Health
VANCOUVER, Canada — The night before Jim Chu’s first day as Vancouver police chief, a constable on the force shot and killed a 39-year-old bipolar man at a busy intersection on the edge of the city’s downtown.
On Aug. 13, 2007, Paul Boyd struck two policemen with a bicycle chain. Officers subsequently shot him eight times, with the fatal bullet hitting him as he crawled along the ground. A coroner’s investigation revealed Boyd was off his medication when he was killed.
The death became symbolic of a challenge that grew to consume much of Chu's attention as chief: police interactions with the mentally ill and other marginalized groups. In the months that followed, he began to slowly reform how the Vancouver Police Department responds to those calls, but the problem continued to grow. Arrests of mentally ill offenders posing a risk to themselves or others climbed each year, hitting an all-time high of more than 3,000 in 2014.
Chu and Vancouver Mayor Gregor Robertson together declared the situation a crisis and in 2013 issued a public call for help from the provincial government agency responsible for health. But with little aid having come, Chu has intensified efforts to better prepare his officers to serve Vancouver’s severely mentally ill residents, many of whom struggle with addiction issues. At the same time, Chu has stressed that the police department is the wrong agency to provide care for this group and warned that people are falling through the cracks.
“The answer for someone suffering a mental-health crisis is not a cop with a gun,” he said at a September 2013 press conference. “We need a shift from dealing with the crisis to preventing the crisis from occurring in the first place.”
A task force convened by the mayor estimates there are approximately 2,000 severely addicted or mentally ill people living in Vancouver’s downtown who are not receiving treatment.
Dr. Bill MacEwan is a member of that task force and the head of psychiatry at St. Paul’s Hospital, Vancouver’s largest inner-city care facility. Asked about people who struggle with a severe mental-health issue, he inevitably turned the conversation to the Downtown Eastside, a roughly 12-by-six-block neighborhood that in the 1990s gained notoriety for having the highest HIV transmission rate outside the developing world.
Roughly 19,500 people call the Downtown Eastside home, MacEwan said. Of those, an estimated 9,000 are believed to struggle with a health issue that is the direct result of drug use. “It's a very high concentration in a very small area,” he emphasized.
It’s this group that accounts for the police department’s rising statistics,
In 2014, Vancouver police made 3,010 arrests under the province's Mental Health Act, which permits officers to detain individuals deemed to have a mental disorder and pose a threat to themselves or others. That number marks a 32 percent increase since 2010, the year police began to track such arrests.
Those arrests concern only the most serious cases. According to statistics supplied by the Vancouver Police Department, as many as a third of reportable calls to which the force responds include a mental-health component. That translates to 75 to 100 police interactions every day, or 27,000 to 36,500 per year in a midsize city of roughly 600,000 people.
Health care providers have recorded similar trends. Vancouver General Hospital and St. Paul's Hospital together saw 15,450 emergency mental health or substance misuse visits in 2014 — up 66 percent from five years earlier.
Lyle Richardson is one of the police’s more recent mental-health cases. In late January, he was arrested under the Mental Health Act and turned over to St. Paul's Hospital.
On the phone from a hospital room where he is still recovering, he said the incident was the result of a schizoaffective disorder which, over the years, has gotten him into trouble with police more than a dozen times.
Recounting the January incident, Richardson said that at the time, he believed he had the cure for cancer. That being the case, he stole a pair of shoes from a sporting goods store. "If I had the cure to cancer, I thought the president would be OK with me having a pair of shoes," he said.
Soon enough, he was arrested without further incident.
"Police are the gateway to the system, and so they need to be a friendly way of getting people the help they need," Richardson said. "It’s so crisis-driven, our system. We don’t really have a prevention mode."
Those types of negative interactions happen less often than they used to, he said. But they're not the only time he sees police. He works part time at the Justice Institute of British Columbia, the academy through which every new recruit must pass before joining the Vancouver Police Department. His job: to interact with officers in training so they can better deal with encounters with mentally ill people.
The Justice Institute’s executive director, Steve Schnitzer, said that sort of focus on empathy is part of the school's response to recommendations for a larger mental-health component.
“The recruits hear firsthand from people that have been on the other side of dealing with police,” he said. “They give us valuable information on how things possibly could have gone differently.”
According to Schnitzer, time spent on mental health has grown over the years to account for roughly 20 hours of trainees’ 13 weeks at the academy. He added the school has adopted a model called crisis intervention and de-escalation, which is a program gaining favor across North America.
After graduation, a recruit with the police department can apply to join a dedicated mental health unit that the force established in 2012.
That group of about a dozen officers is headed by acting inspector Howard Tran, who said that since 2012 every police officer in British Columbia is required to undergo crisis intervention and de-escalation training and that officers must take an online refresher on those topics every three years. The police department partners with health care providers to deliver services in the communities where mentally ill people reside, he continued. There's also a requirement that officers assigned to the Downtown Eastside have at least two years on the force, and most have five years of experience or more.
"I think it is very clear in Canada that we're a hotbed for a lot of these issues," Tran said. He argued that police have gone to significant lengths to adapt to a job for which it was not designed. "Further than most jurisdictions in Canada.”
The provincial government has acknowledged the city’s calls for assistance on mental health. But more than a year since the police chief's declaration of a crisis, the Ministry of Health has failed to respond with even a fraction of what Vancouver has requested. For example, in March 2014, a new psychiatric unit at St. Paul's Hospital made nine additional beds available for long-term mental health care. And in December it opened 14 beds at another facility. But the mayor’s task force called for 300.
The Ministry of Health refused repeated requests for an interview. An email supplied by spokeswoman Kristy Anderson emphasized that in 2013 the provincial government spent $1.8 billion on mental health.
At a Dec. 17 press conference, Health Minister Terry Lake took issue with how the mayor's task force describes the scale of the problem. "The data is not settled on how many beds you need for that high-intensity, institutionalized, longer-term care that they were referring to," he said.
However, speaking at another press conference earlier in the year, Lake conceded the problem could still get worse. "Will we see those numbers continue to go up?" he asked in reference to arrests under the Mental Health Act. "I hope not. But at the same time, we recognize that around North America — it’s not just in British Columbia — you are seeing police departments having to deal with mental health issues."
At St. Paul's Hospital, MacEwan listed a number of reasons Vancouver’s concentration of patients with a mental illness and an addiction issue is symptomatic of a problem more acute and more complicated than other cities’.
The simplest factor, he said, is climate. Vancouver is the only large city in Canada where winter temperatures seldom drop below freezing. The relatively good weather attracts a disproportionate number of the country's homeless population, which is a group with an above-average mental illness rate.
At the same time, the police under Chu grew reluctant to send drug users into a revolving-door justice system, MacEwan said. That has allowed for the emergence of an open-air drug market selling to a population already at risk of developing psychiatric health problems.
"We are in the most congenial environment for drug use in North America," he said. "Our drug laws are much more open and broader than they are in other jurisdictions."
The result was laid bare in 2013 study published in The American Journal of Psychiatry. Researchers found exceedingly high rates of mental health and addiction problems among people who live in the Downtown Eastside’s substandard hotel rooms, which are often the last stop before homelessness.
"Ninety-five percent addiction, 75 percent major psychiatric illness, 20 percent HIV," MacEwan recalled from that study. "Staggering numbers. And they are clustered … They are all within a block and a half of each other. You don’t see that anywhere else."
John Higenbottam, a clinical psychologist with the University of British Columbia’s faculty of medicine, traced Vancouver’s problem back further, to deinstitutionalization, a process that occurred across North America beginning in most areas in the 1960s or 1970s.
A report he authored presents a history of Riverview Hospital, a provincial mental health care facility that at its peak in the 1950s housed more than 5,500 patients before it was slowly decommissioned. He said the complex attracted mentally ill people from across British Columbia and then, when it closed in 2012, released them into Vancouver.
The nonprofit Portland Hotel Society is one of the largest providers for mental-health and addiction services in the Downtown Eastside. The group’s executive director, Ted Bruce, said most clients’ problems originate as early as childhood. He suggested many of these people’s addiction issues are cases of individuals self-medicating.
“If you’re living in poverty, if you’re living in an environment where you're stigmatized, that’s going to contribute to it,” he said. “And then on top of it … there is huge trauma in many of these people's early lives, and that has contributed to their mental health problems.”
One of those 3,010 arrests police made under the Mental Health in 2014 involved Amy Faith House, a First Nations woman who lives in a cheap hotel on the edge of the Downtown Eastside.
According to police files obtained through freedom of information legislation and reviewed with her permission, House has been abused or threatened more than two dozen times in the nine years since she moved to Vancouver.
She said she has had good and bad encounters with police. However, she took issue with authorities’ claims they are responding appropriately to people the police label in their reports as having a mental illness.
“When I read these police files, I think one thing. They didn’t put down how they harassed me,” she said. “They put down everything else and every other people’s business, but not how they treated me.”
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