A Letter from Dr. Lindsay Mackay, Mental Health and Addictions Committee Chair
Dear Colleagues,
We want to acknowledge the pressing substance use crisis affecting Vancouver and the surrounding area that has resulted in devastating loss of life and harm to our community. Over 14,000 people have died since the toxic drug poisoning crisis was initially declared in April 2016. In 2023 alone, BC’s chief coroner, Lisa Lapointe, reported 2,511 deaths — averaging nearly seven people every day. This crisis is a complex issue that impacts our community deeply, and it’s important for all of us to recognize our roles in addressing it. We understand that as family physicians, your experiences with this crisis may vary.
Some of you may have lost loved ones, may have witnessed the effects firsthand on your patients and practice, while others may see its alarming rise through news reports. Regardless of your vantage point, we appreciate that you are on the front lines of healthcare, and we recognize the challenges you face in providing care to those affected by substance use disorders.
Furthermore, we acknowledge that this crisis is intertwined with broader systemic issues such as racism, health inequities, the toxic drug supply, and social determinants of health. While these systemic issues are beyond the scope of the Vancouver Division, we recognize and acknowledge them as significant contributors to this crisis. We understand the frustration you may feel, not with your patients, but with wanting to provide holistic care that is not universally accessible.
However, amidst these challenges, your involvement remains profoundly meaningful. Your support is crucial in their journey towards recovery and better health outcomes, and we are committed to supporting you. Our organization is actively working to contribute to solutions by conducting a situational analysis, engaging the right voices, highlighting existing resources, and keeping you updated along the way. However, we know that we cannot do this alone. It requires a collective effort from all of us – healthcare professionals, people with lived experience, community organizations, government agencies, and our broader community – to find lasting solutions. Together, with communication and collaborative efforts, we can make a meaningful difference and provide vital support during these challenging times.
We appreciate your dedication and compassion in this critical work. We invite you to stay updated with our fundamental groundwork through our Initiatives page (link will be provided later) as we work together to address this crisis.
Sincerely,
Dr. Lindsay Mackay, MD, CCFP
Mental Health and Addictions Committee Chair
Vancouver Division of Family Practice
Dear Dr MacKay, Thank you so much for this thoughtful note. I am a family physician who has been focusing on mental health and ADHD for the last few years. To be brief I would post few questions here:
– What does the division do to increase access to mental health and addictions care? Or in better words, what can we do? How open are you to listen to suggestions. I do not have a positive experience here.
– Family physicians and GPs as frontline providers are not compensated enough for the time they need to spend on complex mental health patients, even on LFP model. How can the division advocate for better incentives for both GPs and also Psychiatrists?
– Based on studies, ADHD and substance use comobridity is as high as 71%. It is clear that we cannot treat substance use, if we do not address the underlying mental health conditions and possible ADHD. The main centers who deal with mental health, like AAC, clearly announce that we do not see ADHD, I am not sure why. Given this high comorbidity, how could the division address the shortage of ADHD care?
I would be happy to assist in any way possible. You just need to ask.
Thanks
Mitra Motamedi
Thank you for your insightful questions, considerations, and dedication to mental health. Your input has prompted us to reassess and improve our communication to membership regarding project activities. We are actively working on updating our Mental Health and Substance Use page.
Regarding MH supports, we collaborated with Vancouver Coastal Health to trial the FP Collaborators Network: a support for providers that involves FP collaborators preparing assessments and treatment plans for referred patients with suspected mild to moderate OCD, ADHD, anxiety/depression or bipolar conditions. We also recently launched Choosing Therapy: a navigation resource for patients and providers looking for the right kind of therapy for them.
We are continuing to partner with the CBT Skills Groups Society of Victoria, which offers patients education in skills that support their mental health. This support includes collaborating to ensure the program is grounded in equity, diversity, and inclusion. We are also partners with the Vancouver Local Action Team and host community learning sessions around supporting patients with their mental health and substance use (particularly children and youth). Lastly, we are embarking on a project that explores the current and future state of an ecosystem for patients with affective instability. This project will also involve educational opportunities for providers in dialectal behavioural therapy (DBT) as the ecosystem will be grounded in DBT, though we hope to explore training for other supportive treatments (i.e., co-regulation).
For Substance Use supports, we are conducting a situational analysis and have outlined some key next steps. The letter was the beginning of us starting to focus our attention on supporting providers in this area. In collaboration with BCCSU, we host seminars on the clinical management of Alcohol Use Disorder (next one is March 11th).
Your statement about the high comorbidity of ADHD and stimulant and other substance use is invaluable and something we’ve been hearing from our FP Collaborators Network. We recognize the importance of addressing and assessing comorbid conditions. We also appreciate your question about the LFP model as it is something we hope to gain more insight into as we conduct our situational analysis of substance use in Vancouver.
We highly value your feedback and would like to create space for your perspective, including your experiences and suggestions. We will reach out to you directly to schedule a time for a more in-depth conversation.
Thank you again for your commitment to mental health. We are eager to collaborate with you. Family physicians interested in sharing experiences on Substance Use in Vancouver can reach out to us at membership@vancouverdivision.com. Any collaboration done with family physicians to support Vancouver Division projects will be remunerated at the current sessional rate.