The Province of British Columbia is experiencing a mental health and addiction crisis.  Mental illness and addiction affect one in five people across Canada, significantly affecting business and the economy. Further, untreated (or undertreated) mental illnesses and addictions are pervasive within the homeless population, which can lead to anti-social behavior affecting public safety that can, in turn, affect local business. In addition, un- or undertreated mental illnesses and addictions complicate the transition of homeless people into permanent housing and can lead to recidivism in offenders, increasing the costs of social housing and to our justice system. 

Across BC and across Canada, these issues impact citizens in many ways. Businesses near treatment centres and temporary shelters are seriously impacted and have experienced increased maintenance and security costs. Municipal governments and business associations are also shouldering costs for cleaning and security that have been historically outside their mandates and have stretched budgets. Business Improvement Areas that were primarily created by the Province as promotional entities are now being charged with cleaning streets and at times, acting as an enforcement agency which is beyond their legislative mandate. The impact of mental health and drug addiction of course spreads broadly across communities, the province and the country impacting personal safety, the economy and our reputation. 

Homelessness affects many Canadians, though some population groups are more at-risk of becoming homeless than others, including single adult men, people dealing with mental health issues or addictions, women with children fleeing violence and Indigenous people. It is estimated that approximately 35,000 Canadians experience homelessness on any given night, and at least 235,000 Canadians are homeless in any given year.[1]

Background

The BC Ministry of Mental Health and Addictions was created in 2017[2] to improve the access and quality of mental health and addictions services for British Columbians, as well as to develop an immediate response to the opioid public health emergency.

While the Chamber is confident that the provincial government will continue to make priority investments in mental health and treating addictions, it is pertinent to question the effectiveness of the current service delivery model.

There are numerous organizations and government assistance offices whose function is to address mental health, addiction issues and housing. Notable in larger centres is BC Housing, the Canadian Mental Health Association, BC Division, and the BC Health Authorities. Access to mental health and addiction services in rural and/or remote communities remains an issue for a variety of reasons, including a shortage of trained staff.

As well, a lack of coordination among ministries has plagued forward planning and programs in BC for many years. Individuals can miss out on care and end up back on the streets as a result.

Recidivism for offenders as well as evictions from social housing are predominantly due to un- or under-treated mental illnesses and addictions.  As demonstrated by Vancouver’s example, an expansion of the Community Court system  would improve and speed up a path to treatment; as well, social housing providers rather than trained health care providers often provide the management and care of many individuals in the system.  Community Courts in BC are rooted in the work done in2004-2005.[3]

History of Federal Responsibilities Moving to Provincial Oversight

In the 1960s and 1970s, the federal government invested heavily in adequate housing for Canadians. The National Housing Act was amended in 1973, and 20,000 units of social housing were built every year. Until the 1980s, many professionals involved with social and economic policy and programs in Canada – urban planners, academics, public health officials and social workers, for example – were focused on ensuring that people had access to safe, secure housing and neighbourhoods. [4]

According to the Canadian Observatory on Homelessness, mass homelessness in Canada emerged around [the 1980s] as a result of government cutbacks to social housing and related programs, starting in 1984. In 1993, federal spending on the construction of new social housing came to an end. In 1996 the federal government transferred responsibility for most existing federal low-income social housing to the provinces.[5]

Today, there are increased calls for the federal government to become re-involved with this national issue and proving to be beyond provincial repair in many cases. In 2017, the Government of Canada pledged $5 billion over 10 years to support provinces and territories in improving access to mental health and addictions services.[6]

Situation at Present – Economic Impact

  • The economic burden of mental illness in Canada is estimated at $51 billion per year. This includes health care costs, lost productivity, and reductions in health-related quality of life.[7], [8]  
  • The Mental Health Strategy for Canada recommends raising the proportion of health spending that is devoted to mental health to 9% by 2022.[9]  
  • Only about half of Canadians experiencing a major depressive episode receive ‘‘potentially adequate care.’’[10]  
  • Of Canadians aged 15 or older who report having a mental health care need in the past year, one-third state that their needs were not fully met.[11]  
  • An estimated 75% of children with mental disorders do not access specialized treatment services.[12]  
  • [13]

Opioid overdoses in BC communities is widespread.  This crisis has a devastating effect on the lives of individuals, families and businesses. Opioid-caused deaths as shown on the table are currently at 1.37 per 100,000, all age groups, all regions. Safe injection sites save lives, but many lives are still being lost; many areas of the province do not offer access to safe-injection sites and drug testing.

Complex Situation; Combined Factors; Limited Treatment; Negative Impact on Business and Residents

BC Coroners Service 2020

The issue is not limited to homelessness but encompasses mental health; addictions; housing; crime; and revolving treatment doors. Negative business impacts in our cities on tourism, safe streets, business access, increased security and cleaning costs, and increased insurance costs can be traced back the complexity of the situation, and ultimately, the cost of ineffective treatment.  The issue also impacts business attraction and retention as well as economic development opportunities.

Many chambers of commerce in BC, including, but not limited to those in Kelowna, Abbotsford,

Nanaimo and Prince George support the Four Pillars approach, now more commonly called the “wrap-around services” approach.  This methodology is internationally recognized as an effective way to address the harms associated with mental health/substance use/addictions.[14] It employs the four pillars are of  Prevention, Harm Reduction, Enforcement, and Treatment to form a balanced, solid foundation on which to build a comprehensive community drug and rehabilitation strategy. The City of Vancouver was the first municipality in Canada to formally adopt the four pillars approach. The four pillars approach to drug addiction was first implemented in Europe in the 1990s. It has been successfully used in such cities as Geneva, Zurich, Frankfurt, and Sydney, this approach has resulted in:

  • A dramatic reduction in the number of drug users consuming drugs on the street;
  • Significant drop in overdose deaths; and
  • Reduction in the infection rates for HIV and hepatitis.

The prevention of problematic substance use contributes to the public good by reducing costs to society as well as harm to individuals and communities. Important prevention goals include delaying the onset of substance use among youth and addressing the underlying causes of drug use. Prevention acknowledges that individuals usually make the best choices available to them, but that factors such as abuse, poverty or a history of addiction in the family may constrain those choices.

Of the four pillars, prevention requires the greatest amount of commitment and collaboration across all sectors of the community over a sustained period to show significant results. In the long-term though, prevention will have the greatest impact in reducing harm from substance use.[15] The Chamber recognizes that the BC Government has invested funding in Prevention, Harm Reduction and Enforcement; however, the treatment pillar is well below where it needs to be. Many, both in and outside provincial government, consider the closure of facilities like Riverview to be a societal failure. 

The Chamber supports harm reduction efforts as having a place within the spectrum of public-health responses to the soaring opioid death rate, but not at the expense of life-saving treatment and recovery. One concern with supervised consumption sites is that it keeps people in place along their continuum and doesn’t move them along a path to recovery or to a sustainable level.

Facilities in communities across the province are providing some exceptional services to persons in need.  As a specific example in the Okanagan, the sad reality is that there are no publicly funded treatment beds in the Okanagan for anyone younger than 17. Other facilities provide services.[16]

Many Chambers support former NDP MLA Leonard Krog, now Mayor of Nanaimo, when he said that some persons who are mentally ill cause public disorder and need treatment in a facility based in the community, similar to seniors suffering from dementia, whose families continue to have contact with them as they receive care. “These are people who are hearing voices all the time, who are paranoid, who won’t go to shelters because of past experiences or the state of their mental health, people who won’t clean themselves, take care of themselves, feed themselves, people who are taking street drugs, people who are threatening people,”  Mayor Krog said.[17] 

The Chamber Recommends

That the Provincial Government:

  1. Ensure a sustained commitment to four pillar approach to mental health and addictions by reallocating funds and/or making a major investment to ensure the treatment pillar is supported to meet community needs and public demands;
  2. Ensure regional integrated teams are properly resourced to provide effective and assertive treatment to minimize impact on citizens and the business community resulting from mental health and addictions issues among the homeless population;
  3. Establish a “campus of care” where persons with mental health and addiction challenges who cannot care for themselves in a safe manner will be provided year-round accommodation and treatment in a safe, secure and friendly manner;
  4. Engage Regional Health Authorities to ensure all harm reduction materials discarded in public and private spaces, are removed and costs to achieve this outcome are borne by the Ministry of Health;
  5. That a combined effort by government Ministries make available unused or under-utilized government-controlled or owned spaces, to provide immediate addictions recovery and/or mental health services outside the lower Mainland in one or more locations across BC; and
  6. Work with the Federal Government to coordinate care and funding of treatment; and establish a dialogue across Canada to coordinate treatment and policy around illicit drug use and drug legalization.
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[1] The Canadian Encyclopedia (TCE), July 9, 2019. https://www.thecanadianencyclopedia.ca/en/article/homelessness-in-canada

[2] 2019-2020; 2021-2022 Service Plan, Ministry of Mental Health & Addictions https://www.bcbudget.gov.bc.ca/2019/sp/pdf/ministry/mh.pdf

[3] https://www2.gov.bc.ca/gov/content/justice/criminal-justice/vancouver-downtown-community-court/the-community-court-s-story

[4] Ibid, TCE

[5] Ibid, TCE

[6] Government of Canada. “A Common Statement of Principles on Shared Health Priorities.” 2017.

[7] Smetanin et al. (2011). The life and economic impact of major mental illnesses in Canada: 2011-2041. Prepared for the Mental Health Commission of Canada. Toronto: RiskAnalytica.

[8] Lim et al. (2008). A new population-based measure of the burden of mental illness in Canada. Chronic Diseases in Canada, 28: 92-8

[9] Mental Health Commission of Canada (2012). Changing directions, changing lives: The mental health strategy for Canada. Calgary: MHCC

[10] Patten et al. (2016). Major depression in Canada: what has changed over the past 10 years? Canadian Journal of Psychiatry,

[11] Sunderland & Findlay (2013). Perceived need for mental health care in Canada: Results from the 2012 Canadian Community Health Survey – Mental Health. Statistics Canada Catalogue no.82-003-X.

[12] Waddell et al. (2005). A public health strategy to improve the mental health of Canadian children. Canadian Journal of Psychiatry, 50: 226-33.

[13] “Mental Illness and Addiction: Facts and Statistics, Centre for Addiction and Mental Health, 2019

[14] “BC Created a Ministry to Deal with the Overdose Deaths. Is it Working? Ian McLeod, The Tyee, March 4. 2-2- https://thetyee.ca/News/2020/03/04/BC-Overdose-Ministry/

[15] City of Vancouver, Four Pillars Drug Strategy, 2020, https://vancouver.ca/people-programs/four-pillars-drug-strategy.aspx

[16] In Kelowna, these include The Foundry, Bridge Youth and Family, along with recently-opened Kelowna Child Advocacy Centre

[17] Canadian Press, December 19, 2019 “Nanaimo mayor wants B.C. to institutionalize mentally ill people who are homeless” https://vancouverisland.ctvnews.ca/nanaimo-mayor-wants-b-c-to-institutionalize-mentally-ill-people-who-are-homeless-1.4729607