Introduction:
BCS is a group of volunteers with experience in government, business, communications, planning and service provision. Since 2009, the focus of our work has been support for the low income community residing primarily in the Downtown Eastside (DTES) of Vancouver.
BCS acknowledges that we are operating on the unceded territory of the Squamish, Tsleil watuth and Musqueum First Nations.
Currently our focus is on the lack of supports and systemic failures that have created an untenable situation for those struggling with physical and mental health crises exacerbated by addictions. Several sources suggest that there is a group of approximately 300 people in the DTES who are constantly left out of housing and health services. For instance, this number aligns with the number of people who consistently fall out of housing after being supported to find housing through the BC Housing/COV housing team. Systemic failures have resulted in conditions where trauma, poverty and lack of connection to community services have left some of our neighbours with nothing. People from this group are often evicted from housing, incarcerated, and hospitalized for overdose episodes. Their lack of hope and the resulting loss of agency creates a situation wherein even the services they are offered will not fill their needs. It is important to recognize that the representation of Indigenous people in this group is high. This can be assumed when we know that forty percent of the homeless population in Vancouver are Indigenous and subject to the same injury and losses but exacerbated by the effects of colonialism.
Goal
BCS is not a service provider. Our objective is to work together with all stakeholders, to create a continuum of housing and health services that will support this particular group of 300 people in the DTES as a model that can be scaled up to other regions of British Columbia where there are similar groups in extreme need.
Approach
Often solutions to social problems are imposed from the top down. Most of us who have worked in or around the system of service provision know that this approach is not working for those most vulnerable to homelessness, incarceration, and the opioid epidemic, with its attendant risks of brain damage and death.
BCS believes that there is a need to do it differently: to work from both ends of the service continuum. Lived experience and the wisdom of elders and peers who have first-hand knowledge of the struggles of their neighbours and family members provide a wealth of information that can be used to create welcoming and effective programs that alienated people will want to access. Some of this is already seen to work in the community – the overdose prevention sites are a good example of people coming together to keep their friends and community members alive and cared for.
At the other end of the planning continuum, it is time for collaboration and accountability among service providers and funders to produce programs that work for the people who need them most.
(BCS) Concept Plan Outline
The following outlines the three aspects of a proposed concept plan.
1. Draft Service Delivery Model
The basic principle is the commitment to never give up on the attempt to walk alongside people in their search for housing and health stability and to have meaningful options available for their use.
The intention is to gather information from service providers and user groups to forge a continuum of health and housing services that would make it possible for individuals who are struggling with multiple health burdens to gain access to a stable and healthy life. Our emphasis will be on identifying the current gaps in service and building partnerships (and support) with the organizations already serving this population group. These are our stakeholders along with government and potential funders in business and foundations.
BCS will work with stakeholders to support the implementation of this model.
Once we have gathered further input from stakeholders regarding the creation of meaningful services, the next step is to create and refine a service delivery model in collaboration with community partners. This model can then be presented to the stakeholders and the public in the hopes of creating an effective, coordinated continuum of housing and health programs for this group of people.
From what we’ve learned to date, the following elements may be included in this service delivery model, pending further revisions by stakeholders:
- Operations/Welcoming Centre – a community base for a support team, housing programs, and the critical program entry point. This could be operated in cooperation with the planned BC Housing-led navigation centre, with a dedicated stream for this group of 300 people. The Welcoming Centre can’t operate unless connected to designated housing and health services under the control of the Support teams. It is vital that any promise of help made to individuals be backed up with practical supports and that they not find themselves once more on the street.
- Multidisciplinary Support Teams – will provide intensive support to find housing and income, along with medical, addiction, and psychiatric treatment and follow up. This team will function for – walk with – individuals through all stages of their path toward stability and will continue to seek solutions in partnership with the users of the service. Each person may require a unique service plan. Indigenous ways of healing will be incorporated with the support of people with expertise in Indigenous wellness including those with lived experience of mental illness and addictions issues.
- Long Term Treatment (up to three years) for mentally ill, severely addicted individuals, based on a housing and service model that builds resilience and autonomy.
- Housing - A housing continuum (see accompanying document on housing continuance) can provide a path to autonomy at a level that is personally achievable. The housing needed by people who suffer from a combination of brain injury, trauma, mental illness and substance use changes depending on the severity of these conditions, and the treatment and supports they need. An element of self-determination is vital if people are to gain health and stability and the housing available must reflect the individual capacity to make personal choices.
- Training and Support - In recognition of the deep level of commitment and skill required for this work, a program of training and support for care givers and housing providers will be put in place.
- Individual Funding - Funding that is allocated for, and follows the individual, in the search for appropriate and adequate care. We estimate at least $30,000 per year per individual to address their housing and treatment needs. This is above and beyond their usual income assistance, pension or disability allowance. At all points along the continuum the funds that are allocated to individual treatment and housing (a draft overview of the role of individual funding, it’s administration and costs is attached in the email with this document) will play a part in securing needed services. For instance: a supportive housing provider may agree to hire a part time care worker to provide individual attention. Or funds may be used to alter the physical environment in a way that can accommodate the person’s needs. There is a provincial model for this arrangement in the Community Living BC (CLBC) crown corporation that funds supports and services to adults with development and other disabilities such as Fetal Alcohol Disorder.
2. Governance / Monitoring / Oversight Panel
BCS envisions a governance body with members from key government ministries, City of Vancouver representatives, First Nations representatives, community members and non-profits. No plan, including this one, can be effective without this broad-based input and support. This Oversight Panel (OP) will provide collaborative planning and accountability to help shape and coordinate the effort to provide a meaningful continuum of service and to monitor performance. The OP will not directly provide service but will provide annual reports focusing on qualitative and quantitative outcome measures of health and stability for the people served.
We propose that the OP report to the Minister of Housing in partnership with the Ministry of Mental Health and Addictions. BCS will support the formation of, and will have ongoing representation on, the OP.
3. Data Collection
There is currently no organized way to track services across service providers to determine who is being served, or if that service is consistent and effective.
The OP will be given the authority to gather the needed housing, health, addiction treatment and justice information required to allow a coordinated and integrated approach to analyzing, disseminating and performing needed outcome evaluations. This will allow meaningful direction of resources toward the gaps or interruptions in the housing and health continuum needed by the group of individuals we wish to serve.
The intention is to work with academic researchers with experience in gathering health and housing data.
Privacy considerations regarding data will be addressed. Anonymized data will allow us to discover/uncover the reasons why some individuals cycle in and out of supportive housing or the justice and health systems. This analysis will inform the focus and design of both treatment and housing options. Individual data will be obtained through consent of the individual served and will depend on the cooperation of those entities, such as health authorities and housing organizations, who hold this personal information to share it once permission is granted. This may need to be mandated by government.