Dr. Julian Somers – Recovery Oriented Housing
Call to Action Met with Ludicrous Response by ‘Progressive Councillors’
Dr. Julian Somers’ “A Call to Action” stirred a variety of responses in people. 1
Many gravitated to the idea of people with mental illness gradually improving and normalizing their lives through scattered site housing and the assistance of a skilled outreach team.
Understandably, progressives have had knives out for Dr. Somers, because he is not a champion of safe supply. 2
Dr. Somers has pointed out that 79% of publications advocating for safe supply were conducted in BC with an HIV/AIDS researcher as the lead author (page 13). None interpreted their results as indicative of the need for evidence-based housing, employment assistance, or addiction treatment (page 23). There were many medical, legal, ethical and cost issues unaddressed by these studies (pages 24-30).
Councillors Boyle and Swanson, both in support of substance use and safe supply, thought they had found a smoking gun in a 2017 paper of Dr. Somers’ and harangued speakers with unusual and intrusive questions about it (Boyle [2:42:40], [3:30:18], Swanson [1:44:15]).
Kits for Inclusivity even dragged in an HIV doctor into this, but their weak hearing presentation was eclipsed by Speaker 241 in Shayne Ramsay Cannot Man Up.
Ian Cromwell of OneCity desperately tried to sound intelligent with a Twitter monologue on Dr. Somers’ research.
It was much ado about nothing, according to Dr. Somers:
The people who were randomly assigned to usual care, and who we know remained homeless, improved as much as the people who received market housing and support and the people in congregate. Everybody’s scores went up. It was true across the country in all five sites.
David Eby’s name made another appearance at the hearing, first avoiding a rape victim in his constituency office (in Shayne Ramsay Can’t Man Up) and now being duplicitous with Dr. Somers regarding use of his research.
David Eby just can’t let go of his Pivot Legal Society creds and mature into a competent politician, not just a commisioner of reports.
Dr. Somers’ presentation is transcribed below.
Dr. Julian Somers, Speaker 256 - July 25, 2022, in public hearing about CD-1 Rezoning: 2086-2098 West 7th Avenue, and 2091 West 8th Avenue
Dr. Somers presentation starts at 2:43:57.
Thank you, Mayor and Council. My name is Julian Somers.
I live on Vancouver’s north shore and I was raised near the proposed redevelopment site.
My remarks are based upon my 35 years of clinical practice and research addressing harm reduction and recovery from addiction and mental illness.
There has been little mention of mental illness in these public hearings or the fact that recovery from mental illness is common and attainable with appropriate support. Evidence is that unaddressed mental illness plays a central role in BC’s crisis of homelessness, crime and addiction and death is overwhelming.
I oppose the current proposal because the built form of the building is markedly at odds with that evidence.
When the BC government closed Riverview Hospital, it committed to providing support for recovery closer to home. As Vancouver police have detailed those commitments remain “Lost in Transition.”
In 2006, Canada’s Kirby Commission called for an evidence-based vision, and I quote “At the core of this vision is recovery-oriented primarily community-based integrated continuum of care.” That vision informs Portugal’s successful national strategy which states, I quote “Strictly speaking, there is no such thing as treatment without social reintegration.”
Canada also implemented the world’s largest scientific project addressing recovery among people deemed the hardest to house and I was honoured to lead that research in Vancouver. Our 500 study participants had been homeless for an average of 10 years and all experienced serious mental disorders. There most common health-related goal was to overcome their addictions. 25% had children under age of 18 that they were separated from, 25% had been in foster care, and over 80% wanted to resume paid work the day we met them.
Using comprehensive provincial data, we learned that only 17% of our clients were living in the Vancouver region when they became homeless – that’s Metro. They migrated from communities with few resources. Each year, they spent more days in hospital, in custody and needed additional income assistance.
We randomly assigned participants to 3 groups. One group received choices of dispersed, affordable housing with 24/7 support. A second group received residences in a single building, like what is being proposed, with 24/7 support on site. A third group received usual care, meaning standard services in the community at large.
Our results showed that in contrast with usual care, most people remained homeless. Both congregate housing and dispersed affordable housing created marked housing stability.
However, those living in dispersed housing also experienced a 71% reduction in crime, a 50% reduction in medical emergencies, and significant and meaningful improvements in continuity of health care.
In congregate housing, levels of crime and medical emergencies were not significantly different from those who remained homeless in usual care. The culture of their building was comparatively homogeneous with limited opportunities for social mobility.
There is nothing inherently wrong with congregate housing. Every successful apartment building confirms the value of congregate housing. What matters is the mix of tenants or residents.
Imagine two buildings. One with a cross-section of society living in affordable housing. The other would be all at the shelter rate experiencing homelessness, mental illness and addiction. Which building would you choose to live in? And if you chose affordable, socially diverse housing, why should be expect people who experience mental health illness to choose differently?
Internationally, 84% of people experiencing homelessness and mental illness prefer independent housing.
By approving single room congregate housing for people who are among the hardest to house, Council would expose residents to excess medical emergencies and preventable involvement in crime. By endorsing that the shelter rate should define the value of housing available to people with serious mental illness, Council would be practicing stigma. While restricting opportunities with reunion with children and social integration more broadly.
Given the highly engaged Kits community, there is an opportunity to secure a small percentage of affordable units on the proposed site for people exiting prolonged homelessness and extend the same approach to other new and existing buildings in the neighbourhood.
I encourage Council to embrace the Kirby Commission’s vision of a community-based recovery by supporting practices that align with evidence and values of the community members who want to be a part of the solution, while inspiring other BC communities to do the same, recognizing any solution must be provincial.
Thank you.
Councillor Hardwick:
Thank you very much, Dr. Somers. There are two issues we’ve been focussed on. One is the physical built form in height and massing. Density has been covered. The other is the composition of residents. Do you see a correlation between the two? Would it matter if it was a 6 storey building with this composition of residents, or the height and massing have anything to do or reinforce the composition of residents?
Dr. Somers:
I agree with an earlier speaker who characterized, or maybe a Councillor recalling a speaker characterizing the built form as prison-like or institutional. Small windows, double entry, a courtyard manufactured on the interior as though the intent was to prevent people from interacting with other neighbourhood members, and having access to outside within a confined space. It is not a built form at all conducive to social reintegration for people who have been homeless for long periods of time.
And most people who have been homeless for long periods of time also experience mental illness. That’s what differentiates long-term homelessness from the many other people exit homelessness more quickly and through their resources.
The built form, it seems like it could work for very select groups of people, but not for people who’ve exited homelessness. It’s more like student housing, housing for people who are here for a short stay, flight crews, that sort of thing.
When we did our research, no other city in the country thought it made sense to implement a congregate building, because none of them thought there was value. They thought the results were already in. It’s why we deinstitutionalized.
Councillor Hardwick:
Right.
Dr. Somers:
Compelling people to live together is antithetical to their prospects for recovery. And its diversity and proximity to loved ones and community membership and fellowship that are the major components, as they are for most of us.
Councillor Hardwick:
So paraphrasing, if social reintegration is our objective, this is not the form physically that it should take.
Dr. Somers:
Agreed.
Councillor Hardwick:
OK. There have been a couple of speakers that have been suggesting that your research is flawed and that there are other individuals which whom you have done your research are contradicting the position you’ve taken forward. Would you like to address that?
Dr. Somers:
Boy, would I. Thanks.
There are two that I know of out of a lot of people I’ve worked with over the years and neither of them got in touch with me first. So, I wish they had because probably we could have addressed what I believe are misunderstandings. Dr. Palepu is attributed, saying that results favour congregate and congregate works as well and referencing a 2017 paper that I’m the lead author on.
So we publish papers on discrete facets of large projects like this in separate studies. That particular study reported one of our main outcomes of interest which was housing stability. And indeed, I’ll confirm there was no significant difference in the overall rate of housing stability amongst people who received congregate versus the option of scattered housing.
All of the other outcomes in that manuscript are based on questionnaires that were adapted from other research that didn’t involve homeless people. And the results were extraordinarily perplexing. Mainly, everybody’s scores went up and about the same. There are only two measures where there was any significant difference. They happen to favour the congregate group, but the perplexing part is that in questionnaire measures, ten item questionnaires assessing things like overall wellness, psychiatric symptoms, community integration.
The people who were randomly assigned to usual care, and who we know remained homeless, improved as much as the people who received market housing and support and the people in congregate. Everybody’s scores went up. It was true across the country in all 5 sites.
Boy, we were disappointed.
Councillor Wiebe:
First question, you talked about the built form doesn’t work for social integration. Can you talk about what changes to the built form you would like to see?
Dr. Somers:
Well, I was here for the earlier presentation of a 6 storey rendering, and I’ll lend support to that, although that’s the first time that I’d seen it. But the reasons I’ll lend support to it are that one, it reflects the sentiments of people who live in the neighbourhood, which I don’t any longer, and it refers to the goal of establishing additional housing that is consistent with the fabric of existing housing and is designed to welcome people who would be exiting homelessness and in need of housing, but along with others who would further complement the social milieu that’s established in Kits, which provides the people who are exiting homelessness with the greatest opportunity to feel welcome and to feel not singled out, to feel that they are truly a part of things.
And if that approach is followed, I can’t comment on the specific form that was proposed because it was a sketch.
If that overall ethos was pursued, it would lead to a form that is more conducive to people choosing homes and feeling valued and welcomed as community members and that ought to be. If we make good on what we said in the 70’s, the deinstitutionalizing, that ought to be applied to many, many other buildings where people have the opportunity to join as neighbours and as we showed in our trial, there was no NIMBY backlash.
There was no concerns raised in the scattered site housing. Lots of naysayers telling us that you’re not going to get landlords to rent to you, bad things will happen, none of that came true.
And people experienced the most profound thing was not what they got from our team. It was telling us that after a year, two years they felt as though they belonged. They felt as though they were welcomed and that they were being treated as normal people. Imagine that.
So where people have opportunity to experience that, I’m for it.
Putting them in a building that advertises “special needs inside” such as the renderings I’ve seen of the proposed building are simply frightening and are essentially displaying people in a way that is stigmatizing.
I think you’ve seen enough already in the presentations to hope get the gist of what I’m referring to and why the 6 storey building was presented with the elements that were described.
Councillor Wiebe:
OK. Second follow up question. You’ve talked about a different and more diverse mix of people in the building creates healthier outcomes. Can you talk from your research what type of mix would create the best outcome in a building of this size?
Dr. Somers:
Social engineering is a dangerous sport. What we found best and what most of us apply to ourselves and others we care about in our lives is providing people with choices. And why did they choose that building next to the park with oak trees or next to the corner store that reminded them of something they had access to when they were children. What is important is the opportunity to present people with decent, dispersed, affordable housing options and providing them with the dignity to choose. And they will make choices that resonate with them in the same way the rest of us do.
Councillor Wiebe:
OK. Thanks for coming to speak today.
Councillor Dominato:
Thanks for coming in today. A couple of quick questions to start. You talked about congregate housing over here. We don’t formally have that definition with the city in terms of our housing stream and we talked about this, they’re studio units not the same as they’ve represented as SRO’s and they’re not in that context. Can you expand upon your view of what congregate housing is, because we don’t have a definition in the city?
Dr. Somers:
Sure. The term is used in literature along these lines of supporting recovery and helping people who’ve been homeless for many years to have a chance of recovery is used not specifically in relation to bachelor, SRO or other sizes or configurations of units. It’s more a reference to the social diversity in the building. And individuals, as done in some research, including ours, when we are housed altogether in the same building, that is what we refer to as congregate, a congregate approach, as opposed to dispersed, choice-based approach. The two comparators that have been most researched. So it doesn’t have to do with size of units. It’s the social mix in the building.
Councillor Dominato:
OK. So in that context then, whether it’s 50 studio units or 120, it’s still congregate.
Dr. Somers:
That’s right. That’s right. You can also think of it as concentrating people who are all coming from similar histories and similar types of social disadvantages, right, the foster care, the level of adverse childhood experiences that typically goes back to childhood. Now, there is a middle ground. People who’ve been homeless, have less severe needs and choose and do well in housing where they are supported alongside other people with comparable needs. Now we did that research also in a randomized trial and where people who need supports on an occasional basis, not 24/7, but someone who might help them broker access to care, are likely to do better when they are supported alongside other people with comparable needs.
But the more severe and complex their challenges are, the more strongly indicated it is that they have a choice and opportunity to experience social surroundings that are normalizing and healthier.
Councillor Dominato:
Super helpful. I have one more question. Councillor Wiebe asked a couple of questions I wanted to ask. I just want to drill down on an example, if you’re not familiar with it, that’s OK. Councillor Wiebe asked about the type of mix…The Kettle on Burrard has been operating for a number of years and it opened up after Marguerite Ford and there’s a lot of lessons learned from that and they started using the Vulnerability Assessment Tool to make sure there was a mix of tenants within that building. So some individuals may have higher needs and some less needs and supports. Can you comment on that? Is that tool still being utilized by BC Housing or within this sector, if it’s come up in your research? It’s been my experience there is that there was a lot of lessons learned from the Marguerite Ford. So there was a move to diversify the tenanting based on the use of this tool. But I don’t know if that’s still being used.
Dr. Somers:
I don’t know what BC Housing is doing. There’s no tool like the Vulnerability Assessment Tool that would play a prominent role in understanding the needs of the group of people that I’m referring to.
They require a thorough clinical assessment, neuropsychological assessment and proper diagnostics. They require a thorough physical history and exam, as well. And so, it’s not a matter of a straight forward tool. And the fact that we don’t provide these kinds of assessments to assist people is part of what perpetuates this category we refer to as “hardest to house.”
There is a group typically struggling with serious mental illness the longer they remain homeless and at risk the more likely they are to experience poisonings, cognitive damage, mortality and that only further complicates or increases, I guess, the need for thorough and careful clinical assessment as well as social and forward looking assessments. ‘
What are they interested in? What are the long-term prospects that are the most likely to be a part of their recovery? There is no simple tool that cuts through all of that.
Councillor Dominato:
Thank you. I’m at my time.
Councillor Boyle:
Thanks. I have a number of questions, but I think you answered to Councillor Dominato, but that sparked an additional question from me. You described congregate housing as social mix and I’m curious to hear if a building of all height and high cost housing that also lacked a social mix by income definition that we’ve heard would also qualify as congregate housing?
Dr. Somers:
You mean if it was homogenous, but everyone in the building is a rich person?
Councillor Boyle:
Yeah, if everyone in the building…if it’s high cost you have to have a certain income…
Dr. Somers:
I haven’t had an opportunity to do research on exclusively rich people buildings and how they fare. So a term like congregate hasn’t been used in that context. It is used in the context that I described earlier of what difference does it make if people with particularly severe needs, again, those that have been least well served by existing resources are placed in buildings altogether, so congregated, versus provided with opportunities to choose where they would live, in which case they will…all those people we gave choices to chose to leave the neighbourhood where we met them and they did not choose to be in buildings that they knew had other individuals in them who had also exited homelessness. They chose immediately, as happens in other places where this choice is given, they chose places where they thought they could have a chance at establishing themselves and…
Councillor Boyle:
I’m sorry to cut you off. I have a few questions.
Dr. Somers:
Sure.
Councillor Boyle:
I want to make sure I get through them.
This particular building already been changed to be only 50% units at shelter rate so I’m interested to hear, that seems to me to increase the social mix. So does that sound like a better situation by that definition?
Dr. Somers:
So, ah, no. It doesn’t. When we closed Riverview and promised people with serious mental illness who lacked support that they would be provided with services closer to home…I worked at Riverview…this was in the 1980’s…no one said to me or anyone else we’re going to supply you with resources closer to home as long as the housing is at the shelter rate. Cause that would have been crazy. We didn’t budget our hospital beds around the shelter rate, right?
The reason that this scattered approach to housing is cost-effective is because we spend so much on people who are homeless each day in hospital, each day in custody. So, ah, no. Anything anchored to the shelter rate as I said was stigmatizing.
We wouldn’t provide housing to people with cancer only at the shelter rate, right? Why are doing that with people with mental illness. How did we even get into that trap?
We need to support people in ways that support their recovery. That costs more than BC’s shelter rate.
Councillor Boyle:
Again, sorry to interrupt. I’m curious to hear if you think congregate housing is better or worse than the status quo?
Dr. Somers:
What is the status quo?
Councillor Boyle:
I’m not allowed to answer your questions. We see people living in tents in parks. People living on tents on Hastings Street. We don’t have a proposal in front of us for scattered housing. We have a proposal in front of us for the building as you see and been discussing. So I’m interested in is this building better or worse than people in tents and people on the street?
Dr. Somers:
I don’t want to answer that for other people. It would be a huge step in the wrong direction, because you would be affirming that.
Recall what I said that 17% - one seven – of the people we met in Vancouver who been homeless here and deemed the hardest to house – one seven were in Metro when they became homeless.
They came from far afield and building something like this is essentially further declaring that the only place in BC where you’re going to get help are big buildings in Kits or other places like that. Cause nothing like this is happening elsewhere.
Councillor Boyle:
I’m running out of time I think. We could debate that particular point for much longer
Councillor Kirby-Yung:
Thanks for coming to speak to Council. I appreciate it. I think that you were very clear and I appreciate the clarification with respect to congregate housing being about the diversity of housing. My question is this: we see increasing prevalence of mental illness, so beyond the housing if we subscribe to that philosophy that you’re describing in terms of a mix, I’m really interested in seeing and keeping it related to this application, a need to pivot in terms of just providing the housing which used to be providing the housing without the service and/or how to you provide those needed supports for mental wellness we’re increasingly seeing more prevalent even with a mix.
Dr. Somers:
How do we provide the supports that are needed? We, SFU and at least a dozen non-for-profit societies spent about 8 months developing a proposal “A Call to Action.” It was featured earlier in one of the slides today. It’s online. It describes the process of preparing teams to deliver the exactly same quality of support that was provided in our randomized trial. It’s exactly the same intervention. And there is no place currently doing it. BC Housing is actually opposed to it, as is the provincial government when I presented this.
Councillor Kirby-Yung:
Why is that?
Dr. Somers:
I don’t know. I don’t know. Strongly opposed. Strongly opposed.
Councillor Kirby-Yung:
OK. Regardless of the mix, and I appreciate what you’re saying, I’m hearing and it sounds like you’re agreeing, we also have this gap in terms of how we deliver supports…To me, this isn’t just about housing, it’s about housing and…
Dr. Somers:
This gap is completely feasible to address. The fact that we’ve addressed it previously with multiple teams that we’ve trained in our research, to the same standard…
Councillor Kirby-Yung:
What is a team look like conceptually? Can you sketch that out for Council?
Dr. Somers:
Eight to ten people, mix of medical, social, and vocational rehabilitative skills. Everybody facile in mental illness, psychopathology, and the process of recovery. People working actively in specific roles, landlord relations, or housing portfolio management, ensuring people are a good fit with the building they’ve first chosen. Vocational experts who are working with employers preparing individuals to enter the work force.
I mentioned 80%+ want paid work and over 2/3 had paid work for at least one year before they became homeless. So, they had it in their history as well as in their aspirations. So the vocational piece in the housing and portfolio management piece are central and stand alone.
Most of the others are relating to various specialty areas in health and social well-being, including mental illness expertise, different kinds of addiction related expertise, harm reduction, recovery-oriented skills. So that about rounds up the team.
Councillor Kirby-Yung:
I just have about a minute and half left, and you can answer this if you feel comfortable or not, do you think the reluctance is about cost, is it about the model we don’t have today, or a collorolly to that, has there been any analysis that it’s more expensive not to provide something like those teams support in terms of hospital visits, emergencies.
Dr. Somers:
Three times. Three times.
We did it in 2006 for the entire province $55,000 a year per person. It costs while people are homeless in B.C. I thought that would move the needle. The two other teams have led research on the same topic in B.C. using different methods and thank goodness for me, they come in about the same figure, $50-55,000 in easily countable public costs, not inferring costs like costs of crime or things like that, but days in hospital, days in custody, those kinds of things.
Yes, there are people that we are seeing in our communities for whom it costs substantially less to intervene immediately and provide them with what I’ve described than it does to leave them on the street for another year.
Councillor Kirby-Yung:
Thanks. That’s very informative. Appreciate it your speaking.
Councillor Carr:
A couple of questions. I appreciate you taking the time to speak to us. My first question, I was very interested in what you’re saying about Riverview and I remember the closing of the psychiatric hospital and I remember specifically the provision. The government had promised $23 million to families in communities spread throughout BC to take home one of their family members that was there and they never delivered. Not one penny of that amount of money. So the question around that, and those people, many, because I’ve had conversations all through BC, end up coming to the DTES. So my question is really around providing the resources at the community level and making sure that people have the supports they need. Is that a fundamental part of what you’re talking about?
Dr. Somers:
Yep. It absolutely is. It is not in the main skill set, it is not a strength in any of our existing major structures, not BC Housing, not Health Authorities. And they’re busy doing other things. I don’t mean to imply criticism. They’re not experts at this. But none of those existing structures are themselves experts.
It’s in fact the not for profit societies who have the most insight into how to best help people, but they are completely segregated system of entities with no common standards, no common training, and also without common budgets. They’re competing against each other. There are as you can expect, in some instances, where those pressures lead.
So part of our Call to Action was to create communities of practise that all would be trained to the same standard, would adhere to the same standard, would enable some of those people, Councillor Carr, that moved to the DTES maybe to access supports here, but may want to relocate to Quesnel, but also importantly be assured that they would be supported in the same way. Right now it’s not possible.
It’s different and I think that’s where it fell down. That’s the reason for it torpedoing. But it is not at all an unsolvable task to prepare six not for profit societies teams to provide the same standard and to support one another in that endeavor.
Councillor Carr:
OK. There are a lot of passed down solutions that aren’t there. I’m very interested in what you have to say around the mix of people. That seems to be a big theme of what you’re talking about. When the staff introduced our last night of public hearings, they answered a lot of questions that we posed to them as Councillors, and regarding, some of those had to do with mix of people. And staff answered this way and I’m interested in your response to this. They said the first priority is housing people who are homeless from the neighbourhood. Then they said this proposal would include a mix of people, people who have disabilities, mental health issues, drug addiction issues, people who just don’t have enough income and that’s why they’re homeless. So, is that getting at the right kind of mix of people. I said “right”, a mix of people that would work?
Dr. Somers:
I don’t really know what that is meant to bring to mind. Are we talking about people who experience schizophrenia or other psychotic illnesses, is that what we’re talking about? Or someone with bipolar disorder and a methamphetamine addiction? Is that what we’re talking about?
Councillor Carr:
They didn’t get into that specific. They did mention people who may have addiction issues, including drugs and alcohol, people with mental health issues, people with physical disabilities, people who just don’t have enough money. That is the mix they described for us.
Dr. Somers:
That doesn’t sound like a mix. That sounds like a back-handed way of saying “people we don’t want to have in our other buildings.”
Councillor Carr:
I don’t understand.
Dr. Somers:
It sounds like people who we have systematically excluded. We’re all going to put them in one place.
Councillor Carr:
I think it was getting at the question posed by speakers who said it’s all going to be people who have mental illness or who have drug addiction problems. I think it was getting at that.
Dr. Somers:
So, not only that, it’s people with physical disabilities.
Councillor Carr:
And people who just don’t have enough money.
Right. And how many of them would choose to live in that building versus the alternative.
Councillor Fry:
So I understand some from Dr. Anita Palepu, head of medicine at UBC*, who you referenced earlier, she controversied about vulnerable populations, homeless and vulnerable populations not being heterogeneous, and so by that extension, I’m assuming your critique of congregate housing wouldn’t be would be heterogeneous in the sense of some scenarios work better than others. I’m wondering if you could allude to what you might think a better context of congregate housing if we’re looking at sort of the metrics of success that you’ve established here?
(*) Dr. Anita Palepu’s title stated by Councillor Fry is incorrect.
Dr. Somers:
So as I’ve said, any well-functioning apartment building attests to the value of people living together. So diversity is one thing. In sort of my area, in addiction there are a number of models that use co-habitation, people living together. So, we have, for example, therapeutic communities. We also have recovery homes. We have problems relating that particular descriptor in BC at the moment, but that is an approach that can serve people very well. For people with stimulant addiction, residential contingency management, which involves housing people together is the treatment of choice. My former research team at the University of Washington has worked closely with a managed alcohol program. This is where typically older men are housed together and provided with alcohol in their homes. So there are examples of housing where people with specific challenges reside together as part of a continuing program like managed alcohol, but most of them, therapeutic communities, recovery homes are time-limited. That time can be months to years, but they’re time-limited and they beg the question “What next?” And what comes next would best be entry into the community. People who experience homelessness are widely heterogeneous. Some of them are purely because of money, but ones who get stuck, though, have other challenges.
Councillor Fry:
Yes. I speak to a lot of folks experiencing homelessness and I know there’s a wide variety. So, curious then if your research has uncovered any successes in, moving congregate-style housing or supportive housing what have you outside of the DTES, have you kind of extrapolated any benefits to for tenants, if they’re not in the DTES, for instance.
Dr. Somers:
Not around here. Not so specifically in Vancouver. And not in Canada. Here the examples tend to illustrate the opposite, because the attempt has been made to cluster people who have very high needs together with woefully inadequate supports and no vision of recovery whatsoever.
So they have been horrible services to the people themselves chiefly. So, no, I am not aware of examples that illustrate straight success for those deemed the hardest to house, people who have serious mental illness often with addictions as well and who have been homeless for many years. Those that are supporting people are supporting individuals with less complex needs.
Councillor Fry:
OK, with my last 30 seconds, recognizing there’s not…the province is paying for this, this is their model putting forward and the option for scattered sites really isn’t on the table, would you say, what would you say to that?
Dr. Somers:
Put it on the table.
Councillor Fry:
Tell the province to put it on the table and walk away from this?
Dr. Somers:
Yes. Get Council to put it on the table. It’s about time.
Councillor Fry:
OK. I’m out of time. Thank you.
Councillor Swanson:
Yeah. So I used to volunteer at the Carnegie Centre, that’s the thing as you mentioned down there. So people would come up to me, “Jean, can you get me a place at that new modular housing that’s being built?” Not the place we’re discussing now, but other ones that were built before. And basically I couldn’t. There were people who were homeless or lived in SRO’s. But some of them did manage to get in and then I’d see them and ask “How do you like your new housing?” And they would say, this happened to be 6 or 8 people, they all had the same phrase for how they liked their new housing which was “I feel like I’ve won the lottery.” And this is the same type of what you call congregate housing. So what you’re saying is contradicting my experience. Can you explain why?
Dr. Somers:
I’ll try. But one key was provided in your description: they chose it. They came to you and said, “I want that.”
Councillor Swanson:
OK. I get that. Choosing. Is there any evidence that people who would move into this building would not choose it, that someone would force them to move into it?
Dr. Somers:
People will make desperate decisions when the alternatives are so dire, as fear of losing one’s life, which as you know, I’ve heard increasingly, I’m sure you heard the same thing that people who are living rough now or who were living rough and who’ve moved inside over the past few years and who occasionally go out into the streets and will say I don’t think I would make it and if I’m out there through the next winter, I’m not going to see the other side. So people in those circumstances, this is part of that crucible of increasing desperation that is causing people to take their own lives. More than half of those experiencing non-fatal poisonings experience suicidal ideation at the time of taking the drugs. There are violent acts towards other people that are not caused by people’s mental illness or by their character, but by the prolonged suffering of the circumstance they live in. So people will make choices. I’m perplexed. It’s not a win to say that well, that 84% support, does that means 16% or some fraction of that might choose congregate housing? Yeah, it does. My question is why in the world are you building for that minority when there is such a gaping need and opportunity to help the much larger number.
Councillor Swanson:
So what about people who just want housing? They don’t necessarily want treatment. They might want a few supports, but they don’t want a big, medicalized thing.
Dr. Somers:
Yeah. Provide them with affordable housing. I mentioned the primary health-related goal among people in our experience is overcoming addiction. When we randomized people to the Boseman Hotel, our congregate arm, the main reason people moved in and said “Can you please get me out of here?” which we did, was “If I go in here, that will trigger my addiction.”
So now we’re talking about a building with a consumption site and that’s where people are going to be supported toward recovery? It seems incongruous.
Councillor Swanson:
So are you saying: a) that people have to pushing towards your definition of recovery, and b) that people who don’t have mental health or addiction and don’t use drugs shouldn’t be living with people who do?
Dr. Somers:
Let me emphasize, this is not my definition of recovery. Your very assertion reflects a misunderstanding, or perhaps a lack of understanding, of what the term recovery means in the mental health and addiction field. It is an individual-defined construct.
We know a great deal about components that go into it, but it is never a thing a clinician or somebody outside the individual asserts or offers a definition of something to aim for. The experience is animated by substantial qualitatively different experiences of agency and self-control, of opportunity, of optimism for the future, of connections, and of also of reduced symptoms. But it is not something that people like me foist onto people.
Mayor Stewart:
I put myself on the list for questions. So I am familiar with the intersection with politics and academia and I’m going to pull you over to the politics side.
Councillor Kirby-Yung:
Mayor, it’s Councillor Kirby-Yung. Would you like me to take over so you can ask questions?
Mayor Stewart:
The Mayor is allowed to ask questions until the motion is moved.
So the decision in front of us tonight is this. We are a quasi-judicial body in this. We have very strict guidelines on what we can not only decide upon, but what we can discuss. And our options are thus. We can approve this project as it is, the rezoning, the height and form. We can send it back to staff for a re-do. Or we can say “No.” If we do anything other than approve it, we lose the funding. And so, we don’t get a “Maybe” in this case. It’s a “Yes” or “No.” I’m just wondering, if you were in our situation, which would you pick?
Dr. Somers:
I’d send it back for rezoning. I might say “No,” though out of outrage that the province is holding vulnerable people and you hostage…I’ve been working with Minister Eby on justice-related things when he got his new mandate letter and when I first offered to provide support, he took me up on it. I approached the whole enterprise with optimism and good faith, and I learned that he was not at all doing the same. Not at all.
Mayor Stewart:
Well, we won’t go down that road. I just gotta click a button in the next couple of days, either “Yes” or “No” and I was just wondering which button you’d click.
Dr. Somers:
I’m listening actively to the discussion, and thank you for asking. I would send it back to staff and the reason being…
Mayor Stewart:
OK. We lose the funding then. You don’t get that option. It’s either take the building as it is, or lose the funding.
Dr. Somers:
I thought you said there were 3 options. Send it back to staff or say “No.”
Mayor Stewart:
No, no. If we send it back to staff, we lose the funding. That’s what we’ve been told.
Dr. Somers:
Well, I would send it back to staff and let province explain, Mr. Eby explain why this public hearing process that has elicited such a powerful outpouring of ideas, of shared sentiments by a great many people and an interesting dialogue with Council that has moved towards, based upon today’s presentation, to be a viable end goal that could set a precedent, not only for Vancouver, usefully for the rest of the province.
Why, after achieving that progress, would the province say ‘Forget about it.” It’s all worthless. That simply would be wrong-headed, cruel and wasteful and perhaps further emphasize why a change in leadership is needed.
http://www.sfu.ca/content/dam/sfu/carmha/resources/c2abc/C2A-BC-June-2021.pdf
http://www.sfu.ca/content/dam/sfu/carmha/resources/rapid-review/SFU_PSAD_RapidReview.pdf