High-risk substance use and co-occurring psychiatric disorders are a major challenge in society and, in particular, to the health care system given its impact on emergency departments, acute care services, and outpatient resources. Heightened morbidity and mortality of this patient group has reached historic levels and there is urgency for the health care system to respond in a manner that addresses all aspects of patient care to improve outcomes. It is evident that approaches that exclude the unique skill sets and attitudes of psychiatry have been inadequate. Psychiatry needs to address the following challenges:
The care for patients with substance use and psychiatric disorders needs specialized knowledge and training to change current systems. Leadership in addiction psychiatry is required to facilitate change and improvements in treatment outcomes. Expertise development requires advocacy and leadership in training in addiction psychiatry for medical students, residents, practicing physicians, and other health care providers. Establishing standards for training in addiction psychiatry will help build towards subspecialty status for addiction psychiatry.
Increasing quality of care needs to be made accessible throughout Canada, from urban to remote areas. Virtual care and online resources need to be expanded as well as specialized tertiary services to cover the needs of the patients including special needs related to age and specific risk constellations.
The interdisciplinary collaboration and synergy of care between providers, disciplines and institutions creating an integrated system and coherent model is the foundation of a functioning clinical pathway required for best possible outcomes, especially in the times of a public health crisis in addiction and mental health. Psychiatrists need to be actively involved along side individuals with lived experiences to support decision making processes impacting those with substance use and psychiatric disorders.Policies and guidelines need to be developed and implemented addressing the often neglected psychiatric components of care, based on the expertise and experience of addiction psychiatry guided by clinical and scientific evidence as a critical tool.
Research and innovation in this area needs to be expanded. More effective interventions are possible if there is systematic clinical research led by addiction psychiatry. Based on the experience with COVID we learned about the critical role of interventional and health care system research to inform the response to current and future challenges. We need to increase research capacity, involvement of psychiatrists and trainees, and strengthen support within our universities and funding agencies.
Patients with substance use and psychiatric disorders are highly stigmatized and neglected within society and our healthcare system. Even healthcare professionals often avoid providing care for this highly vulnerable group. Psychiatry has the knowledge, skills, and attitudes required to best help those with substance use and psychiatric disorders and make them a priority based on their high risk of mortality and multi-morbidity. Health professionals should know better and we should contribute to openness, empathy and professionalism.
The current public health emergency based on the opioid overdose crisis and a historic mortality due to a mental illness is a critical challenge. We all need to step up our response through:
The Canadian Academy for Addiction Psychiatry (CAAP) wants to attract every engaged professional in the field to strive towards outcome oriented collaboration to achieve high quality care and synergy caring for the most vulnerable.
