Hardest to house: Gaps, flaws and failures

Written By Fran Yanor
Published

Over the past months, front-line workers, mayors, and citizens have called for action as inner-city crime and random violence wreak havoc on communities across the province. Police data show a small number of individuals – about 500 so-called prolific offenders – are committing an inordinate amount of crime with seeming impunity. Critics say these individuals have been allowed to surf through the justice system in a “catch-and-release” cycle.

This three-part series If not prison, then where? investigates who these individuals are, why they are loose on the streets, and what can be done about it.

Part I Mean streets examines why many prolific offenders are not in jail.

Part II Hardest to house investigates why some repeat offenders are living on the streets without housing or the health care they need.

Part III Mandatory treatment will explore the issues, ethics and practicalities of treatment (or prison) for individuals repeatedly committing crimes.

Note: The names and some personal details of the people living homeless have been changed to protect their privacy.  


When RCMP Const. Adam Moleski returned to his hometown five years ago to serve in the Prince George detachment, he was blown away by the number of people living homeless outdoors.

“I came in October. It was cold, minus 25. Lots of people on the streets. It was mind-boggling. I was like, ‘Why do you live on the streets?’” There’s housing available, he says, but some have such poor mental health, they’re not able to access or maintain it.

Moleski works in the RCMP downtown safety unit where a typical shift involves proactive patrols and responding to calls from the public, most involving mischief, theft, causing disturbance, and drug trafficking. Well-acquainted with the inner-city regulars, Moleski knows most people by name, particularly the prolific offenders who walk among them. 

Moccasin Flats encampment

Moleski pulls the unmarked police vehicle about a third of the way into the Moccasin Flats encampment, cuts the engine and hops out. 

A once bustling makeshift tent city for the unhoused, the one-block stretch of flat, muddy land on the edge of the Prince George downtown core is now largely abandoned. Most of the occupants moved into motels leased by the Province last year as part of a B.C.-wide campaign to shelter the homeless during the pandemic. 

The city lost its bid to fully dissemble and clean up the Moccasin Flats encampment area in Prince George after the Supreme Court ruled alternate housing was “not sufficiently low barrier and accessible to all of the occupants.” [Photo Fran Yanor]

Today, the encampment resembles a disordered dumping ground of personal belongings and scavenged materials. Clothes, shoes, scraps of wood and metal; a broken office chair; an overturned baby stroller; many, many bicycle tires; drug paraphernalia; discarded tents, tarps and poles; and big, bulging, black plastic bags all lie in jumbled mounds, exposed to the elements.

Towards the centre of this disorganized landscape, a waist-high wooden structure stands like an off-kilter ruin: pieces of particle board, wood sheets, metal railings, a dirty window, sections of a partially framed wall and other remnants are cobbled together, wedged, one onto the other, forming a circular exterior about three metres wide.

Trevor and his wife

“How’s it going, Trevor?” Moleski calls out on his approach.

Inside the roofless structure, a woman sits cross-legged and immobile. Her head hangs forward, her face obscured under darkness of a hoodie.
 
A young man squats beside her, his arms wrapped around his knees. He stares at the ground in front of his feet.
  
The place where Trevor and his wife lived in April. [Photo Fran Yanor]
“Are you doing OK,” Moleski asks, then nods towards the young woman. “Is she doing OK, too?”

“We’re OK,” says Trevor. “She’s waking up.”

The woman doesn’t move.

Trevor’s voice is without inflection, drained to a dull monotone, but he converses readily enough. He was born in Toronto, moved to Victoria as a kid and lived with his mom briefly in a mid-sized northern community before moving to Prince George eight years ago when he was 18.
 
He met the woman beside him – his wife, he says – in Prince George. They’ve lived in the encampment off and on for two years, with a few brief stays at one of the local motels converted to a shelter.

“After we were there for about two weeks, there was a knock on the door and it was the cops,” recalls Trevor. “We didn't let them in because we were sleeping and after that I just ignored them.”

Eventually the police broke down the door. Trevor and the others in the room were evicted.

“No arrests were made. No seizures were made. Nothing was taken. They just raided our place. Then (the shelter provider) gave us an eviction notice and told us we had to leave,” says Trevor. “Two weeks later, they gave us a room back. They said that wasn't right, so they let us back. Then the same thing happened again.”

Dens of problematic behaviour

Afterwards, Moleski clarifies. The RCMP executed search warrants on several people in different motel rooms for drug dealing. BC Housing subsequently evicted Trevor and several others “who were obviously dealing too,” he said.

When the encampment occupants moved into the converted motel shelter housing, criminal activity from the tent city migrated with them. The drug-dealing in particular, became rampant and obvious. “You’d have people arriving with a TV. They’d go into the room. Then not have the TV and they’d be smoking meth on the balcony,” Moleski said.

“Sometimes there were over 10 people in those little rooms huffing meth or shooting fentanyl.”

Adam Moleski

Moleski was the lead on several drug search warrants executed at the motel. “Sometimes there were over 10 people in those little rooms huffing meth or shooting fentanyl,” he said.

“With (supportive) housing, you can’t warehouse people in concentrated numbers, or all you’re doing is creating concentrated dens of problematic behaviour,” said Geoff Plant. A former B.C. attorney general and current litigation lawyer, Plant has been involved with various supportive housing initiatives in Vancouver, including Project Civil City in the early-to-mid-2000s. 

Ultimately, the project succeeded in building a lot of housing and helping a lot of people, even as it fell short in solving the larger societal problems of substance addictions and homelessness, Plant said. 

Along the way, they learned a few things.

One element to successful supportive housing is dispersing people and blending the housing, Plant said. “If you get too many people in the building who are the source of problems… then the first thing you’ll see is the dealers all move to the neighbourhood. Or they just let it be known that they’ll be there every Tuesday morning and Friday morning. Then the customers know.”

Undisguised drug dealing

At a Victoria supportive housing complex one chilly spring afternoon in May, a drug dealer boldly sets up shop on an outdoor table in the facility courtyard. People of all ages shuffle past him to access temporary housing and other support services like food or a warm, indoor place to sit. Some stop by the drug table.

Dressed in black track pants and a black hoodie, the dealer’s face is obscured in darkness. He does steady business, palming fistfuls of money, he sorts through his stash, passes little packages back to customers who sit or stand while they wait – all in plain view of staff, facility patrons and a visiting reporter.
 

“It’s never-ending”

“If one dealer goes to jail, there’ll be another guy there tomorrow,” said Derrick Forsyth, a community support worker in Victoria. “It’s never-ending. There’s (always) another guy ready to take his place. It’s not like McDonald’s where when they lose a worker, they can’t replace him.”

“If one dealer goes to jail, there’ll be another guy there tomorrow.”

Derrick forsyth

Forsyth, who has done “every drug you can imagine” (“except Ayahuasca”), is now 10 years sober and working with people on the long path to recovery he still walks himself.

Several supportive housing facilities in the city are known as hotbeds for drugs and stolen goods like bicycles and electronics, particularly those motels and hotels bought or leased by the province as emergency shelters.

“They already got people busted over there with guns in their rooms, drugs in their rooms. There were people committing prostitution in those rooms,” said Forsyth who knows the scene well and spent many a night on the street himself when he was a drug user. 

“Those are the kind of places they should give to people that want recovery. Not somebody ‘Oh, you’ve got a tent and you’re sleeping in a park. Let me help you,’” Forsyth said.

Dangerous tension

“(Supportive housing) has become, on the ground, the primary strategy to deal with such a litany of issues that I think it was a recipe to overwhelm our sector and to challenge many of the communities’ sensibilities around what people should do when they struggle with these barriers,” said Bob Hughes, CEO of Ask Wellness Society, a major provider of supportive housing in Kamloops, Penticton and Merritt.

“Unfortunately, we’ve seen cities, municipalities, drowning in a segment of our population that have really disengaged and found themselves without housing.”

“We’re really creating this very dangerous tension in these communities.”

Bob Hughes

A polarization has developed between those who are trying to support people struggling against barriers, and “another part of the community that literally is saying, ‘These people are menaces. They’re creating havoc in our streets. They’re robbing. They’re damaging or vandalizing. They’re stealing,’” he said.

In 2020 community surveys by Ask Wellness Society in Kamloops and Penticton, respondents voiced general agreement with the goals of supportive housing, but widespread discontent with the collateral effects on their neighbourhoods: increased public drug use, violence, street disorder, and threatening, unhygienic or lewd behaviour.

“So we’re really creating this very dangerous tension in these communities,” Hughes said.

Mayors demand action

In April, a coalition of urban mayors, representing 55 per cent of the provincial population, asked then-Attorney General David Eby to rein in “repeat offenders’ criminal activity and the catch-and-release justice cycle.” 

Eby has since temporarily stepped aside from his housing and attorney general portfolios to run for the BC NDP leadership. If he wins as expected, he will become the next premier of the province.

The mayors said about 200 people are responsible for almost 12,000 negative police interactions in 10 of their cities, causing a disproportionate impact on community safety. Even when police recommend charges, individuals are often not charged or are quickly released on bail, most of the time without conditions. The mayors called for stricter consequences for repeat offenders and other measures to maintain “public confidence in the administration of justice.”

In response, Eby and Public Safety Minister Mike Farnworth tasked a two-person panel with recommending solutions “to interrupt behaviours” of prolific offenders related to inner-city crime and random violent attacks. 

Some of the remedies under consideration are electronic monitoring following bail or sentencing, and mandatory treatment for prolific offenders with addiction issues or mental illness. The panel is to report back in September.

“Certain behaviors are unacceptable. And we need to address them.” 

David Eby

“Our compassion and concern and interaction on mental health and addiction can’t cloud the fact that we need communities to be safe,” Eby said in an April interview with Northern Beat. “Certain behaviors are unacceptable. And we need to address them.” 

Catch-and-release

In Williams Lake, the main crimes perpetuated by prolific offenders caught up in the “catch-and-release cycle” relate to break-and-enters and car thefts, said Mayor Walt Cobb, whose own home was broken into by a repeat offender.

“Once you’ve had 200 charges laid against you, seriously, you shouldn’t be out on the street,” said Cobb. “Now we don’t want to put them in jail. Well then, do something else with them. Because if they’ve been in the system 200 times, they either need some kind of help, or you’re never going to be able to help them. And that needs to be determined – either get them the help they need or keep them locked up, because they’re a menace to society.”

“Either get them the help they need or keep them locked up, because they’re a menace to society.”

Walt Cobb

Over the past several years, federal Criminal Code amendments, Supreme Court cases and provincial policies have coalesced to restrict certain people from being charged, held in custody or sentenced to jail. For instance, Bill C-75 instructs special consideration be given to vulnerable and disadvantaged accused, including racialized populations, the homeless, the poor, or those suffering from mental illness or addiction.

Read Part I: Mean streets to learn why repeat offenders are often caught and released onto the streets.

Basically, because of who they are and the struggles they have, certain offenders cannot be unduly detained following arrest, nor can they be given bail conditions that “unreasonably” restrict their liberty. All of which can give the appearance of “catch-and-release” when individuals are not charged or detained in remand, or are quickly released into the community following an arrest.

Federal law and the Supreme Court of Canada have “very clear messages” regarding offenders with either “mental health or addiction issues, or other systemic challenges that might lead them to come into contact with the justice system,” Eby said, responding to a question in a March press conference. “The court will not tolerate prison as being the solution to those underlying issues, systemic issues.”

Some people belong in jail

Some offenders may need mental-health and addictions treatment, said Abbotsford West MLA and BC Liberal attorney general critic, Mike de Jong. “But we’ve got to be cautious about stereotyping a particular prolific offender, or prolific offenders generally.”

There is a tendency to suggest that anyone that falls into the category of prolific offender is suffering from mental illness or substance abuse, de Jong said.

“Some are. Many are not. Some are bad people. Some are people who do need to go to prison,” said de Jong, who served as both attorney general and solicitor general under Gordon Campbell’s BC Liberal government. “But let’s be careful about excusing everyone’s behavior. Because there are people out there who are simply criminals and engaged in a lifestyle of crime. And for the moment, seem to be getting away with it.”

“Let’s be careful about excusing everyone’s behaviour. Because there are people out there who are simply criminals.

Mike deJong

In Prince George, prolific offenders are not just involved in mental-health and addiction-fueled street disorder crimes, but are very much a part of the violent drug trade, said RCMP North district Chief Supt. Warren Brown. 

“Prince George is as violent and dangerous as any community that I’m aware of in Canada for abduction, torture, murder, shootings, or the drug trade,” said Brown. “We seize guns off people all the time – not grandpa’s shotgun – SKS rifles, handguns, sawed-off shotguns; wicked, wicked guns that kill people.”

Violence is inherent to the drug trade and decriminalization won’t change that, he said. New federal law taking effect January 2023 will decriminalize personal possession of up to 2.5 grams of any drug, including cocaine, methamphetamine, heroin or fentanyl.

People with addictions shouldn’t be criminalized, Brown said emphatically. (“No one goes to jail for simple possession anymore anyway,” he said.) But decriminalization isn’t the answer. “Because it’s not just about the user. It’s not just about the addicted person.”

Predators and victims

There are echelons of drug traffickers. From the drug lord shipping boatloads of cocaine, to the organized crime ring distributing it. But the most common drug trafficker is also a drug user. “They get high, but maybe half the drug that they bought, they’re going to resell,” Brown said. The dealer will “step on it” or dilute it with other agents, then resell it. “So they get their money back.”

Because most of these individuals fit the profile of marginalized, impoverished, and/or addicted, the justice system tends not to jail them. Which makes it a murky situation for police to enforce. 

“Where is the rigor around people who are trafficking drugs?” Brown asked. “Let’s say it’s fentanyl that’s going to kill people. How can that be a police responsibility when people are allowed to have it?” 

“How ugly is that when women … have to sell themselves to be able to feed their (addiction)?”

Warren Brown

And what of the “very vulnerable” woman who told him she needs $500 a day to feed her addiction? How does a person get hundreds of dollars a day when they have no job? They steal, aggressively panhandle, and prostitute themselves. “They get beaten up daily by John’s who don’t pay them,” said Brown, calling this a “black hole” and “something we’re not paying thought to.”

There are people in the downtown core with mental illness and addictions who aren’t getting the proper care they require, and they are being victimized daily, Prince George RCMP Supt. Shaun Wright said in an April interview with Northern Beat

The “forgotten ones”

These are “the forgotten individuals,” Dr. Bill MacEwan said in a 2020 CBC interview before he retired as head of psychiatry at St. Paul’s Hospital in Vancouver. Many have traumatic brain injuries, “addiction and craving, the grind they have of going and getting and using their drugs. 

“They tend to come in and out of emergencies, often at the behest of the police because they’ve had serious mental-illness behaviours on the street which are felt to be a danger to themselves,” said MacEwan who spent nearly 20 years administering to patients living in the Downtown Eastside of Vancouver.

Mental institutions were disbanded for good reasons, he said, but community supports are not reaching these most vulnerable people. 

Downtown Eastside, Vancouver, on Aug. 22. [Photo Zach Proulx]

Mental-health clinicians steer clear of this population. “(The individuals) are sometimes too ill. They’re too aggressive. They cause problems in immersion. They’re being very disruptive,” MacEwan said.

So they don’t get proper treatment and are often excluded from housing facilities.

“They do not get admitted to hospital. They’re simply punted back out. And they make it back to the Downtown Eastside before the police who brought them in … (have) written their reports.”

Health authority can “walk away”

“A lot of it’s left on the housing provider’s plate,” said Amanda Owens, executive director of ‘Ksan Society, a non-profit social-services organization that operates a range of supportive housing in Terrace. “We can shelter people, we can support them, take them in, feed them, and make sure that they’re safe. But it’s super important that there’s health supports through the health authority that can meet the needs of the mental-health and addictions issues.”

Of the 85 people the city identified as living homeless in the 12,000-plus population of Terrace, Owens estimates about six individuals are unable to maintain access to shelter or street-level social services, mainly because of behavioural issues. 

“There’s not the appropriate supports here in our community for them,” Owens said, citing one individual who broke windows in two of the shelters, threatened violence against shelter staff and vandalized their vehicles. The RCMP banned the person from accessing the shelters but did not jail him. Owens isn’t sure what the individual’s health needs are, “but we can’t house them.”

“There’s such a gap there in who is providing what services, what supports, and who is left holding the bag.”

Amanda Owens

Because health authority resources are limited, there is a breakdown in supports for people, Owen said. 

“They’re able to walk away and say, ‘I’m sorry, I can’t help you,’” she said of the health authority. Meanwhile, housing providers are left to deal with the troubled individuals in their community and take the heat from the public for behaviour playing out on the streets.

“There’s such a gap there in who is providing what services, what supports, and who is left holding the bag, so to speak,” Owens said.

Police are medical first responders

“There needs to be some sort of model for those very high needs individuals that 30 years ago would have been institutionalized,” said Wright. “Because they’re still falling through the cracks today and causing a lot of issues in a lot of our downtown cores, and generating a lot of calls for service, and interfering with a lot of other activities in society.”

“The drug crisis has … turned police officers into medical first responders.”

Anthony Hanson

A lack of support services and treatment for addictions and mental illness has left people with one resource to call in a crisis – the police – and those calls for service are taking up more and more police time, Fort St. John RCMP Insp. Anthony Hanson told Peace River regional district board of directors in August.  

“In essence, what the drug crisis has done, has turned police officers into medical first responders,” Hanson said. “People become addicted … much more quickly than they used to become addicted to some of the older substances. They also die much more frequently, because they’re so powerful.”

Fentanyl 

Over the last 25 years, the most sought after hard drugs of choice have evolved from heroin, meth, and cocaine, to the game-changer, fentanyl.

In 2012, fentanyl was detected in five per cent of all illicit drug overdose deaths in the province. Ten years later, fentanyl or its analogues were detected in 91 per cent of all deaths, according to a July release from the BC Coroners Service.

“Our coroners don’t even see (heroin) anymore. It’s all fentanyl.”

Lisa Lapointe

“I used to respond to people who died as a result of heroin toxicity,” said B.C.’s chief coroner Lisa Lapointe, of her early days as a coroner in the mid-1990s. “Our coroners don’t even see that anymore. It’s all fentanyl. And fentanyl (combined with) a million other things.”

Since a public emergency was declared in April 2016, more than 10,000 people have died of illicit drug overdoses in B.C.

Means to an end

For the past several years during the unrelenting opiate crisis, people working in addictions and mental-health sectors have been desperately, and almost singularly, intent on preventing people from dying, said Hughes, from Ask Wellness in Kamloops. 

“We had harm reduction just to keep them alive.”

Bob Hughes

It’s no wonder harm reduction has taken front and centre stage. 

“We had harm reduction just to keep them alive,” said Hughes, likening it to an emergency room procedure keeping a patient alive for subsequent surgery (treatment). But harm reduction alone isn’t the answer. “It’s a means to an end.”

Four pillars drug strategy

It didn’t start out that way. 

British Columbia was strong out the gate as far as inner-city drug strategies go. In 2001, Vancouver city council adopted its version of the globally well-regarded four pillars drug strategy. Similar strategies had already been implemented in Europe coinciding with the deinstitutionalization of mental health patients in the 1980s and 90s. 

For Canada, North America even, the Vancouver drug strategy was an innovative remedy to the rising heroin use playing out in the city. The idea was to tackle the dangerously addictive drug problem from four angles. 

“We had the four pillars before: prevention, harm reduction, treatment, and enforcement.”

Bob Hughes

“We had the four pillars before: prevention, harm reduction, treatment, and enforcement,” said Hughes. “They didn’t always work well together, but we at least tried to bring them together.”

As the deaths from illicit drug overdoses escalated, the whole system tilted toward one facet of what had originally been a multi-pronged strategy.

Implementation of the drug strategy was skewed towards harm reduction from the beginning, said former attorney general Plant, whose Project Civil City initiative adopted the four pillars approach in the early 2000s, yet focused on harm reduction from the onset. “It’s always been the focus, at the expense of a truly integrated four-pronged approach. Because this was about Insite and safe injection sites.” 

Insite began operating in 2003 and the practice of safe injection attracted a lot of attention and caused less time to be spent thinking about the other three pillars, Plant said. 

This, despite early feedback from the public in Vancouver in 2000 before the four pillars strategy was approved and initiated. Public response indicated support for harm reduction, but also an “urgent need” for treatment facilities and supports, prevention/education campaigns and “increased and/or better-targeted enforcement efforts.” 

Treatment fell by the wayside

But the treatment, education and enforcement pillars of the strategy never took root like harm reduction. 

“Harm reduction should be a stopgap. Not a long-term solution… where you just subsist as a drug user wandering around.”

Shaun Wright

“Harm reduction should be a stopgap until you can get to treatment. Not a long-term solution, or a long-term strategy, where you just subsist as a drug user wandering around,” Prince George RCMP Supt. Wright in an interview on CFIS-FM 93.1 community radio.

“Where is the rest of it? Where’s the prevention? Where’s the treatment?” asked Wright.

According to chief coroner Lapointe, treatment and recovery centre options are scarce-to-none in B.C. and the programs that are offered are not regulated or evaluated by government. 

“Because there are no reporting requirements, we actually don’t know what’s effective.”

Lisa Lapointe

“What is lacking provincially is a model that is evidence-based that takes into account residential treatment and supportive recovery and establishes some clear goals and guidelines around that treatment, brings it all within provincial oversight, and ensures evaluation of all of the different programs,” Lapointe said in an interview, referencing the most recent Death Review Panel report which calls for a continuum of care for addictions treatment and safe supply in every community, among other measures. 

“Because there are no reporting requirements, we actually don’t know what’s effective,” Lapointe said. 

Essentially, it’s unknown what treatment is being offered by which providers, to whom, let alone what works, what doesn’t, and why.

“It’s a huge gap in our knowledge,” said Lapointe.

“Taking it on the chin”

Meanwhile, police and supportive housing providers are “taking it on the chin” because the public is blaming them for what’s happening in the inner cities across the province, said Kamloops North Thompson MLA Peter Milobar. 

What’s happening in Terrace is similar to what’s going on in Kamloops and elsewhere, said Milobar, a former mayor of Kamloops. A few people are having huge numbers of interactions with the police “with no seeming consequence whatsoever (which) just adds to that feeling of a lack of community safety, and lack of governmental steps being taken to try to bring some order to what is a very disordered type of environment right now,” Milobar said. 

“Over the last five years, it’s gotten worse. At some point, a finger needs to point back towards government, and not them pointing the finger at everyone else,” he said.

There’s no panacea

“Unfortunately, when the next new thing comes along, we tend to kind of look at it as the panacea. So, when supportive housing first came out, it was hailed as the answer “the catch-all, the be-all, the solution” to homelessness, said Hughes of Ask Wellness Society.

“For those people who are able and wanting to participate and work through their issues towards their own recovery, supportive housing can bring benefits and success, (but) you can’t be everything for everyone,” Hughes said.

“To think that every single one of those people are going to be able to work within … supportive housing is just unrealistic,”

Bob Hughes

Data from Ask Wellness supportive housing operations in Kamloops and Penticton indicate roughly 15 per cent of their program residents were evicted for behaviours related to a mix of substance use, mental illness and criminality.

Similarly, about 15 to 25 per cent of people who are homeless live on the streets, in tents, or makeshift structures outdoors, according to 2021 surveys in 16 cities across the province.

“To expect everybody that is in desperate need of housing and finding themselves street-involved, maybe having some histories of criminal convictions and criminal issues, to think that every single one of those people are going to be able to work within the expectations of supportive housing is just unrealistic,” Hughes said.

‘Ksan Society in Terrace operates a range of emergency, transitional and supportive housing and social services, including the low barrier extreme weather shelter (shown), which offers food, shelter, telephone, and a warm place to rest for people under the influence of alcohol and drugs. [Photo Fran Yanor]

Housing first

Supportive housing, particularly, the “housing first” model employed in B.C. (and much of western United States) provides low-to-no-barrier housing on the premise people will be in a better position to tackle issues of addiction and mental illness if they have secure housing. The motel Trevor was evicted from falls into this category.

“If they’re on the streets… then their lives are just constant chaos. If you give them housing, if you give them a place to live, you provide a measure of stability, that can be very helpful,” said former attorney general Plant, pointing to the success of organizations such as the Portland Hotel Society which began delivering similar housing in downtown Vancouver more than two decades ago.

With the Project Civil City initiative that Plant worked on in Vancouver, “The housing was built. Then the problem evolved. And the problem continued. And the problem grew,” Plant said.

“The mistake was thinking it was a finite set (that) … you could do something once and the problem would be solved.”

Geoff Plant

“The mistake was thinking that it was a finite set – if you just built 1,200 units, you’d end homelessness. The mistake was thinking you could do something once and the problem would be solved.”

It’s a common political misstep, Plant said. “Setting false expectations publicly by saying we can solve homelessness and we can reduce it by 50 per cent if we just build X Y Z housing.”

But there’s no silver bullet with issues this complicated because there’s too many parts, and they’re all moving. 

“Governments have to step up again, and they have to do so continuously. And the commitment required is extensive,” he said.

Complex-care… the next solution?

“In every municipality in British Columbia, people with complex mental-health and substance-use challenges too often face homelessness,” said Mental Health and Addictions Minister Sheila Malcolmson at a press conference in Prince George in June. “They’ve historically been left behind. Their complex and unmet needs have led to a cycle of homelessness, addiction, emergency rooms, sometimes jail.”

Under pressure from the province’s mayors to resolve inner-city crime and violence, both Malcolmson and then-Attorney General Eby repeatedly pointed to complex-care housing as a response to inner-city crime, street disorder and other challenges related to prolific offenders.

“Their complex and unmet needs have led to a cycle of homelessness, addiction, emergency rooms, sometimes jail.”

Sheila Malcolmson

The $164 million for 500 complex-care housing “spaces” ($150,000 per unit) in this year’s budget aimed to “engage with, and hopefully interrupt, this rotating door of the criminal justice system for people with serious mental health and addictions issues,” Eby said in March.

Since then, Eby has been unwavering on one front: the cycle of repeated criminality in the inner cities is largely driven by mental illness and addictions and those individuals need treatment.

Will complex-care deliver treatment?

Complex-care defined… sort of

Complex care is a difficult concept to nail down. Not the least because, most of the 355 complex-care housing “spaces” announced so far are theoretical or in the throes of implementation; the program structure and ministerial oversight are convoluted and counter-intuitive; multiple ministries are involved in the program planning and delivery; and the services themselves will be different things, in different communities, across multiple facilities. 

For some, complex-care housing conjures the image of a long-term care-type facility with 24-hour nursing and other healthcare services for people with severe addictions and mental-health challenges. 

However, only the flagship Foxglove complex-care program in Surrey is confirmed to have medical clinical staff working full-time in the RainCity Housing facility where complex-care residents will be living – a nurse will be on-hand 11 hours during the day. Residents there will have in-facility or remote access to addictions specialists, care aides, a psychiatrist, social workers and primary care physicians.

In all other complex-care locations, the services, access, and the living environments are less clear. 

Despite being touted as health care, many complex-care services are non-medical, delivered by non-clinical support staff, such as cultural and peer supports, life skills training, meal supports, and overdose prevention. Health-care services will vary location-to-location, as will access to them. Some residents will be able to access psychiatry, medication management and primary health care, but non one seems to know yet whether that will occur onsite, offsite, remotely (by Zoom or telephone) or how often. 

And, crucially, all of the complex-care money announced so far is earmarked for existing beds scattered throughout existing supportive housing operations – there will be no new complex-care housing facilities.

The mayors didn’t want to wait for new builds, Malcolmson said in a June interview.

“So, you’re (announcing) housing but there’s no housing? What does that even mean?” said Owens from ‘Ksan Society in Terrace. “Then it’s not complex-care housing then, it’s just complex-care supports. Just name as it is. You’re giving people the false hope that there’s actually more housing coming.” 

“So, you’re (announcing) housing but there’s no housing? What does that even mean?”

Amanda Owens

“Complex-care is obviously a response, a very appropriate response, to say we need something that is more intensive,” said Hughes from Ask Wellness. “(But) really, is this housing or is this health care?”

Who’s in charge here anyhow?

As it stands today, B.C.’s Ministry of Housing funds and oversees the supportive housing facilities and the tenant-support programs where complex-care will be offered. 

The Ministry of Health, via the health authorities, will deliver the health and mental health complex-care services. 

The Ministry of Social Development and Poverty Reduction funds the rental supplements for residents (paid directly to supportive housing providers).

Yet, the Ministry of Mental Health and Addictions, which will fund and deliver none of the services, is responsible for overseeing the complex-care program.

“Unless that minister has all the tools necessary to solve the problem, including all of the funding, then the solution is not going to be within reach.”

Geoff Plant

“It’s one thing to say, ‘Well, let’s create a minister who’s responsible for that,’” said Plant. “But the way government works, unless that minister has all the tools necessary to solve the problem, including all of the funding, then the solution is not going to be within reach.”

In 2017, the NDP government unveiled the creation of the Ministry of Mental Health and Addictions in a hail of self-congratulatory fanfare about how it was the first provincial jurisdiction in Canada to create a ministry solely tasked to deal with the opioid crisis. 

Five years later, the ministry’s total 2022/23 budget was $21.5 million. By comparison, RainCity Housing – which will host the flagship complex-care program the ministry will oversee – received more than $36 million in provincial government funding the previous fiscal year. (RainCity operates 29 supportive housing and social housing programs in the Lower Mainland and Sunshine Coast.)

Having a minister of mental health and addictions is fine, said Plant, “but do they actually have any ability, authority, responsibility and accountability?”

Two years ago, even the Prince George Chamber of Commerce noticed the disconnect.

When the provincial legislative finance committee solicited feedback on the 2020 budget, chamber president Todd Corrigall asked the committee to fund the Ministry of Mental Health and Addictions for something beyond staffing. (See the Ministry of Air.)

“Staffing and marketing are clearly not stopping overdose deaths,” Corrigall recalled telling the finance committee. “It definitively threw them for a loop. But the reality of it is, these persistent issues are on the doorsteps of businesses. So it behooves us to be solutions-orientated for the benefit of our businesses, and really the community writ large.”

Murray

Driving through downtown Prince George, RCMP Const. Moleski turns onto an inner-city street and spots Murray, a man with wild hair and a long, straggly beard crouched over a public garbage can and scribbling furiously.
 
“This guy’s not all there,” Moleski says pulling to the curb before exiting the vehicle.
Murray has 205 police files associated to him, including 22 convictions. Most incidents relate to theft and mischief, others to  causing disturbances and assaults. He currently faces charges for mischief, break and enter, and breach of conditions. Murray also has many “emotionally disturbed person” mental-health files which include psychotic episodes, and he’s banned from one of the shelters in town.
 
“Not sure if he’s banned at the other ones, but he lives and sleeps on the street,” Moleski explained later.

“Everything OK?” the officer calls out as he walks towards Murray.

Murray doesn’t look up and he doesn’t answer.

“No?” asks Moleski.

The man pauses when Moleski reaches his side. Several felt markers lay strewn on top of a plastic garbage container already defaced with haphazard-looking black scrawls. As the officer stands by, Murray seizes a piece of paper and unleashes a torrent upon the page. Is he trying to tell Moleski something? Or is Murray engulfed in a fury of unrelated thoughts?
 
Moleski peers at what the man has written. The cursive is over-sized and wholly illegible.

“Are you OK?” Moleski tries again.

Suddenly, Murray swivels his torso to face the police officer. It's a dramatic reveal: his right eye is angry red and swollen shut. A fight? An infection? Murray cranes his neck to look with his good eye at Moleski while the constable waits expectantly.

Murray shakes his head. Yes or no, it’s hard to tell.

Moleski waits for the man to speak. He doesn’t. Sometimes Murray talks. Not today.

“Well, don’t write on the walls though, eh?” Moleski says by way of goodbye, then turns toward the vehicle.

A couple weeks later, Moleski interrupted a street drug deal. The dealer was arrested and the drugs confiscated. The customer was Murray, who’d been sold some fentanyl.

Reality check – complex care won’t house Murray

The first hurdle for Murray is that he won’t qualify for complex care as it as currently envisioned. The screening process, as with most supportive housing in large cities (where they have a choice of applicants), will select the clientele most likely to succeed, weeding out those with the most severe addictions, mental illness, and behavioural issues, including criminality – i.e. prolific offenders.

“Intensive level support is not going to meet everybody’s needs,” said Becky Doherty, clinical director for Fraser Health Authority, which will deliver the complex-care services at Foxglove. “If people require a lot more than this level, then we typically wouldn’t be matching them to put them into Foxglove.” 

Foxglove is categorized as intensive supportive, according to the Ministry of Mental Health and Addictions. The highest level of care is 24-hour, seven-day-a-week health supports and supervision. No units with this level of support are yet operating in B.C.

Even if Murray were offered a spot in complex care, it’s hard to imagine how he could live within the rules. Similar to supportive housing, residents must commit to no criminality and refraining from behaviour that threatens the safety of others.

At Foxglove, if a resident exhibits a psychotic or other unsafe behavioural outburst (as Murray has) after medical staff have gone home for the night, tenant housing staff do what they’ve always done. They will try to connect with the resident, de-escalate the situation, and failing that, call 911, said Catharine Hume, co-executive director of RainCity Housing, the Foxglove supportive housing operator. 

Which means Murray would inevitably be evicted and back on the street.

But Malcolmson, the Mental Health and Addictions minister, insisted the design of complex housing will help the individual suffering bouts of psychosis “to avoid those crises moments, because people are being looked after in a wraparound way with enhanced supports that are designed specifically to care for them.” 

In concept, the complex health services are tied to the person, rather than the bed, ensuring the services “wrap around” the individual, so they are “never evicted into homelessness,” according to Malcolmson. 

But, if the services are not tied to a bed, how does a person have a “home” to return to? How exactly will complex-care “wrap around” a prolific offender who is perpetually homeless on the street?

Not likely to volunteer

All of which is moot for Murray, because it’s doubtful he’d volunteer or adhere to any structured, rules-based living environment, let alone benefit from a program without a treatment capacity or objective.

“We really let them drive (the process) because it has to be what’s important to that person at the time.” 

Becky Doherty

“We offer that range of options and have a very harm-reduction approach to services, but not demanding any particular action or treatments or anything like that,” said Doherty of the strategy at Foxglove. “We really let them drive (the process) because it has to be what’s important to that person at the time.” 

As for the goals of the health-care team: “I think what we would hope for is somebody experiencing an overall improvement of their health and their quality of life,” Doherty said.

Complex care will help a lot of people, Eby said while conceding the voluntary component may not be a good fit for many prolific offenders. 

Given the absence of treatment, or even a strategy guiding individuals towards treatment – a remedy Eby has insisted most prolific offenders require – it seems the government will have to look elsewhere than complex care to interrupt the behaviour of those suffering mental illness and/or addictions who repeatedly commit crimes.

What now?

“People will say that if all the support services were there, this problem would go away. Maybe it would, but what are you going to do until then?” asked Terrace councillor Sean Bujtas, whose own city is grappling with a range of crime, addictions and homelessness issues in the downtown area.

“You hear these stories about people with 15 or 20 convictions who then are charged with a serious crime of violence against individuals – sometimes random acts of violence, frequently caught on video – and people learn that within hours of being detained, they’re back on the street. It really defies any sort of logical explanation,” said BC Liberal attorney general critic, de Jong.

In short order, the attorney general could establish clear policies that say, “‘In the following circumstances, Crown counsel is going to request, demand, of the court that a person will be detained.’ Ultimately, the decision is for the judge, but you’ve got to ask,” said de Jong.

“What prisons do, is, at least it keeps the community safe for a period of time.”

Warren Brown

“Obviously, prisons haven’t worked, because how long have they been around?” acknowledged North district RCMP Chief Supt. Brown. “But I’ll tell you what prisons do, is, at least it keeps the community safe for a period of time.”

Prison as a consequence

Jail also serves as a consequence, which acts as a deterrence. “Fear of consequence – not morals and ethics – fear of consequence is probably the number one driver for lack of recidivism, for the curtailing of criminal acts,” Brown said.

Law enforcement needs to be at the table, said Hughes from Ask Wellness supportive housing. “There is a role for enforcement for those who are being predatorial (when) their addiction and their drug use and alcohol use collides with the criminal justice system, or, frankly, just civility in our community, in our city.” 

The solution is to find pathways into “more recovery-oriented supportive housing.”

Bob Hughes

But the solution is to find pathways into “more recovery-oriented supportive housing” that help people to reach their potential, Hughes said. To do that requires stabilizing their substance use, either through full abstinence or prescribed treatment, “to really get it to a place where it’s not damaging you and others around you,” Hughes said. 

“It’s not a linear pathway by any stretch,” he said. Ask Wellness is now one year into a new three-tiered program to help people move beyond harm reduction into recovery. An intensive 90-day recovery program is followed by six months’ recovery time, and an additional year of support to access and maintain a job. 

The inherent challenge remains the same said Hughes: “How do we get a street population that is often struggling with substance use and mental health to have some buy-in and incentive to participate in a recovery-orientated approach?” 

Buy-in will be challenge enough for the committed candidate, never mind the unwilling individual caught in severe addiction, mental illness and repeating criminal acts.

“Whatever we come up with is going to have to have some element of compulsion to it and provide courts with that option to require people to take up those services,” Eby said of treatment for prolific offenders.

“Whatever we come up with is going to have to have some element of compulsion to it.”

David Eby

After a decade’s distance from drug use and jail, Forsyth thinks some form of carrot and stick is in order. Put the offender in jail for a month. “Let his mind clear.” Then offer him jail or reduced time in treatment. “He’s going to learn something, whether he wants to or not,” said Forsyth. 

“He has more of an opportunity to get sober than just leaving him uncharged, unaccountable, or we’ll-let-you-do-as-much-drugs-as-you-want-you-can-kill-yourself-because-we-don’t-care-anymore society,” he said. “There’s 150 people dying every month of overdose, like, let’s do something.”

Trevor and his wife

Back at the Moccasin Flats encampment in Prince George, Const. Moleski talks to Trevor.

The 26-year-old has been crime-free since his release from jail a year ago, he says. “We’re trying to get our kid back right now. In order to do that, we need to see a counsellor.” 

Their baby is almost a year-and-a-half. “I was in jail when she was born. I got out right after her birth.”

He says they’ve been trying to get housing and have spoken with BC Housing and staff at the local not-for-profit cultural centre about getting on wait lists.

“It's hard to find a place to stay with my criminal record and just all kinds of things…” he says, trailing off.

“We’re both addicts,” he adds after a moment, noting it is a barrier to housing.  “We're so close to being off of it, it's crazy. We're trying to get on methadone.”

They need a face-to-face meeting with a doctor to get a referral for methadone treatment, a long-acting opioid used to help get a person off heroin, fentanyl and other street opioids. Trevor expresses frustration at trying unsuccessfully to get access, conceding they’d had three appointments already that had fallen through.
 
Moleski suggests alternative clinics, but Trevor says walk-in clinics don’t prescribe methadone, so patients have to visit one of two locations in the city to get started on a treatment program.
 
Meanwhile, Trevor and his wife are considering another option. “This Tuesday that just passed, we were going to take the five-dollar bus to Vanderhoof so we could go get clean, because my mom got a place for us to stay,” he says.
 
He stops talking and looks around impassively at his surroundings. “We make the choices ourselves. We put ourselves here,” he says quietly. “It's up to us to get us out of here.”

Maybe next week they’ll be on that bus.
 
Or maybe we could build a system that helps them.


Note: By the time of publication, Trevor had been arrested again and remanded into custody, awaiting trial on arson-related charges.

Stay tuned for Part III of the series If not prison, then where?Is it time for mandatory treatment?

Part I Mean streets: Nowhere else to go delves into the laws and policies designed to keep some repeat offenders out of the prison system.