HOMELESSNESS KNOWS NO CITY BORDERS

Problems Facing Downtown Eastside's Unhoused Are Challenges For All
Levels Of Government

This is a condensed version of Chapter 17 of the new book A Thousand Dreams: Vancouver's
Downtown Eastside and the Fight for Its Future.

When Gregor Robertson, a businessman and former NDP MLA, became the
city's new mayor in November 2008, he announced tackling homelessness
would be his first priority. But homelessness and the other problems
facing the Downtown Eastside are challenges not just for that
neighbourhood or for the city of Vancouver. They are problems that all
levels of government -- municipal, regional, provincial, and federal
- -- must tackle, and all of them will have to come to the table if
meaningful solutions are to be found.

Ending Homelessness

Homeless people continue to die on the streets of Vancouver. In
December 2008, a 47-year-old woman known only as Tracey burned to
death in a cardboard shelter she had erected over her shopping cart on
an unusually chilly Vancouver night. She had lit some candles in a
feeble effort to keep herself warm, and her body was found smouldering
in the cart just before dawn. Even if Tracey had wanted to come
inside, there is not always a place to stay, regardless of the
weather: the Triage Shelter routinely turns away 400 to 600 people a
month because it is full. Lookout and other shelters report a similar
situation.

Most experts agree that Vancouver currently has at least 2,000
homeless people, the vast majority of them in the Downtown Eastside.
The Metro Vancouver region needs a supportive housing plan for all of
its 28 municipalities, Larry Campbell and Neil Boyd believe. Every
city has challenges with drugs and homelessness, and the problems
can't be defined by the borders of a municipality. A coordinated
approach should be overseen by a regional council on homelessness and
run by veteran bureaucrats from city halls; mayors and councillors
often have polarized views, and they usually serve only one or two
terms in power. Some of the new social housing needs to be in the
Downtown Eastside, close to services for the marginalized; some needs
to be outside that area, for the working poor and recovering addicts.
A coordinated policy will also be needed to deal with NIMBYs, the
not-in-my-back-yard people who don't want social housing on their
residential streets, despite the reality that the folks affected could
have grown up in their neighbourhoods.

What the Downtown Eastside needs is not more shelters, everyone
agrees. The goal, Campbell and Boyd say, should be more supported
units run by non-profit agencies who specialize in this work,
stalwarts like RainCity and the Portland Hotel Society.

RainCity executive director Mark Smith estimates that Metro Vancouver
needs 3,000 new social housing units to put a dent in the homelessness
crisis which is ravaging the Downtown Eastside. Successful social
housing must be geared to providing proper long-term accommodation
with private bathrooms and kitchens. Most buildings will need ongoing
medical and social support systems, according to Smith, because many
future tenants will be mentally ill and/or addicted people who have
been abandoned by the system for so long that they have little hope of
ever leading so-called normal lives. "Do we think any of these folks
are going to get to a point where they get a job and commute in from
the suburbs each day? No, that's never going to happen. The population
we see are so isolated and entrenched in addiction," Smith says. "They
are owed supportive housing by all of us, because in many respects we
put them where they are today."

Smith believes homelessness can be wiped out. "We could end
homelessness if there was the will and the resources were there. And
we have the resources in this country."

When the federal Liberals were defeated in 2006, they left a $17
billion government surplus. The Conservatives diminished that surplus
by a third in order to shave 1 per cent off the GST. Even half of that
1 per cent cut -- $3 billion -- easily would have funded the
construction of enough supportive housing to fill the need right
across the country, Campbell and Boyd say.

Many people believe that if we are determined to end homelessness and
ease the burden on the medical system caused by entrenched drug users,
we need a countrywide housing strategy that requires the provinces to
match federal funding and cities to provide the land for the
developments. With the economy struggling and government deficits
soaring, a national housing strategy may seem further away than ever.
But Campbell and Boyd both believe it is crucial to begin building,
even in an uncertain financial environment. Supportive housing and
treatment resources will cost a tremendous amount, they admit, but
those services will ultimately save society money by reducing the high
cost of people revolving repeatedly through the justice, health, and
social service systems. Once people are in a home and stabilized,
there will be opportunities for some to get off welfare and to work
and pay taxes.

"Everyone in Canada should care about this. So many people are one pay
cheque away from having their financial security crumble," Campbell
says. "Whose responsibility is homelessness? It's everyone's
responsibility."

Improving Treatment

A shocking February 2008 Vancouver Police Department report found that
49 per cent of police calls for service in the Downtown Eastside
involved a mentally ill person, which Darrell Burnham, of Coast Mental
Health, says is proof that many vulnerable street people haven't been
supported properly for years. "I think there's a ton of people who
need help, but they are sent to jail or a shelter or sent to a soup
kitchen," says Burnham, whose organization receives funding from all
three levels of government to provide services and housing to the
mentally ill. As a solution, Burnham champions new social
housing--including so-called wet buildings, which allow drug use and
methadone treatment--built outside the Downtown Eastside to get
vulnerable people away from victimizers and opportunists.

Burnham says many mentally ill people in the Downtown Eastside today
don't even have a diagnosis. Those with an active addiction or who are
"rough around the edges" are often excluded from existing mental
health services. The Strathcona mental health clinic in the Downtown
Eastside is more inclusive, Burnham says, and does wonderful work, but
the staff there are overloaded, seeing an estimated 125 clients a day.

The province's new 100-bed Centre for Mental Health & Addiction in
Burnaby, opened in 2008 to treat some of the most difficult-to-reach
people on the streets, is a start, Larry Campbell says, but many more
long-term beds are required to stabilize people before they can move
into supportive housing. Much as some people might shudder at the
suggestion, Campbell says, the quickest way to get hundreds of people
off the street and into care would be to reopen Riverview, which is
now almost empty as remaining patients are being transferred to newer,
smaller mental health facilities across the province.

"When I was a Mountie," Campbell says, "if someone was mentally ill
you arrested them and took them to the hospital for assessment, then
drove straight to Riverview. I think there's still a need for a place
like that, for ... many of the chronics, for example, identified by
the Vancouver police report. In many cases now they are treated and
back out in a short time with medication." Such an approach, of
course, would only be an answer for those willing to accept help once
they got to a place like Riverview.

Many more drug-treatment beds are also need in B.C. Treatment needs to
include a wide range of options, since the same solution will not work
for every addict, and be situated within a system that is easy to
access and non-judgmental. There must be sufficient detox beds for
drug users to be admitted the same day they make the request, Neil
Boyd says, and the system must be tolerant enough not to reject people
who need to go through detox five, ten, or twenty times before it
sticks. Critics must remember how often smokers try to butt out or
drinkers try to sober up before they are successful; those with drug
addictions are no different.

Once patients have gone through detox, there must be many more
transitional beds where marginalized people can stay while waiting to
get into long-term recovery programs. The system also must continue
providing treatment beds specified for women and youth. And for those
who are diagnosed with both a mental illness and an addiction, Boyd
says, we need treatment services that address both challenges at the
same time.

Embracing the Four Pillars -- Prevention, Treatment, Enforcement, and
Harm Reduction

The Downtown Eastside no longer has the worst rate of HIV infection in
the Western world, as Dr. Julio Montaner had declared in 1997, but the
situation remains dire. Vancouver Coastal Health recently pegged the
death rate from HIV-related diseases in the Downtown Eastside at 38
times greater than that in the rest of B.C. Other studies have offered
even higher estimates. The medical system still doesn't serve the
community's marginalized population, Montaner says, and in his opinion
continuing to ignore that is "genocide" -- the deliberate
extermination of a specific group. The solution starts, he says, with
better housing, better social services, and better mental health support.

Donald MacPherson, author of the four pillars report and still city
hall's drug policy coordinator, is also disappointed the blueprint he
drew up hasn't resulted in more change. "Basically, we should be
farther ahead on all of the pillars. We need more harm reduction, we
need a couple more injection sites, we need more treatment. Prevention
almost isn't even on the map. It's stunning how slow change has been,
considering the public support," MacPherson says today.

Campbell and Boyd advocate a future drug policy that supports a
continuum of care for people, serving everybody from the person who
can quit by simply abstaining to the person who can get stable only if
a doctor is prescribing him or her heroin. "If abstinence-based
treatment worked for everyone, we wouldn't even be having this
discussion," Campbell points out. To move towards a harm reduction
strategy, say Campbell and Boyd, it's imperative to remove the stigma
from addiction, which is now a crime. Legalize marijuana, says
Campbell, and "tax the hell out of it," with the money collected going
into treatment programs for those addicted to harder drugs.

The NAOMI project in Vancouver and Montreal and countless trials in
Europe have demonstrated that heroin prescribed by a doctor to
entrenched addicts can lead to improvements in both the rates of crime
and the physical and mental health of users -- all without allowing
supply to migrate into the illicit market. The onus, Boyd says, is now
on senior governments to support heroin maintenance through Criminal
Code exemptions and funding.

Another shift many harm reduction advocates support is the
decriminalization of prostitution. It is a controversial stance,
reviled by some service agencies and family members who argue public
action should instead be directed towards arresting johns and getting
women out of prostitution altogether. But Campbell and Boyd, along
with some Aboriginal leaders and community activists, argue that women
forced into the survival sex trade need safer working conditions until
they can get out.

Improving Aboriginal Health and Well-Being

At Vancouver Native Health's Positive Outlook clinic only about 130 of
its 400 HIV-positive clients, for a variety of systemic reasons, are
receiving life-prolonging antiretroviral AIDS drugs. "Our death rate
is still unacceptably high at our clinic. It is still ten per cent
each year, similar to sub-Saharan Africa," says executive director
Doreen Littlejohn. Aboriginal people, she adds, are still becoming
infected at the highest rate in Canada, despite all the harm reduction
advancements that have been made.

Littlejohn's boss at Vancouver Native Health, Lou Demerais, is
realistic about the situation, though he confesses to being an eternal
optimist. "The AIDS thing notwithstanding, the Hepatitis C
notwithstanding, the lousy housing that has been allowed to be
perpetuated notwithstanding," he says, Aboriginal people in the
Downtown Eastside are healthier today than they were when he helped
start the Vancouver Native Health Society clinic in 1991.

As a senator, Larry Campbell continues to lobby for funding that would
allow the Native Friendship Centre to construct an Urban Native Youth
Association building. The idea, first proposed during the years
Campbell was mayor, would give Aboriginal teens a safe place to hang
out. "There's a huge issue with Aboriginal youth and gangs in
Winnipeg. Vancouver will have that problem unless we help youth move
in a better direction," Campbell says.

Strengthening Community Pride

Among the many successes in the Downtown Eastside, the most striking
has been the ability of marginalized people to organize and advocate
for themselves. DERA, VANDU, and various Carnegie Centre groups have
accomplished much over the years. The staff at non-profit agencies, as
well as nurses and outreach workers who have committed their lives to
supporting the area's residents, have also brought energy to the
neighbourhood.

There is an unmistakable sense of community in the Downtown Eastside,
from the celebration of small milestones in a struggling person's life
at the Portland Hotel to the athletic, academic, cultural, and
entertainment programs run out of the Carnegie Centre.

Poet Bud Osborn is confident about the future of his resilient
neighbourhood, which he calls the "spiritual heart" of Vancouver.
"This is my community, and I had never known what a community was, or
a family," Osborn says. "This is the first place I didn't feel out of
place."

The challenge, people agree, will be to keep the Downtown Eastside a
community but make it a healthier one in the future. All levels of
government and every caring citizen should want to participate in that
vision.

A Thousand Dreams: Vancouver's Downtown Eastside and the Fight for Its Future is
published by Greystone Books, an imprint of D&M Publishers Inc., and available in
bookstores Saturday.

A Thousand Dreams: Vancouver's Downtown Eastside and the Fight for Its Future, written
by Larry Campbell, Neil Boyd and Lori Culbert, reaches book stores on Saturday. The
book, which chronicles the history of this neighbourhood and makes recommendations for
its future, is a collaboration by Vancouver's former chief coroner and mayor; oft-quoted
Simon Fraser University criminologist Neil Boyd; and Vancouver Sun reporter Lori
Culbert. The Sun is publishing condensed versions of three chapters from the book.

Thursday: Lethal Heroin, Killer Coke, and Expo 86

Chapter 3 is set in the 1980s and early '90s, when drug addiction
began to escalate in the neighbourhood.

Friday: Canada's First Supervised Injection Site

Chapter 12 looks at one of the key harm-reduction initiatives to
combat drug addiction.

Today: The Road Ahead

Chapter 17 calls for solutions to make the neighbourhood healthier and
raises crucial questions for other large North American cities.