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Study Finds Mental Health Services Better in Canada than US

July 26, 1993

WASHINGTON (AP) _ Every night in Vancouver, Canada, an unmarked police car staffed by a specially trained officer and a psychiatric nurse sits ready to respond to emergency calls until 3 a.m.

Car 87, as it is called, is one of the reasons a new study rates the mental health services in British Columbia better than anywhere in the United States.

The province on Canada’s West Coast delivers services ″almost twice as good at approximately half the cost″ compared with New York State, said the study released Monday by two Canadians and an American expert on mental health.

British Columbia’s population of 3.2 million is about the same size as such states as Colorado, Connecticut and Oklahoma; and Vancouver, with 600,000 residents, has as many people as Memphis, Washington and Boston.

The province spent $59 per capita on mental health services in 1990 in U.S. dollars, half as much as New York state and less than seven other states, but more than the other 42.

The authors said British Columbia ranked well ahead of all 50 states for the quality of its services.

Unlike the United States, Canada has a universal health care system with all hospital and physician bills paid by the provincial government with revenues raised by taxes. About 16 percent of U.S. residents have no insurance.

Psychiatrists in Canada earned an average of $100,000 in 1991 in U.S. dollars, compared with $127,600 for their counterparts in the United States.

Psychiatric nurses play a larger role and psychiatric social workers a smaller role in British Columbia than in the United States.

The report cited Car 87 as one example of what it called the province’s more effective outpatient services for mental patients. A psychiatrist is on back-up call and can be summoned as needed.

The study also pointed to a follow-up study on one Canadian hospital that found only 18 percent of discharged patients had to be rehospitalized within a year and only 5 percent were arrested.

By contrast, it cited reports that as many as 30 percent of patients were rehospitalized within 30 days in Illinois, and 32 percent of patients in Ohio were arrested within six months of their release.

The study praised British Columbia’s housing programs, but said the high cost of cigarettes in Canada ($5 a pack) prompts many of the seriously mentally ill ″to live in cheap, rundown motels or hotels ... to save their money for cigarettes.″

The Canadian system has other shortcomings, it said, including a concentration of psychiatrists in the cities of Vancouver and Victoria; failure to use involuntary hospitalization when needed; and a lack of coordination between inpatient and outpatient services.

But overall, those with serious mental illnesses ″are substantially better off in British Columbia than they are in any state.″

The report was released by the Public Citizen Health Research Group. The authors are Dr. E. Fuller Torrey, a staff researcher; Douglas A. Bigelow of the British Columbia Ministry of Health; and Nicholas Sladen-Dew of the Greater Vancouver Mental Health Service Society.

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