Homelessness isn’t just a housing problem

New tent city shows strategies for homelessness, addiction aren't working: citizens group

Businesses, residents near Strathcona Park frustrated with homeless tent city. | Rob Kruyt

After a tent city in Oppeneheimer Park was shut down due to concerns over the COVID-19 virus spreading in the encampment, some of the homeless who had been living there were placed in hotels and other temporary housing.

But it didn’t take long for the tents to begin sprouting up again just a few blocks away in Strathcona Park.

Business owners and residents in the area are alarmed and angry over the increased crime, open drug use, threatening and erratic behaviour, general deterioration of their neighbourhood and falling property values that this encampment has brought to the area.

A citizens group called Stepup is now demanding an audit of how an estimated $360 million that is spent each year, just in the Downtown East Side, is being spent. Whatever strategies are being used to address homelessness, drug addiction and mental health, they aren’t working, says one the group’s spokespersons.

“I think Strathcona has always been a neighborhood on the edge,” said Dallas Brodie, a lawyer and Vancouver spokesperson for Stepup. “But when Oppenheimer Park broke up, they saw the influx. It was immediate, and it was dramatic. And it was scary immediately.

“And there have been some horrible scenes take place down in those parks. Apparently, also, real estate is suffering because no one wants to buy now in these areas. But I think that the biggest thing people are feeling is a loss of a sense of safety in their own community.”

While the homeless problem is most pronounced in Vancouver, it’s by no means limited to Vancouver. It’s also a serious problem in Victoria and Nanaimo.

“There are many people who live in hell on our streets,” said Leonard Krog, the former NDP MLA who is now mayor of Nanaimo. “And they are making it hell for many others.

“It is the greatest source of complaints and concerns in terms of correspondence with mayor and council. And it's probably the most absorbing thing for our local police… our fire departments, the paramedics. They're all feeling pretty stretched, dealing with those who suffer from significant mental health and addiction issues.”

Despite more than 200 social agencies and non-profits operating in in the Downtown East Side, the problem just keeps getting worse, Brodie said. And part of the problem may be that homelessness is viewed too much through the lens of housing stock shortages.

 “To our mind, the biggest problem is that we're calling it a homelessness problem,” she said. “But it's not it's not just about homelessness. This is mental illness and drug addiction.”

While some people who are living in tents, on the streets and in temporary shelters are homeless because they simply can’t find affordable housing, it is estimated that half to two-thirds of the homeless population in the Greater Vancouver region have some form of mental health issue, drug addiction, or both.

An estimated 7,655 individuals were identified as homeless in B.C., according to the 2018 Report on Homelessness.  Fifty-six per cent of respondents reported an addiction, 40% reported having a mental illness and 33% had a physical disability.

To address the drug addiction problem on the Downtown East Side, a four pillars approach was adopted. Those pillars included prevention, treatment, enforcement and harm reduction. But key pillars of that approach are missing, Brodie said – enforcement being one of them.

“There's no enforcement because the police have been have been literally handcuffed from doing their jobs,” Brodie said.

“What we're doing isn't working,” Krog said. “The numbers are not diminishing, the severity is worse. The social costs are horrendous.”

With respect to mental illness, and how it has led to so many mentally ill and drug addicted people living on the streets, one nexus is the deinstitutionalization of mental health that occurred throughout the 1960s and 1970s. Throughout North America, large mental hospitals like Riverview Hospital in Coquitlam were shut down.

The idea was to build smaller, community based homes and support services where people with mental illness could live and receive the support they need in their own communities.  But to a large extent, that second phase of deinstitutionalization was never followed through on.

Krog thinks it’s time governments followed through with what was originally planned.

“In severe cases, that kind of institutional care is appropriate, and it keeps people alive and safe,” he said. “I'm not advocating returning to 1,000-bed institutions by any stretch, but you know, a 40 to 50 bed facility -- a therapeutic community.”

He also supports the idea of decriminalizing narcotics. Even the police chiefs of Canada have recently come out in support of decriminalizing drug use.

In the more severe case of chronic addiction, Krog believes that addicts should be able to receive narcotics.

“If you've been a serious street addict for five or 10 or 20 or 30 years and actually say treatment hasn't worked, I think you're probably a candidate for prescription drugs,” Krog said.

“When you have the police chiefs of Canada talking about decriminalizing drugs, to ensure, basically, a safe supply, then that’s a recognition that what we have been doing is not been working.

“There are lots of people in our community who are in methadone today who function perfectly well. They have jobs, they have families, they are not engaged in criminal activity.

“And I know that's hard for some people to accept. But I will happily take an addict on methadone or some other substitute or indeed on drugs, who isn't out stealing or engaging in criminal activity in order to support their habit.

“I'll take that person any day over some poor individual who's homeless, wandering the streets and pilfering everything they can in order to support the habit that is literally killing them.”

Prime Minister Justin Trudeau has thrown cold water on the idea of decriminalizing drug use, however. He said his government would not support decriminalizing drugs as a way to combat the opioid crisis, which claimed the lives of 177 people in B.C. in the month of June alone.

Julian Somers, a clinical psychologist at Simon Fraser University and director of SFU’s Centre for Applied Research in Mental Health and Addiction, agrees with Trudeau that decriminalization is no silver bullet.

“Nobody has been cured of addiction with a drug,” he said. “There’s no publication showing that…. increasing the supply of drugs to a population improves health. In fact, it’s the opposite. What people need is genuine care and material support.”

If politicians are looking for models that work, they already exist, he says.

“There are therapeutic communities that have been shown to work,” he said.

He cites the “housing first” strategy used at At Home Chez Soi, a national program that has helped to house and support some 500 homeless people with severe mental illness and drug addiction in the Metro Vancouver region.

“That's the model that we were supposed to implement, following deinstitutionalization,” Somers said.

Under that model, the first priority is stabilizing someone by providing housing, followed by whatever supports they need, including treatment for addiction and mental health disorders.

That's the reverse of conventional programs, which typically require someone to successfully complete and addictions treatment program first before being housed in subsidized or supportive housing.

Participants are given choices in terms of where they want to live and treatment regimes.

“When people are struggling with addictions are asked what they want, nobody says they want free drugs,” Somers said.

He added the At Home Chez Soi approach appears to be more cost effective than the programs in place now, which are mainly just aimed at housing, but don’t necessarily address all the other the underlying issues, like mental illness and drug addiction.

A final report on the Housing first approach concludes: "Receipt of HF services resulted in average reductions of $42,536 in the cost of services compared to usual care participants. Thus every $10 invested in HF services resulted in an average savings of $21.72."

“We're spending, publicly, as much money supporting people while they're homeless, as it takes to fund these programs,” Somers said. “It’s a loss financially.”