Clients at the Forensic Psychiatric Clinics, which operate across the province, can now access opioid agonist therapy and benefit from the services of outreach workers, physicians who specialize in addictions medicine, as well as counsellors who specialize in what the mental health community calls concurrent disorders, or co-occurring mental health and substance use disorders.
The Forensic Opioid Use Disorder Initiative is part of BC Mental Health and Substance Use Services' broader provincial strategy to address the opioid overdose crisis in B.C.
"We're introducing a new scope of service," said Kim Korf-Uzan, who is managing the roll-out of the project. "We're not changing who we serve, but what we offer. Previously, when clients had substance use challenges, there was a limited amount that we could do to support them in the clinics. Now, the Forensic Psychiatry Clinics are more of a one-stop shop, taking into account that many clients live with both mental health and substance use challenges."
Concurrent disorder counsellors provide individual and group trauma-informed substance use and mental health counselling services. They also assist with identifying and supporting connections to various community-based treatments and services to support client recovery in the long term. Contracted through the John Howard Society, a partner organization, outreach workers are responsible for getting clients engaged in the program, as well as helping them integrate into the community and connecting them with community programs, services and resources.
BC Mental Health and Substance Use Services has also secured eight new residential substance use treatment beds for clients in both the Regional Forensic Psychiatry Clinics and Correctional Health Services.
"With direct access to residential treatment, our concurrent disorder response is at a level it has never been before," said Angus Monaghan, the regional director of the Forensic Psychiatry Clinics.
"For us, direct access to residential substance use treatment for individuals who need it is unprecedented. We've always had to gain access through other resources, but when we go through other channels, it can take weeks, if not months," said Monaghan. "But by that time, the client's motivation has changed. Direct access means we can provide placement into residential treatment when the individual is ready to access it."
Monaghan and his team developed the proposal for the Forensic Opioid Use Disorder Initiative in collaboration with Forensic Psychiatric Services' medical director, Dr. George Wiehahn, as well as Dr. Nader Sharifi, who is Correctional Health Services' medical director and an addictions medicine specialist.
"The acuity and severity of the current opioid overdose epidemic is motivating us to use unconventional and creative means to ensure that everyone who needs and wants opioid agonist therapy has access to it."
As part of the initiative, staff at each clinic will be trained in group sessions to build the skills clients need for recovery and relapse prevention. Staff from Correctional Health Services, the Burnaby Centre for Mental Health and Addiction, and the Forensic Psychiatric Hospital, as well as some BC Corrections partners, have all undergone the same training, so the same model is being offered consistently across all BC Mental Health and Substance Use Services programs.
Dr. Holly Stamm is a physician and addictions medicine specialist with BC Mental Health and Substance Use Services. Her first opioid agonist therapy patient, who has "a major mental illness and active substance use disorder," lives on one of the Gulf Islands with no internet access, limited ability to travel, and access to a phone only through his mother.
"With help from his case manager, we have been able to ensure a follow-up every two weeks via outreach and telephone consultation, and to collect urine drug screens when he is seen in person either on his home island or when he makes periodic visits to the Victoria Forensic Psychiatry Clinic," she says.
"The acuity and severity of the current opioid overdose epidemic is motivating us to use unconventional and creative means to ensure that everyone who needs and wants opioid agonist therapy has access to it."
Dr. Stamm appreciates working in partnership with the Forensic Psychiatric Clinic case managers. "I admire their strong communication and organizational skills, and dedication to doing as much as possible to help their clients. It is inspiring."
