Voices From The Community
Breaking down the walls
Dr. David Goldbloom discusses stigma, treatment "silos", and other barriers faced by those suffering from addiction and mental illness.
Story by Janet Harvey/Illustration by Peter Mitchell
Addictions. Mental illness. Most of us think of them as two entirely different things. But in fact, often the conditions go hand in hand. At a conference AHFMR hosted recently, it emerged in discussion that somewhere between 40% and 80% of people diagnosed with a variety of psychiatric disorders may have co-occurring addictions to a range of both legal and illegal substances.
Which is where Dr. David Goldbloom of Toronto's Centre for Addiction and Mental Health (CAMH) comes in. Although he never anticipated a career in this field, Dr. Goldbloom found himself drawn to the complexity of problems he encountered during his psychiatry rotation in medical school. "Psychiatry is a fascinating fusion of biology, psychology, and culture," he explains. "Neuroscience was just starting to heat up as a discipline at that time and contribute a great deal to our understanding of the brain. And I found the patients so very engaging."
Sadly, not all of society shares Dr. Goldbloom's empathy with those patients. Stigma and discrimination remain among the biggest problems faced by those with mental illness. But the veil of secrecy and shame is starting to lift, partly because of the increasing tendency among celebrities and public figures to acknowledge the addiction and mental-health issues they have faced. Singer Natalie Cole wrote a book about her struggles with drug addiction. In Canada, much-loved CBC host Shelagh Rogers has been candid about her experiences with depression.
"When famous people talk plainly about their experiences, it has a permissive effect on the rest of us to acknowledge these all-too-common human problems as well," says Dr. Goldbloom. "There is a long way to go, but we have seen a gradual lessening of stigma, and an increasing recognition of the enormous cost to society, families, and individuals."
And addiction and mental health, as fields of study, have seen a number of changes over the years in terms of both treatment and research. Traditionally, mental illness and addiction have been studied and treated separately in "silos"-a situation brought about by healthcare providers. This is starting to change nationally and internationally, thanks to more patient-centred approaches which integrate research, treatment, and teaching. The Centre for Addiction and Mental Health has been at the vanguard of this movement.
Now celebrating its tenth anniversary, the Centre was created in 1998, when four institutions merged. The oldest partner was the Queen Street Mental Health Centre-opened in 1850 as the first asylum in Canada for the mentally ill. The other partners were the Clarke Institute of Psychiatry, the academic seat of psychiatry for the University of Toronto and a major research centre; the Addiction Research Foundation, with its international reputation for neurobiology and social-policy research; and the Donwood Institute, Canada's first publicly funded hospital for addictions. The merger brought together academic research and front-line clinical care in addiction and mental illness.
Treatment of patients with both addiction and mental illness remains a very difficult challenge. Those with symptoms of severe mental illness are likely to receive treatment for that illness; for a variety of reasons, however, they are unlikely to receive treatment for their addictions as well. Although this situation is changing-partly because of the advent of facilities like the Centre for Addiction and Mental Health-there is still a long way to go. "We're moving in the right direction," says Dr. Goldbloom, "but we're still in motion."