leader for the Fraser South Early Psychosis Intervention Program, and he is a clinical professor in the department of psychiatry at the University of B.C., where he is also director of the schizophrenia program. Several times a month, he is on call at St. Paul's Hospital in downtown Vancouver and Peace Arch Hospital in White Rock.
On top of these duties, he liaises with police and the courts, serving as an informal link between agencies. Information sharing in any official capacity is complicated by B.C. privacy laws. Under the Freedom of Information and Protection of Privacy Act, police, hospitals and other health agencies are strictly limited in what they can share – sometimes at the expense of being able to facilitate a full psychiatric risk assessment of patients. Meanwhile, health authorities lack a comprehensive system for easily sharing information across boundaries.
A review launched in response to the case of Nicholas Osuteye, an Alberta man who visited a psychiatrist at St. Paul's Hospital days before violently attacking three women in Vancouver last December, has resulted in the creation of a task force to explore the possibility of sharing relevant forensic and police records. As well, Health Minister Margaret MacDiarmid says the ministry has started working on a system of fluid information-sharing among health authorities.
On a recent stroll through the Downtown Eastside, the 57-year-old psychiatrist – smartly dressed in a pinstriped suit, gingham shirt and paisley tie – stops every few steps to speak with patients whose names he knows by heart. Near the intersection of Main and Hastings streets, he sees Raymond Hogan, a patient he first met on some church steps maybe eight years ago. Their next appointment is not for a month, but the two stop and chat.
Mr. Hogan, cradling a one-litre carton of milk and transferring his weight from foot to foot, tells the doctor he has been feeling much better lately. The 48-year-old had been dogged by hallucinatory voices that told him to pick up litter, to clear the sewers when it rained. They often had him getting out of bed in the dead of night to pick up garbage.
"He gave me some stuff for my brain," Mr. Hogan said, referring to an injectable antipsychotic medication Dr. MacEwan prescribed. "And then I didn't feel like I had to clean the streets any more."
Dr. MacEwan's approach to meeting with patients is unusual, to be sure. He does it, he says, because it is naive to believe those with serious drug addictions or mental illnesses – or both – can arrange treatment themselves.
However, even those with strong family or community supports can face considerable hurdles in B.C.'s mental health system. For example: A 2012 report by the Fraser Institute found that, of specialists surveyed, the average wait from referral by a general practitioner to psychiatric treatment is 21 weeks in B.C. – more than three weeks longer than the national average. A report released on Tuesday by Mary Ellen Turpel-Lafond, B.C.'s representative for children and youth, stated some youths were on waiting lists of more than a year, while 40 per cent of physicians said a wait of six months for an initial psychiatric assessment was typical.
The Canadian Mental Health Association in B.C. wants mental health to be an issue in next month's provincial election, demanding a health care system that values mental and physical health equally. Other advocates, including Dr. MacEwan, emphasize the importance of stigma reduction and early intervention. While some mental illnesses are not curable, they can be managed similarly to physical ailments, Dr. MacEwan says: "You get them to try and think of these psychiatric illnesses like asthma: 'I've got asthma, but I don't have any symptoms right now because it's not asthma season. But when springs hits, I should get on my puffer because it will prevent my asthma.' People can do the same thing now. It's pretty cool."