Mental healthcare system lacks resources

February 09, 2006, vol. 35, no. 3
By Howard Fluxgold



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British Columbia's mental healthcare system spends too much on hospital-based care and too little on community-based services, contends Marina Morrow, assistant professor in the faculty of health sciences.

Morrow has recently completed a study of mental health services in the province entitled Community Based Mental Health Service in B.C.: Changes to Income and Housing Security.

“The imbalance in the mental healthcare system means that the dominant model of care is psychiatry, rather than a more holistic approach that includes housing, income and social supports,” Morrow maintains. “There are community based programs that address these issues, but only people diagnosed with the most severe illnesses get access. If you don't deal with social determinants of mental illness at the community level, the need to hospitalize people escalates.”

Morrow's research on housing and income support focused on the Vancouver Coastal Health Authority, which stretches from the Lower Mainland to Bella Coola. It included interviews with policymakers as well as frontline workers.

She found that the system was “under-resourced and therefore workers must determine who gets access to care.” That means the system is crisis-oriented and only the most seriously ill can get care. “Some things aren't funded at all, like long-term psychotherapy or counselling, which is particularly important for people with depression, or survivors of childhood physical or sexual abuse, for example.”

Morrow also found that when the Liberals first came to power they made changes to welfare disability benefits and employment programs that directly and indirectly affected people with a mental illness.

“The Liberal government has said that we have to get people back to work,” Morrow points out. “They say everybody is employable unless you can prove you are not. But the system does not recognize that people with mental illness have periods of wellness and periods of illness. They need more support at certain times than others.”

The lack of housing for people with mental illness is another issue raised in the report. “Despite increases in supported housing for people with mental illness, the need for housing far outweighs what is available. As a result many with a mental illness are homeless or living in precarious environments,” says Morrow.

One of the recommendations in her report is the reinstating of the mental health advocate, a position that was cut by the Liberals when they took power in 2001.

“The mental health advocate was a person who did systemic advocacy,” Morrow explains. “The mental health system needs mechanisms that allow for a better understanding of problems in the continuum of care.” She also advocates structures that better support the input of those who receive care and their families.

This study is part of a larger program of research that Morrow is undertaking. Her next project focuses on former patients of Riverview hospital, who were transferred to communities throughout the province.

Morrow's work on housing and income supports is part of a major initiative, Economic Security: Redefining Public Service in B.C., funded by the Social Sciences and Humanities Research Council of Canada under its community-university research alliances program.

The initiative enables university and community researchers to examine the impact of B.C. public policies on British Columbians, with a focus on welfare and health.
Political science and women's studies professor Marjorie Griffin Cohen and Seth Klein, director of the Canadian Centre for Policy Initiatives, B.C., are the principal investigators of the major initiative.

Morrow was assisted in her research by women's studies doctoral student Silke Frisch and researcher Alicia Johnson of Vernon.

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