Background:

Discussions about mental illness and addiction are increasingly combined into one topic. The conflation of these distinct issues has led to significant challenges in providing effective and tailored support to individuals facing severe mental illness. In public discourse, it has increased confusion about the causes of, and solutions to, societal problems like rampant homelessness and perceived increase in violence. This has resulted in more stigma and discrimination against those with a severe mental illness.

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At the same time, an increasing amount of resources are being taken from the common budget to go towards treatment for substance use disorder. Consequently, the already-strained budgets for treating severe mental illness fall further behind. Additionally, housing options are increasingly combined, which leads to concerns about treatment centres and housing that take a harm reduction approach will introduce new problems for those with mental illness and not substance use disorder.

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Front line workers (nurses, social workers, police and others) are expected to know how best to communicate with those in their care. More and more, language and expectations appropriate to addictions are being applied to those with mental illness. For example, expecting someone with a mental illness to admit to their illness as the first step to recovery will lead to failure for a patient with lack of insight, or anosognosia.

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Effective treatment approaches to severe mental illness differ from those for addiction to substances and it is imperative that they be approached in a way that prioritizes the safe treatment and support of each within distinct and separate settings. As we hear from many families, those who have concurrent disorders (both a severe mental illness and a substance use disorder) are often refused treatment for either condition until they have received treatment for the other – making it impossible to get help. Consequently, there needs to be comprehensive, integrated treatment for those with concurrent disorders.

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Position:

• Mental illness and addiction are two quite different conditions, with different origins and requiring distinct treatment methods. By recognizing and addressing these issues independently, we can pave the way for more effective, targeted, and compassionate support for individuals grappling with severe mental illness in Canada.

• There must be separation of mental illness and substance use disorder in the realms of treatment, resource allocation, and legislation within the Canadian healthcare system. Everyone living with a mental illness, a substance use disorder, or both, must be given treatment that is appropriate to their situation.

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Supporting Research:

1. Centre for Addiction and Mental Health (CAMH): Mental Illness and Addiction: Facts and Statistics

2. CAMH: Concurrent Disorders

3. Fraser Health (BC): Concurrent (dual mental health and substance use) disorders 

4. CAMH: Concurrent Substance Use and Mental Health Disorders: An Information Guide [PDF]

5. Peter F. Buckley, MD: Prevalence and Consequences of the Dual Diagnosis of Substance Abuse and Severe Mental Illness, 2006