Thank you, Mr. Chair.
The situation in which we find ourselves in Canada and B.C. has been described by Ms. Brett and the previous speaker. The question is why. How can we move forward in improving those outcomes?
In 2013 the chief of police and the Vancouver mayor called a press conference declaring a mental health crisis. There were about 300 people with severe mental illness, polysubstance use disorders and acquired brain injury who were displaying some of the situations that have now overwhelmed our communities. The chief of police and the mayor asked the health system to please take care of it: “We are unable to do it. We are police officers.”
Why is it that in the past 10 years in Vancouver, we went from 300 to 10 times that, and to 100 times that for those at risk of suffering those severe illnesses?
There were three main causes for that. The first one was the 2012 closure of Riverview Hospital without a replacement. The replacement should have been sufficient community services and sufficient inpatient beds to provide treatment, mostly voluntary treatment but at times involuntary treatment, as needed.
The second reason was the technological revolution that happened. As with every technological revolution, it took society by surprise. That technological revolution was the backyard production of cheap synthetic opiates at scale, with precursors that are impossible to stop and cheap to obtain. They allow anyone with entrepreneurial instincts and no ethical boundaries to transform $1,000 into $1,000,000 by creating the tragedy we're seeing.
It has happened in many areas of human experience that technological revolutions have had an impact like this. Moore's Law for microchips predicted that every two years the potency of the computational power of chips would double. Well, morphine in the hands of these entrepreneurs has led to a hundred times more powerful fentanyl and to ten thousand times more powerful carfentanil. When that happens, nature is transformed by these molecules. Our brains are transformed. The ability of these drugs to produce addiction while at the same time damaging the brain and preventing people from recovering and engaging voluntarily in treatment has been overwhelming.
The third cause for this situation was that, as was highlighted by the previous speakers, a group of patients was particularly vulnerable—patients with severe mental illness who were exposed systematically to these synthetic drugs. By the way, it's not only opiates; it's also the synthetic stimulants, the crystal meths of the world and the new combinations of every drug that now contaminates the illicit drug supply. For people with severe mental illness, the systematic exposure to these drugs generates acquired brain injury. That acquired brain injury has generated a new clinical triad that is now the norm in our cities. We were unprepared for it, because it didn't exist to the scale, severity and complexity that we're seeing.
I'm a psychiatrist in an assertive community treatment team. We are interdisciplinary teams who treat these patients in the community—finding them where they are; finding the homeless housing; finding them an adequate inpatient bed when they need it, and ED visits just for the time they need it; giving them involuntary care when they are unable to seek it out themselves; and pulling them out of involuntary care the minute they are able to regain their ability to engage and the mental impairment is treated by the adequate combination of psychiatric medication and ACT.
These three things have created a blind spot in most of our societies, in most of our communities.
How do we fix this? Since June of this year, I've been the chief scientific adviser for psychiatry, toxic drugs and concurrent disorders, and, based on a decision to develop and implement evidence-based policy, we have access to all the provincial data. We know the number of beds, FTEs, psychiatrists, GPs, nurses and social workers that are needed, and our recommendations have to do with many of the things that have been said by the two speakers before. There's a thread of agreement in our three testimonies that I would like to highlight.
We need streamlined access to life-saving pharmaceuticals, including the ones that were mentioned right before me, like depot naltrexone and naloxone, but we also need to simplify the use of clozapine, which is a life-saving drug for these patients, and there's a lot of red tape around its use.