Opinion: Hundreds with mental illness are falling through the gaps

Daphne Bramham: Violence and chaos on Vancouver’s Downtown Eastside has increased, with those problems migrating to other parts of the city.

Daphne Bramham 5 minute read February 8, 2021

There aren’t just cracks that people are falling through because of the inadequacy of B.C.’s social safety net. There are chasms.

A mother wrote to me about her 32-year-old son who is on the bipolar spectrum and has been on a disability pension since he was 20. He is living with her because even after 12 years on B.C. Housing’s registry, he has never got a call.

“Nothing ever comes up because he’s not on the street or at (hospital) emergency on a regular basis,” wrote the mom, who asked that their names not be used because of her son’s paranoia.

Community mental health teams have refused to work with him because the pharmaceuticals he has tried don’t work for him and he won’t try any more.

Cognitive-behavioural therapy is often recommended. But psychiatrists who are covered by the provincial health plan don’t do it. Psychologists who do aren’t covered by medicare.

“I suppose it’s one battle at a time, but this one (psychologists not being covered) really irks when mental health issues are only rising during a pandemic,” she said.

There is another hitch, even for those who can afford it.

“No Canadian province or territory has established standards for accrediting (cognitive-behavioural therapy) practitioners,” according to the B.C. Partners for Mental Health and Substance Use Information, which is funded by the Provincial Health Services Authority.

“For now, there is no easy way for people who are seeking treatment to find out how qualified or skilled a particular practitioner is in (cognitive-behavioural therapy).”

Without her help, the mother bluntly says that her son would be on the street and likely dead by now.

I also heard from a father whose son has schizophrenia. He has overdosed on fentanyl a dozen times in the past 12 months and been revived with naloxone.

He’s known to police and was recently charged. His parents were forced to get a peace bond to keep him away from their home because he has broken in so often. They try hard to maintain contact, but they just can’t let him into their home.

There are thousands of British Columbians who are homeless, mentally ill and addicted. It is generally agreed that this is the tragic legacy of the closure of Riverview Hospital, a provincial institution for those with mental illness, without properly funded housing and supports to replace it.

The phase-out began four decades ago, and it finally closed in 2012. But it’s over those decades that people have been falling through the cracks and dying of neglect.

Of the homeless, an estimated two per cent have profound mental illness usually coupled with addiction. That means as many as 300 in Vancouver’s Downtown Eastside alone.

Here’s another chilling statistic: Of the homeless, it is estimated that 27 per cent have traumatic brain injuries sustained at birth, due to an accident, or, increasingly, from having been revived from an opioid overdose.

Attorney-General David Eby describes the whole disconnected mess as “a legacy challenge.” And it was dumped on his desk when Premier John Horgan’s mandate letter made Eby the Minister-of-Almost-Everything-But-COVID.

He is now responsible for developing a homelessness strategy, increasing supports for people with mental illness and addictions including better access to nurses and psychiatrists, more supportive housing, more affordable housing, more help for Indigenous people both on and off reserve, and a whole bunch of other stuff related to condo insurance, renter protection, housing affordability and drug decriminalization.

In an interview, Eby acknowledged that it’s “a fairly big assumption,” for example, that someone coming out of detox will immediately get into treatment. And after treatment, getting appropriate housing “is really speculative at best.”

Beyond that, “People age out of one program, but they’re not old enough for another. The gaps in services really eat a lot of people up.”

Disjointed and inadequate as the services and supports were before COVID, social distancing requirements have only made it worse. Violence and chaos on Vancouver’s Downtown Eastside has increased, with those problems migrating to other parts of the city. Smaller cities are also facing growing challenges from homeless camps and unprovoked violent attacks.

“It’s pretty terrible when you’re struck by the jarring reality that people are living in, because a homeless shelter or the drop-in centre is closed due to COVID,” Eby said. “In some ways, although it’s horrific and the suffering is profound, this is what was necessary for everyone to say ‘enough’.”

But solutions are slow and, for many, unsatisfactory. The province has already bought or rented unused hotels in Vancouver and Victoria, and an old brewery in Kelowna.

It will be April before people from the Strathcona Park homeless camp will be moved to a city-owned motel and a youth hostel. Next month, Victoria’s homeless encampment will be dismantled and people moved to a hockey arena.

Building housing takes time and Eby admits frustration with how long approvals take. “I’m spending a lot of time writing to cities asking them to please approve this housing.”

Building housing is a start. But it doesn’t begin to address pressing human resources questions. Is complex mental health care affordable outside of congregate housing? Are there enough trained people to manage supportive housing for the mentally ill and addicted? Are there enough psychologists, psychiatrists, nurses and others to care for the most desperately in need? And if not, where are they going to come from?

Those are questions for another day.


Twitter: @bramham_daphne


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