Homelessness, Mental Illness, and Substance Abuse
Detailed Discussion
The very social fabric of Vancouver has changed over the past decade. Many associate the problem with the Downtown East Side, which has received most of the media attention.
Over the course of my volunteer and community work I’ve witnessed a massive growth in residents who are homeless and suffer from drug addiction and mental illness that is found in every neighborhood of Vancouver. The solutions we look for must not only address the Downtown East Side but also in neighborhoods such as Marpole, Collingwood-Renfrew, Sunrise, and Fraserview to name a few. What I’ve also learned is that people became homeless for many different reasons – they are not all mentally ill and/or drug addicts. Meeting and working with many over the years revealed multiple causes, which ranged from physical and sexual abuse to physical disability and economic hardship. These causes are discussed in detail in a report put together by community services called “Building Trust in Our Neighbourhoods: Harm Reduction and Civil Society.
There has been debate over size of the homeless population, which, depending on one’s source ranges from a low of 6,000 to a high of 15,000 within British Columbia. A widely available research report authored by some top notch epidemiologists at Simon Fraser University provides the most up-to-date information on the scope of homelessness in BC and recommends solutions with associated costs. It is called “Housing and Support for Adults with Severe Addictions and/or Mental Illness in British Columbia”. Another is “Housing for People with Substance Use and Concurrent Disorders: Summary of Literature and Annotated Bibliography” which summarizes best published research on these issues.
To me, any number is unacceptable.
The NPA decided to ignore these reports and findings and instead chose to create research available, the NPA created “Project Civil City” which has been a dismal failure and commissioned yet more studies under the title of “The Collaborations for Change” which has done little more than ensure three more years of talking about a problem without taking any action. Indeed, by the time the talking was done and the lead time it takes to get any project underway, our city’s homeless residents could not expect any assistance for a nearly a decade from now!
The time for study is over. The Provincial government and the City have commissioned studies as early as the 1960’s when the homeless and substance abuse issues became noticeable. At a recent Vision Vancouver forum, Jeff Brooks, a retired social planner for the City noted that virtually all have recommended the same solutions. The first real action wasn’t taken until 2003 when the pilot project for InSite, North America’s safe injection site for heroin addicts was started. Despite its success, the future of InSite remains unclear. I support InSite because it is part of our health care system and worked in significantly reducing the incidence of HIV, hepatitis and other communicable diseases. It also established regular contact between addicts and health workers from which a trusting relationship can be built that will help the addict seek the appropriate long term help.
Besides Vancouver, several other cities in North America have also been studying homelessness, mental illness and addiction and the findings and solutions were remarkably similar. The most recent plan within the Canadian context was released by the City of Calgary. Calgary’s plan is remarkably similar to Vancouver’s Homeless Action Plan first released in 2005 in that is puts the emphasis on finding ways to create appropriate housing first.
It is clear, we know what to do and it is time for action. With the NPA there is little political will or expertise on these issues.
In my opinion, we need to adopt the framework of Calgary’s 10 year plan whose basic elements of housing first and prevention are found in all plans. All that needs to be done is to revise it to suit the unique circumstances in Vancouver. This can be done quickly and the work can get started immediately.
In my experience working with our City’s homeless and at-risk residents, there are some specific elements that address the unique needs of Vancouver.
Some Short Term Solutions
In the short term, to immediately relieve the crisis on the street it will be necessary to build and develop emergency shelters. There is a shortage of emergency shelters and what exists is generally small and efforts of the groups running them are uncoordinated.
It is not enough just to build more shelters, but to use them as a triage center that brings users into direct contact with trained shelter staff that will over time develop a trusting relationship with each person that will allow appropriate referral.
Such a model was used at Collingwood Neighborhood House’s “Breakfast and Shower Program”. Homeless residents were invited to come every Saturday morning to take a shower and enjoy a hot meal - and in so doing come into contact with staff that got to know each individual and the circumstances that led to homelessness. By getting know each person, we found that many were the victims of abuse, some were runaways, some had physical disabilities that prevented them from keeping a job, and others were simply the working poor. Not everyone was a drug addict. With this knowledge and the trust gained we were able to make the most appropriate referrals to health care services and housing services.
This small program has been remarkably successful, with obvious positive impacts between January 2005 and March 2007 includes:
- Over 80 people were “homed” in about 18 months
- 6 or 7 people per week found safe shelter
- 6 people per week accessed detox facilities
- 5-6 people per week accessed short-term medical care
- 2 people per week were connected to long-term health care, i.e. Family physicians
- Approximately 40 people reconnected with family and children
- 50 program volunteers received training in Mental Illness First Aid, empathic communication skills, and Non-Violent Crisis Intervention
- 30 participants contributed back to the program, and other Collingwood Neighborhood House programs, as volunteers.
On a recent tour of the single room occupancy (SRO) hotels in the Downtown East Side with members of Vancouver’s police, I was taken aback by the squalid conditions of the hotels and rooming houses, and how the owners and their staff take advantage of the mentally ill and addict residents. A simple and cheap step is to enforce existing building and occupancy codes on these properties and heavily fine or consider appropriation of those SRO’s that cannot or will not comply. This is in addition to the plans to purchase and renovate SRO’s already contained in Vancouver’s Homeless Action Plan.
Long Term Solutions
The long term solution would be to immediately develop our 10 Year plan that takes into account the most appropriate elements of Calgary’s plan but with some unique changes to suit Vancouver’s needs.
The key change is to develop an Office of the Mental Health Advocate that reports directly to Council. This office is tasked not just with leadership, but also to get the job done. In my experience a key element of success is to not to mandate mental, addiction and homeless services and housing but instead work to get the permissionof local neighborhoods using a community agreements model. The importance of such agreements was discussed at a recent forum that worked on entitled “Building Trust in Our Neighbourhoods: Harm Reduction and Civil Society” that brought together a wide range of community service providers in Vancouver who shared their experiences on establishing services within a community.
The community agreements model (also known as “good neighbor agreements”) is one where there is a signed agreement between local area residents and the service that outlines how the service is placed and run in a community.
The first step is to educate local residents on fact based, evidence based research on the causes of various problems and impacts on communities. Education is not consultation. Education dispels fears and allows informed decisions when it comes to consultations later for the development of a community agreement.
Education is an important job of the Advocate. For example, the Advocate would be tasked with educating and communicating with residents that supportive housing does not increase crime or lower property values! Here is a recent study by the Wellesley Group entitled, “We Are Neighbors: The impact of supportive housing on community, social, economic, and attitude changes”.
Specifically, they found that 1) property values and crime rates are unaffected; 2) neighbours do not think the buildings have had a negative impact and that opposition that existed to the houses when they were proposed has dissipated; and 3) the tenants contributed to the vibrancy of the neighborhood by participating with local residents on noise and speed reduction, and garbage removal. On the other hand, tenants were the target of criminal activity. With staff, they developed internal ways to handle crime that was found to protect both tenants and the neighbourhood.
Once fears were dispelled by education, the Advocate continues working in the community, local residents and service providers on consultation that will lead to the development of the community agreement. This is the job of the Mental Advocate is a hands on, get the community organized so that the neighborhood has a real role in defining the problems, picking a solution, and playing a role in the operation of the service. The job of the Advocate is in complete contrast to the NPA’s Project Civil City Commissioner whose job was simply to sit in an office and act as a crime czar who pushed other people to do the work.
A good example of how well this model works is the one that exists between the Evergreen Health Care Center and residents represented by the Drug and Alcohol Committee at Collingwood Neighborhood House to establish a needle exchange for heroin addicts within a residential area.
In sum, it is important that we take advantage of the hard research data available and learn from the successful (and unsuccessful) programs that exist. With this in mind, I am supportive of the following principle that will address the interrelated issues of homelessness, mental illness and addictions throughout the City:
1. Act on the strong research evidence that shows that supportive housing facilities are not harmful to a neighbourhood, and that they contribute to strong communities. The City should recognize that supportive housing is a necessary part of every neighbourhood by setting targets for all parts of the city but that the construction of such housing is subject to a community agreement or “good neighbour’s agreement”.
2. Create a streamlined approach that assigns projects to senior city staff that are responsible for securing the necessary approvals.
3. Ensure that all neighbourhood planning, zoning and building processes recognizes that housing is a human right for everyone. This is modeled after the very successful Montréal City Charter that covers the main sectors of municipal activity: democracy, economic and social life, cultural life, recreation, physical activities and sports, environment and sustainable development, security and municipal services.
The Charter establishes the principle rights and responsibilities, and the collective effort of citizens and the city to ensure these rights are respected.
The Montréal Charter designates Montréal’s ombudsman to promote solutions when citizens and the city disagree on issues based on its content.
4. Establish clear supportive housing targets as part of its 10-year housing strategy.
It is important to build a mix of housing that is suitable for people in transition and in treatment as well as social housing for those that have recovered, and that it is sited in areas that are close to transit and services. Being close to transit is important in helping a recovering person be close to services and help he or she gain and keep employment. Is also important that housing and services are not concentrated into a single neighborhood that would create a “ghetto”, or that some neighborhoods will carry the greatest burden of the responsibility for the homeless and their recovery. With a community agreements model, there is little concern about homes and services being concentrated in one neighborhood and permits collective responsibility for the homeless across the city to be taken.
5. It is one thing to build housing but it is another to keep people there. It is one thing to build housing but will it fit in with the community it will go into? A missing element in many housing plans is that it does not include input from the recovering homeless that will eventually live there (e.g., concerns about security and privacy) and that it sticks out like a sore thumb that inadvertently identifies residents as “homeless” leading to further stigmatization. The importance of these elements was recognized in San Francisco and in Santa Monica in the design of housing for the homeless.
-oOo-
Short Description of Issue:
The number of Vancouver Homeless increases by 20% per year.
Short Description of solution:
Support Prevention programs for at risk individuals and families.
Detailed Discussion:
Nathan Allen is a representative of Insite For Community Safety, an initiative of the PHS Community Services Society, which co-manages InSite, North America’s only supervised injection facility wrote, “…One issue that needs a fresh perspective is prevention of drug addition. Prevention must be far more than just an advertising campaign intended to scare parents, but focus on providing real education, and honest information. Prevention also includes many of the other concerns facing the people of Vancouver, including the need for expanded day care and improved affordable housing.” (June 17, 2008. Mayoral candidates must adopt fresh perspectives on DTES, Georgia Straight).
A leading cause and consequence of homelessness is drug addiction. Prevention must be a key aspect of any addiction homeless action plans. Nathan is absolutely correct and within the Vancouver context is home to many very successful prevention programs aimed at children, youth, new Canadians, families at risk which use peer support, “buddy” programs to street proof kids with education and knowledge. Programs such as these must be supported better, and it is not simply a matter of providing funding – many of these programs are funded – but that we must ensure stable funding as well.
However, most funding is provided on an annual basis, but in my experience at least a 3 year cycle is required. Moreover, grants also must be flexible to allow the provider to adapt programs to fit local needs and circumstances. All funding should be subject to annual progress reports to make sure the services provided are serving community needs.
