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home / 世界杯决赛2022

opinion: until we integrate substance use and mental health, progress will continue to stall

most big changes don’t happen overnight. they are born ...

by calgary herald

dec 9 2021
read time 3 minute read
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louise bradley, the former ceo of the mental health commission of canada, says we need to do more to integrate the treatment of addiction and mental health. crystal schick / postmedia file
most big changes don’t happen overnight. they are born from incremental shifts: in awareness, in attitudes, in behaviours and, finally, in public policy.
so it goes with the slow march towards integration between treatment for mental health and substance use. a once firmly entrenched divide is closing, ever-so-slowly bridging the gaping chasm that threatens to swallow patients who do not fit neatly on either side.
in my time as head of the mental health commission of canada, there was discussion of creating a national organization equal to the challenge of addressing mental illness and substance use. i regret that it did not come to fruition under my leadership, because i felt strongly it was the right decision.
as a clinician, i remember patients walking a tightrope between mental health and addictions medicine, unable to access a coherent treatment plan. one not always independent of the other. the early childhood traumas that may breed problematic substance use are no less worthy of investigation than those that manifest in eating disorders or self-harm.
people are infinitely complex. but each day, as we get a tiny bit closer to solving the great mystery of the human brain, we inch nearer to better understanding the practical applications of that knowledge. when i was practicing, so many things about substance use were misunderstood or willfully maligned.
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forget instagram — stigma has always been the ultimate influencer.
but where once it was thought mental illness fell squarely in the realm of the biological and psychological, and that substance use skewed towards the social and spiritual, it is now understood more like a wheel, with each piece of the pie shaping a circular whole.
if you leave out any one aspect in the diagnosis and treatment of mental health issues or substance use — or concurrent disorders — you wind up off-balance, stalling progress on the road toward recovery, leaving people stranded on the verge.
since i have retired as head of the pan-canadian voice on mental health, i’ve been doing a lot of reflecting on my decade there. while we accomplished a tremendous amount — creating canada’s first national mental health strategy and the world’s first psychological workplace standard — some important work remains undone.
to suggest that mental illness and substance use are an either/or proposition is to ignore the potential tilling of the fertile ground where our work intersects. we know that addressing mental health concerns in early childhood, or mitigating adverse childhood experiences, can help to prevent problematic substance use in the teen years. there is a direct relationship between the two, which is further nuanced by social determinants of health, like poverty and racism, which breed structural inequities that make accessing treatment more difficult.
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in terms of concurrent disorders, 47 per cent of people living with schizophrenia have a history of substance use disorders, while 78 per cent of people in addiction treatment have had a psychiatric diagnosis at some point in their lives. these numbers point to the overlap practitioners have long understood — but have rarely been able to address within the confines of the current system.
solutions to these challenges are not simple, but they will continue to evade us if we cling to outmoded ideologies. there is an increasing evidence base around the medical treatment of opioid withdrawal. we recognize severe addiction as a brain disease and the need for corresponding treatments. rapid access addiction medical clinics, like those at the royal ottawa hospital or st. mike’s in toronto, are pointing towards a path where patients’ needs are the compass that treatment and supports must follow.
while there needs to be room for a diversity of voices and perspectives, we are stronger, and more likely to be heard, by coming together.
it may not happen overnight, but these things seldom do.
louise bradley is the former president and ceo of the mental health commission of canada.
 
 
 
 
 
 
 
 

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