When Lee Johnston arrived in Vancouver at the Greyhound bus station off Main Street, the only place she had to sleep that night was Covenant House at Drake and Seymour.
Then 25 years old, Johnston said she had been living on the streets of Edmonton and had grown tired of Alberta’s winters.
A woman named Stephanie greeted her at Covenant and took her in, Johnston recalled in a telephone interview. But staff worried she needed more help than they could offer.
“I had all of these depression issues and I was suicidal,” she continued. “So they hooked me up with Inner City Youth as an extra support kind of deal.”
That was October 2010. Two years and one month later, Johnston graduated from Canadian Tourism College. She was her class valedictorian.
Now 29, Johnston thanked Providence Health Care’s Inner City Youth Mental Health Program for helping her get back on track.
“They are the entire reason why I was even able to go to school,” Johnston said. “They were so involved. I get anxiety about the dumbest things. So if I needed someone to come and hold my hand, they would totally do that.”
The Inner City Youth program was founded by a group of psychiatrists at St. Paul’s Hospital in 2007. Since then, it’s grown from a loose partnership between those doctors and Covenant House to involve B.C. Housing and the City of Vancouver.
At his office at St. Paul’s, one of those founding psychiatrists, Dr. Steve Mathias, told the Straight that there are between 150 and 160 youths in the program’s care at any one time.
“It came out of a group of psychiatrists seeing that youth were coming into the emergency room at St. Paul’s with profound mental illness as well as addiction issues, and being discharged from the emergency room with really no follow up,” Mathias recalled.
He said they decided they would try and intervene at a point preceding a visit to the ER.
“What we’ve done is say, ‘We need to get ahead of the problem, ahead of the crisis’,” Mathias emphasized. “So we provide services to the younger population, when they tend to be less crisis-driven.”
Cops on the front line
Providence, Vancouver Coastal Health, and a number of community partners such as the Portland Hotel Society provide an array of services for individuals with severe addictions and/or mental illness (SAMIs, for short). But mental-health advocates argue that programs like Inner City Youth—efforts that try and get ahead of problems—are few and far between.
Statistics show that too often, people struggling with severe mental-health challenges are not provided help until after they have already entered a state of crisis.
During the first six months of 2014, Vancouver police made 1,470 apprehensions under Section 28 of the Mental Health Act, which permits officers to arrest and detain individuals deemed to have a mental disorder and to pose a threat to themselves or others. That number represents an average of roughly eight apprehensions every day in Vancouver. It also marks a five-year high for the period of January 1 to June 30.
Severely mentally ill people are also victims of crime—sometimes violent—and susceptible to harming themselves. According to a report on mental health and addiction received by city council on September 17, Vancouver General Hospital and St. Paul’s Hospital together registered a 43-percent increase in emergency mental-health visits between 2009 and 2013.
The publication of that report was timed to coincide with one year having passed since Vancouver police chief Jim Chu stood alongside Mayor Gregor Robertson and called attention to the increasing frequency with which officers are the first point of contact for people with mental-health challenges.
“The answer for someone suffering a mental-health crisis is not a cop with a gun,” Chu said on September 13, 2013. “We need a shift from dealing with the crisis to preventing the crisis from occurring in the first place.”
Chu and Robertson have repeatedly requested help from the province.
The B.C. Ministry of Health, B.C. Ministry of Justice, and B.C. Housing all refused to grant interviews on the topic of mental health.
Care in the community
Andrew MacFarlane, director of mental health and addiction at Vancouver Coastal Health (VCH), told the Straight that since the mayor assembled his task force, care providers have begun working closer with counterparts in law enforcement and the justice system.
“We are working together and really looking at creative new services, an expansion of existing services, and new partnerships,” he said.
For example, MacFarlane continued, VCH has increased the number of Assertive Community Treatment (ACT) teams working in Vancouver.
ACT teams were created in January 2012 as a means of addressing gaps VCH had identified in mental-health care in Vancouver, MacFarlane recounted. Expanded this year from three to five teams, the ACT program sees nurses and social workers deployed to help people struggling with severe mental illness and addiction challenges in the communities where they live.
“Some of the most behaviorally-challenged…we weren’t doing a very good job of engaging them where they were at,” MacFarlane said. “They were coming to the attention of police and coming out of the jail and criminal justice systems. So we knew that we had to look at a higher intensity model, which was the ACT.”
According to a May 2014 B.C. Ministry of Health media release, the expansion of ACT teams currently underway will increase the program’s caseload from 215 clients to 420. It’s noted there that to the run two additional ACT team it will cost the province $3.6 million annually, making for a total cost of roughly $9 million per year.
On results, that release states that after one year under the care of ACT teams, clients experienced a 70 percent reduction in emergency-room visits, a 61-percent drop in criminal justice involvement, and a 23 percent decline in incidents of victimization.
Homes changed lives
Before taking the position of vice president of knowledge and innovation at the Mental Health Commission of Canada (MHCC), Jennifer Vornbrock spent 12 years working with Vancouver Coastal Health, during which time she largely focused on the Downtown Eastside.
On the phone from Toronto, she described a multi-year, cross-Canada study called At Home that provided shelter for homeless people struggling with mental illness. (In Vancouver, 58 percent of participants were also observed to struggle with drug dependence.)
“We basically said, ‘We’ll give you housing, and then we’ll work with you to deal with your issues related to mental health and addiction,” Vornbrock said. “It was the largest research project on homelessness in the world and the findings were outstanding.”
According to a MHCC 2014 final report on the At Home experiment, participants who were provided shelter experienced half the number of emergency room visits as their homeless counterparts. They also incurred “significantly fewer” criminal convictions.
While Vancouver Coastal Health’s ACT teams cost roughly $20,000 per patient per year, the MHCC report states the At Home program provided care for the severely mentally ill for $28,000 per patient per year, and for a moderately ill individual for about $16,000 annually.
“Not only can it save you money and avoid unnecessary costs, it can actually change people’s lives,” Vornbrock said. “Housing first does work.”
Money spent "unwisely"
In 2012-13, the province spent $1.3 billion on mental-health and substance abuse programs, according to a Ministry of Health email supplied by spokesperson Kristy Anderson. That message emphasizes that the province has approached care for the severely mentally ill with a “housing first” approach but provides few details.
In a telephone interview, Sue Hammell, NDP MLA for Surrey-Green Timbers and Opposition critic for mental health and addiction, noted that the majority of the province’s services for the mentally ill do not prioritize preventive or early-intervention care.
“The system is spending money, but very unwisely,” Hammell said.
She suggested the government could shift some of the money it currently spends on policing to mental-health services, with the goal of preventing police involvement from ever being required.
“If we’re not effective in the community, it will leave people untreated, and that will have long-term negative consequences,” Hammell added. “Not just from the person’s perspective, but from the community’s perspective.”
During an interview at VPD headquarters, Const. Brian Montague described a situation where police officers have reluctantly accepted that they will often be a mentally-ill individual’s first point of contact with the system.
“They are not mental-health experts,” he said. “But they are being asked to deal with individuals who are clearly suffering from a mental illness, who are often extremely violent, and who probably wouldn’t be in the situation if they had proper medical care prior to police being called.”
Accepting this reality, people like Lyle Richardson work to minimize the potential for a police interaction ending with someone getting hurt.
Richardson participates on panels at the Justice Institute of British Columbia. Diagnosed with schizo-affective disorder, he talks to new recruits about mental health, and offers advice on how to de-escalate situations that involve an individual with a mental illness.
During a drive near his home in New Westminster, Richardson recounted realizing the extent to which B.C.’s mental-health care system revolves around points of emergency.
“The crisis line, it’s 1-800-SUICIDE,” he said. “We don’t really promote a system that allows for people to reach out before things get to a point where police need to get involved.”
“You shouldn’t have to be suicidal to reach out for help,” Richardson added.
Chasing a crisis
This article is the third in a six-part series.
Part one: Vancouver police still seeking help to prevent a mental-health crisis
Part two: Amid a mental-health crisis, Vancouver care providers revisit the debate on institutionalization
Part three: Vancouver service providers fail to get ahead of a mental-health crisis
Part four: B.C. prisons lock mentally-ill offenders in isolation
Part five: Vancouver's ill and addicted lost in a mental-health care maze
Part six: Deaths involving police reveal a long pattern of mental illness and addiction