IH: It's not easy to simply remove people from our streets

A lesson in mental health


Frustrated and angry!

That was the reaction of Kelowna councillor Charlie Hodge following a lengthy presentation from Interior Health mental health and substance use officials.

MHSU medical director Dr. Paul Carey and network director Debi Morris were invited to speak at the request of Hodge.

At a recent meeting, Hodge suggested Interior Health explain to council the threshold within the Mental Health Act to take people with obvious mental health issues off the streets and get them the help they need.

The request was spurred on by an impassioned letter from a downtown business detailing what she, and her customers were forced to deal with from one chronic individual.

It's not as simple as putting people into treatment for a substance abuse disorder or forcing treatment on someone if they refuse.

Four criteria are required to be present at a particular point in time, as outlined within the Medical Health Act, in order to trigger involuntary treatment.

"It's a complex issue, but if I am not a capable decision maker, if I am suffering from an acute mental illness, and I am refusing treatment, and I am at significant risk because of that impaired decision, then I will be treated involuntarily,"said Dr. Carey.

"But, under every other circumstance, I won't be.

"There are significant numbers of people who do not adhere to recommendations, best evidence treatments, of availability of services in ways we know based on evidence would lead to a better outcome."

That's their choice, he says, adding as individuals, we have the right to live at some significant degree of risk if we so choose, and are capable of making that decision.

Not everyone living on the streets, council was told, are incapable of making their own decisions.

"I find it very disturbing there are a number of people on our streets today that have been there for quite a while, and they literally have some significant mental health issues going on, and yet they continue to remain on the street, and it's not getting any better," said Hodge.

"I have a problem with the criteria. It seems we need to find a way to help more people sooner...I guess I'm just frustrated."

It's a constant juggling act, admitted Dr. Carey, saying involuntary detention under the MHA is arguably the most profound infringement of human rights outside the criminal justice system.

"It's our obligation under the law to be detaining people we believe fulfill the criteria and require treatment, who themselves are not able to consent or request treatment at that point of care.

"It's a constant juggle in balancing the risks of infringing on people's rights and providing care when they need it."

Council, and the Urban Mayors' Caucus, co-chaired by Mayor Basran, continues to lobby the province for housing specific to those on the streets with complex needs, specifically a combination of mental health and substance abuse issues.

Councillors were told to continue advocating for specific housing, while also acknowledging overdose prevention sites, safe injection sites and opioid therapies are all saving lives.

The opioid crisis itself, says Dr. Carey, is also stretching the medical community in how it views, plans and implements treatment services.

"Opioid addiction, dependence and overuse is unique in the addiction field because of the kinds of treatments that are evidence based to help people stay alive," he said.

"Educating ourselves about what role we have to play to continue to de-stigmatize these illnesses. I've never yet met a client in the thousands I've treated who ever wanted, ever, to be dependent on a substance they are struggling with.

"It's heartbreaking. For us as a community to continue to support services that bring solutions and hope to these people is profound."

The last 'Point in Time' homeless count in March of 2020 estimated there were 297 people who identified as homeless in Kelowna.

Of those, 196 had complex needs.

Those numbers, according to experts, are only going up.

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