The committee met at 9 a.m.

[N. Sharma in the chair.]

N. Sharma (Chair): Good morning, everybody. It’s day 3 of our hearings this week.

I want to start by acknowledging that we are all gathered here today on the traditional territory of the Squamish, Tsleil-Waututh and Musqueam people. I invite everybody to reflect on that as we do our work.

I want to welcome today Chelsea Minhas from Covenant House Vancouver.

Welcome, Chelsea. I’m just going to do a quick introduction of the people that we have here today, and then we’ll go over the presentation. We all have a copy of it on our screens.

My name is Niki Sharma. I’m the MLA for Vancouver-Hastings. I’m the Chair.

T. Halford: Trevor Halford, MLA for Surrey–White Rock.

S. Furstenau: Sonia Furstenau, MLA for Cowichan Valley.

D. Routley: Doug Routley, MLA for Nanaimo–North Cowichan.

R. Leonard: I’m Ronna-Rae Leonard, MLA for Courtenay-Comox.

N. Sharma (Chair): We have Pam on the phone.

Go ahead, Pam.

P. Alexis: Pam Alexis, Abbotsford-Mission MLA.

N. Sharma (Chair): Chelsea, I’ll pass it over to you. You have about 15 minutes for the presentation and 45 for discussion afterwards.

Briefings on
Drug Toxicity and Overdoses

COVENANT HOUSE VANCOUVER

C. Minhas: Thank you so much. I just wanted to say this morning, to members of the committee, good morning. My name is Chelsea Minhas, and I am the director of clinical services and complex care at Covenant House Vancouver. I’ve been there for 15 years.

I would like to begin by thanking the committee Chair and the Deputy Chair for the invite to come here today. It’s really a privilege to be with you all. I would like to invite you to listen not only with your ears but with your hearts today. I must admit that I was a little bit nervous to come today. I feel the weight of this issue and making it an issue about real people and not just statistics.

Today I’m not here alone. I’m bringing with me people we have lost, like Simone, who was a young mother, fighting desperately to be reunited with her child. I bring with me the happiness and success of young people like Dominic, who were able to access the supports that they needed — now he is a successful personal trainer, living on his own, a healthy and happy life — and the thousands more that your decisions could have an impact on.

I truly believe that if we intervene at the right time, in the right way, in the arc of a young person’s life, we have the opportunity to make a real difference.

My presentation today is broken down into three sections. You can see it on your screens, or later. The first section will introduce Covenant House. The second will talk about how vulnerable young people are impacted by the current illicit drug toxicity and overdose crisis. The third and final section will speak to how continuing to build an evidence-based continuum of care will really make a difference in our communities.

Who are we at Covenant House? We were established in 1997. We’re a leading expert in British Columbia, and western Canada’s largest non-profit agency, dedicated to serving homeless and at-risk youth. With values rooted in unconditional love and absolute respect, we offer a continuum of services using evidence-based theories and practices that ensure we care for the entire person — mind, body and spirit. Trauma is a holistic experience, and we need a holistic response.

Ranging from outreach and drop-in to residential and support services that enable youth to transition to independence successfully, we understand the unique challenges of homelessness and at-risk youth. Thank you for taking time to understand that this is a unique population that requires unique interventions.

At the core of our success in aiding youth are individualized case plans, each of which are tailored to meet the specific needs of a young person using a one-size-fits-one approach to ensure that specific supports — whether that’s life skills, housing supports, clinical counselling or otherwise — are made available to our youth based on their respective journey as we endeavour to meet their unique needs.

At Covenant House, we offer a full range of services through a carefully designed continuum of care. This includes support from our integrated case management team, all of whom are registered social workers and registered clinical counsellors. Our current programs include our community support services, which include outreach and drop-in; our crisis program; and our Rites of Passage program.

Each year we’re serving between 1,000 and 1,200 unique youth between the ages of 16 and 24. Of those youth, approximately 30 percent identify as LBGTQ or Indigenous. This is of note, because Indigenous young people only make up about 5 percent of the population, but they’re making up 30 percent of the young people that we see. We need to do better.

[9:05 a.m.]

On your slides, you’ll see more information about our programming. Because I only have 15 minutes and this clock, I will leave that for you to review, and contact us if you have more questions.

We’re in the process of opening our new buildings, and some of your colleagues have been with us this week to celebrate those new openings. Please accept this as your invitation to come by for a tour and a chat. I would love for you to experience what I’m sharing about, to immerse yourself in this work, to be a real part of the change I know that we all want to see.

Illicit drug toxicity deaths have been increasing since 2015. In 2021, there were over 2,200 deaths — over six a day. Those are our brothers, our sisters, our family members, our friends, our clients. In the last two years, 40 percent of these deaths have also found the presence of estazolam, a non-opioid sedative which does not respond to naloxone. It’s making it harder for us to save lives when responding to these situations. Illicit fentanyl is also involved in 80 percent of these deaths.

Deaths from illicit drugs is the only major cause of unnatural death that has been steadily increasing in B.C., while all others remain stable. For example, in 2011, there were approximately 300 deaths to both motor vehicle incidents and illicit drugs. But in 2021, the number of deaths from motor vehicle incidents was similar, but the number of deaths as a result of drug toxicity had increased seven times. We have to do better.

The number of illicit drug toxicity deaths of young people under the age of 13, which is our area of practice, has followed the same pattern that has been seen in the general population. In 2021, in B.C., over 350 young people died from overdose deaths. That is almost one young person, one child, a day. These young people had people who loved them. They mattered, and the trauma of their deaths has ripple effects in the community, including lending itself to vicious cycles of trauma that inevitably lead to more substance use and more death.

There are effective strategies. There is hope. We have been working on harm reduction at Covenant House Vancouver, and this includes such things as harm reduction kits. We supply safe smoking kits, safe injection kits, naloxone kits, safer sex kits and fentanyl testing strips. We believe that a nonjudgmental form to engagement is critical when serving young people.

Harm reduction conversations — we need to talk to these young people about how to reduce the harms associated with their use. Opportunities for education and empowering young people to understand that they have options and that they’re worth exploring those options.

When we introduced harm reduction at Covenant House — I’m not going to lie — some community members questioned that. They said: “Is supplying harm reduction supplies not just going to increase drug use in youth? Is this not just enabling them to stay in their addiction?”

What I can say is that over the past year, we’ve engaged with the McCreary Centre to research what we’re doing — is it working? — and learn what we don’t know. We don’t know what we don’t know. What we’ve seen, over the past year, is an increased engagement with Covenant House, as well as increased engagement with substance use supports. So harm reduction with young people does not result in increased drug use, and it does not result in simply creating an environment where we’re condoning addiction.

Along with this, it requires an overdose response plan — administering naloxone and providing overdose responses within our buildings, as well as within the community. We’ve done things like ensure that we have oxygen throughout our buildings, AED machines, outreach, carry oxygen-level monitors, and we have overdose technology in our buildings.

For example, in our drop-in centre, we have overdose prevention. They look like smoke detectors in the bathrooms. So when young people go in there, it will detect if there hasn’t been movement for a while. So it will alert staff to go and check on them. It is simple technology like this that can save lives. It’s not very expensive, and it saves lives.

[9:10 a.m.]

Naloxone training is important, not only for professionals but for youth as well. We know that peer support is crucial, and we know that if they’re going to be using drugs, it’s likely to be around their peers, not us, so we need to make sure that their communities are supported to know and understand how to save lives.

We also have introduced reflective practice and training for staff. This is hard work, and we cannot forget to support the staff who are supporting these young people.

Youth don’t have enough harm reduction services to access to build relationships required to create opportunities for change. Harm reduction is about reducing harms in a compassionate way so that we can keep people alive long enough to hope and dream for their futures. If we can intervene at the right place and the right time in the arc of a young person’s life, we can truly change the course of not only their life but improve outcomes for future generations.

There are significant challenges currently with the ability to provide harm reduction to youth. These include access to safe supply, no safe consumption sites — although I would like to note that there is a promising practice happening in Mission, where they do have an overdose prevention site that is serving youth quite successfully. These young people are using alleyways and bathrooms and putting themselves at risk of exploitation to use. There is a lack of detox and treatment spaces, and while we can distribute supplies, there is nowhere to go to be safe, to be believed in, to connect.

Adult safe consumption sites are not safe for young people, but what we do know is that they’re needed. Deaths are not occurring at safe consumption sites.

Human connection and attachment changes direction. These young people need love, not judgment. People shouldn’t need to be drug-free or sober to access services. This drives people into isolation, impacts mental health and continues the vicious cycle. We have dehumanized people that use drugs. Harm reduction and recovery need to be a relay race, working together to stop this overdose crisis. We need to stop fighting over the right way and start fighting to save lives.

As per recommendation 4 from the Representative for Children and Youth, “That the Ministry of Mental Health and Addictions and the Ministry of Health lead the development of and implementation of a full spectrum of youth-specific harm reduction services, including the creation of youth-specific spaces for supervised consumption that is embedded within a system of wraparound supports and services,” we need increased detox, treatment and second-stage housing.

It’s really hard to get a young person anywhere if they don’t have housing. We can only work with them so much if they’re still living on the street. Wait-lists are turning into death lists. We need funding for 24-7 drop-in services, not drop-in supports for young people that are open business hours.

We need a safe supply system that is age-appropriate and works for young people. Currently, there is no clear path for youth, a lack of qualified medical professionals. Policy is getting in the way of saving lives. We need low-barrier accommodation. These kids need to be seen and develop housing. We can only take people so far if they are not housed.

We need increased access to spectrometry. It needs to be readily available, providing funding for agencies to purchase and do this testing where the young people are and have the relationships.

If we do not address poverty and homelessness, we cannot address this issue. If you are fighting for survival, you can’t make different choices.

Substance use is used to numb the pain and the trauma that these young people have experienced. We need to make sure that our systems are designed to create belonging and do not impede healing and growth. Engage with youth to co-create harm reduction policies. Make them a part of the solution.

[9:15 a.m.]

We need a cross-ministry approach. I need to stop going to meetings where I hear that it’s not within our mandate. “Oh, you need to talk to this person.” “Oh, it’s this person’s responsibility.” We need to work together. The community is all of ours, and we need to approach this in the same way.

What’s the solution? At a high level, we believe the solution is rooted heavily in continuing to invest in a continuum of care that combines housing and support services under one roof. Thankfully, we know the province has already headed in this direction because of the graphic on a slide that you’ve seen from the Ministry of Mental Health and Addictions with relation to complex care and housing. We’re very grateful to see this progress.

We need a resiliency model of harm reduction for young people that includes low-barrier, attachment-based, client-centred, strength-based and trauma-informed care. There are many societal benefits for you all to take this on.

As I head into my final 42 seconds — maybe it’s going to be 90 seconds — I’d like to conclude by talking about some of the benefits for you all to invest in this approach. Multiple studies have shown that investing in complex care housing reduces other taxpayer-funded expenses related to health care, legal issues, shelters and social services.

Below are some quotes from a story done by the CBC.

People without a home and lacking supports for mental illness and addiction can draw significantly on social services for survival, including shelters, social agencies and hospitals. They also tend to interact more frequently with police, fire, paramedic and other front-line services. That all costs money. In Vancouver, the annual cost for a person struggling with homelessness and mental illness is approximately $53,000.

There is real hope for success if we can provide access to the right set of services using a housing-first approach. Only then can we reduce the heavy economic burden of homelessness. Said another way, by investing in complex care housing, there would be significant reductions in costs associated with emergency room visits and hospital stays, overdose responses, treatment beds, mental health supports, rehousing, emergency services, societal productivity and long-term adult homelessness.

Investing in youth homelessness is investing in homelessness prevention. If we can stop the superhighway to homelessness, we can stop homelessness.

By way of a final thought, I’d like to note that though we believe this methodology is universal and can be used to care for all those dealing with homelessness and/or substance misuse, there are two reasons why specific investments in complex care housing for youth should be made.

Youth have different needs than adults. Science tells us that their brains are not fully developed till 26, 27, maybe even beyond that. We need to intervene in a different way.

Second, the positive outcomes are numerous, from meeting a young person’s immediate needs to helping drastically reduce their likelihood of struggling with homelessness and substance misuse into adulthood to all the lifelong economic benefits related to caring for generations that, with the right supports, can become our future community, business leaders, all of you. They’ll be listening to this. To invest in youth will only further a cycle that continues. To not invest in these youth only furthers to continue this cycle.

I want you to understand that a youth overdose death is not a result of a failure of young people. It is a result of a failure of systems, it is a result of a failure of belonging, and it is a result of a failure of human connection. All of us have a responsibility to do better.

N. Sharma (Chair): Thanks so much, Chelsea.

Now we’ll go to questions. Maybe I’ll start off.

You said a lot of things that stood out to me, but one of the things was that we have to intervene at the right time. I’m really wondering if you can expand on, from your perspective, what the right time and what the right place are, where you reach young people for that intervention.

[9:20 a.m.]

C. Minhas: I think the right time is during adolescence. I think the right time is as soon as they walk through those doors, when they make a choice to come to a service, when they make a choice to reach out to somebody in a school. We need to be ready with supports available. We can’t tell them: “Oh, that’s great. I’ll put you on this really long wait-list to maybe get some supports later. Oh, great. I’ll call your social worker, but actually the social worker can’t help because you’re aging out next week.”

We need to have an array of services that meet the variety of needs of young people, and that looks different by individual. That’s why I refer to this continuum of care — making sure that young people have options and are empowered to take those options. It’s about making sure that you have drop-in spaces for young people who aren’t quite ready but just want to test it out, opportunities to create touchpoints, opportunities to create relationships, opportunities to intervene.

We have to have adequate staffing, not only at the community level but at the medical level, to intervene. We can’t have year-long wait-lists for psychiatry. We can’t have year-long wait-lists for treatment. We can’t have all of our youth detox beds now closed in the city of Vancouver. We can’t have that.

R. Leonard: You mentioned about the drop-ins and stuff. I know that across the board, the support for Foundry is very strong. I’m just wondering what kind of relationship you have with Foundry and, maybe, any other youth-serving organizations. In my community, it’s John Howard. I’m just curious about that partnership and the networking and interplay.

Also, just another question around the population that you serve. You’re Vancouver-based, and we have a very big province and a different range of services and levels of service. How much of your population has transplanted themselves to Vancouver as that geographic fix, running away from problems?

So the two questions, please.

C. Minhas: Sure. I’ll start with the population one. Our population. Yes, we’re based in Vancouver. There is a significant portion of our population that is coming from outside of the Lower Mainland. They’re coming from the North. They’re coming from on and off reserve. There are a lot of young people that are coming from various places.

We also have young people that are coming from different parts of the country. There’s something about the draw of a city that is bringing them in. We do our best, when appropriate, to offer opportunities to be reconnected with community, whatever that looks like and means to that young person. But absolutely, there are young people from all over the place.

The other thing…. You know, there are not too many good things about COVID. But one good thing about COVID is that it taught us that we can do some of our service provision remotely. Our counsellors are now remote capable, and they can offer virtual counselling.

This has helped because the city is so expensive. Oftentimes when we are able to find somebody housing, it’s not necessarily in walking distance to our building anymore. So being able to offer continued support and make sure that these young people are not falling through the cracks….

What we know is that the really dangerous points are those seams in service — when you age out of care, when you leave detox before you go to treatment, when you leave treatment before you have stable housing. What we really want to do is close those seams, those opportunities for young people to fall through the cracks. Virtual opportunities are something that we can do as a province.

I’m from the North, from Kitimat, from a tiny little community that didn’t have any support services at the time. I think they’re getting a few now. There’s a Foundry in Terrace. But we need to get creative about how to bring the services we have here into those remote communities. I think that technology is our friend in that respect, and we can reach kids in remote places. We have partnerships with people like Telus so that we can get young people the technology they need in order to engage in that.

The second question is about Foundry. Foundry is so close to my heart because, as you might or might not know, Foundry actually started at Covenant House. Before Foundry was Foundry, before Dr. Steve was this big fancy guy, they actually did their drop-in services in our tiny building. The psychiatrist would come, and they would go with our outreach workers. We provided the space.

[9:25 a.m.]

People started to see it was making a difference, and it grew into the Foundry it is today. So we’re very close with the Foundry.

Actually, in August, in one of our new buildings, the Foundry is going to have a satellite clinic within our building, because another gap where we lose young people is when services are scattered. These young people are trying to survive, so if they come to you and you tell them, “Okay, here’s the address of where you need to go; please figure out how to get there,” that’s just not something they’re capable of in that moment. There’s not always the staffing or funding available to escort young people everywhere they need to go at all hours of the day.

We are working with them to bring these medical and psychiatric services on site. This will reduce the need…. I mean, family doctors are horrific to find right now in the province. So we will have five to seven days a week of primary care right inside of our building, as well as psychiatry access, which will reduce wait times and get these young people the support that they need so that they can start the process of healing and dreaming.

We’re very connected to the Foundry. We love them so much and are very supportive of them bringing their approach everywhere we can.

We’re also very closely connected with other community members in our realm, people like UNYA, the Urban Native Youth Association. We work closely with them and their outreach teams to make sure that we’re catching all of the young people that are on the streets. We coordinate our efforts to make sure we’re having the most reach possible. We make sure that we are checking in to make sure that we have access to culturally appropriate supports for young people that are requesting it.

We also work closely with Broadway Youth Resource Centre and their supports and their schooling program. We work closely with Directions, and we refer back and forth. So we have great relationships with all these service providers.

I think that it takes a community to solve this problem. It took a community to create this problem. It’s going to take all of us to solve this problem, so we work very closely with our partners.

S. Chant: I worked at Evergreen health unit.

C. Minhas: Oh, yes.

S. Chant: In ’97, ’98, ’99, as things were evolving. You guys have evolved extraordinarily well. Thank you so much for the service that you provide our lost youth. It’s so critical, and it must be heart-wrenching at times.

C. Minhas: It can be.

S. Chant: Two brief questions. One: how many actual beds do you have now?

C. Minhas: Sure. So we’re in the middle of an expansion. Right now we have 63 active crisis program beds. What that is…. Most people understand that to be equivalent to a shelter. However, the difference for us is that most underage shelters have a 30-day stay limit.

We do not have a length-of-stay requirement. You can’t even get a birth certificate in 30 days. It’s completely unrealistic, to me, to expect that a young person who has been trafficked, has been abused, is expected to get it together enough and find housing in this city within 30 days. That’s not happening. Rules like that create cycles of homelessness, where they have to leave after 30 days, stay out for a few days, come back. We don’t have a length-of-stay requirement, which is what makes it different.

We’re also not a mat program. This is…. Our shelter program is their home. These young people are 16 to their 25th birthday. We work with them to create plans to create successful futures. Whether that takes 30 days, whether that takes five years, we’re in it.

Then we also have our Rights of Passage program, which is a transitional supportive housing program, kind of that last step before independence. Those are individual bachelor suites where young people learn life skills. It’s still fully staffed for support to help them learn and journey that process. We currently have 25 beds, but that will be going up to 44 as soon as the renovation of that building is complete.

Our crisis program has the capacity to go to 150 beds. We have 63 open, but there is the capacity to go to 150.

We also have a sanctuary program in the works. That will be 21 beds, and that is a low-barrier shelter program. We’re just working on the final pieces of funding to get that open. We’ve been working with your colleagues to get that funded. The purpose of that program is to reach young people who the community isn’t doing a good job at bringing in and connecting with.

[9:30 a.m.]

These are young people who have significant untreated or undiagnosed mental health or significant substance use issues who aren’t really ready to commit to a plan. They need a safe space. They need a touchpoint. They need a relationship. They need to be seen. So we’ll be opening 21 beds there as well.

S. Chant: Okay. A quick follow-up, if I may. I thought that would be quicker than it was. Thank you for that detail. That’s marvellous.

With the kids that you see, how many of them are — I don’t know what the right words are, so bear with me — drug seeking, drug using or whatever words the appropriate words are? As a percentage, would you say 10 percent, 50 percent, 90 percent?

C. Minhas: I would say that substance use is affecting approximately 75 to 80 percent of our young people.

S. Chant: Okay. That’s really grim. Seventy-five to 80 percent of the kids you see are….

C. Minhas: At least. Sometimes higher.

S. Chant: Oh my goodness. Thank you.

S. Furstenau: Thanks so much, Chelsea. I really appreciate the work you’re doing.

Can you tell us, if you have a sense of the figures, how many of the youth that you’re serving are either in the child welfare system or have come out of the child welfare system?

C. Minhas: A conservative estimate…. A lot of young people don’t want to talk about it, so we learn about it later. If you’re to look at our KPIs, our outcomes, about 45 percent of young people have a documented history of involvement in the foster care system.

Some people don’t define it that way. They don’t identify that way, or they’ve had different touchpoints. They might not have been in foster care, but they were involved with the ministry. Some people just don’t want to talk about it.

I would say that’s a very conservative number based on my personal experience working with these young people. At least 45 percent are noting it.

D. Routley: Thanks very much for the work you’re doing. I agree. We can’t have wait-lists, but we do. As you point out, family doctors are difficult to find. Carpenters. All of our professions are stressed right now, including mental health professionals, as we learned in studying the issues around the Police Act in response to mental illness.

Those capacity issues, like expanding complex care housing…. You can only do it so fast, because there are only so many builders. Those are kind of difficult to overcome, those obstacles of not having, actually, enough people to do the jobs. Community acceptance is another barrier around establishing a place. People will respond: “Not in my backyard.”

It’s really valuable to hear you speak about the services you offer and about those kids. I wonder if you’re asked to contribute to public meetings or that sort…. Do you do that routinely?

C. Minhas: I’ve done it for us. I’d be happy to do it for anyone else.

There are two parts. I’ll address the public piece first. You need to invest in building relationships with the community around you just as much as you’re investing in the relationships with the people that you’re serving. That’s something we take very seriously. For example, when we implement programming such as the harm reduction stuff we did…. We tried to think about: “If I was a neighbour in this community, what would be my concerns?” We try to address that.

Simple things that we did were to make sure…. Part of our maintenance team’s daily routine was to walk around the immediate neighbourhood and make sure there was no garbage, no nothing. It actually didn’t turn out to be a problem, which is great, but we had that in place.

We send chocolates at Christmas to neighbouring stratas. We invite them to events that we hold. We invite their questions. We give them a phone number that they can access 24-7 if they have concerns.

I think, for a lot of communities, it’s the unknown that scares them, right? They see things in movies. They’re not sure. “What does it mean? What do you mean you’re bringing this to our community? What does that mean for me? What does that mean for my kids?” It’s the unknown. Sometimes just having a number to call is enough of a safety net. They know: “Well, if something goes bad, I’m going to call you.” It rarely happens, but they have that.

You need to invest in relationships with the community around you, the businesses. Invite them to be involved in things that you’re doing. You have to be really intentional about it and purposeful in planning and try to think about all the possible things they might be concerned about and put a plan in place.

[9:35 a.m.]

The other piece you talked about, in terms of resourcing, I would like to respectfully disagree with, just a little bit. I think that, yes, there is a shortage of public professionals like family doctors and things like this, but there are agencies such as ours, others as well, who are ready with brand-new buildings, bed spaces available to implement this, if we had the funding.

I could open Sanctuary tomorrow, with full staffing, internal social workers, internal clinical counsellors, all of those resources. We hire our own. We’ve learnt not to depend on having enough public professionals.

Also, we need to be in partnership with you. It’s not helpful for us to come here and say: “You need to fix all of this.” No. I’m just as responsible. We’re just as responsible to serve these young people as all of you.

We need to invest in more partnerships. We need to invest the funding in the right spots, what I talked about in terms of investing at the right time in the right way in these young people. You need to invest your money in the right place at the right time with the right people. There are organizations, such as us, who are ready. These are turnkey operations, ready to go, and we’re fighting for the funding to open these spaces.

I go into meetings, and I’m told: “It’s not our mandate. You need to go talk to this person. No, go talk to this person. Actually, we sent all the money to the health authorities. Go talk to them.”

There are delays created by policy and systems. These beds could be open tomorrow.

P. Alexis: Thank you for this extremely important information for us to hear.

I just want to go back, though, to a comment that you made with respect to research that was conducted once you provided harm reduction. You needed some proof that there was little or no incidence of increased drug use as a result. If you could just go back to that research, I would appreciate it.

C. Minhas: Sure, of course. We launched a harm reduction pilot project, and we have a research evaluation and learning team of our own that does all of our KPIs, outcomes, all of this sort of stuff. We also contracted with the McCreary Centre, which is an expert in youth research, to conduct an external evaluation as well.

We had a bunch of outcomes we wanted to measure, like youth engagement, engagement with substance use supports, access to treatment, all of these things. We’re about a year and a half now into that two-year research project. Our one-year report, which I’d actually be happy to share with you, about the outcomes…. I could send it maybe. I don’t know how I’d get it to you, but I can get it to you.

We didn’t know what we didn’t know. We want to make sure that we are engaging in things that work for these young people, and we want to make sure that we’re not having unintentional outcomes.

We had things like increased engagement with our staff and the organization, increased engagement with substance use supports. We’ve had increases in mental health outcomes, engagement with health services. We have not had an incident. No youth who have participated in this harm reduction program have been the young people that we lost to overdose deaths over that year, none of them.

As well, we have not had an increase in critical incidents in our spaces, which was another concern, right? If you’re bringing this population, what’s that going to mean for everyone else? We didn’t see that. We’re not seeing that internally or by external experts who are evaluating our programs.

As part of that, we also did focus groups, not only with our staff but with our young people, to make sure that our staff are supported, what young people are thinking about the program. Is it working for them? What do we need to do better?

That’s the research that I’m talking about. We’re doing a two-year research project on this. We are about a year and a half in and have a full year of data to report, internal and external, that I’d be happy to share with you.

T. Halford: Thank you for the presentation. It was quite enlightening. A couple of things stood out to me. You talked about kind of mental health support. I’m imagining that everybody that comes through your door has experienced a level of trauma, different levels, but there is trauma that is there.

We’ve heard from other presenters, talking about trauma therapy and access to that. Maybe if you’re able to speak to how that access occurs, either internally or externally, if there are gaps in the system, wait times, things like that. You mentioned wait times.

[9:40 a.m.]

The other thing, just to dovetail on that, is that when somebody leaves your facility, leaves Covenant House, how are they best integrated back into society? Kind of a two-parter there.

C. Minhas: The first part is that we have both internal and external mental health supports. Right now we have three full-time clinical counsellors on our staff, and we offer one-to-one, group as well as art therapy. Art therapy has proven to be quite a tool for engaging with young people with trauma histories. It’s a great start. We can do one-to-one art therapy. We can do focused art therapy around specific topics, like healthy relationships, substance use. We have three on-site counsellors that we try to use to fill the gaps in the community, to reduce wait times.

We also have our partnership with the Foundry. When you make friends with community members, sometimes you have a little bit of an in. Or if you’re in a real crisis, even if that young person can’t be seen, we can get a phone consult with a psychiatrist really fast. I can call Dr. Dan or Dr. Steve and say: “Look, we’ve got this situation. What can we do in the meantime?” You have to have friends in places. That’s how we address it.

We hire internally. We have registered social workers. Each young person that is in our program is attached to a registered social worker to support them. That provides, as well, some of that care in the community. That’s kind of how we manage the wait times.

The second part about reintegration — that’s where the really comprehensive care planning process comes into place. We need to start, really, from the beginning, knowing that this young person is not going to be with us forever. How do we create plans with them, co-create plans, that help them reach their goals and help support them once they’ve left our building? So we have individualized case plans. We start transition planning early.

The other thing that we do is safety planning. If there’s a young person with significant mental health or trauma history, somebody who has significant substance use — any reason why they might need a safety plan — we have individualized safety plans with them. If you leave and you don’t come back, what are the things we’re going to do? We’re planning for planned leaves as well as unplanned leaves from our program.

In terms of when somebody ages out of our program or has a successful leave — they’ve moved out to their own housing — their social worker follows them right into the community to make sure that they’re set up. That even happens when they age out of our care.

Your 25th birthday, technically…. There are exceptions to this, but technically, you’re out of our mandate. But your social worker and your youth workers will support you until we know that you’ve been connected to the appropriate supports or until you are connected to people in your community to call or until you feel confident enough that if you need us, you’d call us.

It’s different from other age-out processes, where it’s like: “Okay. See you later.” We plan for this. We make sure you’re set up in your community. We make sure you know how to call us, and you have the capability to do that.

N. Sharma (Chair): Shirley, go ahead.

S. Bond (Deputy Chair): Thank you very much, and I apologize for being late. It was beyond my control, I can assure you.

C. Minhas: I’m happy you’re here.

S. Bond (Deputy Chair): Thank you very much for the important work you do. I’m interested in knowing if there is…. When youth come to you, what is the connection with the system that they’re coming from? For example, do you serve 19-year-olds that are aging out of care? Have you seen that number increase? Maybe just speak to that in terms of who you serve at Covenant House.

C. Minhas: Yeah, so we see young people coming from a variety of systems. They come to us from hospitals. They come to us from the justice system. They come to us from MCFD.

I think that there has definitely been an increase in the number of youth aging out of care who are coming to us. I don’t think that it’s because there are more kids aging out of care. I think it’s the complexity of the issues that young people are facing now, aging out of care, and the lack of supports that have evolved to support those evolving needs that has led to an increase in them seeking support with us.

[9:45 a.m.]

It’s always best for us if we can connect with social workers and be a part of the transition planning. That’s not always possible, for a variety of reasons. One, social workers have completely unmanageable caseloads. Two, young people really start to…. What I’m finding is that they disengage with their ministry supports much earlier than 19 because they don’t feel safe. They don’t feel supported. It has not been a good experience for them, that system, so by the time they get to us, they’re usually distanced from their social worker.

If there is one involved — and certainly if a young person who is underage is coming to us — we have a responsibility to report and work with their assigned social worker. We definitely engage in that way. We definitely reach out to MCFD and make sure that they continually know who we are, despite their staffing changes. I meet with Minister Dean often to talk about these things. I bring youth to her to talk about their needs.

We’re definitely engaging with them, but it’s a little bit of an uphill battle. I’m not going to lie. That’s where I struggle with the conversations around: “Well, they’re 19. That’s not my mandate. I wish I could help you, but it’s not in our mandate.”

They’re working towards that. In fact, this afternoon I’m going to a consultation about the amendments to the child and family act that make it possible to change the legislation to actually provide the promises that ministry has told us they’re going to do. Right now it’s not possible. The legislation…. It’s not in their mandate. These changes require a change to the legislation, which I’m told is not going to be tabled until 2024.

That’s very deeply concerning to me. So I’m going to a consultation with them this afternoon to talk about what needs to change in that act.

Those are some of the ways we interact. But to be really honest, we are here and serving the young people, because those systems aren’t enough. We need to work better together, for sure.

S. Bond (Deputy Chair): My other question — Pam asked it, about McCreary Centre. It would be great to see the first-year report and also the second…

C. Minhas: Of course.

S. Bond (Deputy Chair): …because, of course, they do incredible work with young people across the province. I think that is very wise — that you engaged with them to say what’s working and what isn’t. People want to be assured that there are positive outcomes, and I think measurement is an important part of that.

Pam asked my other question.

N. Sharma (Chair): Okay. I have a couple, but just for clarification, the consultation you’re talking about is about expanding supports to the age of 27 for kids that….

C. Minhas: Yes. In order to enact the promises that they’ve made in terms of increased access to mental health…. They made a whole bunch of promises. But in order to do most of them, it requires legislative change to the child and family community act to expand their mandate to make that possible.

They plan to table those legislative changes in 2024. That’s what Minister Dean told me. They’re hosting a series of stakeholder engagement sessions to consult on the changes required to that act to fulfil these promises, and I’m going to one today.

N. Sharma (Chair): I had a couple of questions as well. I’ll try to be quick here. The first one was…. You mentioned the harm reduction, the example of youth harm reduction in Mission.

C. Minhas: Yes.

N. Sharma (Chair): I’m just wondering, from your perspective…. We haven’t talked a lot about harm reduction services for youth yet, so this is a perspective that you bring. What are the kind of different regulatory and/or situations you need to be in to provide harm reduction or safer supply to kids, or people, under 18?

If you can help with that, I think that would be interesting to learn. Then I have another question after that.

C. Minhas: We’re kind of in regulatory limbo right now. That’s what we need from all of you — some regulatory process and parameters and guidelines around providing safe supply to young people. It’s one part of it.

There are some ways to get exemptions in terms of opening safe consumption sites. I’m not entirely informed of the process that Mission was able to do to get that done. We’ve been visiting them and working with them to see how they’ve been able to do that.

There are ways to get exemptions quicker to open overdose prevention sites, and we’re currently navigating that legislation and laws. It’s not easy, and it’s not clear, which is part of the problem, I think, and also lends to the fear of opening such places.

[9:50 a.m.]

What we know in the adult population is that deaths are not occurring in overdose prevention sites. Thousands of deaths are happening on the street; they’re not occurring in these places. We believe that the same will be true for young people. We want to see that happen, and we need support on the regulatory piece. That’s what we need.

N. Sharma (Chair): Okay.

Just a quick one, maybe, and then I’ll go to the second round of people’s questions. I know, because I’m a Vancouver MLA, that you recently expanded to 40 beds, or housing units. I’m just curious. Are those with all the wraparound things that you’re talking about — those services?

C. Minhas: Yes.

N. Sharma (Chair): How did you fund that? What was the way that you put it together?

C. Minhas: Every young person who’s involved with Covenant House has access to all of our services. That’s the first piece. They have access to the social workers, clinical counsellors, programming, everything.

The second piece is: how did we fund it? We’re only about 5 percent government-funded. We have a very generous community that funds us privately. We have some dollars for those beds from B.C. Housing. We had some investments from the province for initial capital for this new building. We had some investments from the federal government to open the capital piece, but our operating dollars come from the private sector. We’re trying to become more in partnership with health authorities and the government.

Our donor community is asking us: where is the government? Where are the matching dollars? The thing that’s unique about us is our expansive donor community. We come to the table with a lot of resources and things to offer a partnership, but right now we’re only 5 percent government-funded.

N. Sharma (Chair): Dan, you had your hand up. Go ahead.

D. Davies: Thanks, Chair. That was one of my questions — the funding, what that looked like and such. We obviously want to take our hats off to the community that does provide the funding.

My second question. You talked about the 30-day limit, block, whatever we want to call it. What is the average stay of one of your clients that do come in? That would be my second question.

C. Minhas: It depends on the program, for sure, but young people in our Rights of Passage program are staying on an average of two to three years right now — which is really important and unique, because that young person has an opportunity to come in, maybe finish their education and get a really great start on post-secondary training or enough time to be assessed for long-term housing in the community as an adult. Whatever their need, there’s time to sit out some of those wait-lists.

They’re staying there long, and I think that speaks to two things: the needed service, and that they’re also feeling safe there. What I know about young people is that they give you their vote of confidence with their feet. If they don’t like you, they’re not sticking around, right? It’s their choice to come to Covenant House. We’re not a mandated service. They come and go as they please. They’re speaking to us with their feet.

In our crisis program, our average length of stay is about two to three months. What impacts that average length of stay is that young people, when they’re beginning to engage in services, come and go at first. They’re testing us out. Even though individual average lengths of stay might be two to three months, their engagement with us, on the longer term, is much longer. Once they decide that we’re safe, that they trust us, that they’re getting their needs met with us, then: “Hey, those social workers aren’t so bad. Maybe I want to work with them.” That speaks to that as well.

We have many, many young people that have been with us for many years. We also have young people who are with us for very short periods of time, but that’s what they needed to, perhaps, reconnect with their community. An example of that: we had a young man that came to us from the SkyTrain police, actually. He had been trafficked here to work on construction sites near the Brentwood SkyTrain station. He had built a relationship with this SkyTrain police officer that he would see. He was with us a very short time because all we needed to do was reintegrate him, repat him to his family.

The same is true of local young people, and the same is true of young people who might need a different service. Our goal is to make sure that young people get where they need to go, whether that’s with us or somewhere else. But it’s definitely longer than 30 days.

[9:55 a.m.]

N. Sharma (Chair): Chelsea, I have two more people with questions. Let’s see if we can get them in, in the next five minutes.

We have Ronna-Rae and then Susie. Go ahead.

R. Leonard: A couple of questions. I know that you just get more and more questions.

You provide an array of services, and you know about all the services around…. What would you say…? How do I put this? Are there any services that are being provided that are not helping?

I get that we need more and all of that. But the question I have is because…. We’re looking at overdose deaths, and the numbers are going up. You’re providing these great services. Is there anything that you see that is maybe not the best route to be going or that we should be accenting more than not? I really appreciate you saying that the first thing out of the gate is safe supply and safe consumption sites, but you’re also saying we need beds and we need this, that and the other thing.

C. Minhas: One thing that immediately comes to mind when you say, “What’s not working?” is the model around detox and treatment that is in home or in community. These kids don’t have homes. So moving to a model where they’re removing detox beds for youth and deciding to replace it with in-home or in-community supports….

They don’t have a home. That’s not going to work. You need to embed these supports where these young people are, which is in these community service providers’ buildings and spaces. We need to have these services accessible. You can’t send a nurse to a home they don’t have.

So that is the immediate thing that comes to mind. I mean, I’m sure there are many, but that’s the first thing that comes to mind. We need to make sure that when we’re thinking about youth, it’s not just youth from the nice communities who may have gotten into drugs at school. They need service too. But kids are dying on the streets, and they don’t have homes. So that system’s not going to work. It’s not going to work. It’s needed, but more is needed.

S. Chant: Two small things, I hope. Can a youth come in, in a planned fashion? If a kid is having troubles at home, in care or others, can they call you and say: “Can I come in?” And then, say, they can’t work with me as their parent, for whatever reasons. Can they arrange to come to you?

C. Minhas: Yes, as long as the young person wants to come. Like I said, we’re a self-referral. We’re not a mandated place, so nobody can force the kid to come to us. But absolutely, we have many experiences where we’re working with families and we’re providing family counselling and supporting that family to come to the best outcomes possible. But absolutely, we have many planned intakes — yes.

S. Chant: I was a foster parent for a long time, before Covenant House existed.

C. Minhas: We work with foster parents….

S. Chant: Is it Steve Mathias?

C. Minhas: Yeah, Dr. Steve.

S. Chant: Yes, he’s lovely.

C. Minhas: Yes, he is. He’s a force.

N. Sharma (Chair): Chelsea, on behalf of the committee, I just want to thank you for the time that you’ve spent with us to help us learn your perspective and the work that you do at Covenant House. We really appreciate that.

C. Minhas: Thank you. Please come visit us any time. My email information is in your slides if you have further questions or you want to come chat. We’re walking distance from here.

N. Sharma (Chair): Okay. We have a little bit of a break till our next one.

The committee recessed from 9:58 a.m. to 10:22 a.m.

[N. Sharma in the chair.]

N. Sharma (Chair): Welcome back, everybody. I’m pleased to welcome our next guest, Katrina Harry, manager of the Parents Legal Centre, Legal Aid B.C.

We welcome Katrina.

We’ll do a quick introduction, maybe, of everybody around the table, and then we’ll pass it to you. I think you have about ten minutes for a presentation, and we’ll leave the rest of the time for questions.

I’m Niki. You know me.

Go ahead.

T. Halford: Trevor Halford, Surrey–White Rock.

N. Sharma (Chair): Shirley, did you want to go? Deputy Chair.

S. Bond (Deputy Chair): I’m Shirley Bond, the MLA for Prince George–Valemount.

D. Davies: Good morning. Dan Davies, Peace River North. I live in Fort St. John.

S. Furstenau: Sonia Furstenau, Cowichan Valley.

D. Routley: Doug Routley, and I’m from Nanaimo–​North Cowichan.

S. Chant: Susie Chant, MLA for North Vancouver–​Seymour. Nice to meet you.

R. Leonard: I’m Ronna-Rae Leonard, MLA for Courtenay-Comox.

N. Sharma (Chair): Over to you, Katrina.

LEGAL AID B.C.

K. Harry: Okay. Thank you. I’m going to introduce myself, by way of context, with my prepared notes here. If you bear with me, I know you already know that I’m a manager within Legal Aid, but I’ll start there anyways.

I am also a proud member of the Shuswap Nation and come from Esk’etemc First Nation, formerly known as the Alkali Lake Indian Band near Williams Lake, B.C.

I would like to acknowledge that I am presenting today from the unceded territory of the Coast Salish peoples, including the territories of the Musqueam, Squamish and Tsleil-Waututh Nations.

I was invited to speak today as a manager within Legal Aid B.C., and I thank you for giving me the opportunity to share my experience as a lawyer and as an advocate. I manage a program called the Parents Legal Centre. The program I oversee specializes in child protection. Parents legal centres offer early, preventative, wraparound support and legal representation for parents engaged in child protection processes.

The perspective that I bring today is that of a Legal Aid lawyer who represents clients who often live in poverty, who are marginalized, who have disabilities and who are experiencing other challenges. Many of them are dealing with concurrent criminal, mental health and addiction issues. They often have histories of or current traumas.

[10:25 a.m.]

We are just now, as a society, beginning to conceive of the tremendous impact that trauma has on one’s psychological development and health. We also know there is an overrepresentation of Indigenous children in care. More than 60 percent of all children in care in B.C. are Indigenous. Therefore, in child welfare, there is a disproportionate impact on Indigenous children, their families and communities.

The removal of a child from their home in and of itself can be considered an adverse childhood experience, or ACE. ACEs can include things like physical and emotional abuse, neglect, caregiver mental illness, household violence and the incarceration of a parent. This is not an exhaustive list.

The more ACEs a child experiences, the more likely they are to suffer from lifelong physical illness, poor academic achievement and substance abuse later in life. When children experience overlapping ACEs, compounded with racism, they are more likely to suffer from toxic stress. By definition, children who are in the child welfare system have experienced ACEs.

What can we do to combat ACEs? We ensure exposure to positive childhood experiences, or PCEs. PCEs can include timely and culturally relevant social support services. We know that community, culture, land and Indigenous laws are essential to providing positive childhood experiences. However, if we look upstream even more, we can offer to help families meet their basic needs and provide essential services which can, in light of the topic today, keep families together if parents are offered harm reduction, treatment and community-based, family-focused solutions.

In the child protection realm, I see parents who very much want to parent their children. In fact, all of the parents I’ve ever worked with have wanted to be the best parents they could be for their children. It’s just that sometimes they have a difference of opinion with social workers about whether they’re able to safely care for their children.

When it comes to illicit drug use, what parents need is culturally safe, accessible, trauma- and violence-informed meaningful ways to both address their addiction and parent their children. They need more spots in treatment, more options for substance-misusing pregnant moms, more support for moms who have just given birth and are hoping to care for their babies once they leave the hospital and more family treatment centres so the family can heal together. They even need more social or financial supports so their children can visit them when they go to treatment without them.

If anyone has ever tried to help somebody get help with their drug or alcohol addiction, you know how hard it is. The wait-lists are months long. The aftercare from detox is self-arranged. We need a culture shift around how to heal families, not divide them up when somebody needs support. We need medical-legal partnerships to facilitate the sundry issues that parents face in order to unburden them while they seek treatment and recovery for themselves. Loss of housing, loss of employment, loss of child care or loss of contact with your children should never prohibit parents from being able to address their drug or alcohol misuse.

I’ve seen so many new moms have their children removed at birth or shortly after birth due to substance misuse. Once children are removed by a social worker, the shame spiral begins. They’re often permitted one, one-hour visit per week. At a time when they need to stay sober for their children the most, they feel the most hopeless and alone. It’s during the precarious postnatal period that women are most vulnerable to postpartum depression.

[10:30 a.m.]

The combined impact of losing the ability to bond with one’s baby, the sudden loss of interest that the community has once the woman is no longer pregnant and the significant shift that comes with motherhood has meant that I’ve seen many mothers barely able to pull themselves out of their spirals. Once the drug or alcohol use takes over, it can mean precious months or years of parent-child bonding and confidence-building as a parent that are lost. Many aren’t able to recover, and the long-term impact is signi­ficant.

Our system is quick to remove but slow to support. In my experience, programs like Sheway in the Downtown Eastside, FIR Square out of B.C. Women’s Hospital and Maxxine Wright in Surrey support women, and even the whole family, while offering what the parents need to stay with their children. By offering recovery options where families can stay together, we are offering children positive childhood experiences to contrast their adverse childhood experiences. We are helping parents by offering healthy options, where they can stay connected to their children.

It is essential that we look at how to be patient-, parent- and client-focused; that we acknowledge the value of family connection in recovery; that we help build stronger, healthier families for the children and their parents and the future generations so that we can break the cycles of adversity and replace them with demonstrations of strength.

N. Sharma (Chair): Thank you so much, Katrina.

We’ll switch to a question-and-answer.

Sonia, I saw your hand up. Go ahead.

S. Furstenau: Thank you, Katrina. This is, I think, really important and valuable information and something we’ve worked on a lot in our constituency and riding. A couple of things I’d just like your thoughts on.

You work in legal aid. When you go to family court, you’re representing the family. The lawyers for MCFD are lawyers on salary. Can you talk about the inequity just in that situation, in the difference in the supports that you get and that you’re able to provide compared to the government side of things? What do you think could help with that inequity?

K. Harry: I would share my comments not as a representative of Legal Aid. I can only comment on my thoughts as a practitioner in the area. Our CEO can only be the one to make comments about the nature of our organization in that respect.

What I can say is that it’s very similar to what we see with Crown corporations, when they are on the other side, anything Crown, basically, versus anything that is privatized — with First Nations, for example. We certainly don’t have the same level of access to resources that the government has. We have a finite number of hours that we’re provided with. Many legal aid lawyers go above and beyond the prescribed hours because of the ethical obligation that we feel to provide the best service possible and not disrupt the representation of the clients.

I know that I would often do work outside of what I was going to be paid for, just because it was the right thing to do for the clients. I know a lot of other legal aid lawyers do the same.

S. Furstenau: Thank you.

N. Sharma (Chair): Any other questions?

I have one. Something that really stuck out to me with your presentation was this idea of pace. We’ve been hearing about how the adverse child experiences really can be that trauma that leads to all these things that happen with mental health issues later on. You mentioned three programs that are doing a good job. Can you just repeat them? I missed it. Then I have a follow-up question.

K. Harry: Yeah. There’s Sheway in the Downtown Eastside. That’s a pregnancy outreach program. They work in partnership with FIR Square out of B.C. Women’s. FIR Square is a combined care unit for substance misusing pregnant women. It’s a program…. I can speak personally to my experience, having worked with, actually, all three of those programs. That’s why I know them intimately.

[10:35 a.m.]

I was providing duty counsel services. Normally we provide duty counsel in a court house on a court day. That’s the history of what it means to be a legal aid lawyer doing duty counsel. What I started doing 12 years ago was taking it to the streets and being in the community and putting the program…. This is why the importance of medical-legal partnerships cannot be overstressed.

Women would go to Sheway. They were able to go in and use the drop-in lunch program. They were able to have their children, their babies, see the registered nurse; go see the dentist there; see the psychiatrist; see the drug-and-alcohol counsellors that are available; and also do their income assistance forms, if they needed a top-up, if they were pregnant again, if they needed other supports that way through income assistance.

Then they’d come and see me as a lawyer who’s there to see women on a drop-in basis. Some of them would become my regular clients. I was able to provide them…. They would come to me and say: “I’ve got court tomorrow.” Really, it’s being all in one, a one-stop shop for people who are really, really high needs in their legal needs.

There was that. There was also, as I said, FIR Square combined care unit for substance misusing at B.C. Women’s. B.C. Women’s has a number of other programs, like Heartwood, and other programs that they offer for women who are either pregnant at the time or shortly after giving birth, where they’re providing the supports that they need.

There are a limited number of places for people, a handful of places for families, to go for treatment. There are often restrictions around the age of the child so they can attend. There doesn’t seem to be that many resources available for families who do want to stay together during the treatment period because, as we know, going to treatment for three to six months is a significant period of time. So what you see is people who are signing voluntary care agreements so that they can go to treatment. Sometimes it doesn’t go well when that does happen.

You are really signing people up to be involved in the system more heavily than, I think, might be necessary if there were other resources or supports available through the types of treatments that we can offer families.

S. Chant: I’ve been in several situations where children, neonates, have been removed from their mother, and it seems that the mother has no representation during those times. In this role that you were speaking of, were you able to be…? At the time of the birth, is there any way for a parent to get a representative in there?

K. Harry: Yeah, absolutely. That’s, actually, a significant push for legal aid. But what we need at legal aid are the people who have first contact with the vulnerable people in the system to refer them to us as soon as possible. A lot of the advocacy that we do with our outreach lets people know that as soon as you know you’re pregnant, you can get a legal aid lawyer if you financially qualify, because you don’t know….

The reason I started going to FIR Square at B.C. Women’s was because, at the time, when I started going 12 years ago, I was noticing I started getting calls from women who were saying: “I just had my baby removed today. I gave birth at noon, and the social worker came in at four. They did a paper removal. I’m still in the hospital with the baby, but they said they’ve done this paper removal. What does it mean?” I’d run over, assist them, do their legal aid application and start representing them right away.

What I started doing was…. Legal Aid said: “You’re getting enough of these calls. Why don’t we just send you there so that you’re there on a weekly basis?” I was able to work with women for weeks and months before they even gave birth, and I was able to advise them about their rights and responsibilities, let them know about what I would call the five pillars that they need to address in order to make sure that the social worker sees that it’s going to be a safe and appropriate home for their child and that they’re putting measures in place to make sure they’re able to meet the baby’s needs.

They’ve got shelter. They’ve addressed their criminal issues. They’re getting on income assistance if they’re coming from the streets and need more stability, the various things that they need to address.

Once I started going there on a weekly basis, every week, 52 weeks of the year, they stopped doing these removals at birth, and it became a rarity. That was because we had the medical-legal partnership with FIR Square, and the social workers knew to call us and say: “Mom is about to give birth. She just came in last night. We’re worried. So come in and see her and start working.” Right off the ground, we just basically hit the ground running with working with a lot of the parents.

[10:40 a.m.]

Parents are eager once you explain. Once people have an awareness of their rights and their responsibilities as a parent, and they have somebody who is advocating for them, they begin to engage, for the most part. It was very rare for me to find somebody who really didn’t want to speak to me at all. That can be for a whole host of reasons as well, in terms of fear of dealing with authority or lawyers or their own experiences with the justice system.

S. Chant: So that’s in the greater Vancouver area. What about anywhere else?

K. Harry: Yes. Outside of the Lower Mainland, I mean, I really look towards…. I’m not aware of any outside of the Lower Mainland. That’s just it. There are some treatment centres that are Indigenous-focused, mostly, for families, but very few options available. I’m not aware of any actually…. That’s just my having experience practising in the Lower Mainland.

R. Leonard: Thanks for coming today. Thanks for finding us.

K. Harry: Glad I did.

R. Leonard: We made a change around pregnant women who had been identified as having substance-use challenges and at risk of having their children taken away. I’ll just say…. I don’t want to say “accosted,” but I was approached by a family doctor who works with vulnerable expectant moms who was quite alarmed that the mandatory incarceration, I’ll call it, was being lifted and that women could not be identified any longer in that way.

I’m assuming that you’ve been around long enough to have experienced those two different formats of services and how the legislation is being applied. I’m just curious about the impact, as opposed…. We’re talking a lot about harm reduction and those opportunities for people to grow and take power.

K. Harry: So you’re talking about the elimination of the birth alerts?

R. Leonard: Yes, birth alerts. Thank you. I couldn’t remember the term.

K. Harry: I think what’s important is that…. I referred to the numerous supports. Now, not everyone gets supports. Not every community has the resources to offer prenatal supports. We need to have…. I think it’s…. In fact, I’ve met with doctors. I’ve presented to the College of Physicians and Surgeons. I know that there’s…. I think the concern that women have about engaging in resources and supports and the medical community is fear of judgment, fear of reprisal, fear of report.

I understand the concern there, but I think what we have to do to address any concerns, allay those concerns, is for people to be educated about the resources and supports available to the vulnerable women instead of judging them. Making sure that there are resources available and that women know how to access them — that’s the most important piece, I think, to address any concerns people have about…. Those women are going to end up on the radar, just maybe not at birth. But they more than likely are for other social reasons, oftentimes.

D. Davies: Thanks for the presentation. I’m glad you found us as well. Following on what Ronna-Rae just said, are things getting better — over the past few years, let’s say? I know some of these issues that you’ve brought up have been forefront. It’s been in the news. It’s been talked about. Are things getting better?

I guess a second question: what more is needed, legislatively, to improve things?

K. Harry: Those are very good questions. Are things getting better? I think that what I notice is…. They’re getting better in some circumstances, for some people, in some regions. I think that there’s an inconsistency in practice and application that makes it challenging to be able to predict with certainty, or anywhere even generally, what to expect on a region-by-region basis. I think that there’s a different application of policy and legislation.

[10:45 a.m.]

I know that since the federal legislation in child welfare for Indigenous children has come out, people are still finding their way about how to apply it and about what to do with it. I find that even in the courts, there is an inconsistency…. Not from the courts, rather, but when you’re engaged in the court process, there is still debate between ministry lawyers and parents’ counsel, as we’re called when we represent parents versus the ministry, about how to apply the legislation. So things are getting better, but they’re only getting better where people are actually changing their attitudes.

I can say that ten years ago if I was in a collaborative process, sitting around a table with my client, who was a parent, and the social worker and their lawyer, and we were trying to talk out some of the issues that we needed to resolve to set up visits for the weekend, and the parent got significantly upset and started to become really, what we would say, escalated or agitated and maybe swearing at us and becoming unmanageable, as some people would say….

What we now see in that person is somebody who is triggered and experiencing a trauma response to having their autonomy taken away, to feeling as though this is just another part of a bigger system that they can’t control, and elements of fear of discrimination, racism, sexism that were always undertones. It’s almost like we….

Even as an Indigenous woman, there are things that are going to trigger me, but I wouldn’t have used the word “trigger” ten years ago. But I now recognize that because of the trauma training that many of us, as professionals in the legal profession, have had the benefit of experiencing over the last few years.

I think the place we’re at now — we’re actually under­standing better the responses that we have from people. It’s not just…. We don’t look at things…. At least from my perspective, I don’t see my clients as acting out. I see them as reacting and being reactive to a really negative experience for them. So I think that there’s a lot of potential. It just has to be that we find the right resources with the attitude shift, the culture shift, about what families are going through.

When we talk about addiction, when we talk about, we know…. Anyone who has read Gabor Maté…. You know, it’s the loss of connection that leads…. It’s that feeling of loss and hopelessness that actually leads to addiction — very, very common. And it goes for any profession, anybody who is experiencing substance misuse. It’s from fear, anxiety, depression, hopelessness. Pulling oneself out of that, no matter how badly one wants to do it, is absolutely one of the hardest things that parents can do, especially when they’re being told that they’re bad parents simultaneously.

I know that, like most parents, I’m sensitive to other people’s judgment about how I am as a parent. No more are people vulnerable to this than people who are in poverty and living in a fishbowl, because they get more calls from schools. They get more calls from doctors. They get more reports made by them than other people who aren’t living in the same types of environments that they are, under the same pressures they are.

D. Davies: So legislatively, what might be some suggestions?

K. Harry: Well, I did assist in writing a paper on modernizing child welfare in B.C. I co-chaired that publication. That would be something that I think would be of assistance.

D. Davies: Could you give me a copy of that?

K. Harry: Yeah, for sure. I can definitely submit that.

There are a lot of technical points that I would do to encourage collaboration, a lot of supports around…. I don’t want to get into the whole paper. It was about a two-year process, so I won’t get into it here, but I will share it with you, for certain.

D. Davies: Thank you.

[10:50 a.m.]

N. Sharma (Chair): We have two more questions, and then about ten minutes. That should be….

D. Routley: I’ve got to go. I’m going to phone in and listen to the rest of your presentation.

N. Sharma (Chair): Okay.

Sonia, go ahead.

S. Furstenau: Over the course of what we’ve heard so far…. The child welfare system has come up several times, for example. When you talk about a way to find the right resources…. Resources are available for foster care, but those resources aren’t available for supporting families where they’re at, for example. The orientation….

You’ve touched on it. I think the experience we’ve had with families and parents is this extraordinarily punitive model. If you’re a family that is interacting with the child welfare system, it’s really one false step, right? One mistake or one action that’s deemed not acceptable, and there’s a punishment. That punishment often is removal of children.

Can you talk to us about that reorientation of resources to support families, as opposed to operating in this punitive manner? I think the point you made at the outset was really important, that parents want to parent.

We talk about the removal of infants at birth. The research on brain development shows that to be a traumatic brain injury for an infant. So I think really understanding…. A lot of what we’re hearing at this table from people may have started with a decision at their birth. Can you just give us a little bit more insight into that allocation of resources and how that can be shifted?

K. Harry: I’ll give you an example. A woman comes from a remote community. Maybe she’s from up north, or maybe she’s from the north Island. She could be anywhere in the province.

Eventually, we get a report to court about her. It says that this mom…. One of the things she did not do…. She didn’t engage in prenatal supports. That’s a strike against her. This is somebody that is going to be presumed as uncaring for the health of herself and also the care of her unborn child. She is too disorganized to get her life in order and to get in to see a doctor.

In fact, we have somebody who has no financial ability, no vehicle, no supportive partner, no one that she can turn to, to help her make that 2½ hour commute to see a doctor, a doctor who is going to be really challenging to find in a lot of places, for prenatal support. Even then, if she does engage, she may feel judged for having been there in the first place. They’re asking very invasive questions. For example: “Is it the same dad for all of your kids?” Things like that, which are common for women to experience.

The supports for people to say: “Okay, if you need to get prenatal care, here are financial resources to get to it….” I know that there’s an income assistance top-up. When I last heard, it was a $30 top-up for just extra food, and you could get free prenatals. That’s not going to be helpful for somebody who needs to go in regularly, once a month, and, towards the end of pregnancy, multiple times a month, if not every week, after 37 weeks, to see their doctor. Yet they’re deemed as somebody who is, obviously, then, not able to be a fit mother if they can’t even make it to doctor appointments. Where are we looking for the places that will lead to judgment?

We have a lot of clients who have children. You touched on it when you referred to the financial support for foster families. That financial support isn’t there for children who are with their parents. I think that that’s really devastating to the families. If you know of anybody who has a child with a disability, knowing that you don’t have the financial supports available to you and the social supports, just the way that people are characterized when they have children who are acting out…. The determinations are….

A common theme that I see is we have a child who is having difficulty in school, and they’re acting out. The parent is being…. There’s escalating tension in the house, and there might be other compounding issues happening in their family. The social worker is telling me and telling the parent: “You just don’t have control of your children. You need parenting classes. You need this because you’re not parenting properly. There’s something wrong with your ability to parent.” Then that child goes into foster care.

[10:55 a.m.]

Something significant happens. The child goes into foster care, and the foster parent says: “I can’t parent this child. They have all these issues.” They’re suddenly being rushed in for an assessment. They’re finding out that the child has ADHD, potentially some other issues going on. Suddenly there’s a ton of supports, wraparound supports.

There was already an identification that this child was struggling. But the onus was on the parent to prove that it wasn’t their parenting, as opposed to: “What kinds of supports does this family need? What’s actually happening with this child?” That’s a really common one, actually. It’s when they hit school age. As we know, those issues show up more so as the child ages.

That’s just one example of how the resource disparity creates missed opportunities for parents to be able to exercise their rights as parents and for children to be able to have the right to live in their own home.

R. Leonard: Along similar lines, we’re hearing a lot about safe supply and harm reduction and trying to make that shift, societally, that is supportive of going down that road. Then there is the abstinence road.

I’m curious about the impact that it’s having on the work that you do to support harm reduction and safe supply.

K. Harry: Unfortunately, I can say that throughout our program…. We represent 900 or so parents. Eighty percent of our clients are women, so hundreds of women.

Even before I went to work with Legal Aid, in management, we lost a lot of parents, a lot of overdoses. Even then, where we didn’t have deaths due to overdoses for our clients, where they became disabled as a result of an overdose, were wheelchair bound, had other…. You could tell that they were…. A lack of oxygen had caused other deficits for them psychologically and physically.

The impact of the illicit substances has been significant in the area of child protection, for sure. We don’t see…. I see mostly support for abstinence-only programs in child welfare. I can understand the reason for that.

What I see in harm reduction is where parents don’t have their children with them. They’re not under the same microscope. Basically, that is what happens. So if they are engaging in harm reduction, it’s because their children aren’t with them. The social workers…. They’re just being monitored more closely, if they are actually using to any degree, while they have their children in their care.

When I talk about use, I’m also talking about…. I mean, we’re talking about illicit substances. I’ve had many removals where a mom tells a social worker that she had a glass of wine last night. She was under a supervision order that says no alcohol. They do a removal, because she’s admitted that she had a glass of wine at a friend’s place. If you do something contrary to a court order and the social worker decides that that is a reason to remove, they will remove on that basis.

Certainly, the impact has been significant, though. I can say, as a practitioner, that I lived in fear for a lot of years on Wednesdays and Thursdays. For a lot of years, the last Wednesday of the month was a pretty triggering day of the month for me. It was my court list day too. In Vancouver, we go to court every Wednesday, and I’d be concerned about whether parents would be making it to court on the last Wednesday of the month.

It’s been a very stressful time as a practitioner and as somebody who really cares about the parents and their children. A lot of loss over the last few years. Without clean supply, without the proper supports, without proper understanding, without what families need to be safer, it has, unfortunately, devastated a lot of families I know.

N. Sharma (Chair): Okay. We’re up on time, Katrina.

On behalf of the committee, I just want to thank you so much for coming in and teaching us about all that you know and that you’ve experienced through the work that you do. Thank you so much for being a champion for so many out there over the years.

The committee recessed from 11 a.m. to 11:06 a.m.

[N. Sharma in the chair.]

N. Sharma (Chair): We’ll do some intros. I want to just officially welcome you on behalf of the Health Committee. We just want to thank you for coming and helping us learn from you.

We’ll maybe do introductions, starting with Sonia.

S. Furstenau: Sonia Furstenau, MLA for Cowichan Valley.

D. Davies: Dan Davies. I’m MLA for Peace River North.

T. Halford: Trevor Halford, MLA for Surrey–White Rock.

S. Bond (Deputy Chair): I’m Shirley Bond. I’m the MLA for Prince George–Valemount, and I’m the Deputy Chair.

R. Leonard: I’m Ronna-Rae Leonard. I’m the MLA for Courtenay-Comox.

S. Chant: I’m Susie Chant. I’m the MLA for North Vancouver–Seymour.

N. Sharma (Chair): Go ahead, Pam, on the phone.

P. Alexis: Pam Alexis, MLA for Abbotsford-Mission.

N. Sharma (Chair): Doug had to step out.

We have about 15 minutes for you to present and then question-and-answer afterwards. Over to you.

OVERDOSE PREVENTION SOCIETY

S. Blyth: I thought I’d mostly just wing it, in terms of telling you who we are and what we’re doing and giving you some information about what we’re going through right now. The Downtown Eastside is mainly where we’re from. I’m the executive director of the Overdose Prevention Society. We started in 2016 to deal with the overdose crisis.

At first, what we did was illegal, but we were seeing so many overdoses in the street, and it was just undeniable how many people were overdosing at that time. So eventually the government said: “We’ve got to fund these initiatives.” They have thankfully…. There are more of them, and we’re saving lives every day. Our sites see up to 900 people a day. They are coming in and accessing our services. No one has ever died at our site.

We work with people to get them housing. We work with people to get them health care. Trey goes to the hospital with people very frequently. We help people if they want to go into recovery eventually. Trey used to hang out on Hastings Street, and now he helps people who have come to the end of using. He takes them to NA and helps them get help they need and go through the process with him.

We help people where they’re at. They may be in an alley, and we give them jobs. Our site is run by the people, for the people. The only people that we hire are either former drug users or current drug users, and that’s it. The reason being is that we just want to make sure that the funding that’s being given by the government gets right to the people. It gives them opportunities, because opportunities like jobs and housing make a person’s life whole again.

A lot of people are in the alley and dying in the alleys, and they don’t have any hope or family that they can talk to. So we’ve created quite a community of people who help each other and take their skills into SROs and save lives there as well.

[11:10 a.m.]

Also, I didn’t say this, but thanks for having us here today. Thanks for creating this committee. It’s really important to gather this information and hear from different community members and allowing us to speak. It means a lot, especially since we’ve been going through so many years of this crisis. People are dying at such a rapid rate.

Between Trey and me, people say: “How do you do it? How do you continue this work?” It’s difficult. We just do it, because we don’t know who else could do it in the way that we do. We just couldn’t simply walk away from all the people dying and who need our help that are there that we see every day. We know all the services, and things like that.

We just couldn’t simply leave, even though it’s going to alter our lives permanently, I’m sure. He was just saying he has nightmares every night, and he actually had no nightmares the past couple of nights. I have nightmares all the time. We see people walking around.

It’s a common occurrence for us to see people that we knew walking around the Downtown Eastside. Not ghosts, but out of the corner of your eye. If you see a lot of people that have died, or have known a lot of people that have died, you start to see them through other people. It’s a common occurrence for us. More and more people die, and you haven’t dealt with the last one who has died, and then you’re dealing with the next.

Our overdose prevention site is…. We put on memorials for people — quite frequently working with families, because sometimes the families are also living in poverty. They’re not prepared and not able to afford…. A lot of the folks are really young. Sometimes they’ve lost touch with their family. So we’re having memorials every Monday and calling it Memorial Mondays. It’s definitely a tragedy that we’re going through and that so many people are going through.

We test drugs. We have a MySafe, where we have some access to safe supply at one of our sites. We provide washrooms to people, which is a very challenging job, but people need bathrooms, obviously. We test drugs, which is good, because we can work with some of the people selling drugs on the street to try and make sure that they’re accountable for what they’re doing. You know what I mean? They’re selling drugs. If someone overdoses, we can check the drugs, see what they were, see who it came from, deal with that right away.

All of it is just band-aids and holding off what’s really happening, and that’s just that people are dying. I think it’s just when people get secure enough that they’re going to be okay, that’s when they die. When they’re taking benzos, which are in most of the drugs now, it’s just so lethal, so easily, with fentanyl that they may not even know that they’re going to take another lethal dose. Some of them don’t know what’s happened to them for days. Women, even men, have had sexual assaults. They’ve lost every­thing. It’s made the crisis so much worse.

I want to be pretty specific about what I think we should do, and maybe give him a couple of minutes. I’ll give you some minutes too. You can have a couple of minutes.

Specifically, I think we really have to figure out how to get people a safe supply, especially in the Downtown Eastside, of anything, in all different kinds of models. The cannabis store was just shut down on Hastings. They served thousands of people. They can’t even get a safe supply of cannabis in a neighbourhood where people are dying. I’ve seen people — because we’re now right next door — walk away from there and go and access something else. They’re just like: “You know what? I’m just going to go buy something else.”

[11:15 a.m.]

Some of these things aren’t making any sense. There should be some exceptions, I think, made in an emergency in the Downtown Eastside especially and, obviously, in the neighbourhoods around where there are young people using. There are different approaches to different things, but specifically, if we want to stop people dying that are vulnerable, we’ve got to get them safe supply.

Prescriberless would probably be the best way — to go around prescribing through doctors and through the pharmacists. I know that that would likely be some sort of partnership combination through the provincial and federal governments, but I think we need to make it as easy for them to get it as they can get it from the drug dealers on the street.

People like us — I’ve worked at different organizations that do some safe supply — get a licence, and you’re able to receive the supply from the pharmacist and to give out other kinds of medications. It would be just trying to get people their medications on site, at an overdose prevention site. If they come into an overdose prevention site, we would be able to give them something that’s safe, and then start getting them using safe supply. It’s just the easiest thing that we could possibly do.

You can do it easily with a med management licence. I have one, and people can get them in three days. You just have to have someone count — to receive the medications and dispense the medications — and make sure that people are the right people taking them, how much they’re taking and things like that.

I think there are really simple ways of getting people a safe supply that we’re not looking at. Really, at the end of the day, we’ve just got to get people off those toxic drugs in any way we can. That will stop people from dying — pretty quickly, I think.

I’m going to just leave it to Trey to maybe expand on that.

T. Helten: Hello, my name is Trey Helten. I’m the general manager at Overdose Prevention Society. I’ve been there for four years.

Yes, Sarah is correct. I had two days without nightmares recently, which is a big win for me. I’ve been having a lot of nightmares lately.

I think our goal here is to just really advocate for those drug users who aren’t ready for treatment. I know everyone always wants to talk about treatment and recovery, which is great.

I myself am in recovery. I’m coming up on 6½ years completely abstinent from all mind- or mood-altering substances, except for coffee, but there are a lot of people that aren’t ready to stop, and there are a lot of people that don’t want to stop. They’re getting a toxic supply, and it would be really, really great to be able to help them access something that wasn’t just toxic street drugs that were made in a bathtub inside an SRO, across the street from 139 East Hastings, across the street from Insite, or in the Woodward’s building, the Woodward’s SRO or whatever.

It’s pretty tragic, every day, seeing these things. I don’t really know what else I can expand on, except just that. We’re just asking for safe supply for these people that aren’t ready to stop — basically the lifers, the people that don’t want to access recovery.

If I were going to say anything on the recovery side of things…. I’ve always said that lower-barrier access to detox clinics for the people that want it, for the people that are trying to access recovery — like, if they really want it, they’ll try to access it. But lower barriers when they’re calling for detox access provided by Vancouver Health. It’s a 1-866 number.

[11:20 a.m.]

A two-week waiting list is problematic for those people. They’re street-entrenched. They don’t always have memory, or maybe the window is very small, when they say they want help. Two weeks later they’ll be on to something else, and they won’t want to access recovery.

More drug testing places. Currently OPS provides drug testing, through VCH, on a spectrometer. It’s intermittent. It’s on different days, which I can’t always remember myself. Just as an example, the schedule, off my head, is Monday 10 a.m. to 12 and then again from two to four. Wednesday is 10 a.m. to 12, two to four, and then Friday, two to four. It’s so infrequent.

I often end up sending people to Get Your Drugs Tested, which is located…. It’s an actual place where you can go get your drugs tested. It’s located at 880 East Hastings. They have the most permanent hours that I can remember, 12 p.m. to 9 p.m. Unfortunately, it’s off the main block where most of the chaos is happening. It’s down by the Rice Block, across from the Astoria Hotel. So many people go there. Sometimes when someone wants to get their drugs tested it’s a two-hour wait because there actually is a lineup there. It is super problematic.

I would like to see more of a permanent spot in the war zone for people to get their drugs tested. I know myself, as a former drug user, when I’m physically dependent on drugs and I pick something up off a dealer on the sidewalk, I’m not going to walk up to 880 East Hastings to get it tested. But if there was something more localized that was an actual stable, permanent place, I might go there and get it tested before I put drywall dust or cement dust into my system.

The main thing I really want to say — I’m just going to end, with the last 25 seconds — is that we really are advocating for safe supply. There are a lot of people who aren’t ready to stop and don’t ever want to stop. It would be nice to give those people a safe supply of drugs, which they’re actually seeking.

N. Sharma (Chair): Okay. Thank you.

We’ll switch to questions.

Go ahead, Ronna-Rae.

R. Leonard: Thank you so much for coming. We’ve heard your name from other presenters and know that you do really good work, and you’re very trusted in the community.

I just want to acknowledge, too, the challenges that you face personally doing this job. We know it’s hard, but to actually hear it from you, I think, is good for us, and it’s good for the rest of British Columbia to hear about those challenges and to see why you support safe supply.

I wanted to ask…. You talked about a medical management licence. I was hoping you could describe that a little bit more, because I don’t know that we’ve heard about that. Or if I did, I didn’t realize it.

S. Blyth: For a long time, ever since I remember, in the Portland Hotel Society but other hotels that deal with folks that may have mental health or physical health issues, prescriptions are dropped off to those places that people live, which includes methadone and other things. The staff need a med management licence, generally, to be able to identify who you’re giving the medication to. It’ll have the person’s picture. It has the dose of what they’re supposed to take. You fill out all the forms, and then it’s a couple…. It’s a process.

Anyways, the idea is that you receive the medication. You account for the medication, and you watch the person take the medication, in most cases. Then they’re done, and you get the next person. Sometimes you’ll knock on a door and say, “Hey, you didn’t take your medication today” — whatever it could possibly be. It could be they’re mental health medications, which is really important, because mental health issues…. If you’re not dealing with your mental health issues, sometimes fentanyl is just the thing to get rid of everything, because it’s pretty powerful, and it works better than….

Some people with schizophrenia…. And we see a lot of schizophrenia in the Downtown Eastside. Their medication just isn’t working for them, and it causes more problems for them than not, and they just end up using the street drugs because they can’t get something to get rid of their obvious pain and trauma that they’re dealing with.

[11:25 a.m.]

I mean, a lot of people in the Downtown Eastside that are not going to come off drugs have mental health, physical health…. You know, they’ve maybe even lost a limb over the process of using drugs for so many years, and they’re not going to want to ever come off of drugs completely, but they may not have endless control over the drugs that they’re using. So just getting them something to ease the pain or the trauma….

I think prescribers, doctors, are just…. I think because there’s been some legal action taken against them for prescribing…. Some of them get penalized, that I’ve spoken to. Some of the doctors who are actually willing to do this are getting in trouble along the way, so then they just are afraid to do it.

A Voice: Not doing it….

S. Blyth: Yeah. Only the most brave, progressive doctors are left, willing to lose their licence, willing to get demoted. There’s a lot of fear in that.

Getting around that and having folks like, even, myself, or people like me, or just nurses that are working in the Downtown Eastside…. Some of them can, but really, making it a simple access point for a lot of people to get help…. That would be a place like the Overdose Prevention Society, where we see up to 900 people a day. We’re really, really busy.

If we could just say: “You come in. We’ll give you your medication. Here’s your photo. We know who you are. This is what you’ve got….” We’re doing all the paperwork, reporting on what’s happening and trying to help people get into treatment eventually. It’s really hard to come off these…. Even to get on to drugs that are prescriptive is going to be a bit of a challenge because people are so used to the street drugs now.

Anyway, I don’t want to go on and on. I think there’s a way that we can have a really simple approach where we don’t need prescribers and that we can maybe get the medication through the pharmacy. I know that Fair Price Pharma…. There are a few doctors willing, but I think the barriers are coming up with the pharmacy and the doctors that are penalized.

S. Chant: Further to Ronna-Rae’s question, the other thing that I heard was prescription lists. What do you mean when you say prescription lists?

S. Blyth: Being able to figure out a way to get medication to people without a prescription. I would have to be creative. I’m sure someone’s…. People have been working on this for a long time. I’m not entirely sure what that would look like. But being able to purchase from a pharmacy, and being able to account for all the medication…. As a professional mental health worker, I think that that should be sufficient to get people medication, maybe getting it from a pharmacy, getting it from an actual producer.

I just got a cannabis licence. It’s really quite rigorous how you have to report. I got a federal licence. It took me two years to get. You have to report, every few weeks, everything that comes in and out, or else you lose your licence.

There could maybe be some ways to license people to be able to buy from producers like Fair Price Pharma, maybe something similar to the licence that I have for medical cannabis or something like that, where we’re able to purchase, receive, store properly and then give it out and then report back to the government on exactly the comings and goings so that we know that everything’s accountable, because it is drugs. We’d need to follow all the protocol, which they have with the cannabis licensing. I think you could look at that a little bit.

[11:30 a.m.]

S. Chant: If I’m thinking about it, what I’m hearing from you, and I just want to be really clear, is that pharmacy X can give you the medications without a person being attached to those medications. So you’re getting X number of, say, fentanyl. You’re getting X amount of fentanyl, and then it is up to your discretion who gets that fentanyl on your site and at what dosage, etc.

S. Blyth: We could, in a sense, do the prescribing. In terms of that, I would say: “We’ve got this person, this person. This person needs it, and this is the amount that they’ll take per day.” Then I would go to the pharmacist or go to — maybe not a pharmacist — the producer, and it would be tracked. We would be able accountable for it, as opposed to having even a pharmacist be accountable for it.

I could go to Fair Price Pharma and say: “These are all the people that are using.” They’re going to have something smokable soon. We have a big smoking site. I could say: “I’d like 20 pens a day. I’ve got 20 people a day that would like a smokable substance. They want two per person.” Then I could purchase that, or — I don’t know — the government could pay for it or some sort of thing that we could figure out that would work. Then we would be able to have that to either (a) give out, or (b) they could purchase for as cost of how to….

You know what I mean? There’s got to be some way of doing it. It doesn’t necessarily have to cost the government. There are ways to do it where the government would fund something. There are ways to do it where there would be a fee attached to it, for the person to purchase something that’s not going to kill them.

D. Davies: Thanks, both of you, for your presentation. You answered a lot of my questions from both of those guys’ questions as well.

The last couple days we’ve heard of a couple different ways now that meds are distributed. The machines — there are three or four machines down here.

S. Blyth: Yeah. MySafe is good.

D. Davies: Yeah, MySafe, and now this med management licence. Obviously, we have heard a lot as a committee around almost the shaming around accessing methadone and having to go into a pharmacy and that whole process. Obviously, this is…. People would prefer to come to see you to take their methadone, at your facility. That was one of my questions which got answered.

My next one, I guess, real simple, is: how many of you are there that have this licence, and is there something to try and get more people?

S. Blyth: Well, I think you could look at the way…. I mean, obviously this federal licence that I have…. You could maybe even do a provincial version of it. But it’s very….

Okay. So the med management licence and the federal cannabis licence. I mean, the federal cannabis licence basically has a bunch of rules around how you deal with cannabis and selling it and purchasing it from producers. It’s really strict, and you can easily lose your licence. I think that would be good…. It would be okay to do that and get people to…. You have to go through a huge test screening. It took me two years to go through this screening. I think that was a bit ridiculous.

In the end, I think that you can get people like me who know the community. There are people like me who could do it. Trey could do it, at this point. We help with the MySafe. We already intake the medication for MySafe and bring it and put it into MySafe. So we do have that.

The med management licence is a three-day course. I think some of the…. It’s already mandatory for some of the housing that offers medication. You would just, then, likely expand the medication to include some of the substances that are not really included in the medication. But then that would mean prescribers would have to prescribe, which they could if they wanted to. But they don’t, because they get penalized for doing it.

[11:35 a.m.]

They end up prescribing things that people don’t want, and they’re just not going to take it. They’re just going to go out into the street, which is…. There’s a guy waiting out front to give them whatever they do what.

One person’s mother, whose kid died, said: “I wish we could find some way, that it was just as easy….” You know, getting drugs is easier to get than a pizza. We’ve just got to make it as easy as we can so that people can just show up and feel better, right? It’s about that they feel horrible before. If they’re in withdrawal, they’re just feeling horrible.

Some of them are screaming. All day long we get screamed at. We hire drug users. Some of them are screaming all day long. We’d get them as many jobs as we can afford. We fundraise. We try and help them as much as we can. I mean, we’re just, at this point, desperate to help people feel like normal human beings that are going through terrible traumatic situations.

Did that answer your question? Okay.

T. Halford: Thank you, and thank you to you, Trey, for coming in here. Being vulnerable like that is not an easy thing to do, so I appreciate that.

In terms of the testing, do you guys provide…? Just walk me through how that…. What stood out to me is that 900 people a day are coming in. If people are coming in, are they walking out with testing strips? How’s that process going? Obviously, it’s not helping as much as we’d want it to. But is there anything more that you guys need in terms of testing that you’re not getting?

S. Blyth: I mean, we would definitely like to have testing all the time at our site. We’re right next to Insite now, so either one or the other having testing all the time.

T. Helten: Or like a booth or something, like a centralized location.

T. Halford: Forgive my…. Where is the nearest testing machine?

S. Blyth: It’s at 800….

T. Helten: It’s 880 East Hastings to get your drugs tested. It’s owned by Dana Larsen.

T. Halford: Yeah, I saw that.

S. Blyth: But that’s not ideal.

To be honest, drug use is happening on a three-block radius in Vancouver, really. It’s drug users and drug dealing and drug everything and camping. It’s all happening in a three-block radius, and people will not walk a few blocks away. They’re just not going to walk a few blocks away. They’re just not going to test a few blocks away. They’re going to get it and use it if they’re sick. That’s just the way it is. I mean, we’re lucky to….

Really, at the end of the day, we just need to give them something — they know what they’re going to take — that’s going to get them so that they’re not sick anymore.

T. Helten: To answer your question, though, and to walk you through a situation with a drug tester, it would be like a VCH spectrometer tech walks in with a large suitcase, a locking suitcase, with the spectrometer inside of it. It’s a $50,000 machine. They walk in. They set up a little table, just like this, and set up the spectrometer to their laptop, which runs a software called OPUS, the OPUS software. It has the library of all the drugs from the Alabama library and the London drug library.

It takes about 15 minutes for the computer and the spectrometer to be ready. Then they just sit there, and we say: “Hey, we’ve got drug testing available from 10 a.m. to 12 today, and then he’ll be back from two to four.”

We encourage drug dealers that we know outside, around the building, to get their drugs tested frequently so we know what they’re putting out. They’re usually pretty happy to provide a sample to the spectrometer tech. Or because they trust me, they’ll give me a small amount to go bring to the spectrometer tech. Or participants from the site will say: “Hey, I’ve got something. I want to get it tested.”

All they really need is a small, little chunk — about the size of half of a matchhead — of the suspected substance to put on the anvil of the spectrometer. They’ll squish it down and run infrared light through it. It takes about 40 seconds, and then it’ll be compared to the two drug libraries as to what it is.

[11:40 a.m.]

The spectrometer tech is pretty good at seeing what it is on the map of drugs that come up on the OPUS software to compare to something else. It will then be strip tested by a fentanyl test strip and benzo test stripped by a benzo test strip.

The whole process can take anywhere from ten to 15 minutes per sample. Then the sample is given back, what’s left of it, usually squished inside of a tiny little dixie cup, like a shot glass dixie cup, with a small piece of paper provided by VCH with the suspected substance on the top, what they think it is, what it came out to, comparing on the spectrometer software, what the two test strip results were, the fentanyl test strip and the benzo test strip. Then that’s provided back to the person who got their drugs tested.

T. Halford: Thank you.

N. Sharma (Chair): Just a quick follow-up. If it’s a drug seller, will they then remove it, not sell it, if it’s toxic? Does that change behaviour?

T. Helten: Yeah. I’ve had conversations with them about that. “You can’t put this out.” They don’t always listen.

I’ve worked with the spectrometer techs pretty regularly. Sometimes we’ll have chemists, actual street cooks, come in with a bag of carfentanil that could kill this room three times over easily. We have to be discreet with that person.

We could be, like: “Holy crap.” Do you know what I mean? You have to be discreet. You can’t start yelling at the person. We’re told by VCH that we have to discreetly tell them: “What you’re carrying on you is technically a biological weapon. You could hurt a lot of people with this. You really need to know what you’re doing.”

Usually my experience with…. The people that bring in pure carfent know that it’s pure carfent. They can usually tell you the exact percentage and how much of it is carfent. They actually know that. They are drug processors. They’re processing their drugs inside of a bathtub, inside a Woodwards SRO or whatever.

Does that answer the question?

N. Sharma (Chair): Yeah.

Sonia, go ahead.

S. Furstenau: Thank you, both. I just want to acknowledge the weariness that must accompany being six years in a declared health emergency and being on the front lines and just how much of a toll…. You talked about it, and I think it’s really important for us to hear that.

Trey, you said we need lower-barrier access to detox so that it’s there when it’s needed, yet earlier this month a youth detox centre was closed down. Can you talk about the impact of the closing of a detox centre and what the effects of that are?

T. Helten: Specifically, with the youth detox closing…. I mean, we do have youth come into the site. They’re usually identified pretty quickly. Someone will be: “I think that person is a minor.”

The protocol for when that happens is that myself and another staff member will go up to this person and ask them if they can produce ID. Usually they can’t. No one that comes to the site can usually produce ID. Everyone has lost it or flailed it or whatever. We’ll ask them if they can prove how old they are. You have to be 19-plus to come into any safe injection site. It’s like a bar. If they are youth, “We suspect you’re a youth, and you can’t provide ID,” we have to just follow protocol and call a youth worker. Usually we call Covenant House.

Usually they’ll admit that they’re a youth. They already have a worker. They’ll provide their worker’s phone number, which we’ll call for them. We always have to just call the worker and tell them that they’re on site or that we’ve seen them around on site.

[11:45 a.m.]

It is kind of a sticky situation. We don’t want to tell them that they’re not allowed to be there. Obviously, they’re coming in to try and use safely, because they don’t want to die. At the same time, they’re not supposed to be there, but usually they’re entrenched heavily already by that point of coming in.

Basically, just every time they come in, we have to call their worker and let them know that they’re there. Whether or not their worker comes down is 50-50, but that’s the protocol.

My job, as manager, is really…. I’m just the guy on the street. I see all the front-line crazy all day long. I’m just always trying to advocate for people to try recovery if they want it. I spray painted a big Access Central phone number across the top of our site so that it’s there. Each number is about four feet high, about two feet wide. It’s nice and big. Anyone can come see it anytime they want to call.

It sucks — the barriers. I talk to a lot of people, and they say…. An example is a fellow named Clinton, who I’ve watched progressively what we call decomp. In the last four years, he went from smoking fentanyl to injecting fentanyl. He’s a young man. He’s 24. He now has HIV. I’ve encouraged him to try detox so many times. You know, we’ve had a lot of moments where I’m sitting there talking to him, and he says: “You know, Trey, I’m feeling done. I don’t know that I can continue this way any more.” So I say: “Would you like call Access Central and make an appointment for detox?”

We’ll call. They’ll ask him what he’s using. Usually, everyone has benzos in their system. As you guys know, obviously there’s no more heroin. It’s all fentanyl. Now it’s like a 50-50 shot. You buy fentanyl with benzos in it, and the person lies to you. You say, “I want fentanyl with no benzos,” and they give you benzo-fent. Or you get the wrong stuff, whatever. It’s just a 50-50 crapshoot whether you get benzo-fent or regular fent.

Basically, once you have benzos in your system, you have to go to a medically assisted detox. It’s more of a harsh comedown. You can go into seizures when you’re coming off benzodiazepines, so you can’t just go to the…. There are two kinds of detox. There’s regular detox and then medically assisted detox. You automatically have to go to the medical-assisted detox, which is higher barrier.

I’ll call them. We’ll make an appointment. They’ll ask what he’s using. They’ll say: “Okay. We have a bed opening in two weeks.” By the time two weeks rolls around, Clinton is not going to remember. He’s not going to remember two weeks from now. And also, by two weeks from now, he may not want to go.

I always end the conversation with: “If you really want to get access to detox right now, this is what you have to do. You have to go to the hospital. You have to tell them that you’re suicidal. You have to use specific language. You have to say: ‘I have a plan. I’ve given away all my material possessions that I have. I’m going to walk to the Lions Gate Bridge, and I’m going to jump off. I’ve been thinking about this for a while.’”

Obviously, this is a lie, but this is how you have to manipulate the system to get instant detox. He will then be put under the Mental Health Act. He’ll be locked up in the St. Paul’s mental ward. I have to tell him: “Once you’re in there, you’ll be safe. You’ll be in the hospital. Then you have to advocate for yourself that you want to be transferred to a detox facility from the mental health unit.”

That’s the only way you can get instant access to a detox facility.

S. Blyth: Yeah.

T. Helten: Does that answer the question? Sorry, I go on a bit.

S. Bond (Deputy Chair): Thank you both for being here.

S. Blyth: We need a Trey detox.

S. Bond (Deputy Chair): Trey — for sharing your story with us. We really appreciate that.

And Sarah — for the longtime work that you’ve done.

I wanted to ask something. There’s lots. I really appreciate Trev asking about drug testing, because that’s something we’ve asked about across the province. It’s also not readily available in other parts of the province where people are dying as well.

I just wanted to ask something very specific to you. I know there has been a lot of debate about…. You’ve had to move recently.

S. Blyth: Yeah.

S. Bond (Deputy Chair): I think it’s been well documented that you save lives and care for people and that there’s been a big debate about an inside venue, and outside, and also a permanent location. Lots of issues around the cost of building something with proper ventilation — WorkSafe hazards, all of that stuff.

[11:50 a.m.]

What does your future look like? Are you worried about having a permanent location? I know I read an article about your concern that even the move a block or a half a block or whatever it was can cause confusion, disorientation, and people may die as a result of that.

Can you just tell us a little bit about your future? I think that’s also relevant to us in terms of the struggles that organizations like yours are facing.

S. Blyth: Yeah. I mean, when we have to move, there’s…. If we move from one neighbourhood to another, even if it’s half a block, there are different people in different neighbourhoods, so violence happens sometimes. Drug dealers get violent, and they have territories. These guys want to come over here, and it’s…. Just negotiating that before it happens and during that is really stressful, obviously, for us, because we have to get in the middle of it and create community in the middle of a really sad situation where….

Most of the drug dealers are drug users themselves that are on the front lines. They either do that or survival sex trade or they steal things. There are not very many options. Or they work for us, and that’s a preferred option. Actually, the street market — selling things that they can buy, sell and trade. There are some things going on.

What was your question? I’m sorry.

S. Bond (Deputy Chair): Your future, the concern about an indoor facility or outdoor. There has been a big debate about the cost of it — “Oh, it costs too much” — and a permanent location so that you don’t have to move again.

S. Blyth: Yeah, so we’ve moved. We have a new place. It’s good. We’ve got an indoor and an outdoor area, and we have bathrooms. But yeah, having a permanent place…. In some ways, we don’t want to be a permanent place. All of us would like to move on to other things eventually.

I think I’d like to see the site become more of a place where people can get a safe supply. They can get their drugs tested if they need to. Not losing the peer workers — they could help people get into rehab, help people get safe supply. So eventually it turns into something where we’re just helping people and employing people from the community so that they have jobs and getting them housing and things like that, because we do a lot of things besides saving lives that also save lives.

It would be great to have something that we could stay at for a long period of time. It would be nice to be located in a government building, because I feel like there’s a bit more control over the amount of time we can stay. Whereas if someone owns the building, even on the block, someone could come in and buy it. Then we’d have to leave again, which would cause more problems.

Yeah, it would be nice to have something, but it would also be nice to provide different services eventually.

N. Sharma (Chair): I have a couple of questions. I think your whole story of OPS is just so…. It’s groundbreaking in so many ways. The work that you did on the front lines before it was seen as a necessary thing for health care…. You’re very humble about the way you talk about it, but it really was a groundbreaking thing that happened here in Vancouver that helped us see a different path.

I’m wondering. We’re hearing from different parts of the province that are having trouble getting these sites up or don’t have…. There are delays or there are issues, on-the-ground issues, that I know that you’ve encountered when you’ve set up sites — about NIMBYism and people just not wanting it.

Do you have a cross…? Do you share, somehow? Is there some connection of helping? Is there a way to help people learn from your experience and get those kinds of cares up in the rest of the province? That’s my first question, and I’ll ask the next one after you’re done answering.

S. Blyth: Yeah. We’ve put together a how-to. But there are certain ways that…. You know, we always want to be a good neighbour, and we try to be a good neighbour. Right now we’re working with Chinatown to help them address some of their issues.

[11:55 a.m.]

If issues come up, I feel like we can…. We should be collecting needles. We should be making our space and area around us better than what it was when we got there. We want to be a good neighbour, and I think being a good neighbour is a huge part of making sure that something’s going to be successful — and not putting it in neighbourhoods that necessarily don’t want it or don’t have drug users.

You want to find places that aren’t going to create a lot of issues and also show the neighbourhoods what these overdose prevention sites can do to improve the state of the neighbourhood, especially if there are needles and other things around and drug users.

You want to help people. It’s a health crisis. You want to provide places for people to go so that they are safe and they don’t die. At the same time, you want to be a really good neighbour and make sure that you’re on…. If there has ever been an issue, people call me. We go down there, and we figure out what the problem is, and we come up with a solution. A lot of times we end up with people volunteering for us. You know what I mean? So you can kind of….

But it’s something to manage. I think that is something that would really be key in opening these things up in different communities — just making sure that you’re always doing your best to be the best neighbour you can and having people cleaning around the area and making sure that you’re very low impact and that you’re bringing people in and that the place they’re coming into is an acceptable amount of space that fits everyone so people aren’t out and about.

I mean, at the end of the day, if you were giving people safe supply, a lot of these issues wouldn’t be happening, because they would have something. They’d know what they were getting, and you wouldn’t have as much chaos, I think, generally.

N. Sharma (Chair): That’s actually my next question. We’ve been hearing from lots of people, and you’re very much at the front line of it, about how toxic the drug supply is. We heard a little bit about it, and then some people say: “It’s safer supply. It’s not safe supply, because it could never be safe.”

I just am wondering: when you’re talking about safe supply, what is that thing that you’re seeing that’s working or could work to get people off the street supply?

S. Blyth: It’s anything from cannabis for sleeping at night…. Some people take cannabis at night. A lot of people that volunteer with us take cannabis at night. They were buying next door. They’d eat something, and then they’d pass out and go to sleep. Instead, they’re left to use alone at night. I mean, there’s that.

There’s also from that all the way to just being able to take a Dilaudid instead of doing a shot alone, which you can get out of the MySafe, or alternatives to using alone something that’s toxic is really what I would consider.

How about you, Trey? Would you like to expand on that question?

T. Helten: Yeah. I don’t know what to say. We need all sorts of different options for lots of different people. There’s not one clear solution. Everyone wants different substances that work for them.

S. Blyth: Yeah. I mean, I’ve seen some people get off of speed using something like Wellbutrin. But just having different options available.

Sometimes people don’t even know what options are available, because they haven’t been educated. They haven’t been assessed. They haven’t been educated. They’re rejected everywhere they go. I’ve taken people to the hospital, and they get rejected to even see someone, because they’re just hostile, because they’re mentally ill. It’s just: “There’s just no point of helping them.”

S. Chant: Thank you. If I haven’t said thank you once, I’m saying it again. I’m going to continue to say thank you, even if I’m not here.

When you talk about drug testing strips, can they tell you the percentage of something, or do they just tell you that it’s of the substance?

T. Helten: There are over 80 different analogues of fentanyl. The drug testing can’t tell you exactly what analogue it is. It’s not that advanced.

[12:00 p.m.]

That’s why the strips are used after the spectrometer has run the sample through — so that they can tell you, basically that yes, this is fentanyl. We can’t tell you exactly what analogue it is, but it is definitely fentanyl.

S. Chant: Just so I’m understanding, because this is information that I don’t quite get…. So the spectrometer runs it and says: “Yes, this is fentanyl,” or what is the result from this?

T. Helten: The spectrometer will tell you what the buffing agent is.

S. Chant: Okay. So it won’t tell you what the….

T. Helten: It won’t tell you what analog of fentanyl it is.

S. Chant: Okay. So it will tell you if there’s talcum powder in there.

T. Helten: It will tell you what, like…. Usually, when a dealer is making product, they get their fentanyl, their raw fentanyl or whatever, and then they’ll add, like, caffeine or mannitol — it’s usually what we call the Hastings special — as a buffing agent to bulk up their product so they can double their money, essentially. But people use all sorts of nasty…

S. Chant: Pig dewormer.

T. Helten: Pig dewormer, drywall dust, cement dust as buffing agents.

S. Chant: Comet.

T. Helten: Or bunk. Like, bunk dope. They sell that frequently. That’s what you get at three in the morning. You’re desperate. You’ve get ten bucks or whatever, and then you go buy something in front of Insite, and it’s cement dust, because that person was just as desperate.

S. Blyth: And everybody’s trying to make money.

S. Chant: So it’s actually got no drug content in it — no useful drug content.

S. Blyth: So some guy will be like, “I need ten bucks to buy my own drugs,” so they’ll give you whatever they have and sell that.

S. Chant: For the ten bucks.

S. Blyth: The folks on the street are usually drug users and drug dealers, and they’re trying to make money to support their own habits and getting into debt with the guys here. Then there are the guys here that have lawyers that you can’t…. The police can’t even get to them because they have a very good legal counsel. They’re like, I don’t know, normal people that are dealing drugs at a higher level and are untouchable.

S. Chant: A professional level.

S. Blyth: A professional level.

T. Helten: So 95 percent or 90 percent of the drug dealers I interact with are survival drug dealers, meaning that they sell drugs to just make sure that they have enough drugs for themselves.

S. Blyth: So arresting them is ridiculous, because as soon as that one goes, another guy goes: “Oh good, I finally get an upgrade in my position.” Then they move in, and there are just a thousand people to replace those people.

The violence against women and violence that happens that we have to intervene in all the time…. I think we have to — you know, just with drug dealers — negotiate with them not to get people into really big debt, because people do get killed. They do. They kill each other. The people that are slightly above everyone will say: “You’ve got to kill that guy if he doesn’t pay up so that everybody else knows that it’s not okay.”

T. Helten: So much stuff that doesn’t make the news in the Downtown Eastside.

S. Blyth: We, basically, say: “Don’t get people into debt.” We try and create a community with our barbecues and our getting people housing and helping people the best that we can with our ability and trying to deter people that are predators in a neighbourhood where there are lots of predators. It’s challenging, right?

Safe supply would actually save us a lot of having to deal with those things.

N. Sharma (Chair): On behalf of the committee, I just want to thank you for not only the work that you’ve done for so long, but also just being here and helping us learn from you about what you’re seeing and hearing.

S. Blyth: You can contact us any time or come and see what we do. I don’t have a card, but I’m easy to find.

T. Helten: Me neither. Sorry.

S. Blyth: My email is blyth2008@gmail.com, and if you want to come and see what we do, we’re more than happy to show you what we do and give you a little tour.

N. Sharma (Chair): Now it’s also broadcast, so people might be reaching out to you.

S. Blyth: Everybody can reach out to us if they want. We are definitely an open book. We want to make sure that everybody has an opportunity to see what we’re doing so that they’re aware of what we do.

N. Sharma (Chair): Thank you, Sarah and Trey.

A motion to adjourn.

Sonia and Dan.

The committee adjourned at 12:05 p.m.