Feb 4/08: Health System Failing DTES: Police Have Become Defacto Social Workers ...

Det.-Const. Fiona Wilson-Bates of the Vancouver police department belies the usual beefy image of a cop: She's petite and polished, and would not look out of place behind a Holt-Renfrew counter.

She's also the author of a very big and very tough report. Wilson-Bates wrote Lost In Transition, the six-month study the VPD released Friday, and which was subtitled, at some length, How a Lack of Capacity in the Mental Health System is Failing Vancouver's Mentally Ill and Draining Police Resources.

It's vivid reading, especially her anecdotes of people whose lives have been ruined by mental illness.

Howeer, as wrenching as the human stories are, the real importance in Wilson-Bates's study resides in its statistics.

For years now, the public has watched the deterioration of the Downtown Eastside and come to the belief that things were getting worse, not better.

What Wilson-Bates did was take those beliefs out of the realm of the anecdotal and into the empirical. She did what any good cop does: She gave us proof. She also showed that this was a problem that had grown beyond the borders of the Downtown Eastside ghetto, and was now city-wide.

As much as one-third of police service calls deal with the mentally ill now city-wide, she found, and up to one-half in the Downtown Eastside. Even in the staid, well-off west side, over one-quarter of the calls involved mental health cases.

And this, Wilson-Bates found, constituted an exponential explosion from as little as 10 years ago.

In 1999, the VPD made 360 arrests under the auspices of the B.C. Mental Health Act, in which it was deemed that those arrested posed a danger to either themselves or others.

In 2007, there were 1,743 such arrests.

That is almost a 400-per-cent increase.

All of this came during the time of the vaunted Four Pillars plan, and during a time when the

Liberal provincial government liked to boast that, since 2001, it has been building on "the continuum of the mental health system," as Health Minister George Abbott said to me Friday.

Abbott - who allowed that the report was "powerful" - preferred to see it as a criticism of a very narrow portion of that mental health continuum. Overall, he said, the system was in good shape: where it needed work, he said, was in that area that deals with the 150 to 200 people who are chronically in trouble with the police, who commit disturbing, and sometimes violent, acts upon themselves and members of the public.

Wilson-Bates was not so sure. When I ventured that her report showed a "dysfunctional" mental health system, she said that she would probably have to agree with that assessment.

The problems with the system, she demonstrated in her report, were more widespread than its dealings with chronic offenders, and showed themselves in a myriad of ways - from the lack of long-term care in the Lower Mainland, to the restrictive applications of the B.C. Mental Health Act that make it difficult to get people assessed, to the lack of hospital space. (Our provincial government can fast-track a billion-dollar convention centre, but dithers over a replacement for St. Paul's. If our mental health system isn't dysfunctional, our priorities are.)

In one startling passage, Wilson-Bates takes on the Vancouver Coastal Health Authority with a withering frankness rarely seen in a bureaucratic document.

Noting that studies show that over 50 per cent of people with mental illness abuse drugs and alcohol, clearly, she writes, the issue of dual diagnosis treatment "must be included in any discussion on the subject of resources for people who are mentally ill."

Then she drops the hammer.

"Despite the prevalence of people who require both mental health and addictions assistance, there is a disturbing lack of available resources for such individuals. Vancouver Coastal Health Authority operates one designated concurrent disorder program for people who are actively addicted and mentally ill. Ironically, the brochure for the Centre for Concurrent Disorders states that 'you can begin the program by attending an information session. Come to this session clean and sober' (Vancouver Coastal Health Authority, 2007, p. 2).

"In addition to this, they operate eight mental health teams throughout the city. According to their website, the teams are 'multidisciplinary and may include nurses, occupational therapists, physicians, psychiatrists, psychologists, rehabilitation therapists, social workers and support staff . . . each team is unique, with the mix of staff and services reflecting the needs of each community health area population' (Vancouver Coastal Health Authority, 2007, p. 2). An official at Vancouver Coastal Health asserts that the clinics will treat people who are also drug and/or alcohol addicted as long as their primary diagnosis is a mental illness and the received services are voluntary.

"However, a phone call to the West End clinic suggests that this is simply not the case. With the exception of the Strathcona clinic (in the Downtown Eastside), case workers do not take a concurrent approach to clients, insisting that they receive addictions treatment before engaging mental health resources. Further, they do not follow-up to ensure that this treatment is received and will not see clients who are 'difficult' (i.e., refuse to take their medication or are volatile). The result is that people who are drug addicted and severely mentally ill, a particularly disproportionate population in the Downtown Eastside, fall through the cracks."