Reconfiguring Mental Health and Addiction Services in the Health Authorities
Reprinted from "Concurrent Disorders" issue of Visions Journal, 2004, 2 (1), p. 47
Imagine you are a person with a mental illness. Now imagine you are also a person with an addiction, and that this concurrent disorder (mental disorder plus addiction) interferes with your ability to live a normal, productive and healthy life. Even further, imagine that even though your addiction and mental illness are affecting each other, neither a service from the mental health system or the drug and alcohol addictions system is fully able, or even willing, to help. You are turned away by the mental health system, you are told, because you have an addiction and need to treat that first, only to be told by an addictions service that what you really need to do is go treat your mental illness first.
Unfortunately, that routine was more common than one would hope, but with the recent paradigm shift that has put addictions and mental health in the same sphere, services are being improved to ensure that all mental health and addictions services work together better to put the person dealing with both a mental illness and an addiction at the centre of the health system’s focus. Over the last two years, the provincial government has initiated a series of reforms that have amalgamated several smaller health regions to larger health authorities. With this amalgamation came a series of changes to mental health and addictions services – transferred to the health authorities to manage in their communities at that level – with the mandate to ensure that those services are best tailored to serve their region in the most effective way. What follows is a rundown of some of the highlights in each health authority.
Vancouver Island Health Authority
The Vancouver Island Health Authority (VIHA) has what many consider to be one of the most cuttingedge programs available to enact system change. While all the health authorities have a comprehensive system in various stages of development, VIHA has contracted with Dr. Ken Minkoff (see the preceding article) to develop a concurrent disorders plan that reflects the needs and capabilities of the people on Vancouver Island.
This plan was designed with an eye to changing the mental health and addictions system to ensure that it was accessible to all and that any contact a consumer with both a mental illness and an addiction makes creates a pathway to the appropriate service.
In January 2002, a consensus conference among stakeholders on Vancouver Island agreed to create a system of care where people with concurrent disorders would be welcomed. In the process started on Vancouver Island, everyone in both the addictions and mental health field is introduced to each other’s fields and educated in the proper response to dealing with someone who may come to them with a co-occurring disorder. These individuals then fan out across the health authority, training others in how to deal with someone coming to them with a concurrent disorder, passing down the information from professional to professional all the way down the line.
“It’s going to take some time,” says Alan Campbell, Manager of Policy Transition for the Vancouver Island Health Authority, explaining that the program lets staff and other providers learn not only how to treat people with a concurrent disorder, but also how to identify them, and to treat them with appropriate care. “Within three years, we can lock in these types of changes and have them as part of our regular quality of care.”
In this system, everybody is involved. People fully versed in the plan developed by Dr. Minkoff train others who will essentially act as trainers to others contracted to provide service to consumers and people with substance use problems by VIHA. Curriculum resource binders are provided and a full day of training, followed by site visits. The progress is documented with selfassessment action plans that are reviewed every six months in an attempt to move forward. The plan is also tailored to specific audiences as required – a nurse’s experience may be different than that of a case worker’s – and, according to Campbell, this seems to be effective. “We look at the competencies we expect people to have,” he says.
Special attention has been made in reaching harder-to-target groups such as physicians and those who work in 24-hour settings, but slowly but surely, the VIHA program is progressing on schedule. This plan will ensure that every person who is the point of contact with the system for someone with a co-occurring disorder will have adequate training in both the addictions and mental health areas – whether that be the local mental health centre, the hospital emergency room, or any other service that is available. The admission policies for hospitals have been adjusted to permanently entrench that philosophy throughout the system.
Campbell says future directions include expanding the program to over 200 agencies within the Vancouver Island Health Authority, and to connect with Aboriginal agencies and the local colleges and universities to train people as they are coming into the system, so that the values presented in Dr. Minkoff’s plan are connected to the curriculum. He notes that while this could take a while, it is the ultimate goal of the health authority.
Other health authorities throughout the province are watching Vancouver Island very closely to see what they can learn from their example, and in many cases have implemented changes in their own regions.
Northern Health Authority
The Northern Health Authority has trained two key staff on the Minkoff plan, and according to Elizabeth Tovey, Mental Health Manager for the Authority, VIHA has been very helpful and open to partner with this region, which serves a very unique audience. Trainers are currently meeting all mental health and addictions staff and having them agree on some core principles – including the key welcoming criteria that the Minkoff plan finds so important, that is, ensuring that no one is turned away from a mental health or addictions service just because they have a co-ocurring disorder.
Fraser Health Authority
Fraser Health has also implemented a unique system by creating 11 new concurrent disorders therapist positions at the various mental health centres throughout Fraser Health’s service delivery area. Debbie Suian, the Concurrent Disorders Therapist in the Tri-Cities (Coquitlam, Port Moody, Port Coquitlam) Mental Health Centre explains her role as a trainer/consultant, rather than a direct service worker, although she does admit to occasionally working with clients with more complex issues. She sees the job as a bridge between the mental health and addictions worlds, and tries to ensure that what she describes as the ‘ping-pong effect’ – where people go between each system to try and get help – doesn’t occur. Only into the job a few months, she has organized monthly training events and a peer support group for staff at the mental health centre, in addition to providing ongoing consultation to colleagues. She co-facilitates a weekly concurrent disorders support group with Cheryl Worfolk, manager of New View Clubhouse, and has recently launched ‘networking’ meetings, where people from various agencies, whether they be non-profit, government or health, with interests in the field, are able to meet at a local restaurant to share information and to make their services available. Information-sharing is a key element in integrating the system, as people working in the field need to know what’s out there. She is a member of the regional training subcommittee, and has also created a monthly newsletter for people interested in mental health and addiction, and is available for consulting to anyone in the Tri-Cities area.
Regional health authority contacts
Interior Health Authority
Interior Health is also beginning its mental health and addictions concurrent disorders training for professionals in the field and according to Carmen Lenihan, Coordinator of Concurrent Disorders Services at the Okanagan Independent Living Society, there has been a greater awareness that concurrent disorders may be more of a rule than an exception in regards to consumers in the system (see more on the opposite page).
While it’s clear that integrating the two systems has not been easy, most people tend to agree that it is a worthwhile effort. Behind the scenes, programs are evolving rapidly and there is general enthusiasm for the project. Only time will tell how effective it turns out to be.
Vancouver Coastal Health Authority
For information on the Vancouver Coastal Health Authority, please see the article on page 52 "Vancouver Coastal Health".
About the Author
Mykle is a Communications Officer at the Canadian Mental Health Association's BC Division