While attending a suicide prevention meeting, I heard someone say: “we don’t want to use the word ‘crisis’ when describing the suicide rate in Niagara; already recognized for our opioid overdose crisis, we wouldn’t want people to think Niagara isn’t a nice place to live.”
(Considering Niagara made national headlines, multiple times this year, over political skullduggery, and shady dealings, I don’t think people are judging us on whether or not we define our current critical mental health situation as a crisis, but that’s a whole other can of worms).
As I pondered which statement affected me more, that we are not in crisis or that it effects whether Niagara is a nice place to live, I thought about the statistics; opioid overdose death, opioid emergency room visits, self harm, suicide, particularly by falling… the Niagara Region continually ranks in the top of all the wrong lists.
Niagara is in an opioid crisis and has been facing a suicide crisis for some time; the fact is, there is a mental health crisis in Niagara – suicide and addiction are symptoms.
Opioids in 2018
In the first half of 2018, 380 units of Naloxone were administered community-wide, while Niagara emergency departments (ED) saw 311 opioid overdoses. There doesn’t appear to be much improvement over 2017 when there were 521 ED visits for overdose and 76 deaths, a 90% increase over 2016’s then-record breaking 40 mortalities.
Niagara had seven opioid overdose deaths in the first quarter of 2017, while in the first quarter of 2018, we had 17 – a 143% increase.
This, in spite of the availability, and prevalence in use, of opioid-reversing Naloxone. While ED data is unavailable, according to Niagara Region Public Health, an additional 436 units of Naloxone were administered between July and October, bringing the total to 816 – as of October 31st.
I had the opportunity to speak with Glen Walker, Co-Chair of the Overdose Prevention Network of Niagara (OPENN) and Executive Director of Positive Living, about the approved overdose-prevention site, and other upcoming opioid treatment changes, at a recent HIV & AIDS awareness event, #RedScarfNiagara.
A small step towards evidence-based harm reduction services, St Catharines is about to take a giant leap forward with the opening of our first overdose-prevention, or safe injection, site. The long-awaited, and highly anticipated, temporary site, to be located in Positive Living at 120 Queenston St, and scheduled to open later this month – is already having a positive impact through increased dialogue between partners and further fostering relationships with health providers including public health nurses and EMS.
Another upcoming partnership is the planned Niagara Health System (NHS)/Canadian Mental Health Association (CMHA) facility, opening in March 2019, which will see multiple short term voluntary non-medical inpatient centres come together under one roof.
Located near Quest, Positive Living, and CMHA’s Page Street facility, this new centre will house Men’s Withdrawal Management (detox), Women’s Withdrawal Management (detox), Out and About (pharmacotherapies for opioid addiction including methadone and suboxone), ABC – A Better Choice (expectant or recent mothers experiencing addiction), and, CMHA’s Safe Bed (offering “crisis counselling and a safe and therapeutic environment” as an alternative to hospitalization).
A literal one stop shop for 3-5 day crisis intervention, for withdrawal or mental health, and medication treatments for opioids, 2 minutes from our safe injection site – sounds good. Is it?
Details about the facility are oddly scarce, what is known is that addictions options in Niagara will seemingly align with the new provincial mandate of pushing treatment over harm reduction, regardless of desire for change. For those clients wishing to go go to detox, from overdose prevention, before going straight onto a pharmacotherapy maintenance, this is incredible news. Unfortunately, that’s neither realistic nor does it account for waitlists to access inpatient rehabilitation, if needed, post detox.
Of other concern, the centre will be segregated, with gender-specific detox units, and separate entrances for the various programming to protect vulnerable people, but is that enough to ensure staff and guest safety?
As a former shelter worker, I can tell you a few things: many women work with the female and LGBTQ community because of previous trauma, working around men in crisis can be triggering for them; single staff is never the best practice and the new detox will have 2 male staff and 1 female – for an 18 bed mens unit and a 6(?) bed female unit. You try dealing with someone who self harms, cut too deep and is now gushing blood, while someone else is bashing someone’s head into a wall for calling them the N word, and others are screaming for their meds; things can get crazy in a second, particularly during detox or crisis when your body and mind are screaming at you, leading to staff burnout.
Safe Beds is an incredible program but they do not actually cater to general mental health crisis- their selected population is dual diagnosis clients, those with a developmental disability in addition to a mental illness as opposed to concurrent disorders clients who live with both a mental illness and addiction. Should someone with inappropriate boundaries, as I’ve encountered while volunteering at Safe Beds, meet someone with predatory tendencies…there’s a reason we consider them vulnerable populations (Then again, addicts aren’t known for being great with boundaries either).
If I were staff, I would be concerned about my ability to intervene should populations come in contact with another and things went south. I’ve broken up women fighting, I can’t imagine pulling a fully grown detoxing male off a 16 year old female – these things shouldn’t happen, but they do, and it’s absurd to think they won’t.
Beyond safety concerns, by instituting a 3-5 day maximum stay in detox, disallowing current policies of permitting extensions to allow for availability in a rehabilitation program and preventative self-check in, withdrawal services will now only manage active substance withdrawal, leaving many newly created gaps in treatment and client safety. Currently, people can check into detox for maintenance – those in active recovery, who may or may not experience a life event, that are struggling with sobriety and need to check in for a few days to regroup, to prevent using drugs and alcohol, will no longer have that option; they must slip (or full blown relapse) before they can access services.
Some of you may be wondering, isn’t this the same woman who is petitioning Queen’s Park for a 24/7 mental health and addictions facility in St Catharines – how does this new facility differ?
St Catharines continues to lack some very important pieces in the recovery puzzle: from 24 hour walk-in crisis services, where regardless of your diagnosis, you can find a human being and a hot cup of coffee any time, to concurrent disorders inpatient treatments, and many of our most vulnerable are concurrent disorders clients, to safe and sober housing options for those barely sober but no longer fitting into the new detox mandate or are awaiting a bed at rehab. This new facility does much for those in active use and recovery but nothing for the rest of our substance abuse and mental illness clients – nor the 200 people currently on the waitlist for CARSA, Niagara’s sexual assault counselling centre.
Are positive changes coming to Niagara in the form of evidence-based addictions treatments? Yes. Are there ongoing concerns about these services? Yes. Do management and staff appear to be at opposite ends of the spectrum with their opinions on consolidation of so many services? Very much so. Does Niagara still need a 24/7 dedicated mental health and addictions facility for those not currently being served? Definitely; our ongoing suicide crisis is a measurable symptom of our sick system.
Why can’t Niagara be both a friendly small town, just outside the Big Smoke, as filled with gardens as we are beaches, unique biodiversity, fruit and wineland Ontario, faced with the harsh realities, and complex symptoms, associated with a mental health crisis including drug (mis)use and suicide.
But dont forget, as we shove our heads further in the sand: we wouldn’t want people to think Niagara isn’t a nice place to live.
December is often the worst month for those living with mental illness and addiction. If you are struggling, please reach out to COAST 1-866-550-5205; if you are worried about your immediate safety call 9-1-1.
If you just need to be around people, whether or not you want to engage, come by a MAPS meeting (Mental Awareness Peer Support), schedule available at www.niagaraunited.org