DRUGGED, DERANGED AND HOMELESS

That's the population at the heart of the debate about the Downtown Eastside

By Lora Grindlay, The Province

They are psychotic, they are drug-addicted and they are homeless.

Doctors, scientists, advocates and those working the streets and
hotel rooms of the Downtown Eastside say those are the people falling
through a large and widening crack in a mental-health system that is
not able to serve the people who need the care the most.

Mark Smith, executive director of RainCity Housing and Support
Society, figures almost the entire homeless population in the
Downtown Eastside -- which he believes numbers between 600 and 1,100
- -- have mental-health issues and use drugs.

"Those are the ones. Those are the ones gesticulating. Those are the
ones that motorists slow down to look at. Those are the ones that
wander into traffic. Those are the visible homeless," said Smith.

"Where the hugest gap is, and where the biggest problem is, is for
people that are still active in their substance use and not really
all that interested in seeking treatment for their mental health."

And Smith said despite some movement by the Vancouver Coastal Health
Authority to recognize the problem, there is a serious lack of
programs for the mentally ill, drug-addicted population.

The provincial government has spent $63 million since 2007 on hotels
in the Downtown Eastside and now owns or leases 25 buildings with
1,550 units mandated as "low barrier" for the mentally ill and
drug-addicted population.

It's a great start, said Smith, but he's not convinced the
government's pledge to provide 24-hour support staff at a cost of
$700,000 for 50 units will be enough.

Most mentally ill people are isolated, he said, and need to reconnect
on a human level with people.

"If they are not reconnected and feel some sense of social obligation
and responsibility, they just continue cycling in the paths of
addiction and untreated mental illness. That takes staff," he said.

Smith said not everyone with a mental illness should be or needs to
be committed to a locked hospital ward, although some with
challenging behaviour do require asylum for their own good.

"People saying, 'Just put them all back in Riverview and lock them
down.' Well, there's a Mental Health Act, there's civil liberties
involved," he said.

"It's not so much about locking people away as it is providing the
appropriate levels of support in the community," he said.

In June last year, the provincial government opened the Burnaby
Centre for Mental Health and Addiction, a residential treatment
centre for the most difficult and complex cases. There are 100 beds,
a waiting list of 400 and it costs $1.2 million a month to run.
Forty-four patients have already completed their treatment there.

"This is a very challenging area of public policy and public health
service delivery, and I believe the challenge is best addressed by
having a broad continuum of services," said Minister of Health
Services George Abbott, pointing to the province's continued
investments in supportive beds for concurrent-diagnosis patients,
outpatient programs and community treatment teams that follow up on
patients once they finish a program.

Abbott said the new Burnaby centre, as well as The Crossing, a new
residential centre for youth with addictions in Keremeos, will help
address some of the challenges in the Downtown Eastside.

Abbot said the dual-diagnosis emphasis of the Burnaby centre is a
first in Canada, and that important lessons in managing such cases
are already being learned there.

Jane Duval, executive director of the B.C. Schizophrenia Society,
said the Downtown Eastside's ill and addicted population suffers from
"a huge amount of victimization."

"The drug dealers on the Downtown Eastside, they've identified all
the mental patients. They've got their cheques off them in two days,"
said Duval.

"All the people with a serious mental-illness diagnosis -- get them
out of there, because they are just victims."

Bev Gutray of the Canadian Mental Health Association said cheap
street drugs such as crack and a deepening gap between the rich and
the poor have contributed to awful conditions in the Downtown Eastside.

"I think you've got a huge vulnerable population with more complex
needs than they've ever had, fewer places to live and more readily
available drugs," she said. "To call that health care is similar to
leaving someone with cancer on the street when you have the right
treatment that could make their cancer go away and their life better."

These criticisms come despite the injection into the community of
millions of provincial government dollars -- earmarked for housing,
addiction, concurrent disorders, housing, health and mental health.

Lorna Howes, Vancouver Coastal Health Authority's director of
mental-health services, said $30 million out of the authority's $163
million budget for mental-health and addictions services is spent in
the Downtown Eastside, with a population of about 16,000. The health
authority serves the health needs of more than one million residents
of Richmond, Vancouver, North Vancouver, West Vancouver, Garibaldi,
the Sunshine Coast, Bella Coola and Bella Bella.

And that's just a fraction of the money being spent by taxpayers in
the Downtown Eastside. A Province investigation undertaken for
Operation Phoenix estimated the overall cost of the Downtown Eastside
at $1 million a day.

Howes said she hears criticism of a disconnect between mental-health
and addiction services "over and over and over again."

"I have been in this role for about eight years, and all of the
programs that we have either supported or put in place over those
eight years -- and there were some in place before that -- actually
don't discriminate between mental health and addictions," Howes said.

She said there is "the odd isolated area that in fact still is a
challenge" and believes "those are the ones that stick out."

She cited two programs that serve people with concurrent disorders.
One was the Strathcona Mental Health Team, which has more than 1,200
people on its roster (70 per cent of whom have concurrent disorders)
and -- at one to between 55 and 65 -- the highest client-staff ratio
of any mental-health team in the city.

She also cited the Vancouver Intensive Supervision Unit, which serves
a total of just 58 mentally ill offenders who are under court orders.

Howes admitted there is a "silent group" of mentally ill drug addicts
who do not engage the mental-health system, and it's not known how
large this group is.

"You absolutely never want to leave anybody on the street who is
unwell and requires care," she said. "We continue to look for
opportunities to link in with that group of people, because they can
be quietly ill for a very, very long time."

Experts say outreach services are the only way to reach this group,
but Strathcona Mental Health Team's outreach effort was cancelled
last fall and the workers called back into the office to help relieve
caseloads that are 30 per cent higher than any other mental-health
team's roster.

Each homeless person costs taxpayers $55,000 a year in health,
corrections and social services, according to an estimate in a study
released last year by Simon Fraser University's Centre for Applied
Research in Mental Health and Addiction.

The SFU study estimated that each homeless person costs about $37,000
a year once placed in supported housing -- a savings of almost
$18,000 from when they were on the street.

Smith's RainCity receives almost $9 million from the provincial
government -- through BC Housing and Vancouver Coastal Health
Authority -- and in the Downtown Eastside alone they run a 28-bed
emergency shelter, have a seven-member outreach team and provide 205
beds for drug-using people with mental-health issues.

They and the Portland Hotel Society are two agencies trying to fill
the housing gap with "low-barrier" housing.

"You say, 'You don't have to get treatment to live here. You don't
have to stop smoking crack or doing meth to live here,'" Smith said.
You just eliminate all the reasons, all the barriers that people
experienced trying to get into housing.

"That's the first step, and for some people that's the only step . .
. but that's better than nothing. It's certainly better than homelessness."

Indeed, most service providers in the Downtown Eastside say good
housing -- affordable, safe, secure and with supports -- is the first
step in changing lives.

"They come inside and they start seeing other possibilities. They
start sleeping at night instead of during the day, which they had to
do when they were homeless, because it's safer," said Smith.

"They don't have to act out and engage in seemingly violent and
psychotic behaviour as a way of keeping potential predators out of
their world."

While the Downtown Eastside is seen by some as a dangerous place for
vulnerable people, others say there is a certain level of tolerance
for behaviour far from the norm.

Downtown Eastside psychiatrist Dr. Bill MacEwan wondered if some of
his patients would be welcomed in neighbourhoods such as Kerrisdale.

"You look at the stigma and the discrimination. There are reasons
they don't live elsewhere," he said.

SFU research scientist Michelle Patterson says there are too many
programs in the neighbourhood, often in competition with one another
for funding, running in a system that is virtually impossible to navigate.

Patterson, an author of the SFU report, said not only is the
mental-health system in desperate need of more housing and resources,
but it's left weak by "a lot of service fragmentation."

"There are a lot of different people doing similar but different
things. They've got their own, slightly unique agenda. There is some
competition amongst different agencies for funding dollars," Patterson said.

"When you've got a lot of different components operating through
different organizations, there is often a breakdown in communication
and a lot of barriers."

Howes denied there is any fragmentation of service.

"We have a complete continuum of services down there. They're not
necessarily under one physical roof, but they certainly exist," she
said. "I think there is so much service going in down there that
people will call it fragmented."

That continuum spans primary care, mental health, addictions and
housing services, she said.