An expansion of supervised-injection services and safe rooms for crack users are two ideas Vancouver Coastal Health (VCH) says it is exploring in a policy paper released yesterday (February 24).
The document lays out strategies and specific recommendations for a “second generation” of health-care designed for the Downtown Eastside (where VCH spends roughly $55 million a year). It is the result of more than two years of consultation with service providers, clients, and partners in the community.
It acknowledges that VCH has largely failed to keep pace with changing needs, and promises the health authority will adapt and improve. Coming changes are “not about cost cutting”, it’s emphasized there.
In addition to an expansion of harm-reduction services, the paper repeatedly discusses plans for an increased emphasis on peer-based support. That would see people with a psychological condition more involved in the delivery of mental-health services, for example, and residents with addiction issues participating in the delivery of drug treatment programs.
In an effort to lower barriers to access, there’s also a recommendation that drop-in centres be better connected to care.
“In the DTES, drop-ins offer an important connection to health care for marginalized people by building relationships with staff and awareness in a welcoming, low-barrier environment,” it states. “VCH will explore ways to integrate drop-in centres as an effective gateway to more intensive supports.”
The paper also says VCH will work to develop a “full-time integrated women’s health clinic” and also establish “smaller, mobile clinics designed to meet women where they congregate”.
On harm reduction, the VCH notes federal regulations continue to delay an expansion of services. However, it makes clear VCH is still actively exploring options.
“VCH is interested in pursuing the development of supervised injection capacity in community health centres and other key service locations across the DTES and Vancouver,” it reads.
The report also addresses calls for similar facilities that would accommodate people addicted to stimulants such as crack cocaine or methamphetamines.
“An additional existing gap for addiction services is stimulant pharmacotherapy,” it reads. “VCH is committed to supporting and driving research and best practice implementation in this area, and to this end, local researchers are planning research into treatment options for stimulant addiction.”
A brief section in the paper’s appendix is slightly more specific. It’s proposed there VCH “develop a business case for providing expanded access to Insite, and identify additional partner sites to host and support new safe consumption programs, including managed alcohol, throughout the DTES.”
Also mentioned is a recommendation that VCH incorporate more managed-alcohol programs into “low-barrier service environments” (which likely means certain social-housing developments).
The paper acknowledges some health-care clients will be resistant to change and emphasizes VCH is working with partners to limit disruptions.
“We will provide transition support, and will keep our clients, community partners, and other stakeholders informed,” it states. “Changes will be implemented slowly, on a small and manageable scale, with ongoing assessments to determine the health outcomes associated with each change.”
The paper also mentions VCH has identified service cohesion as a challenge complicated by privacy legislation.
“A common client database shared between VCH and contracted service providers was identified as a valuable component of a functional health service system. Considerable effort has been put towards this initiative, and privacy restrictions have led to roadblocks on many operational solutions.”
Finally, the paper briefly looks outside the Downtown Eastside. It notes that while many residents are happy in the community based around the 100 block of East Hastings Street, some wish to move to other areas but feel they are stuck in the Downtown Eastside on account of the concentration of services offered there.
“A common barrier that prevents mentally ill and addicted people from living outside of the DTES is a lack of appropriate services and supports, and too often clients who do secure housing outside the neighbourhood return to the DTES regularly because of the lack of supports found in other communities,” it explains. “To address this, VCH supports housing and associated service options being created in other Vancouver neighbourhoods.”
The policy document unveiled on February 24 builds on a trio of highly-critical reviews VCH commissioned and published through 2013 and 2014. Those reports describe VCH’s services in the Downtown Eastside as “too distant and bureaucratic”, as lacking cohesion to a point where “frustration is widespread and acute”, and as leaving clients “unaware of what’s available”.
From here, VCH says it will convene discussion sessions that will inform approaches to implementation.