Monte Paulsen asked a good question about my recent story on the Burnaby Centre for Mental Health & Addictions, which is a 100-bed facility out near BCIT that is pioneering an incredibly comprehensive and high level of care for those people whose problems with combos of mental illness, addiction, and physical disabilities are so severe that no other agency seems to have been able to cope.
His question was essentially: What next?
What I didn’t get into in the story is exactly that question, though I did talk to a few knowledgeable people around town on that.
No one disputes that the centre is taking on some of the province’s most troubled citizens, that it’s helping them get to a calm place they haven’t been for a long time, and that it’s providing some respite for the agencies who’ve been caring for those people with far fewer resources.
But the centre is so expensive that it’s hard to imagine expanding it by much. It’s still not clear where the current residents will go once their nine months or year is up. And it can’t possible cope with all the people with a similar level of problems. The staff there estimate there are something like 12,000-15,000 people in the province with concurrent disorders, and the really severe cases number around 3,000-6,000.
St. Paul’s psychiatrist Bill McEwan, who has been working in the Downtown Eastside for a few years treating a lot of people like the ones now at Burnaby, thinks the facility is an amazing resource. But he is concerned about how 100 beds, where people stay an average of nine months to a year, is going to make a dent in the rather large problem
“For the one person who gets in at the right time, it’s wonderful,” McEwan told me. “But you need an action plan for what to do with all the others who are extremely ill but can’t get in. We have nothing for that.”
He is also worried that local mental-health/addictions agencies will simply use the Burnaby centre as their relief valve for all problems. Instead of providing some kind of immediate and intensive care for dual-diagnosed residents out in the community, they’ll put them on the wait list for Burnaby and that will be the solution. Except that it won’t be because they won’t get in for a long time.
And Patrick Smith, the vice-president of research for mental health at the Provincial Health Services Authority and the head of addictive psychiatry at UBC, said something similar.
“There’s no way this in isolation can do everything. This is a significant step forward, but for a sustainable approach, you need investments along the continuum.”
It didn’t sound to me like anyone envisaged the province expanding the Burnaby model in any huge way. It’s just so expensive. It’s seen by all as a place to give the current housing/mental-health agencies some respite in dealing with these very challenged people, both by temporarily removing them for some intensive care and then, presumably, returning them to the community in a much more stabilized, less chaotic state. Like I said in the story, it’s seen as the G.F. Strong Centre — the emergency, high-intensity place.
But that means for the rest, who aren’t going to make it into that centre anytime soon (and the waiting list is already 300-400, I think I heard), that means there needs to be housing and then at least some of the same kinds of supports available to the 100 people out in Burnaby.
Most of the mental-health and housing agencies now dealing with dual-diagnosed people in their housing, get funded to provided anywhere from two to at most five staffers per shift for a similar number of their residents. That works out to about, at most, 20 or 25 staff overall, when you factor in three shifts a day plus weekends. That’s less than one-fifth of the staffing out in Burnaby.
So now everyone’s waiting to see what the provincial budget might provide when it comes to those kinds of supports for the social housing it’s been developing (the 12 new buildings and the hotels that have been bought). No one expects the same level of staffing, but there clearly needs to be more than two or three staffers on per shift in a building of 100 or 120 very troubled, recently homeless, mentally ill, HIV or Hep C or disabled people, many of whom have some pretty severe problems interacting calmly with others.