Tale of a billion dollars

Written By Fran Yanor

A billion dollars doesn’t go as far as it used to. 

When a story broke that the B.C. government had submitted a last-minute, billion-dollar addiction and mental health package for Treasury Board approval, it sounded conspicuously similar to the treatment and recovery platform released by the BC Liberals a couple of weeks earlier.

But what the B.C. government revealed in this week’s budget was something else entirely. 

While the Opposition’s $1.5 billion Better is Possible proposal imagines a robust “recovery-oriented” system of addictions care, the New Democrat plan – if it can be called that – is tepid and half-measured, with a murky endgame. 

Agree or disagree with the vision, the Opposition’s plan at least has one, and the intended outcome is clear: for $1.5 billion, they say they will create a province-wide system of accessible addictions and mental health care that will move people off illicit drugs, into treatment, and through a supported, sustainable recovery.  

The New Democrat’s $1 billion investment in mental health and addictions services on the other hand seems a poorly explained, grab bag of funding to existing initiatives and new investments to create an underwhelming 195 new addiction treatment ‘spaces’ that will be scattered across the province in some unspecified fashion.

Whether the BC Liberals have severely under-estimated the cost of their proposed top-shelf addictions and mental health system, or the New Democrats have badly ballooned the costs of delivering so little, is unclear.

As it stands, the BC Liberal plan, laid out by Leader Kevin Falcon on Feb. 2, is audacious by comparison. It proposes free, accessible addictions treatment for everyone; live-in complex care facilities and residential recovery communities in five regions across the province; stand-alone addiction treatment units in B.C. jails; additional involuntary treatment for people at risk of harm, and more.

Currently, B.C. has none of that. Particularly glaring in its absence, given the utter scale of human destruction claimed by the overdose crisis, is the resounding lack of addictions treatment.

One of four core pillars of Canada’s and the province’s own drug strategy – prevention, harm reduction, treatment, enforcement – investments in treatment have been largely missing from the New Democrat budgets. In fact, the B.C. government doesn’t even regulate, monitor, evaluate or licence treatment operators. So far, the New Democrats have directed investment almost single-mindedly on harm reduction measures.

Falcon said if the New Democrats moved away from their “almost compulsive fixation” on decriminalization & supply of addictive drugs, to focus primarily on treatment & recovery “we will absolutely be there applauding and working with them to make that happen.”

Meanwhile, more than 11,000 people have died of illicit drug overdose in B.C. since a public health emergency was declared in 2016. One third of Canadians who’ve died of overdose lived in B.C., which has the highest rate of deaths of any province.

A billion dollars’ worth

The $1 billion announced by the New Democrats in the 2023/24 budget, dubbed the “largest investment in mental health and addictions services in B.C.’s history,” appears to buy substantially less than the Opposition’s proposal.

First off, only $586 million of that budgeted billion is specifically earmarked for addictions treatment and recovery. And it won’t build any beds, at least not at first. 

Capital costs are not included, so the budget funding will cover concept planning to create a business case for the capital investment proposal that will be needed to get approval for more money from Treasury Board to, at some point in the next three years, create 195 spaces.

Almost half of those spaces are already allocated to the future expansion of a new model of addictions care delivered by Providence Health and Vancouver Coastal Health Authority, which will move people “seamlessly from crisis response in our emergency rooms and our streets, to detox, to treatment and supportive housing,” according to Eby,

Otherwise known as a continuum of care, in which people can progress from one service to the next without interruption – something completely absent in B.C.’s unregulated and unlicensed treatment environment.

Which leads to Red Fish Healing Centre, the highly lauded 105-bed facility that treats people with both severe mental health and substance use issues – a combination of treatment services that are particularly needed.

Tucked into the billion-dollar package is funding for concept planning and a business plan, as well as, operating dollars to expand Red Fish and duplicate its model of care in three other locations. This too will require additional capital investments down the road, for which the timing is unknown.

Model of Red Fish Healing Centre [Image PHSA]

So, besides the 95 spaces to Providence, some portion of the remaining 100 spaces will go to the Red Fish expansion, and presumably Victoria will also get some new spaces. Whatever’s left over will then likely be sprinkled sparingly throughout the Interior, the North and mid-to-northern Vancouver Island.

How many of all these spaces will deliver in-house addictions treatment is hard to say. 

The government definition of spaces is broad, encompassing short-term sobering and detox beds, residential treatment spots, along with post-treatment, non-clinical supports (not beds) for people living in community. 

When asked where the spaces will be located, Finance Minister Katrine Conroy acknowledged there is need throughout the province, including in the North and in her own home region of the Kootenays and that locations other than the usual urban centres are being considered.

Safe supply and complex care

Also in the billion dollar package is $184 million for harm reduction measures; safe supply of prescribed opioids like heroin; prevention/education for children and youths, and expansion of the police/mental health Car Programs

Rounding out the billion is nearly $300 million in operating and capital investments for complex care. Operating funds of $97 million will sustain access to complex care services for 500 or so people. Another $169 million in capital funds – the first capital allocations for complex care so far – will create 240 new ‘spaces’ over the next three years.

Complex care is not treatment. It’s access to services for people who are already living in supportive housing. Services vary from overdose prevention, counselling, prescribed opioid substitution medication, peer and cultural supports, to access to offsite primary health care providers, psychiatrists and social workers.

The 240 new complex care spaces on the horizon will offer more of the same, except people will be living in built-to-purpose supportive housing facilities and they will be located throughout the province.

Downtown Eastsides in rural B.C.

All of which will likely fall short of expectations as voters watch their downtown communities devolve into tragic versions of Vancouver’s Downtown Eastside, while treatment and recovery services remain practically non-existent. 

“Terrace is in the beginning stages of becoming the Main and Hastings of the North,” said Arthur Renwick, Haisla Nation deputy chief and chair of the health and wellness committee of the Northern First Nation Alliance, which represents nine Indigenous communities in the Northwest.

“Terrace is in the beginning stages of becoming the Main and Hastings of the North.”

Arthur Renwick

“It seems to be a place that people go to live in the streets,” Renwick said. “There’s really no safety net for them. So they go to where they’re accepted onto the streets, where people are living and doing drugs.” 

British Columbians want new ideas

Last October, many voters turfed mayors and municipal councils and surfed their rivals into office with an almost singular mandate to fix their downtown communities.

People may not know how to assist the drug addicted or how to restore safety and civility to their urban cores, but they are hungry for leaders with the courage and the ingenuity to try. Bold ideas win elections. Half measures do not.

Nanaimo mayor Leonard Krog is a vocal supporter of controversial mandatory addictions care. “People are living in hell on the streets and in far too many cases making it hell for others,” Krog said last year, shortly before he was re-elected.

Arguably, the most dramatic election upset landed Ken Sim in the Vancouver mayor’s office. His campaign essentially centred on ‘fixing’ Vancouver’s Downtown Eastside. His key campaign plank was simple – he promised to hire 100 more police officers and 100 more nurses. Which may or may not work, but was a dramatic departure from his predecessor’s approach.

Get the ball rolling

To get the treatment and recovery ball rolling in the Northwest, the B.C. government might want to hash out a plan with Renwick’s group, the Northern First Nations Alliance, which has a three-tiered, land-based detox, treatment and recovery project idea languishing for want of government attention.

Backed by the Terrace mayor and council, the alliance’s program would rely heavily on existing infrastructure and could serve hundreds of people a year in medically assisted detox beds, a mobile withdrawal unit, a residential treatment and recovery centre, and a sober-living house. 

The alliance presented their idea during 2023 Budget consultations last June and got a cursory, ‘Thanks anyway’ follow-up response from a mid-level Ministry of Health official. Which seemed dangerously dismissive for a government that has zero clinical treatment and recovery services operating in the entire Northwest (or Northeast) region.

Prince George hosts the closest detox/withdrawal beds, more than a six-hour bus ride away from Renwick’s home village of Kitimaat. Despite assurances from Northern Health that the queue for a bed is no more than a few days, residents in the Northeast and Northwest report waitlists weeks to months-long. 

“If you want treatment, you need something that’s immediate,” said Renwick. “You don’t want to get on a waiting list.”

Even if someone is lucky enough to get into detox for a few days, it’s unlikely they’ll have anywhere to go for treatment on their release. Instead, people are cycled back onto the street, where many don’t make it past the downtown Prince George drug scene.

“A detox centre is a first step. Then they need a place to heal themselves,” said Renwick.

Health Minister Adrian Dix called his government’s billion dollar package “a serious, thoughtful and, frankly, action-oriented response to what is a public health emergency.”

The New Democrat government press release says the massive investment in this year’s budget builds toward “a new model of seamless care.” 

That may be so, but in the meantime, British Columbians are wandering the barren landscape of B.C.’s inadequate addictions care – a treacherous journey involving bureaucratic sinkholes and yawning pits of despair so deep and wide, 11,000 souls have disappeared into its depths and entire downtown communities are teetering on the brink.