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On the Street

Mental Illness and Addiction on the Downtown Eastside

Cynthia Row and Mykle Ludvigsen

Reprinted from "Concurrent Disorders" issue of Visions Journal, 2004, 2 (1), p. 54

Vancouver’s Downtown Eastside is known as one of the grittiest places in North America to live. It is a community that is faced with serious economic, social and health problems that seem out of place in a wealthy society such as Canada. Thankfully, both the public at large and those charged with making sure our community is healthy have taken a keen interest in this neighbourhood, with the desire to make it a better place.

Concurrent mental illnesses and addictions are found in all walks of life, but the devastating impact of this condition on both individuals and society can best be seen starkly on the streets of this neighbourhood. Every day, while the needs of the most needy fall through the cracks, service providers work closely with these people to help them rebuild their lives and recover from their mental illness, addiction or both. This grassroots reality is far different than the world of endless reports from various levels of government or the minutiae in the restructuring of various services.

Addiction services tend to be the most available on the Downtown Eastside, but there is acknowledgment and awareness by those who work in these services that a high percentage of people using their facilities and expertise indeed have a co-occurring mental illness. The Portland Hotel Society (which operates the controversial new supervised injection site in Vancouver, known as InSite), the VANDU unsanctioned injection site nearby, and the Triage and other emergency shelters are doing the best they can to incorporate the reality of concurrent disorders into their operations, considering the resources they have to work with. The people here have key knowledge into what would make a difference in the lives of those with a concurrent disorder in the Downtown Eastside.

Recently, Vancouver opened its first legal, supervised injection site. Under the authority of Health Canada and the Vancouver Coastal Health Authority, the site is run by the Portland Hotel Society, a recognized community leader in the Downtown Eastside. Because the needs of their clients are so complex, yet sometimes quite basic (a coat here, or a blanket there), and because their clients’ lives are in crisis, staff at every level – from the front door operator to health workers – tend to be advocates for their clients on all issues, all the time, on an individual basis.

The functional goals of the Portland Hotel Society (PHS) are to “establish relationships where (clients) slowly get to know and trust us, and get them to the place where they can access support and services,” according to Liz Evans, Executive Director of PHS. ‘The Portland’ has always held the philosophy that housing is a first step in stabilizing the addiction, which in turn is acknowledged as an important first step in treatment. This strong belief in the value of housing is shared by other service providers, and is also something that PHS provides for people with addiction problems.

The PHS currently has also enlisted the services of a drop-in counsellor at the Portland Hotel, or a “listening lady,” as Evans calls her. PHS subscribes to the view of “continuity and acceptance, based on the therapeutic family model,” according to Evans. Only time will tell how successful it is.

While Evans admits that services in the Downtown Eastside generally are progressing towards the 1998 recommendations for treating and managing addictions – that included the ‘four pillars’ recommendations, leading to the establishment of Vancouver’s supervised injection site – service providers are still under-serving their clientele: the homeless, the drug and alcohol-addicted, many of whom have serious mental disorders.

According to Mary Marlow, Manager of Withdrawal Services for Vancouver Detox, potential clients for their agency are screened by their automated telephone system which, while gathering pertinent information, asks whether or not a client has a psychiatric condition, whether or not that person is under the treatment of a mental health professional, or whether that person is on any medication. If the person is indeed under treatment, then generally, according to Marlow, they would be treated in the mental health system. But anyone with an apparent undiagnosed psychiatric condition who is in the detox facility would be assessed by a mental health worker who comes into Detox regularly to do assessments. Again, these services are just trying to keep up with the demand, thanks to dedicated to staff with a keen sense of being on a mission to help those who want to clean themselves up.

Over at the Triage Emergency Shelter at 707 Powell Street, clients (over 19 years of age), are referred by health care workers, Ministry of Human Resources employment assistance workers, hospital staff, or come in of their own accord. People are not screened at intake and while many have health issues such as HIV, they may not have an official psychiatric diagnosis when they come to Triage. Triage provides short-term emergency housing to people with addictions and operates Windchimes, a transition shelter. Triage has 28 crisis beds and access to 46 transitional beds.

Lesley Remund, Triage Emergency Shelter Manager, is emphatic about what would make the critical difference in the life of anyone on the street with an addiction, including people with mental illness: “The most important need for these people is housing and a continuum of care with minimal barriers to access,” she says. She points out that currently there is no housing for women with a concurrent disorder in the Lower Mainland. There is one 39-bed facility planning to open in 2005; but, as Remund points out, “transitional housing is a stop-gap measure.” Remund also thinks that there needs to be a clear pathway, and a continuum of care for the dually diagnosed. “After here, where do they go?” she asks. “People go from here to Detox and back to here.” She also stresses that services for the dually diagnosed should be available in one location, similar to what has been recommended in the Minkoff plan.

Concurrent disorders as a health issue is gaining recognition in the health community, but there is a long way to go before mental health and addictions issues receive the attention and resources given to other health conditions, such as heart disease or diabetes. In a faltering health care system, competing for recognition is even more of an uphill battle – a battle being fought by service workers on the Downtown Eastside and throughout our communities.

In the meantime, large numbers of people with concurrent disorders go without adequate management of their condition, as they struggle just to survive. Workers on the Downtown Eastside try to help them with their most basic needs – food, shelter and clothing – while a full-blown health crisis rages around them on the streets. A first step towards a real solution is to acknowledge that a large number of street addicts have serious untreated mental health issues. And policy makers would do well to listen closely to those who have daily contact with them at PHS, Triage and detox facilities.

However this is achieved, stable and retainable housing must be available for people with addictions and mental health problems before proper treatment or self-management can truly take hold. People who struggle with these conditions need to be met where they are at – namely by a continuum and circle of care in their own communities.

 
About the Authors

Cynthia is Editorial Assistant for Visions. She lives in Vancouver, is a mental health consumer, and has a background in freelance writing and broadcasting

Mykle is a Communications Officer at the Canadian Mental Health Association's BC Division

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