His calling is treating the patients who are hardest to treat: people who live with a combination of severe, complex mental illness and addiction. They often have additional social and health challenges, often as a result of their mental illness and substance use. They've often had run-ins with the correctional system. They're often homeless, and they often have no interest in visiting a doctor's office—because they're afraid to.
Dr. Seethapathy is one of very few psychiatrists across B.C. who specializes in treating patients with this complex combination of challenges, known in the mental-health community as concurrent disorders. He can't imagine doing anything else.
His eyes light up when he talks about the years he spent leading teams that helped people with addiction and mental illness on the Downtown Eastside. "I don't want to do office-based psychiatry because it doesn't reach the clients who need help the most. I want to help the people who can't—or won't—visit a hospital. I want to give them hope when they can't find it for themselves."
Dr. Seethapathy did similar work in the North West of England, which has a population similar to Vancouver's Downtown Eastside. "I've always enjoyed helping people with the most need—people who are the most vulnerable and the most marginalized."
Today, Dr. Seethapathy applies this passion as the medical director for adult mental health and substance use, and the medical lead for concurrent disorders at BC Mental Health and Substance Use Services.
He spends most of his time with patients at the Burnaby Centre for Mental Health and Addiction and the Heartwood Centre for Women, the only specialized facilities in B.C. that provide comprehensive programs to address both mental illness and addiction at the same time.
Lisa Balkwill (above), currently a patient at the Burnaby Centre, says the program that Dr. Seethapathy has helped build is working for her.
"I came here, and I started to feel better," she says. "I can think more clearly. I used to struggle with psychosis, but I don't get visions and voices anymore. I can cope with life. I have a lot of hope for the future, and the power of hope can go a long way."
Lisa has been a patient since the summer of 2018, and she hopes to be discharged early in 2019.
Part of her program has been trying and learning different self-care methods, and preparing for the future. She hopes to study carpentry when she goes home. She also plans to take time for both exercise and arts and crafts, both of which have been part of her treatment.
"Being able to help and bring about change in even one person like Lisa keeps my energy going," says Dr. Seethapathy with a smile. "She's able to engage and stay abstinent, and talk to people with confidence and without fear—it's amazing to see."
When Dr. Seethapathy and his colleagues at the Burnaby Centre for Mental Health and Addiction treat both mental illness and addiction concurrently, relapse rates are far lower, leading to overall better outcomes.
"Many, many studies over the years have shown that mental health and addiction go hand-in-hand," he says. Addiction isn't about wrongdoing—it's biological. The neurotransmitters of a person with an addiction are not the same as those of a healthy individual. Research has shown that mental illness and addiction even affect the same areas of the brain."
In addition to the illnesses occurring together, one almost always exacerbates the other. "Many people with anxiety also have an alcohol-use disorder because they use the alcohol to self-medicate," he explains. "But if we address the mental illness, they won't need to self-medicate."
Their treatment approach includes tailor-made care plans that use medications and different kinds of therapies, including cognitive behavioural therapy, counselling, art and music therapy, physical therapy, and more. Treatment teams also use the principle of trauma-informed practice, which takes into account a patient's past trauma and seeks to minimize triggers.
Most importantly, the approach gives patients enough time to heal. The Burnaby Centre for Mental Health and Addiction treats people for up to nine months. "Most hospitals aren't set up for that. That's where our facilities come in," says Dr. Seethapathy.
"My vision is that our approach will go beyond Burnaby Centre," he continues. "I love addressing treatment gaps for clients, and my hope is that through PHSA, we can build capacity to help the people most in need through specialized programs across the province."
Read more about Lisa and her journey here.