B.C. has the highest rate among the provinces for hospitalization due to mental illness and substance abuse, according to a national report released Thursday.

Most provinces have at least one mental health condition among their top 10 reasons for hospital admissions, but B.C. stands out with three: mood disorders; substance abuse; and delusional disorders, including schizophrenia. These are credited with more than six per cent of all hospital stays, double the national rate, according to the Canadian Institute for Health Information.

One reason for the difference is that psychiatric patients in B.C. are treated in general hospitals rather than specialized facilities like the former Riverview Hospital in Coquitlam. It once housed thousands of patients, but officially closed in 2012.

Angita Pal, manager of clinical administrative databases at CIHI, said other provinces have dedicated psychiatric hospitals that aren’t included in the annual report. Across Canada, about 86 per cent of mental health patients are admitted to general hospitals compared to 99 per cent in B.C.

St. Paul’s Hospital in downtown Vancouver could be considered ground zero in the changing landscape for treating mental illness. Its emergency ward saw an 88-per-cent increase in visits due to addictions and mental illness between 2009 and 2014, said Dr. Bill MacEwan, the hospital’s head of psychiatry.

“I can’t tell you why Alberta, Quebec and Ontario have kept psychiatric institutions. Certainly in B.C. the move was away from long-stay institutions, which is a method of treating the mentally ill from the past.”

While there may still be a need for some patients to be protected from the outside world in a psychiatric facility, MacEwan says the real answer lies in getting more effective treatment outside of hospitals.

“Are we getting there? I think we are. Do we have further to go? Absolutely.”

Metro Vancouver and, to a lesser extent, Victoria are also unique because people from across the country migrate here for the milder weather. Drifters and runaways with existing psychological problems can exacerbate them with street drugs.

“That presentation of incredibly high levels of addiction with multiple substances in a person who has schizophrenia or bipolar disorder is much more significant here in B.C. than elsewhere,” he said. “Frankly, a decade ago, no one was talking about this. Nobody would have been able to say we were going to have this kind of growth five years ago.”

While the 66 psychiatric beds at St. Paul’s are at “105-per-cent capacity,” MacEwan says adding more isn’t the answer.

Jonny Morris, public policy director of the Canadian Mental Health Association, B.C. Division, agrees.

“The community is an important place for mental health treatment and is enough being invested there to keep people from being admitted to hospital in the first place?”

Talking to a psychologist is costly for the average person so innovative provincial programs such as offering free cognitive-behavioural therapy over the phone hold promise, Morris says.

While these methods won’t prevent a major psychotic episode, they could help some people deal with their problems before reaching a crisis.

“We aren’t at the point of having a fully integrated system where mental health and addictions care is a one-stop shop. Many families say people have to go to one place to receive their addictions treatment and have to do that first, then get mental health care. We know these conditions often coexist,” says Morris.

“Working with people with mild-to-moderate problems is a really good way to spend smart. Most people deteriorate over time when it comes to mental health and substance abuse.”

According to the CIHI report, having a baby is the top reason for being admitted to hospital across the country, resulting in 12.5 per cent of in-patient stays. The most common in-patient surgery is also birth-related — caesarean section.

Nationally, chronic obstructive pulmonary disease (COPD) came in at No. 2, followed by heart attacks (No. 3) and congestive heart failure (No. 4). Mood disorders and delusional disorders including schizophrenia rate near the end of the national list at eight and ninth position.

eellis@vancouversun.com

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