Visions Journal

Building new models of care in the Salt Spring community

David Norget, MA, ABS, and William MacPherson

Reprinted from the "Rural, Remote and Northern Communities" issue of Visions Journal, 2020, 16 (1), pp. 23-26

William’s perspective

My trauma began at birth. I was born blue, unable to breathe. I have Asperger’s syndrome, which places me on the autism spectrum. I was a gifted child, doing deductive reasoning with fractions at the age of 3 and Grade 8 math at the age of 5. But I had poor physical coordination and was unable to understand child social dynamics.

I was also obsessive. I had numerous illnesses and was given antibiotics many times a year. I now understand how this devastated my gut microbiome and contributed to the issues that followed.

By 9, I had suffered significant violence at the hands of bullies, which made me fearful of people. Luckily, I am an autodidact, which means I learn primarily by teaching myself. The Age of the Internet is an ideal time for autodidacts. The bulk of my learning was done at home.

At 15, I experienced increasing anxiety. I began using substances to calm my feelings. I was prescribed Paxil to deal with anxiety, exhaustion and depression. One side-effect of the Paxil was hypomania. I interpreted this as an improvement, as it freed me from fear. But as my hypomania intensified, I received new diagnoses: bipolar 1 and borderline personality disorder, co-occurring with an addiction to cocaine and alcohol. Within two years I was having manic episodes. I was prescribed mood stabilizers and antipsychotics.

The next decade of my life was defined by my mental illness. During much of this period, I was living in Vancouver. Eventually, I realized I wasn’t able to cope well living in a city. I moved to Salt Spring Island to live with my parents, who had retired there a few years earlier.

Escaping the people and places that reinforced my bad habits helped—but only for six months. I then found new people with whom to share old habits and create new patterns that contributed to my mental illness.

My mental well-being was always shifting, and my emotional experience was intense. Cocaine and alcohol gave me the illusion of control. Compared with periods of crippling anxiety and depression, my manic episodes felt liberating. My drug use and impaired judgement created a destructive feedback loop. The mental lows following an episode of drug use would leave me with thoughts of suicide. I had to fight to re-establish equilibrium.

The resulting sense of shame and lack of self-worth was suffocating. My doctor told me it wasn’t my fault. I was a victim of an illness that runs in my family. This helped assuage my self-loathing. But nobody seriously discussed the possibility of healing; I was simply prescribed medication to alleviate symptoms. At the time, mental illness was largely viewed as a genetic disease acting through neurotransmitter pathways: a lifelong affliction. But I had a growing suspicion that a lifetime of prescription medications had worsened my health rather than improved it. I also began to suspect that healing was in fact possible.

My obsessive, autodidactic brain kicked into gear. While researching the term “neuroplasticity,” I found a book by Norman Doidge: The Brain That Changes Itself.¹ Doidge discusses the brain’s capacity to heal through rewiring itself after traumatic brain injuries. People who have suffered traumatic brain injuries and lose speech and motor functions can create new neural maps to regain lost function. I felt sure that if a person with a brain injury can relearn how to speak and move, then my brain could heal from its mental illnesses.

Many of the ideas I pursued—such as the principles of orthomolecular psychiatry (the use of high-dose vitamins to address mental illness) or eating a raw food diet—seemed to help temporarily. My doctor figured these ideas were placebos, valuable only in that they increased my feeling of personal agency. I know now he was right—but placebos can be powerful medicine. I was building an internal locus of control, foundational for mental wellness. I forgave myself for my afflictions, which were not my fault, while stepping into the driver’s seat of my recovery, which was my responsibility.

Understanding the distinction between fault and responsibility saved my life. I felt I was painted into a corner, and I identified the few good choices I could make. But those choices opened up new possibilities. A small change in initial trajectory can result in a vastly different destination over time.

I also found health practices that were game-changing for my mental and physical health. These include the Wim Hof method of breathing and cold training, periodic fasting, a ketogenic diet, yoga and—perhaps most personally important for me—the responsible use of psychedelics, the single most powerful tool I have found for healing trauma and rewiring the brain.

Today, my mood no longer cycles unpredictably. I no longer have a personality disorder. I don’t abuse drugs or alcohol. I haven’t taken psychiatric medication in years, and I now realize how medication had a negative impact on my well-being.* I continue to address the underlying causes of my mental health issues, the interaction of my trauma and biology—going into my own darkness while bringing my light. The greatest gift I ever gave myself was allowing my story to be one of redemption.

David’s perspective

William’s story is not an uncommon one; Salt Spring Island presents many of the same challenges to mental well-being that we see in larger urban centres.

Salt Spring has a population of roughly 11,000 residents, with an influx of visitors during the warmer months. We have a high per capita rate of homeless residents compared with the rest of BC^2,3 and, from my experience, a correspondingly high number of mental health and substance use issues. Poverty and domestic and sexualized violence rates are also comparable.⁴

Health care and community research since 2012 identifies similar issues year after year. For example, a 2019 Community Health Needs Assessment³ found that:

• Not everyone has access to care, especially people experiencing multiple barriers (for example, racism, homo- or trans-phobia, domestic violence and fear of domestic violence and the affordability, accessibility and availability of care)Residents of the Southern Gulf Islands (including Salt Spring) score lower in important health measurements than residents in the catchment of Island Health (serving Vancouver Island) and across BC
• About 50% of people needing mental health services on Salt Spring found services unavailable—25% found the wait lists too long and 25% were not able to find the services they needed at the time they needed them
• Services for people with disabilities, chronic illness and substance use issues and for those experiencing violence were available over 50% of the time—but not always when they were needed
• In 2018, 131 individuals on Salt Spring were homeless, a 58% increase from 2016
• In 2015, all of the 3000-plus RCMP callouts were described as having a mental health component. First responders note that mental health is a primary issue, among first responders themselves and the clients they are serving

The 2019 assessment also identified:

• A lack of information and coordination among providers on and off the island (some residents must travel off-island for care)
• A need to better serve those using the system, in terms of the range of services offered and the quality of services provided
• A challenge for clients in knowing where to go and for service providers in knowing where to refer a client
• A lack of information-sharing (organizations focus on fully serving their own clients rather than sharing information with each other)
• A need for greater learning through collaboration among service providers
• Burnout among staff members
• A challenge of interagency confidentiality
• A sense of feeling isolated and overwhelmed on the part of both service users and providers

Because the island lacks a cohesive vision for a healthy and well community, Salt Spring’s efforts to provide adequate service and care are ad hoc. Over the years, needs have increased within an already challenged care system. Individuals and organizations have not felt able to stop what they are doing to take stock, connect with each other and with clients, identify what is needed, and then together enter into the learning required to provide service more effectively.

The challenges have become more apparent in the context of COVID-19,  which has meant additional tasks to ensure health safety directives and additional coordination among providers (for example, to ensure COVID-19 testing for the insecurely housed and client access to showers and food). It has also highlighted disparities in the community—in terms of poverty, access to technology, domestic violence and racism, among other things.

Moving forward: Salt Spring Health Advancement Network’s Mental Health Initiative

Salt Spring is a caring community with many skilled individuals. It includes a number of community-focused organizations, health and care-service professionals and volunteers, such as Island Health, Salt Spring Community Services, School District #64, Salt Spring Literacy Society, Restorative Justice and Copper Kettle (supporting vulnerable community members).

Examples of people and organizations coming together and involving clients to improve services include a collaborative practices table for children, youth and their families, the Salt Spring Health Advancement Network (a community health organization involving multiple agencies and community members) and a Local Action Team (involving agencies and community members). There is increased readiness among individuals and organizations to work together more effectively.

Research studies have shown the importance of social connectedness in maintaining mental health and personal life satisfaction.⁵ In January 2020, the Salt Spring Health Advancement Network initiated a one-year Mental Health and Well-being Initiative. As part of a five-year initiative for mental health and well-being in the community, the collaborative project includes the development of a local mental health and well-being stewardship committee and a mental health symposium. The symposium was planned for spring 2021, but as the pandemic continues, the timeline is being adjusted.

The stewardship committee, composed of decision makers, clients and providers from the community, will lead the planning of a survey to clarify needs and issues, design the two-day symposium and work towards a mental health framework for the Salt Spring community. The symposium will bring a larger group together to discuss what is being done well and what could be improved or enhanced.

Better service for those in need and better support for providers is key. Stewardship will be integral in the next phases of this initiative. The participation of those with lived experience means a reality check is in place. Community mental health and well-being means ensuring all voices are heard.

*Editor’s note: As in all issues of Visions, William’s story is not meant to replace professional advice. You should never stop taking medications, for example, without first talking to your doctor. Also, talk to your doctor and pharmacist before trying new treatments to make sure there are no interactions.