Tuesday, December 12, 2023

In case you were wondering: A surfeit of social realities to explain (a bit) about how we got here

Image by Taken from Pixabay

I haven't worked as a full-time journalist for almost 20 years now, but people still pay me to go find things out. I have a habit of finding way more information than the person who hired me wanted, the curse of a curious nature. 

Here's some of the surplus I've accumulated recently from some of that work, all of it related to the multiple layers of social crises we're seeing emerging in virtually every BC community. I drive along 900-block Pandora Street sometimes and am at a loss to grasp just what the hell is happening to us, but when I consider all the snippets of social tragedy below, it makes a very, very sad kind of sense. 

For instance:

We shut down institutions and never really replaced them with much

Riverview Hospital used to be BC’s largest mental institution, housing 4,300 people at its peak in the 1950s. But by the early 1990s, locking up people deemed "mentally disordered" for indefinite periods of time, with or without their consent, had fallen from favour. Riverview had been scaled back to 1,000 beds, and plans to replace institutional care with community care were in their final stages.

But from the start, the political motivations for closing Riverview were as much about cost savings as they were about philosophical shifts in how best to support people with mental illness. Between 1994 and 1998, spending on in-hospital psychiatric units was cut almost in half, and spending on community services for mental health was reduced as well, despite years of political promises to the contrary. 

Riverview was permanently closed in 2012. The long-abandoned promise of community services to replace what Riverview once provided isn't even talked about anymore. We are not going to return to the days of huge institutions, and that's a good thing, but there must be some middle ground between that and the modern-day reality of abandoning people with lifelong psychiatric health issues to figure out a hard life on their own. 

As for BC hospitals' psychiatric units, people pass through them so quickly nowadays that their mental health crisis doesn't even have a chance to stabilize. People used to stay an average 36 days in BC psych units before being discharged, but that fell to 15 days a number of years ago, and 14 days now. Psychiatric admissions between 2005 and 2017 increased 29 per cent, with no increase in beds[3].

People with developmental disabilities used to have to live in large institutions in BC as well back in the day. But deinstitutionalization happened for them around the same time as Riverview was being phased out. 

That population did seem to get better community care for a number of years after institutions like Tranquille, Glendale and Woodlands closed. But over time, the safety net has frayed substantially for them, too. It's not uncommon now to see people with developmental disabilities among the homeless. 

That is such a devastating ending for all the families who fought so hard in the 1960s-70s for the right for their children not to be locked away in institutions. Be careful what you wish for.

We are drowning in poisoned drugs

BC has always had lots and lots of illicit drugs. But what we've got going on in 2023 looks nothing like the relatively straight-forward drug scene of years past. With fentanyl, carfentanil, benzodiazapines and all kinds of other weird additives stirred into the mix now, people are getting sick in entirely new ways, and the death toll from toxic drugs is staggering. 

Since BC declared a public emergency in 2016, there have been 13,000 deaths from toxic drugs in the province, and no end in sight. Annual toxic drug deaths have increased almost ten-fold in the decade from 2012 to 2022, from 270 to 2,342.

For those who overdose on an opiate, prescription drugs like naloxone can save lives when injected immediately after an otherwise-fatal overdose. But people revived after an overdose are at high risk of having incurred a brain injury during the minutes when their brain was not receiving oxygen, and suddenly, a crisis of brain injury among people brought back to life after an overdose is emerging as a new (and almost completely unserved) concern.

Our governments quit building affordable housing

We all know there's a housing crisis going on. The increasing use of housing as an investment is often cited as a primary driver.  But as stats from BC's rental scene make clear, an equally big issue is that nobody has kept up with population growth. 

BC's population grew 34 per cent in the last 30 years. But in that same period, we've added exactly 6,000 more rental units. Our population grew by a third, while the number of rental units increased by a mere five per cent (from 114,129 units to 120,472[4].)

Equally problematic: Rents that are just so far beyond so many people's ability to afford. 

Average rents have increased 250 per cent in the last three decades. But the shelter allowance for those on income assistance was frozen at $375/month for the last 15 years up until this year’s increase to $500 (which still gets you nothing in any urban area). 

Given all of that, it's no surprise that the Lower Mainland's 2023 homeless count noted a 32 per cent rise in homelessness since 2020, with almost 70 per cent homeless for more than a year. We have created a permanent homeless class. 

We do jail differently now, mostly by accident

Even 15 years ago when the social crisis wasn't quite so obvious, people with mental illness or substance use disorders made up the majority of BC inmates, at 61 per cent. But now, it's almost like jail is the new psych hospital. Three-quarters of inmates now have a diagnosis of mental illness, substance use disorder or both. 

They and their fellow inmates churn through the system with unprecedented speed. The median length of stay in a provincial jail these days is 12 days. Almost a third of inmates across Canada are released from jail into homelessness

Provincial jail is where you do your time if your sentence is "two years less a day." But the majority of inmates in BC jails don't even have a sentence yet - they're in remand, where a person is held while awaiting trial if bail doesn't work out. People in remand units now account for 67 per cent of inmates in BC jails[7], up 15 per cent from a decade ago and slowly on the rise since the 1980s.

So we have recreated the institution part of Riverview by turning our jails into de facto psych units, but minus the psychiatric services and supports. Things that make you go hmmm.

We're still so far from doing right by Indigenous people

Indigenous people are over-represented in virtually every measure that matters for social wellness, health, safety and well-being. This is particularly true in terms of our jails.

Indigenous people account for six per cent of BC’s population, but make up more than a third of people in custody in the province[8]. In 2020-21, the incarceration rate for Indigenous people in BC was 22 in 100,000, compared to 2.3 for non-Indigenous British Columbians. 

A staggering 90 per cent of Indigenous people in provincial custody have been diagnosed with a mental health or substance use disorder[9]. Grimmer still: A Statistics Canada study released this year found that in the years 2019-21, almost one in 10 Indigenous men in Canada between the ages of 25-34 experienced incarceration[10]

We're returning to the days of poverty for some seniors, only this time they're homeless too

More than a fifth of people identified as living homeless in the 2023 Greater Vancouver Homeless Count are ages 55 and up. Nearly half of them became unhoused for the first time after turning 55. People age hard once homeless; those who are chronically homeless have life spans 20 years shorter than the rest of us.

Even comparatively comfortable BC seniors are struggling. BC Seniors Advocate Isobel Mackenzie noted in her 2023 "It's Time To Act" report that seniors in privately run, publicly subsidized assisted-living units are having a hard time keeping up with the array of additional costs that housing operators now charge for every little service, not to mention rent increases of up to 15 per cent a year at some facilities. 

And here's a strange trend: Even though BC's senior population is expected to increase to 25 per cent from 19 per cent over the next 15 years, the number of assisted living units per 1,000 population has fallen 15 per cent in the last five years in the province.

Is that because people don't want to live like that and they're finding other options, or because somebody has quit building that type of housing because they can make more money doing other things? Tune in 15 years from now to find out.


Ah, feels so much better to get those unused stats off my chest. I should wrap this up with some pithy conclusion, or a ringing call to action to fix this by doing a, b and c. But seriously, is it even possible to wish for a fix anymore? We are so profoundly late to the game. 

[1] https://www.publicsafety.gc.ca/lbrr/archives/cnmcs-plcng/cn28441-eng.pdf

[2] BC Ombudsperson report Committed to Change

[3] BC Schizophrenia Society and BC Psychiatric Association joint report

[4] https://www03.cmhc-schl.gc.ca/hmip-pimh/en/TableMapChart/Table?TableId=

[5] https://globalnews.ca/news/10030845/vancouver-homeless-seniors/#:~:text=%E2%80%9CWe're%20already%20in%20crisis,32%20per%20cent%20from%202020

[6] https://www.cbc.ca/news/canada/british-columbia/prison-mental-health-sfu-study-1.6271915

[8] https://www2.gov.bc.ca/gov/content/justice/criminal-justice/corrections/reducing-reoffending/indigenous#:~:text=Indigenous%20people%20are%20nearly%206,and%2027%25%20in%20the%20community.

[9] https://www.oag.bc.ca/sites/default/files/publications/reports/BCOAG-Mental-Health-Substance-Use-Services-Corrections-Report-February-2023.pdf