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Can a giant bureaucracy and a bunch of idealistic missionaries really save the Downtown Eastside?

February 17th, 2014 · 13 Comments

The Downtown Eastside has become our regional mental-health institution, as most of the world knows.

What that means, among other things, is trying to deliver health care to thousands of people who are spread out across a few dozen city blocks instead of one convenient large institution, who can’t be compelled to show up for medical appointments, who end up flailing around between the health and the justice systems, and who can’t be locked up in a room when things get out of hand.

To deal with the whole gigantic mess, the bureaucracy of Vancouver Coastal Health is forced to interact with a host of non-profits to deliver services on the street and to try to manage the many people who come into the area on a mission to save the world. The result, surprise: A lot of conflict.

Coastal Health commissioned a study and report by writer Charles Campbell last year, one that didn’t flinch from describing the conflicts in the area. The health authority has put itself on a path to try to reform its services. But, as I detail in my Vancouver magazine piece here, that’s a Titanic job.

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  • rph

    Good article Frances.

  • teririch

    A great article Frances.

    Services in the DTES need to be culled and those that are found to be ‘worthy’ (for lack of a better word) should be grown and funded.

    Having (at last count) 177 groups all trying to keep their piece of the pie is not servicing those that need the help.

    The number should be brought down to 6 – 12. The UGM, Salvation Army, First United all do great work. Their serives should be increased and funded.

  • F.H.Leghorn

    It sounds a lot like continuing the failed policies of the last 30 years, but with a few tweaks. Guaranteed to fail. The time is long since past for radically different approaches. The emphasis must be on getting people out of the ghetto and into a more sustainable life-style some place else, not growing the ghetto.

  • tf

    Thanks for your perspective Frances!
    Although I will say, the introduction to your blog post puts more emphasis on conflict among the service providers than your actual article does. The actual article outlines very well the challenges of mental health issues in the DTES.
    But I don’t think it’s the high number of service providers that causes the problem – each one serves a particular segment of the citizenry in this community. I think that 10 organizations can help 50 people each better than 1 organization that “claims” to help 500 people. It’s the individual, personal attention that gets results. The large “super groups” do serve a purpose but someone with mental health issues can slip through those cracks much easier than if someone knows your name and sees you every day.
    The real problems facing Vancouver Coastal Health can be identified as poverty, lack of healthy food, lack of adequate housing, lack of education, and let’s remember – a high percentage of DTES citizens are survivors of the Aboriginal Residential School system – the spirits of families and children were broken and many found their way to the “big” city where they could hide.
    It’s so complicated and the only way to make a positive change is to support those who are helping one person at a time.

  • teririch

    @tf:

    …’lack of healthy food’…

    You would think with all the community gardens and city subsidized ‘green’ food programs that healthy food would not be an issue.

    As for lack of education – there are a lot of addicts in the DTES that are far from undereducted.

  • tf

    Hi teririch – someone to reply to!
    “healthy food” – many organizations in the DTES have put a lot of effort into addressing this but again, it’s very complicated. There is a DTES charter for right to healthy food but unless you have a kitchen, it’s difficult to cook it yourself. Food lineups tend to provide high starch and filling food; donuts rather than fruits and vegs. Produce from community gardens is sold to cover the costs, not eaten by people on the street. And tell me, if you need food for dinner today, are you really going to plant a potato seed to see the results in months? Gardeners need to be very stable people to tend plants day after day until the harvest.
    “lack of education” – it’s not necessarily the addicts who lack education; more the result of poverty and lack of childcare; this could also be stated as lack of awareness or understanding of the issues from all sides.

  • teririch

    @tf:

    The one thing that I really want to see – social housing that houses kids not be built in the DTES.

    The argument that this is where people of a certain ‘economic level’ are most comfortable -doen’t stand. The kids are innocent – they deserve a chance to know something different and growing up inthe DTES among the addicts and conditions it presents will only perpetuate the cycle.

    Move social housing that also houses children into other neighborhoods.

    Hey, there is an empty lot at the corner of Macdonald and West 4th that used to house a gas station. It has been cleaned and cleared – Imperial Oil owns it. My hope would be that social housing for moms (sorry but most single parents in S H are moms) and their kids could/will be built there. It is close to schools and public transit and other services. The only downfall of that corner is the traffic – which is growing, but still better than walking out to drug
    filled streets.

  • teririch

    @tf:

    Sorry forgot this – education, when I was volunteering at WISH, I got to know a lot of the ladies (was there for alomost 3 years) and well, the jobs they once held covered everything from teachers to crane perators. Education as I referred to it was specific to the addicts, but I understand and appreciate your opinion, and you are right.

  • Chris

    Unfortunately, it has become an industry in the DTES for these organizations with the vast amount of money been given to them by government. If they actually solved the issues, there would be no more money for these organizations.

  • teririch

    Not even sure what to think of this:

    http://globalnews.ca/news/1157712/dtes-program-teaches-severe-alcoholics-to-make-their-own-alcohol-as-a-safe-alternative/

  • Kenji

    I think it’s a cool idea myself. As a social worker, I encountered almost universal hostility from the clients, and why not? They knew I would snatch their kids, that I thought they were flakes, and that I was a young punk with a degree but no real life experience, no personal conception of that degree of pain and toughness. Naturally, they want to stay far far away from any kind of a heat scene involving cops or really anything to do with The Government.

    Portland Hotel Society, you could say, is one of their enablers…but I prefer to see harm reduction as a Trojan Horse for getting them to edge a little big closer to services like health care, hopefully rehab, and eventually psychological counselling, education, and workforce reintegration.

    That’s the best case, but in the medium case, I say fewer dead bodies on Abbott St is a good thing.

    Cuz I am a bleeding heart and don’t like dead bodies.

  • Kenji

    As for your article itself, I think that the balkanization of services might be ok actually. As long as there is some order (not duplicating services) then I am not really sure what would be the benefit of centralizing them. If every NGO can make a good business case for funding, then why not let them do their thing.

    Thanks for the mention of Charles Campbell’s piece, it was good reading as well.

  • Norman

    There are far too many agencies serving the population in the DTES. The problem is that there is no coherent public policy.