Building Community Society of Greater Vancouver, a nonprofit registered society with many years of experience in social policy in Vancouver, has become increasingly alarmed by the intractable general health, mental health and addiction problems in the Downtown Eastside (DTES), aggravated by extreme poverty and systemic inequality. These health issues are now being further exacerbated by the COVID-19 pandemic.
For the last two decades, the DTES has been pounded by crisis after crisis. From the infection outbreaks of HIV to the opioid overdose crisis (the neighbourhood has the highest rate of death in Canada), it has suffered greatly at all levels.
This wave of crises has grave consequences for the well-being of the whole Downtown Eastside community, and indeed, all of Metro Vancouver. There is profound suffering at the heart of our beautiful city that seems to defy all attempts to relieve it. The situation is in sharp relief now, so what can we learn from it?
A person’s right to health and home
The DTES has a population of 20,000 people, 7,000 living within the low-income community. Of those, 2,500 individuals suffer with untreated severe mental illness and addiction. Adding to an already complex issue: A disproportionate percentage of this most-vulnerable DTES population is Indigenous, the legacy of generations of systemic racism. This should never be forgotten as we search for a response to this crisis.
Further, there is an understanding among health workers that there are approximately 200 to 300 individuals whose mental health issues are too severe to be addressed by the current system. Too often these same individuals suffer from a multitude of daunting challenges: trauma (both psychosocial and brain injury), serious health issues (HIV, Hepatitis C), developmental problems (Fetal Alcohol Syndrome), grinding poverty, and intractable addiction. All of these can affect a person’s cognitive abilities.
Because of the shortage of accommodation at every level of need, there is no way to free up supportive housing units when a resident is able to move on to less-expensive (to operate) social or market housing. While we need to recognize that some individuals will always need supported care due to head injury, etc., we need to develop a meaningful housing ladder that starts with treatment facilities, leads to supportive housing, and goes on to social housing (defined as affordable to those on income assistance).
When it comes to individual health, we as a society wait for individuals to seek treatment of their own accord. It is becoming increasingly clear, however, that the aforementioned difficulties, individually or together, prevent many from having the awareness or insight to be able to seek treatment. Health care is a right in Canada, but individuals with multiple brain difficulties are missing out on their right to health.
A tough question we have to ask now: Do we really want to wait for more people to die of overdoses and suicides, have poorly treated physical and mental illnesses, and repeatedly go in and out of the criminal justice system?
This lack of effective treatment undermines the DTES community despite valiant attempts to restore it to social and civic health. This critical lack drives high rates of crime, is exacerbated by glaringly substandard housing, and leads to open drug use on the streets. Providing both housing and meaningful treatment is the only way forward in the overall healing of the DTES.
Focus on effective treatment and housing
Here in Vancouver, how many people with addiction get the opportunity to access addiction rehabilitation treatments? The answer is embarrassing: We do not really know. The problem is our system for addiction therapy is run by different organizations (health, criminal justice, B.C. Housing, along with private and religion-based providers) who do not share their data broadly. Can you imagine such a disorganized approach to our current COVID-19 public health crisis?
How many major addiction rehabilitation programs have been added in the four years the opioid crisis has been going on? Zero!
The Building Community Society of Greater Vancouver recommends that all levels of the community come together to forge an effective treatment plan that, like the plan for COVID-19, identifies and addresses the problem with commitment and a sense of urgency, both short- and long-term, which finally responds to individuals with mental illness and addictions.
This plan needs to have a single focus with critical supporting features. The focus: Achieving a drug-free life. Harm reduction, opioid replacement therapies and secure/safe drug supplies are helpful and should continue as means toward this goal. Access to treatment also needs to be accompanied by adequate supervised addiction-free housing so people can accomplish the tough task ahead.
To achieve the goals of the right to health and home we need to:
• Establish a single entity that will coordinate all social housing policy implementation. At present the well-intentioned patchwork of agencies, funders and nonprofits providing social housing fails the needs of underprivileged people requiring a home. The goal is to better organize a housing ladder that allows people to move up in their housing and lives.
• Establish forums and discussion platforms that help develop trust within our community. This community trust is needed to lead to a broad level of agreement that can help create the social licence needed to tackle solutions for these difficult problems.
While the DTES is an epicenter, the mental health and addiction crisis is a pervasive problem that dramatically affects all parts of Metro Vancouver as well as the rest of Canada, from cities to reserves. To ensure effective and lasting change, a multi-government strike force is needed with the power to investigate the elements that allow this ongoing crisis to continue and to make the necessary legal, policy and service provision changes that will lead to real change.
The City of Vancouver, which has so much stake in a successful outcome, can take the first step. We realize that the city can only do so much, but the one important tool the city has is in land use and zoning. If Vancouver is willing to step up to offer land to the provincial and federal governments, actually earmarked for treatment, we believe the other levels of government will be more likely to come to the table.
Building Community Society is a volunteer organization focusing on developing effective solutions for Vancouver’s Downtown Eastside. For more information, please see buildingcommunitysociety.org
Dr. Bill MacEwan is the former head of psychiatry at St. Paul’s Hospital and is a clinical professor in the department of psychiatry at UBC;Paul Sullivan is a communications consultant and former editor of The Globe and Mail and managing editor of The Vancouver Sun.
We have highlighted what we feel are a few key ideas, questions and challenges to real action. We are delighted by this op-ed that appeared the other day in the Vancouver Sun and we are happy to reproduce it here.
