“How much worse off would these DTES residents be without the services they have received?”
The costs and efficacy of addictions and mental health services in the Downtown Eastside is a debate that re-emerges time and again in the media, while the true impact and cost-saving outcomes of services in our community are well-known and understood by those who deliver them.
In the opinion piece below, renowned speaker, author and addictions specialist Gabor Mate shines a light on what’s missing from so many of our conversations about the Downtown Eastside and services for the vulnerable people who live here. We welcome continued discussion on these issues and will continue to play a leading role improving coordination and information on outcomes across the mental health and addictions sectors, through projects like the Collective Impact initiative.
January 24, 2016 – A recent Simon Fraser University study showed that expensive services in Vancouver’s Downtown Eastside do not result in improvements in mental health or legal problems for residents of this notorious neighbourhood, often called Canada’s poorest postal code.To ask, however, why many in the DTES do not get “better” is like wondering why patients keep dying or being sick in our hospitals, despite all the health-care dollars expended on treatment, or why, despite repeated treatment, mentally ill people keep getting readmitted to psychiatric wards.
The answer is simple: That’s where ill people go.
As the SFU study showed, most people come to the DTES from other areas of the country. The problem is not that of the DTES but that of Canada, of a society that generates mental illness and addiction, often in the same individuals, and then does not know how to handle them. It is the vexing problem of a health care system that poorly understands and even more poorly manages both mental disease and addiction, and of a legal system that exacerbates both.
Calling addicted people “offenders” may accurately describe their legal status, but obscures the reality that they are the ones who have been, throughout their lives, offended against. None of them chose to be addicted or mentally ill, any more than someone chooses to develop cancer or rheumatoid arthritis. In each case, the addiction or psychological dysfunction is the outcome of childhood trauma superimposed on, in some cases, a genetic predisposition. The latter is less of a factor than mostly people think: The defining cause of addiction is always severe emotional hurt at a vulnerable stage in life.
In my 12 years of work as a physician in the DTES, I never met a female patient who had not been sexually abused as a child or adolescent, nor a male who had not suffered some form of severe trauma. Well beyond my personal observations, large-scale population studies have also proven that childhood adversity is the common precursor of addictive behaviour in adults.
Addictions are attempts to escape pain, no matter what form they take — whether to substances like alcohol or heroin, or to behaviours like shopping, sexual roving, gambling, compulsive Internet browsing or videogames. The degree of pain may very from person to person, but the fundamental question is always, not why the addiction, but why the pain? The primal adversity need not be overt trauma, but always involves more emotional loss than the child could have borne or the adult can sustain.
Imaging studies have repeatedly demonstrated that the brains of addicted people are lacking normal function in areas where pleasure, reward, motivation and impulse regulation are controlled. We do not blame people if their hearts are abnormal; do not make them into “offenders” even if their own life habits contributed to the cardiac disease. Yet we stigmatize people and declare then outside the law if their brain functioning is impaired. And we do this, despite the undisputed findings of modern brain science that the human brain is shaped in its development, especially in the development of the circuits mentioned above, by the child’s emotional environment.
Such facts are not yet taught in our institutions of higher learning. Many addiction treatment providers and mental health workers are unaware of them, let alone law enforcement personnel, corrections workers or judges. In the context of a system that marginalizes the most hurt and vulnerable segment of our population, we ought not to be surprised that, despite the work of many dedicated people in the DTES, our results seem meagre. Or do they?
How much worse off would these DTES residents be without the services they have received? How much medical or legal expense would have been incurred? How many would have died? Further, what if places like Surrey or Edmonton or Toronto opened supervised injections sites, such as the Hastings facility Jane Philpott, our new Health Minister, just visited and found so inspiring? What if certain municipalities in B.C. and the Lower Mainland dropped their insular and retrograde “not in my backyard” policies and came to the support of their troubled fellow citizens?
If we asked ourselves what part of us is so judgmental and impatient with people we call addicts, we would find, to our discomfort, that they represent aspects of ourselves we would rather not acknowledge. Easier to ghettoize these spectres of our society’s dysfunction and then to bemoan the cost.
Dr. Gabor Maté speaks and writes extensively on addiction. He is part of a Jan. 30 workshop, Who Do You Think You Are, that explores links between our early environments and addiction. Tickets: Banyen Books. www.banyen.com/events/gabor-mate