The BC government recently rejected the recommendation of the Union of BC Municipalities to re-instate Riverview Hospital. Our government has made the right decision. The debate and media coverage over recent weeks has revealed a number of important issues that have reframed questions about Riverview Hospital, and the Premier is correct in her comments that there is a new set of problems we need to deal with.”
Surprisingly, the idea of reopening Riverview garnered a good deal of public support, at least in online and radio comments attached to media coverage. However, we question the logic that reopening the hospital would have solved complex problems like homelessness, poverty or the real lack of 24-hour community-based treatment for people with mental illness and/or substance use problems, as many of the comments suggested. We also wonder about the assertion made by many commentators that Riverview would somehow be a “compassionate solution.”
Reopening Riverview would not be a compassionate solution to homelessness or poverty in our province. The truly compassionate solution would be to take an honest look at how we treat people with severe mental illness and substance use problems and change our course of action. We need to deal with these issues head-on.
For starters, we should ensure that people who have disabilities can afford basic costs of living. Poverty can cause a great deal of stress, which can, in turn, worsen symptoms of mental illness and substance use problems. In other words, if we make it easier for people with disabilities to afford to make ends meet, we will have less demand on our mental health care system. The CMHA has been advocating for the government to increase the persons with disability benefit and index it against cost of living increases. This would mean that even low-income people with mental illness could be elevated out of poverty.
Additionally, we need to address the lack of affordable, safe, and supportive housing options in our province. Many British Columbians with mental illnesses or substance use problems cannot access safe and reliable housing. They can be found in on the street, under bridges, and in shelters – which are not homes. To address this in the short term we suggest that the government implement a rental assistance program for people who have low income and mental illness. A longer-term goal would be to invest in building a variety of housing options across the province with varying levels of mental health treatment and supports. This would allow people at all stages of recovery to live in, and contribute to, their communities.
There are significant gaps in our community mental health care system that need to be addressed. For example, many people don’t realize that most community mental health services operate during business hours, Monday to Friday. It is important that we create programs that are available to respond to situations that arise at any time of the day. As the VPD outlined in their recent mental health report, Assertive Community Treatment (ACT) is an example of this kind of program. We support these kinds of initiatives so long as they are embedded alongside of income and housing supports. We also need to ensure that there are places that people experiencing distress from mental illness can go, to receive care, where they can’t be turned away. We should not and cannot rely on our police departments, emergency rooms, and family members to provide this type of care on their own.
There are certainly some who will argue that these solutions fail to address the immediate needs of people with severe mental illness in our province. They might argue that we need to provide an institutional setting to care for people who have severe symptoms now. We don’t deny that there are people on the street, experiencing profound distress, without resources to help. However, people in institutional care eventually leave institutions, often returning to ill-equipped and under-resourced communities. International research has found that patients with severe mental illness do better in community-based settings when provided with the right supports. We need to provide our communities with the supports to ensure that patients can leave facilities, and that when they do there are places for them to live and experience recovery.
In short, a broad continuum of community-based supports is the foundation of responsive mental health care – this is the compassionate solution. It allows people with differing levels of need to access supports and live fulfilling lives within their communities, not hidden away in institutions.
Finally, places like Riverview are expensive. We estimate that operating 300 long-term secure beds would cost at least $45M per year. It is probably more. The ultimate question in this debate is how we choose to spend our money. If we choose to spend it on facilities like Riverview, that’s money that we will not have to spend on implementing the solutions that could potentially help thousands.
Rather than asking our government to reopen Riverview Hospital we should be asking them to invest in programs that ensure that people with mental illness and substance use problems can live in dignity within our communities. We can do this by directly addressing big issues like poverty and housing and through ensuring that a robust system of appropriate and timely mental health care is available for all British Columbians within their communities.
Bev Gutray is CEO of the Canadian Mental Health Association, BC Division, and Marina Morrow, PhD, is Associate Professor and Director at the Centre for the Study of Gender, Social Inequities and Mental Health, Faculty of Health Sciences at Simon Fraser University, and Research Associate at the Canadian Centre for Policy Alternatives' BC Office.