Opinion: Adequate housing is key to life for people with mental illnesses. B.C.’s standard of care has declined to a squalid SRO room.
Published Feb 10, 2023
Click here to read why The Bloom Group’s Victory House is a “glimmer of housing hope” and a “rare ‘oasis’ in Vancouver for people with serious mental illness”.
My father, a Second World War veteran who developed schizophrenia, went into Riverview Mental Hospital in 1953. He remained there about two decades, interspersed with often-difficult stays at his parents’ home.
Riverview Hospital managed to keep my dad, Harold Todd, “safe.” But it also left him institutionalized and passive. In the early 1970s, he was transferred to a not-for-profit boarding house in Kitsilano, where he lived until he died in 1999 from a heart attack.
In the large, old, spartan boarding house, staff watched out for Harold, at least a bit. His bedroom was tidy. To most, he looked odd and withdrawn. Yet he dressed well, walked city sidewalks and spent time in libraries.
He seemed to feel he had some dignity. He didn’t drink or use illicit drugs. He had a subscription to Maclean’s magazine. In his last 10 years, he became involved in an art therapy program.
Would my father have survived B.C.’s current mental-health system?
This is my attempt to understand what would likely have happened to my father if he had gone through what he did, but in the past decade, given that most specialists believe B.C.’s housing and mental-health realms have deteriorated.
What is the likelihood Harold would have been treated in a large institution? Would he have been able to live in a stable boarding house? Would he have succumbed to addiction? Would he have ended up homeless? Would he have gone to jail?
Would he have been able to maintain some self-worth?
I cannot say my father’s time in Riverview was a success. The place was underfunded and overcrowded and the overmedicated techniques for treating schizophrenia half a century ago could be rough. But at least dad was monitored, offered programs and kept off the streets.
Today, he would not be housed in a large institution like Riverview. The provincial government began shrinking the suburban mental hospital in the 1980s and finally shut it a decade ago. Crease Clinic, the ward where my mother, brother and I visited Dad, is now used as a film set, including for horror movies.
Riverview was shuttered because of a health-care trend, desirable on the surface, to deinstitutionalize people with serious mental illnesses and integrate them into the community. The idea was money spent on a big institution would instead go into neighbourhood services.
“Closing Riverview is one of the major reasons for the present mental-health crisis in B.C.,” says Dr. John Higginbottam, who served as a vice-president at Riverview, operated acute-care psychiatric services for Vancouver General Hospital, and is a clinical professor in psychiatry at the University of B.C.
“There have been repeated calls to reopen Riverview Hospital as a backstop for the mental health system and a necessary step to deal with the crisis.”
Every other Canadian province, he said, has a major psychiatric hospital.
B.C. Premier David Eby recently stated he is now among those believing a reinvented Riverview is necessary to shore up community care.
Would my dad have been able to live in a boarding home?
This may be my most burning question. And I don’t like the answer.
After being discharged from Riverview in the early 1970s, my dad was transferred to a boarding house with supportive care on a tree-lined street about half a block away from Lord Tennyson Elementary school. It was a few kilometres from both his parents’ home and my home, an easy walking distance for Harold.
The interior of Capa Lodge, as it was called, could have used a paint job. Carpets were virtually non-existent. Many of the about 10 patient-residents were regulars in the smoking room.
My dad’s bedroom was on the top floor at the rear, with a tiny wooden deck and a view of a neighbour’s backyard. He kept it as spare and orderly as a monk’s chamber. My brother and I could walk in and out of Capa Lodge basically as we pleased. The staff provided meals and dispensed dad’s medications. I felt satisfied paying taxes, knowing Dad benefited.
But now there are virtually no such boarding homes for people with serious mental illness in B.C., say two of B.C.’s leading mental health researchers, Dr. Bill MacEwan, head of Vancouver’s downtown community court psychiatric team, and SFU clinical psychologist Julian Somers.
There are at least three reasons boarding houses are no longer an option.
One is the cost of housing in Vancouver. The land on which his boarding house once sat is now valued at $4 million, according to the B.C. Assessment Authority.
Both MacEwan and Somers explained how the complex means by which non-profit agencies once bought or leased old homes to provide supportive care for mentally ill people is no longer feasible, especially in pleasant and pricey Vancouver neighbourhoods.
Yet a study involving 500 British Columbians with serious mental illness conducted by Somers and others, called At Home/Chez Soi, found virtually none wanted to live in the often-grim Downtown Eastside. The death of boarding houses is yet another substantiation of Metro Vancouver’s housing unaffordability crisis.
Secondly, unlike in the 1970s, neighbourhood attitudes have hardened against having the mentally ill in one’s midst, said Somers, who found people had more of an attitude of “hail fellow, be well” in the past. But now a once-tolerant public is constantly confronted with fearful scenes of mentally ill people in the Downtown Eastside addled by drugs.
The third factor behind the lack of boarding houses is more important: Government policy.
The government officials and advocates in charge of housing for mentally ill people decided several decades ago that boarding homes like Capa Lodge, which offered my father three meals a day and a modest lifestyle, were “paternalistic,” says MacEwan.
With the dismantling of Riverview, advocates claimed mentally ill people should be given more independence, MacEwan said.
But many, like my father, benefit from supportive care.
Now, when a person does succumb to a psychotic break, they mostly show up disoriented at a hospital emergency ward, where they are directed to a psychiatric unit.
“The main focus of treatment is on medication,” says Higginbottam, rather than on psychosocial rehabilitation.
“Too often patients are discharged ASAP, with little planning for housing or followup. This is particularly difficult for people with addictions and histories of brain injury who may be homeless and aggressive,” said Higginbottam, whose views on expanding the number of beds at a redesigned Riverview are shared by Somers as part of a solution.
“Frankly, things would not have gone well for your father if he had entered the mental health system in the past decade. Today’s ‘system’ is fragmented, difficult to access and navigate, with little accountability. Many people with serious mental illness, including addictions, become homeless or precariously housed, with frequent emergency hospitalizations. Their quality of life and life expectancy is poor.”
Where would my father have likely ended up in? The answer is chilling.
They are called SROs, for single room occupancy. They are the size of a small bedroom, about three by four metres in size. With no toilet. Often no sink. They’re bleak, frequently chaotic, crammed.
The narrow hallways of the non-profit SRO I visited in the Downtown Eastside felt claustrophobic. Bolted doors stood at the main entrance, where one of two of the building’s staff hunkered behind a grimy counter and thick security glass.
The people inside, most in their 30s and 40s, looked beaten down. Some talked to themselves. The odour of marijuana filled the air. There was a plastic box to deposit used needles, but the room set aside for so-called “safe injections” was locked. Nobody used it.
There is no point in exposing the name of the squalid SRO, which has about 100 sleeping rooms. It could just embarrass the non-profit housing operator and its low-paid staff. And after all, MacEwan, who has worked for decades in SROs, said it’s one of the better ones.
There are about 5,500 such non-profit SRO units in the city of Vancouver. There are an additional 2,000 for-profit SROs, but they’re more dreadful, MacEwan said, in part because they’re often staffed by drug dealers.
When MacEwan and the then-head of UBC psychiatry, William Honer, interviewed 500 DTES residents for The Hotel Study almost a decade ago, they found 95 per cent of those in SROs were addicted to street drugs.
They uncovered another devastating fact: 75 per cent of the SRO inhabitants had mental illnesses, with half suffering from schizophrenia, bipolar disorder or other psychoses. And those stats, says MacEwan, “would just be getting worse.”
Forgive me for calling the one I saw a hellhole.
I recoil at the distinct possibility my dad would have been warehoused in one of these SROs. I can only imagine how the families of people with mental illness feel about this now-prevalent form of housing.
My father was a bit of a square and old-fashioned, dressing better than most, in sweaters and leather shoes he bought himself. He watched The Lawrence Welk Show. I never saw him angry, although he often seemed tense. To some extent, his restraint protected him.
That said, it would have been too disruptive for me or his parents, who died in the 1970s, to take him in. Presumably, the people I met in the downtown SRO also cannot really live with their families.
The eyes of many of the residents in the SRO I visited had a haunted look. Their anxiety was palpable. For many the demons seemed in charge.
No one else was.
Illicit drugs now an omnipresent draw
If the place in which you live is filled with pandemonium and random theft, and on top of that you are battling the confusion that can come from mental illness, MacEwan and Somers think it’s entirely understandable you will be drawn to street drugs to relieve the bleakness.
But if there is anything most agree on, it is that the past decade has been hit by an explosion of more powerful and poisonous drugs, especially in B.C. Predatory gangs are doing everything they can to get people addicted to fentanyl, heroin, carfentanil, cocaine, methamphetamine. You name it.
If your illness is not making you feel “crazy” to begin, the drugs will push you over the line into psychosis. Despite campaigns devoted to a “safer” drug supply, decriminalization, supervised-injection sites and anti-stigma programs, opioid deaths have only skyrocketed since 2016. A near-record 2,272 British Columbians died of toxic street drugs last year, mostly men.
If my dad had not had stable housing, he would have been vulnerable to such a fate.
Today, I would be naive if I could not imagine my gentle father hooked.
One small stumble away from homelessness
It is most often unsheltered people who go into and out of SROs.
The SRO apartments I saw looked like the interiors of the tents that often pepper Vancouver sidewalks, bursting with a homeless person’s stockpiled objects.
My father could well have ended up unsheltered, along with 10,000 or so others in B.C. who navigate the streets and encampments, where, as MacEwan says, “guns are becoming a big problem.”
My mind has trouble going there, however. That’s even while I know countless agonized families endure knowing loved ones are sleeping under bridges, in building entrances or in tents in the bushes.
The worst irony is that each homeless person with mental illness costs taxpayers an average of $55,000 a year in medical, police, emergency and other services, Somers found. When they are provided housing with support, the cost goes down to $37,000 a year.
If my father had not had adequate housing, he wouldn’t have been organized enough in his 60s to have attended an art therapy program operated by Kitsilano’s community mental care team. It became his path to a kind of recovery. He no longer needed antipsychotic medication. And when acclaimed Vancouver artist Gathy Falk saw an example of Harold’s paintings, she said how uniquely talented he was.
There is significant hope for recovery for most people with serious mental illness, even those who have spent a decade homeless, according to Somers’ studies. But it can’t be realized without support and treatment.
‘The corrections system is the new mental health system’
The atmosphere conveys calm and order inside Victory House. It is a palpable mood change from the seedy SRO.
More than 15,000 British Columbians who use opioids, especially those with mental illness, end up repeatedly charged with theft and assault offences, Somers says.
To those paying attention, it’s no surprise the proportion of people in B.C. prisons with serious mental illness has risen sharply in the past two decades — from about 40 per cent to 75 per cent, Somers said.
When Somers talked to a senior corrections system manager about such findings, the official confirmed, bluntly: “Yes, the corrections system is the new mental health system.”
And when Somers talks to police officers, they say they need more guidance on dealing with the growing host of mentally ill people, most of whom are addicted. Yet, as Somers says: “No one’s listening.”
A glimmer of housing hope
The atmosphere conveys calm and order inside Victory House. It is a palpable mood change from the seedy SRO.
Victory House is a rare “oasis” in Vancouver for people with serious mental illness, says MacEwan. It has a pool table, a dining area, a courtyard for smokers, a policy of no overt drug use and about five staff trained in mental health or nursing.
Victory House, near Oppenheimer Park, reminded me a bit of Capa Lodge, where my father lived. When one of us asked a resident how the food was, she chirped, “It’s good.”
While many residents did not appear high functioning, they conveyed respect for each other and the staff. And at least one bedroom was as tidy as the one my father kept: It contained two guitars and a violin.
Operated by the non-profit Bloom Group, Victory House is home to about 45 people. It is harder than ever to get into. With rare exceptions, there are precious few facilities like it in Metro Vancouver for mentally ill people who are not able to be independent.
Responsibility for the seriously mentally ill has been off-loaded to a patchwork of services: The system now mostly responds to crises.
Would my father have won the mental-health-system lottery and been admitted to a secure alternative to Riverview Hospital? To perhaps a place like Victory House? The odds would emphatically have been against him.
The conclusion on B.C.’s mental health system?
My. Dad. Very. Likely. Would. Not. Have. Survived.
However, in a way, my family is fortunate. Harold’s saga is over: He died 23 years ago.
My heart aches for the tens of thousands of people in B.C. with serious mental illness, and their distressed families, confronting today’s ghastly reality.Tweet