Mental Health

Beds, homes and drugs

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Back to back in recent weeks, three related mental health items were in the news. First, cost-cutting closures of Alberta Hospital beds. What's to say? People with mental health conditions living among us rather than in institutions can be a good thing, in that it can help break down ignorance and fear—but obviously only so when those living in the community are well enough to do so, and when community support and housing needs are met.

We're being reassured that the appropriate community supports will be in place before the beds are closed, of course, but we've heard that before, the last time beds were cut, and the community supports currently available are anything but sufficient. Cost cutting in mental health, those on the inside say, usually results in bedlam on the streets. It's a shortsighted move, one that will only add to the heartbreaking homeless population of our city.

The second related news item is an announcement of a federally-funded project that will give 1325 homeless Canadians in Moncton, Montréal, Toronto, Vancouver and Winnipeg a place to live, along with psychological and social supports for a period of four years. The Mental Health Commission of Canada study will compare how much money the government spends on services for those given both housing and other support to those provided only with the normal services of emergency shelters and counselling.

I'm predicting it'll be $110 million well spent, affirming that homes for the homeless is not only the right thing to do from a humanitarian perspective, but also from a fiscally responsible one.

But the project will have its detractors. There'll be those who see it as a risky experiment, even though the provision of housing for those with mental health and addiction issues is neither risky nor experimental—supported housing has, according to the science, a clear and positive impact on psychiatric symptoms and substance abuse disorders.

There'll be those who say OK fine, just not in my backyard, even though a review of the relevant literature done by the Centre for Applied Research on Mental Health and Addiction (CARMHA) for the Vancouver Coastal Health Authority concluded that the data shows "no observable relationship between residential recovery homes and either property values or crime rates," and that "this type of housing can have a minimal (or even positive) impact on the neighbourhoods in which they are sited."

But you can't really talk about homelessness and mental health issues without talking about addiction, which brings me to the third related news item: heroin maintenance treatment—heroin by prescription—reduces drug use, overdose rates, prostitution and crime among addicts who have not benefited from other treatment options, a study by the North American Opiate Medication Initiative (NAOMI) has found. The research, published in the New England Journal of Medicine in August, supports other research of its kind that has found heroin maintenance to work, and to cost less per person ($7500 per year as opposed to the estimated $55 000 per year for an untreated addict).

Mention this in conversation with friends though, at least in my experience, and you'll meet with some resistance and raised eyebrows. Maintenance, whatever kind works best, is humane and logical. But it is still, to many, simply wrong to keep addiction going, a condoning of something harmful, a relinquishing of our idealism and superiority.

Thin superiority, mind you. We all depend on drugs to manage what ails us, it's just that most of us depend on drugs that are legal and whose purity and concentration are regulated and controlled. And though heroin comes with serious risks and side effects, the biggest risks come with illicit use resulting from untreated addiction—with contaminants found in street drugs, high overdose potential, non-sterile injection practices and addiction-related crime.

Heroin, a semi-synthetic derivative of morphine, was first brought to us by Bayer and used legally and very effectively to relieve pain and fever in lower doses and with fewer side effects than morphine. Because of its highly addictive nature, it has mostly fallen from approved use, though it is still used in the UK (under the name diamorphine) as maintenance treatment and for a number of general medical conditions.

As with all drugs, potent effect comes with a dark side. Clearly, addiction of any kind is not a happy thing, but progressive societies let the data inform their medical practice.

Progressive societies also let the data inform their public program spending, their approach to the addicted, the ill, the homeless. They refuse to play the short-sighted game of cutting costs when lives are at risk. And they take into account the wisdom of those who've learned from being in the trenches, those who know from experience what works. V

Well, Well, Well

Mental Health

Beds, homes and drugs

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