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What are the next steps with the Burnaby Centre for the mentally ill and addicted

January 27th, 2009 · 25 Comments

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.

 

 

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  • Dawn Steele

    The arguments that it’s too expensive to expand these things are generally very short-sighted. Expensive compared to what? How much does it cost to leave thousands of other people living in chaos on the streets every day when you count up all the hundreds of millions that are poured into “containing” the DTES? How much does it cost to leave people to deteriorate until they reach rock bottom and qualify for such crisis intervention, vs. offering earlier supports that can get them out of the trap early for a fraction of the effort? (So if we started investing in moer and earlier intervention instead of just letting everyone hit rock bottom, how much less can we expect this to cost on an ongoing basis, once we clean up the dire mess we’ve created through such long indifference?

    How much does all the lost productivity cost – not just for the individual, but in terms of the wider family and community crises that ripple out all around them?

    And finally, what value do we put on human life and dignity? Do we ask how much it costs to remove someone’s brain tumour? To save a premature infant? Or to keep Grandma patched up into her 90s? Why is this different?

    I can only assume we make this distinction for this particular group of people because – after all these years and after all we know that contradicts this – most people still assume that mental health problems and addiction are simply poor choices – a reflection of poor character, the consequences of which are the poor sods’ just desserts, as pitiable as we may find them.

  • Dawn Steele

    The arguments that it’s too expensive to expand these things are generally very short-sighted. Expensive compared to what? How much does it cost to leave thousands of other people living in chaos on the streets every day when you count up all the hundreds of millions that are poured into “containing” the DTES? How much does it cost to leave people to deteriorate until they reach rock bottom and qualify for such crisis intervention, vs. offering earlier supports that can get them out of the trap early for a fraction of the effort? (So if we started investing in moer and earlier intervention instead of just letting everyone hit rock bottom, how much less can we expect this to cost on an ongoing basis, once we clean up the dire mess we’ve created through such long indifference?

    How much does all the lost productivity cost – not just for the individual, but in terms of the wider family and community crises that ripple out all around them?

    And finally, what value do we put on human life and dignity? Do we ask how much it costs to remove someone’s brain tumour? To save a premature infant? Or to keep Grandma patched up into her 90s? Why is this different?

    I can only assume we make this distinction for this particular group of people because – after all these years and after all we know that contradicts this – most people still assume that mental health problems and addiction are simply poor choices – a reflection of poor character, the consequences of which are the poor sods’ just desserts, as pitiable as we may find them.

  • A. G. Tsakumis

    I’m glad that Dawn’s comments appear twice.

    They’re worth the read. Every word. Twice.

    The provincial govt should hang their head in shame. New housing?? So what?

    What’s an addict with a shopping cart going to use housing for?

    This province needs a comprehensive plan to deal with addictions, first and foremost, and mental issues…

    Reopen Riverview, without buffoon Rich Coleman’s bloody plan to erect towers and gentrify the place…

    Forget Insite, which is a failure, and playing footsie with the Portland Hotel Society and other povertarians, and spend the godamned money on addiction treatment, NOT FANTASY and enabling….

    Then, and only then, go out and build more housing…

    When Dr. Smith talks about “funding along the continuum” it sounds an awful lot like (and forgive me if I’m wrong) CAST and more shooting galleries, etc. THAT’S WRONG. Talk to any of B.C. top addictionologists and they will tell you that they are waging an internal war in their profession, pushing back against doctors who are more interested in getting published in a journal than fixing the problem. I worked in the DTES for many years. The provincial govt doesn’t have the first clue about what’s really going on down there. It’s chemical gulag.

    The culture of a drug for a drug is being played out by big PHARMA.

    I fear that the myopic vision of the Premier of Monuments, will inadvertently result in the just as devastating result of drugs coming from some Honduran refugee’s fannypack, as much as a doctor’s fountain pen.

    Shame.

  • Dawn Steele

    Forgive me for monopolizing this thread, but it’s really struck a nerve.

    I fumed all day yesterday over an after-thought: How is this expensive compared to the Olympics? Do we really rate a 2-week party that most of us won’t attend as more important than being able to walk around every day without stepping over the bodies of broken people?

    Then came the Budget: We can afford to spend billions in tax dollars to offer people like me who can afford $10,000 kitchen renos a $1,350 recession handout?! But if I lose my job and don’t qualify for EI and can’t pay my mortgage, it’s tough luck?!

    Hello? Are Alex & I the only ones who took the red (blue?) pill?

  • Wayne

    It seems obvious that Riverview served an important role and the decision to scale back services there without good alternatives in place has a lot to do with the deplorable state of life for so many mentally ill people in the DTES.

    I agree with Alex. forget about selling off the Riverview property to developers. Firstly, it’s probably the worst possible market and secondly the property belongs to the taxpayers.

    What better time to create employment and renovate the buildings, and create a treatment facility on the model of the Burnaby complex. It’s frustrating to hear all the government excuses for why we can’t undertake such measures while citizens are frequently lectured on putting all their support behind elite money pits like the Olympics.

  • LP

    Dawn,

    If you’re still fuming over this, whichever pill you took is either working overload, or hasn’t kicked in to cool you off yet.

    The feds recession (if there really is one) handouts were screamed for by every Tom, Dick and Harry in the country. Someone in the media quoted they had over $90 Billion dollars in requests for handouts.

    Who do we get mad at, the politicians for dumping money on what we/you/AGT don’t agree with, or with the people that don’t really need the help that will get it anyway?

    It’s easy to dump on politicians, not so easy to walk around and tell everyone you pass on the street that they’re all scumbags. I can just imagine how that would go over, some how a taser would be involved eventually!

    Your question of how is this expensive compared to the Olympics, is another one of ‘me versus them’.

    Our cities and infrastructure for years was neglected and falling apart. The majority of our provincial budget is spent on health care and education, yet it never seems to be enough. Many of the people who don’t use the medical system and who have no kids wonder what they are paying for with their taxes.

    So who do you get mad at, Gordon Campbell and the BC Liberals as AGT does on a weekly basis, or the people who want more out of their tax dollars than health care and education?

    (For the infinite loop, now go back to my walking the streets and calling people scumbags comment.)

    Blaming the Liberals today is no different then the same blame that was placed on the NDP back in 2001. If only I had kept a list I once had of complaints against the NDP back then. It sounds eerily familiar to the BC Libs today.

    The reason I’m not fuming is because the numbers are all so confusing, and frankly I don’t know who to believe anymore.

    This expert says ‘this many people need this kind of treatment’, ‘that expert says those people need that kind of treatment’.

    Each expert seems to have their own agenda, and the people who need the help seem to be pawns in a continuing game of politics with every one blaming the government of the day.

    Frankly I’d like to see one NON-POLITICAL advocacy position for the province to sort through these stats and determine what we really need to start making a dent in a growing problem.

    That means no meddling from the insight people, no meddling from the gov, no meddling from the poverty groups, and no meddling from the health care unions.

    When I can see something tangible that I and the rest of the scumbags can understand, that isn’t influenced one way or another, I’ll give you a shout for one of those red or blue pills.

  • Stephanie

    OK, this is something I do know a little bit about, having worked with this client population in various capacities for most of the past decade.

    All due respect to AGT, but I think he misunderstands what is meant by “funding along the continuum”. The media might be focusing on CAST, but people who work in the field are not. Anyone who works in the field knows that we need a continuum of treatment and housing options: involuntary psychiatric inpatient care for the most seriously ill; residential treatment programs; respite care; and levels of supportive and staffed housing for people who are living in the community. This means adequate primary and secondary health care, as well – doctors, psychiatrists, counsellors.

    We all know that a lot of what we’re seeing here is the failure of massive deinstitutionalization. People often think this means that the community integration model is a failure. But the model is not a failure – its implementation, however, certainly has been.

    Reduction of the Riverview population created immense pressure on limited primary and secondary medical care and housing resources, resulting in a cascading displacement of clients through levels of housing and into the street. Often, clients who are unable to remain in the community with a set of supports in place cannot move up to a program with more supports because of directives from the health authority requiring those places to be retained for people who are being moved out of Riverview.

    Housing providers are then over a barrel, trying to house clients who cannot remain in the community with the supports they’re currently receiving. Some housing providers try to avoid these problems by simply creaming off the easier clients. If a client can’t stay housed it’s treated a a client failure (the wrong thing to do) instead of a program failure (the right thing to do) and clients are simply bounced from the program to the DTES. Discharge planning is often non-existent despite the fact that a program requires it, and accountability mechanisms are nil.

    That said, while it might be good to revisit how we use Riverview, a return to wholesale institutionalization is not the answer to this problem. The community integration model became popular because what we used to do to people with mental illness was wrong – left to rot in institutions, or stuck in boarding homes, drugged to the tits…just as wrong as leaving them to fend for themselves on the streets.

    More thoughts on this in a little bit.

  • fbula

    Dawn,

    As you can probably guess, I have no disagreement with your general sentiment about the need to take care of the homeless/mentally ill/drug addicted/sick.

    But when I noted that the program in Burnaby is likely too expensive for the government to think of expanding it substantially, that doesn’t mean it’s necessarily a choice between Burnaby and nothing.

    The cost at Burnaby is VERY high. If you do the math, the cost of a $14.2-million facility for 100 people is $142,000 per person per year. To provide that level of care for, let’s say, 5,000 people — about the mid-range of the guesses on how many acute cases there are — would be $710,000,000. Three-quarters of a billion dollars every year, and increasing every year as costs mount and the population increases.

    In the meantime, there are still another 15-20,000 out there who also need some level of support, although not quite as rich. As much as I’d like to say, let’s put all our money into doing all of that, I just don’t think it’s going to happen in reality.

    I think even people in the system think that’s not going to happen and it’s also maybe not the best use of a billion dollars or more. What I hear people calling for instead is improved housing and supports for people NOT at Burnaby, so that when people cycle out of Burnaby, they don’t end up back at square one. Or maybe people never have to go to Burnaby because they have enough to keep them stable in their community.

    The real debate is — how many Burnaby-type beds should there be realistically and how much support should there be for everyone else who needs some level of help.

    Stephanie seems to have a lot of knowledge about this and lots to say. Maybe she could weigh in with more, along with others as well.

  • Dawn Steele

    OK, no politics, no Tasers, no ideological debates, no need to go round calling people scumbags…

    Just some simple math.

    How’s this for tangible:

    http://www.edmontonjournal.com/Health/year+lifestyle/1218194/story.html

  • Dawn Steele

    Sorry – we just cross-posted, Frances – I was replying to LP, not to you.

    No disagreement here that a continuum makes sense and that everyone’s not going to need the Cadillac model. But the Edmonton numbers do put it in perspective, don’t they?

  • LP

    A minor misunderstanding. The numbers on what a homeless person costs in government services isn’t what I was questioning.

    I’m referring to how many people need treatment, what stage they are at, how they are functioning currently, etc…

    It doesn’t matter who quotes a number, they’re all different. Someone please give me a real breakdown of what’s out there, without any fluff or bullshit built in to pad budgets or political purposes.

    On a side note: I’ll also throw in the question of how many of these people come from out of province, for work or whatever, and lend up falling on hard times in an expensive place to live.

    Going back a few years Ralph Kline was buying bus tickets for people to move to BC and collect government cheques from the NDP.

    So how much of what happens here should really be split among the provinces? One would think the provinces should have an agreement on sharing these expenses.

    Before anyone gets all pissed and thinks I’m suggesting the Kline method, I’m not. Only raising a question as to how much of our problem in BC is home grown, versus migrated.

    Like I said I have lots of questions that need to be answered before I need Dawn’s red or blue pill. This is so bloody complex and as long as the different stakeholders have different agendas, how much can really get accomplished.

  • A. G. Tsakumis

    LP:

    You toss off that I get mad at the Premier and his party “on a weekly basis” as if it’s some perfunctory exercise that I commit to that has no real rhyme or reason.

    Let me be clear, regardless of your confusion (or blind support of the Man of Monuments): Gordon Campbell has lost his way and this govt, had it a reasonable plan that did not include wrapping the agenda around any whim of the Premier’s, should be MILES ahead of Carole James and the NDP.

    But they are not. Nevermind what Joan’s old partner says, the NDP are within striking distance.

    Think of that: The one party who has generally screwed the province every single time it forms govt, is within striking distance of a man who claims he has made B.C. the best place on earth…

    If you’re not frightened, then you’re a nut.

    Look at what the godamned BCTF are doing with their bullshit.

    Care to have a look at what forestry code will look like. It will go from unions executives writing it, union bosses dictating chapter and verse.

    Still not mad a Gordon for fucking things up and finding religion in all sorts of sidebars?

    70+ IQ issue will only gt accomplished now before an election? How disgustingly expedient is that? Just for the votes? The Ministry of Children and Families is a NIGHTMARE. No comprehensive drug treatment. No new beds for both detox and treatment. Nothing.

    Screw the folks who almost went broke on Cambie. It’s their problem, right??

    Castles in the sky…..

    You’re godamned right I’m mad. What happened to our humanity? What happened to Gord’s?? Was it ever there in the first place?

    Spare me the lecture, with respect.

  • Blaffergassted

    Twinning the Port Mann bridge is definitely part of that ‘continuum’ of care!

    Thanks Gordo and Steve, for building another bridge to sleep under!

  • Stephanie

    This is long and a little disjointed, so bear with me.

    A lot of the problems we have with homelessness and addiction were created by our collective failure to ensure that we had a functioning national housing program and enough mental health and addictions services. One of the things that’s so frustrating is that we need more centres like Burnaby’s partly because deinstitutionalizing people without adequate housing and medical care has *made* them decompensate, pushed them further into active addiction, and badly damaged their physical health. And even if someone has never been in an institution, if they become homeless they are much more likely to become addicted and decompensate in their mental illness. (The popular idea is that addiction causes homelessness, and it’s true that people with concurrent disorders are at high risk of homelessness; but there’s been some good research done that indicates that homelessness itself strongly contributes to the development of addiction in people who previously were not addicted, and the worsening of addiction in people whose addictions had previously been manageable. I can find a study or two if people want to see them.)

    It costs a lot more in time and effort and cash to try to stabilize the lives of people who have already become street-entrenched and really sick than it does to stop them from getting that way in the first place. Cutbacks to social services and medical care are inevitably penny wise, pound foolish – which is one of the reasons I want to bang my head against the wall when they’re proposed by so-called “fiscally responsible conservatives.”

    When we do try to provide housing for people with concurrent disorders, we make a lot of mistakes. Housing for people with concurrent disorders in Vancouver generally comes in two forms: low- or no-barrier housing (think the Portland) for people who are active in addiction; or “dry” housing. This leaves housing impossible to find for a huge number of people who are mentally ill (or disabled in some other way) but who only use drugs occasionally. Move them into the Portland’s main building and if they’re vulnerable they’re at risk of moving into full-on addiction, because the entire environment is saturated with drugs. But the dry housing won’t take them, even if they’re the kind of casual user who might get high for a day or two when cheque day rolls around and who doesn’t bring “street” activity into the building. Fortunately, BC Housing seems to have finally recognized this problem, and the SROs they’re converting will have options for people who use but who don’t have the kind of completely disorganized lives that would necessitate living in low-barrier housing. We’ve needed this for a long time.

    Another problem with low-barrier housing is that sometimes it ends up being the end of the line for folks who are active in addition. There are rarely sufficient options to graduate up and out into housing that’s quieter and more stable – in part because of the lack of mid-range housing like I’ve discussed. (The Portland does offer something like this in their buildings – I believe the Regal is for people who have managed to stabilize their lives – but there need to be many more buildings where people are able to be in recovery and not face eviction if they use). The Housing First model doesn’t work for everyone.

    And so I shudder when I read this quote from France’s post: “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.” The first problem? As a general rule, I don’t think it’s best practice to put 100 or 120 people from that client population into one crowded building. And if there are only a few people on staff, all they’ll be doing is trying to keep the craziness down to a dull roar. Housing for people with concurrent disorders that doesn’t have adequate supports essentially turns into warehousing.

    OK, I’ve gone on long enough. More to come if people are interested.

  • Stephanie

    LP, your ideas about tracking the home provinces of patients just isn’t workable. People have a Charter right to move within the country. And people become eligible for BC health coverage after they’ve been in the province for three months. Trying to bill other provinces would create an administrative nightmare. And it would open up a can of worms in which provinces tried to bill other provinces for things that they didn’t want to pay for – that Ontario criminal’s jail time, say, or that Newfoundlander’s brain tumour surgery, or that Manitoba income assistance case. And the flip side – what about the benefits that people who migrate to BC bring? Should another province be able to get their hands on, say, some portion of the business taxes paid by their newly-migrated local boy made good? If people are residents then they should be treated as residents. Any other approach isn’t equitable and it just won’t work.

  • Stephanie

    Whoops – I didn’t check for typos. Apologies, folks. (Hey Frances, is there any way to get an “edit comment” function built in?)

  • LP

    AGT,

    Not sure what side of the bed you woke up on or how you ascertained that I was lecturing. Also, I didn’t complain that you rail against the Liberals weekly, only that you do.

    Go back and have a closer read if you didn’t get what I was trying to say. Dawn asked why anyone else wasn’t getting as upset as you and she.

    All I was simply doing was explaining the confusion I have around all of the numbers been tossed around by everyone about who needs help and how much and who to believe.

    And I don’t believe I mentioned that I believe the Liberals either.

  • Dawn Steele

    Thanks Stephanie – I’d love to see more of this sort of thoughtful explanation out there in the mainstream. It’s hard to have an informed debate when there are so many misconceptions and often with very strong viewpoints and political/ideological aspects hogging the limelight.

    Any time I listen to people like you, it makes perfect sense. Even Mr. Civil City himself, Geoff Plant, is apparently asking the same questions. What I don’t get it how and why we consistently manage to lose all that common sense whenever this gets translated into public discussion and policy making, and therefore continue to do things that are so “penny wise, pound foolish.”

  • LP

    Stephanie,

    Thanks for the information, it’s definitely helpful in understanding more about the complexities of all of this.

    Your response on inter-provincial migration makes sense, however if it’s too difficult to administer between the provinces then the fed-gov needs to take more responsibility on this. I’m not suggesting limiting people moving here, only asking them where they’re from when we’re trying to assist them. My belief is that BC, based on it’s milder climate would have a higher inward migration rate of people needing help.

    Is there a provincial advocacy type of position to try and coordinate the various levels of care needed (from the various levels of governments, and various levels of health organizations)?

    If not, where in your mind does this fall apart and how could it be better organized?

    The reason I ask is because from what you’ve written it seems to me like the whole treatment process is lacking a front to end process for helping people.

    If there isn’t anyone to spearhead this, how can we ever move forward in a complete and comprehensive way?

  • Dawn Steele

    LP, I think you’re right and the Vancouver police strongly urged the creation of a mental health advocate as one of the measures recommended in a report they released last year. Basically the report explained how police officers, who have no expertise in this field, were being thrown into the de facto role of social workers/mental health workers, due to the lack of appropriate services.

    Mental health is primarily a provincial responsibility, but there are overlaps with the feds and local governments, health boards, CLBC, etc.

    The appointment of an independent provincial advocate with the stature of Mary Ellen Turpel Lafond would do a lot to put these issues on the front burner, but I somehow doubt Mr Campbell would be inclined to do that, given his hostile relationship with the new Children’s Rep.

  • LP

    Dawn,

    Can’t argue, GC mostly likely ain’t the guy to create that post.

    I wonder if this is something the Vancouver Foundation would support/fund, if the right people in the province approached them?

    Just a thought.

  • A. G. Tsakumis

    LP–you’re right, I was wrong, but passionate…all the same…

    🙂

  • LP

    AGT, passion is great, and definitely not over-rated.

    More people need your enthusiasm without all their selfishness (see special interest groups), in this city.

    And yes, provincially you are bang-on with being pissed at the Libs for letting this May be a race without any significant change in NDP party mantra from 8 years ago.

  • fbula

    Stephanie,

    Thanks for all the explanations. I actually had never thought about that mid-level of people who don’t really fit into either the low-barrier or dry housing.

    Sorry, there doesn’t seem to be an edit function. I can’t even go in and change your remarks — perhaps a good thing.

  • Well thank you all very much for the invaluable, interesting information and dialogue on the Burnably Centre. My son (32) is currently in treatment there and I thank God for this place for him to recover in a safe and secure environment. He has been living on the streets for the last few years and it is such a relief for his family to know that he sleeps in a clean, warm bed tonight and is finally getting the help he needs. No matter how expensive. I pay my taxes like everyone else and if another member of my family needed a kidney transplant I would hope that they would have access to the care they required. This level of care IS required for many people and I, for one, think this should be a priority health care initiative, province wide as well as across Canada. From a very grateful Mom!