From downtown ashes to a Canadian Phoenix?
We need to assure the human right of health for those still in the shadow
By Dr. Michael Krausz, B.C. Leadership Chair for Addictions Research, originally published in The Province
No one should be surprised about the situation in the heart of Vancouver -- the growing homelessness, the lack and quality of services, the lack of access and capacity.
Nobody should be surprised, because it is not a priority and never was.
Those on whom society has turned its back -- the mentally ill, intravenous drug users and cognitively impaired people -- are still living in the shadows of society, in the darkness of back alleys and in the lonely destitution of single-room-occupancy hotels. They die after an often miserable life, on average 20 to 30 years earlier than those living only blocks away, with no superhero at their side.
The world will come to Vancouver and will ask a lot of questions. What answers would I like to hear and to give in a few months' time?
Q. How critical is the situation in the Downtown Eastside?
A. Simply put, it is a public-health emergency based on multiple problems, including those outside the Downtown Eastside and Vancouver. Further, it is an unacceptable situation for a country as wealthy as Canada.
Q. Is it possible to find a solution? What needs to be done to deal with the crisis?
A. Yes, it is possible. In Zürich, it took about six months to turn around the worst open drug scene in Europe once the government decided to provide the appropriate support. We know what needs to be done:
1. We need capacity, and treatments like substitution, detoxification and treatment of psychosis to be available on demand with no waiting time.
2. We need housing. Housing is a human right. How can those confronting the challenges facing many in the Downtown Eastside hope to have a chance if they are without shelter or sanctuary?
3. We need innovation. Where treatments are not effective, new treatments must be developed. For that, we need a B.C. Centre for Severe Addiction and Concurrent Disorders following the model of the B.C. Cancer Agency.
4. We need the reorganization of the existing system. Instead of silos, we need clinical pathways and synergy. Instead of barriers, we need patient-centred care.
5. We need a better governance system to plan and allocate resources based on evidence and effectiveness.
Q. Do the health authorities support this approach?
A. Yes, they do everything to create synergy in providing appropriate clinical pathways. All health authorities are working on stopping the drift into the Downtown Eastside through improved mental health and addiction services. The capacity of integrated services is approximately 1,000 for treatment slots now, and the regional programs for complex mental health and addiction have been implemented. They have also decided to provide the funding for mental health and addiction according to the burden of disease.
Q. Does the provincial government deal with it as a priority?
A. Yes, the B.C. government decided to provide the same amount for this initiative as they provided for the fight against cancer, knowing that more then 50 per cent of cancer is addiction-related and that addiction figures heavily in effectively addressing the HIV epidemic. They support the Provincial Centre for Severe Addiction and Concurrent Disorder as a National Centre of Excellence with sufficient funding to train the next generation of experts and do cutting-edge research. The premier wants to make Vancouver a laboratory of solutions instead of a place of continuous failing!
Q. Does the federal government help?
A. The federal government is also willing to contribute substantially and announced a Clinical Trials Network for Addiction Treatment as well as $50 million for sustainable housing solutions.
Q. What does the University of B.C. do? Can research help?
A. UBC, as one of the leading Canadian universities, founded the Centre for Severe Addiction and Mental Illness together with the health authorities. The president announced an active involvement of the university to address the crisis in the community.
Q. Will this not be enormously expensive?
A. No, it is just a much smarter way to spend the money; paying for housing instead of prisons, paying for health instead of property damage and intervening early instead of producing chronic illness.
This vision is completely possible. Through the current and continued transformation of mental-health strategies in B.C., we can indeed rise from a collapsing system into a new strategy that creates meaningful change for those we've cast aside for so long, improving their lives and, as a result, the lives of all. Wouldn't that be wonderful? Wouldn't that be convincing for the world coming to the Olympics?
Dr. Michael Krausz is the Providence Health Care B.C. Leadership Chair for Addiction Research, and a University of B.C. psychiatry professor. He is also one of the principal investigators in the SALOME trial.
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