The committee met at 9 a.m.

[N. Sharma in the chair.]

N. Sharma (Chair): Good morning, everybody. Welcome to the second day of our hearings this week.

We’re all on the traditional territory of the Squamish, Musqueam and Tsleil-Waututh people. I want to start by acknowledging that and remind us all to think about what that means for the work that we’re doing.

We’re starting off today with the Emergency Communications Professionals of B.C.

I’d like, on behalf of the committee, to welcome Donald Grant, president, and Carrie James, secretary-treasurer. Welcome.

I’ll just do a quick introduction of everybody around the table. Then it will be 15 minutes for you to do your presentation and about 45 for questions-and-answers.

I’m Niki Sharma. I’m the MLA for Vancouver-Hastings and the Chair of the committee.

On the phone, we have the Deputy Chair. Shirley, go ahead.

S. Bond (Deputy Chair): Good morning, everyone. It’s Shirley Bond, the MLA for Prince George–Valemount.

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

S. Furstenau: Sonia Furstenau, Cowichan Valley.

M. Starchuk: Mike Starchuk, MLA for Surrey-Cloverdale.

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

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

S. Chant: Susie Chant, MLA for North Vancouver–Seymour.

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

N. Sharma (Chair): Okay. Over to you.

Briefings on
Drug Toxicity and Overdoses

EMERGENCY COMMUNICATIONS
PROFESSIONALS OF B.C.

D. Grant: Good morning. Thank you for having us.

I’m Donald Grant, the president of the Emergency Communications Professionals of B.C. I’m also a longtime fire dispatcher, dispatching for 40 fire departments all the way from Abbotsford out to Armstrong; in the Interior, all the way up to Pemberton; including Vancouver.

C. James: I’m Carrie James. I am the secretary-treasurer for the union. I’m also a 911 operator and police call-taker for 33 agencies in B.C., primarily the Lower Mainland and south Vancouver Island.

Our union represents more than 500….

N. Sharma (Chair): If you’re a little closer to the mic, we can hear you better. The sound is a bit tricky in this room.

Thank you. Go ahead.

C. James: Sure. Okay. Let me know if I need to go closer.

Our union represents more than 500 911 operators, call-takers, dispatchers, IT professionals and support professionals who work for E-Comm Emergency Communications for B.C. We appreciate the invitation to present today on behalf of our membership. We bring recommendations as part of your committee’s examination of the urgent and ongoing illicit drug toxicity and overdose crisis.

In 99 percent of the province, if you dial 911, one of our members will answer the phone. They’re located in communication centres in Saanich or Vancouver. The 911 operator will ask if you need police, fire or the Ambulance Service. If you need a service that’s dispatched in-house within that municipality, your call will be routed back to that community. If you need a service that’s dispatched by E-Comm, your call will be transferred to one of our members. If you’re reporting a medical emergency like an overdose, your call is transferred to the B.C. Ambulance Service or BCEHS.

Historically a 911 operator in B.C. would never disconnect from a caller before their call was connected to a live call-taker from the agency or service that was requested. Normally, that transfer only takes a few seconds, but when there was a delay or a hold, our member would stay on the line to reassure the caller, monitor for changes in the situation and ensure that the caller got connected with somebody that could provide them with the assistance that they needed.

D. Grant: Now, throughout 2021, waits to reach the B.C. Ambulance Service became increasingly longer and more frequent. The most significant increase was during the heat dome that occurred last year, when 911 operators waited on the line with callers for upwards of 20 minutes.

So 911 operators in B.C. are not provided with medical training. They’re strictly prohibited from providing any advice or assistance to callers experiencing medical emergencies. As a result of these lengthy waits, 911 operators waited helplessly on the phone with callers who were desperate for help and reassurance. We were only able to stay on the line and reassure them that the call would be answered. While waiting on those phone lines, 911 operators were not available to answer other incoming calls, resulting in further delays in the 911 system.

[9:05 a.m.]

In December of 2021, a new procedure was implemented by E-Comm. Now when there’s a wait to transfer callers to the B.C. Ambulance Service, 911 operators simply disconnect once the caller is in the B.C. Ambulance hold queue. Regardless of the seriousness of the emergency or the expected wait time, callers now routinely wait alone on hold to get through to the B.C. Ambulance Service.

This procedure was introduced as a temporary operating procedure but is still in place now, more than six months later, with no end in sight, due to the continued extended waits to connect with the B.C. Ambulance Service. While this action was taken to ensure that 911 calls do not go unanswered, this process of unattended transfers goes against internationally recognized standards as set out by the National Emergency Number Association.

It also has potentially deadly consequences for the opioid crisis, as callers reporting an opioid overdose, or any overdose, are dealing with conditions that can change rapidly and without warning. If a caller loses consciousness or stops responding, there is no longer a 911 operator on the line to pass on critical information such as the nature of the emergency or their location. As a result, emergency response is delayed while the Ambulance Service works to track down the caller who is no longer on the line and determine the urgency of the situation.

This stopgap measure was created in response to a critical staffing situation at both B.C. Ambulance and at E-Comm. In the fall of 2021, the president of the Ambulance Paramedics of B.C. reported that up to 40 percent of paramedic and dispatch positions were unfilled, while at E-Comm, a 2021 report done by PricewaterhouseCoopers concluded that the organization’s roster of 153 full-time call-takers needs to increase by 125 to meet operational demands.

In addition to the staffing shortages, the demands for service are increasing. Of significant relevance to this committee, the number of paramedic-attended overdose events has quadrupled in the past three years. Both organizations are drastically understaffed to respond to current demand and, as a result, E-Comm is unable to meet the internationally recognized standard of continuous contact.

In this sector, funding challenges can have life-or-death implications, because underfunding and understaffing delay the response to both emergency and non-emergency calls. And while E-Comm is a municipal entity, its creation and mandate are evidence that emergencies do not respect local boundaries but rather intersect with regional and provincial systems.

The B.C. government has a leadership role to play in closing this gap in service and return B.C.’s 911 service to internationally recognized standards, under which no call is left unattended. One of the critical needs to accomplish this is to ensure both the B.C. Ambulance Service and E-Comm are adequately staffed to respond to incoming call volume, disaster response and call surges. Accordingly, our first recommendation is for the B.C. government to provide additional funding and resources to hire more staff at the B.C. Ambulance Service dispatch centres and E-Comm 911 to close the gap in the 911 response system for medical emergencies.

C. James: The governance of E-Comm is quite unique. It was established in 1999 as a non-profit corporation governed under B.C. legislation called the Emergency Communications Corporations Act. Shares in E-Comm are assigned by utilization of the radio system, and membership in the board is determined by shareholders, with the province holding two seats. The board of directors is responsible for overseeing the company’s strategic direction, finances, operating results and E-Comm’s management of day-to-day operations and administration.

Overdose calls are medical in nature, but those calls can come in on both 911 and non-emergency lines, and police and fire agencies are often dispatched alongside the B.C. Ambulance Service. In many cases, they may be on scene before paramedics. Given the wide-ranging nature of the overdose crisis in B.C., all agencies need to be prepared to respond quickly to these calls.

E-Comm is contractually responsible for answering 911 calls in five seconds or less. For police call taking, E-Comm’s standard is to answer the police emergency line in ten seconds or less and the non-emergency line in three minutes or less.

E-Comm’s standards for fire dispatch and call taking follow the National Fire Protection Association or NFPA standard 1225, where the primary standard for call answer is for 90 percent of fire-emergency calls to be answered in less than 15 seconds and for crews to be dispatched in 90 percent of events in less than 60 seconds.

[9:10 a.m.]

There is, however, no legislation regulating 911 call answer standards. When someone calls 911, the factors complicating the emergency response are of no concern to the caller, who’s experiencing an emergency. Regardless of the circumstances, 911 service, from initial call answer to attendance by first responders, should be timely and seamless. To achieve this, departments and agencies need to coordinate, share practices and information and collaborate on best practices.

Across British Columbia, municipal and regional governments are responsible for establishing and managing 911 services. They do this by contracting with the RCMP or E-Comm, collaborating with other municipalities or providing the 911 service themselves. In many cases, provincial governments are becoming more involved in funding and setting provincial standards and policies for 911.

Similarly, British Columbia needs arm’s-length oversight of 911 to ensure that the primary objective is holding public health and safety in the highest regard, with a clear entity responsible for monitoring and maintaining public safety services. Accordingly, our second recommendation is that the province review the governance structure of E-Comm to ensure that B.C.’s 911 system is sustainable and that 911 service follows best practices regardless of location.

D. Grant: BCEHS reports that 99 percent of overdose patients survive if they receive paramedic care, and the sooner help is reached, the better the chance of recovery. When an emergency response is delayed, permanent injury and death are more likely. So 911 is a vital point of contact for overdose response in British Columbia.

E-Comm handles 99 percent of 911 call answer in the province, but municipal and regional governments are responsible for establishing and maintaining 911 services. In British Columbia, municipalities only have two primary funding sources for 911 services — a call answer levy on land lines and property taxes. Not surprisingly, there are regional differences in the 911 services. But, concerningly, there are still areas of British Columbia — specifically rural, remote and Indigenous communities — that do not have access to 911. In these regions, physical help is often at a distance, making it all the more critical that emergency callers are able to connect quickly with a 911 operator.

Communities that do not currently have access to 911 services have the typical emergency service needs. But inadequate resources for the required infrastructure and access to 911 in emergency situations is an equity issue that requires provincial assistance. With that in mind, our third recommendation is that the province of British Columbia invest in the necessary infrastructure in rural and remote parts of British Columbia to provide access to 911 service.

C. James: Since the overdose crisis was declared a public health emergency on April 14, 2016, six British Columbians die every day because of the poisoned drug supply. The situation is so dire that, as you already heard, overall life expectancy has decreased in B.C.

In Dr. Bonnie Henry’s May 2 presentation to your committee, she emphasized how simply telling people to stop using drugs is ineffective. She outlined how policing practices and gaps in access to medical care disproportionally harm racialized and marginalized communities.

While every community in B.C. is impacted by this crisis, there has been a disproportionate impact on people living in poverty and those struggling with mental health issues and chronic pain. The effects of the overdose emergency particularly impact Indigenous people at a rate of up to six times greater than non-Indigenous people in the province.

In their budget presentation to the provincial government, CUPE’s B.C. division called for $100 million in new funding for critical emergency response to the overdose crisis, specifically including support to expand clinics and programs in rural locations. This solution recognizes the drug toxicity and overdose crisis as a social justice issue.

Illicit drug toxicity, injuries and death are most closely influenced by the rapidly changing composition of local illicit drug supplies. Funding focused on stopping the harm of the poisoned drug supply — such as the Safer Alternative for Emergency Response, offered in Vancouver’s Downtown Eastside as well as Victoria — saves lives. With an annual budget of $1.5 million, this program integrates health care and social services while providing participants with supervised access to medications that substitute the unregulated substances that they would otherwise be using.

[9:15 a.m.]

Early findings show that safe supply services are associated, among other benefits, with lower rates of overdose, reduced use of unregulated substances and reduced hospital admissions. Every community in B.C. should have access to life-saving facilities and programs to prevent drug toxicity injuries and death.

Accordingly, our fourth recommendation is that the province expand clinics and programs that offer a safe supply to those who need it in every community, including rural locations.

D. Grant: In Canada, 911 is a lifeline that the public relies on to reach help when it’s most desperately needed. Everyone in British Columbia should have access to this critical service without delays. A sustainable and equitable 911 service in B.C. requires a multifaceted approach by all levels of government to reduce the strain on the 911 system as well as B.C. Ambulance Service to ensure a streamlined, equitable and resilient 911 system provincewide.

C. James: Thank you again for inviting us to speak today about this issue. We’re happy to take your questions and hear your feedback.

N. Sharma (Chair): Thank you so much, Carrie and Donald, for your presentation. We also have your materials in front of us on the screen, so thanks for laying that out pretty clearly.

Questions, colleagues?

M. Starchuk: Thank you for your presentation. Your job is not something I would ever want to do. Thank you for what you do. I can only imagine, from seeing some of the numbers that are out there, the amount of mental stress claims that dispatchers are going through, because your imagination runs far wilder than what we’re actually seeing at the other side.

One thing for clarity. Emergency Communications Professionals of B.C. — that’s just a naming convention for the local?

D. Grant: That’s right. Yeah.

M. Starchuk: Okay. So there are no other jurisdictions where other people are a part of this?

D. Grant: We only represent the members at E-Comm 911. We’ve got members in Saanich, Burnaby and Vancouver, but there aren’t any other organizations that are currently affiliated with our local.

M. Starchuk: If I may, I’m curious — when you made a comment that some of the provincial governments are becoming more involved. Can you just explain to us how many of the other provincial governments have a — for lack of a better term — private entity running 911?

D. Grant: E-Comm’s governance structure is unique. It is an emergency communications corporation, which is governed under a specific act that’s unique to British Columbia. There are other, I guess you can call them, private corporations, but they’re really run by governments. If you look at the board of E-Comm, it has seats designated by different municipalities, and those municipalities have the oversight and direction of E-Comm via those board seats.

It’s a 22-person board, and it is a unique funding structure, where it has about 73 different municipal payers that come into it. From our perspective as a union, it’s an incredibly large undertaking to go on a government relations campaign when we have 73 different municipalities that we have to interact with in order to make some substantive change at E-Comm.

I can tell you that about two years ago, when I started doing this, most people didn’t know what E-Comm was or that they even paid into it. That has significantly changed because of the issues at E-Comm coming to light and coming to the forefront of people’s attention. But across the country, the governance structures are different. Some of them are undertaken just by cities or regional districts. In other cases, they’re moving towards a wholly provincial system. So it’s very varied.

I know there was a fulsome research document that was put to UBCM in 2013, but more work needs to be done. It’s a constantly changing and evolving situation across the country. I know that many communication centres are struggling with the same problems that we are.

S. Furstenau: Thanks for the presentation. I’m just wondering if you have data on the number of calls that are drug poisoning or overdose calls and trends on that data to help us understand.

C. James: We don’t, really, because those calls are transferred to the ambulance service. On our end, we don’t. As a 911 operator, we wouldn’t ask what the nature of the emergency is unless somebody started volunteering information. An ambulance call is an ambulance call. It could be an overdose. It may not be. But I know that BCEHS had put forward that it had quadrupled in the last three years. What the actual numbers are, I’m not sure.

S. Furstenau: Thanks for that. One more follow-up just in terms of hiring more staff and the funding model. Can you give us a bit more details about the funding model and what it would take to hire more staff?

[9:20 a.m.]

D. Grant: Throughout 2021, the primary issue that we were having was that E-Comm just simply didn’t have the funding to hire more staff. This year, in 2022, E-Comm secured, from its board, a funding increase in the order of $10 million. Unfortunately, we haven’t been able to see that convert into the staffing numbers that we were hoping to see flow from that. A lot of that has to do with retention of our current members.

S. Chant: Thank you for the work you do. I can’t imagine. Question: a possible percentage of people you have on long-term disability?

D. Grant: That seems to be changing every week. We saw a tremendous increase after the heat dome. I don’t have the exact numbers with me. I can provide that.

S. Chant: If you’ve got a sort of ballpark, that would be great.

D. Grant: I think we saw about 15 to 30 members go off immediately after the heat dome. We’ve seen a consistent amount of folks going off every single month.

S. Chant: That’s out of approximately how many?

D. Grant: That’s out of approximately 150.

S. Chant: One hundred and fifty. Okay.

S. Bond (Deputy Chair): Thank you so much for your presentation and for the work you do. It is work that is essential and incredibly challenging.

I just wanted to ask about the measure that was put in place in December. Basically, you end up with two frantic people who are stressed beyond belief. That would be the dispatcher, who has to disconnect, and the person sitting on hold, waiting for a paramedic in, probably, a traumatic situation.

Have you been given any indication of when that…? I look at your presentation. The words you used were “stopgap measure.” You point out that it actually does not meet national standards to disconnect from a person who is making that call. Have you been given any indication on when that stopgap measure, which was supposedly temporary, is going to revert to a process that meets national standards?

D. Grant: We have been working hard with our employer to increase staffing levels, but we have not heard of any projected or conceptualized end time for that policy.

C. James: I would add to that. New staff, as they’re being trained to take those initial 911 calls, are just being trained to follow this policy. They’re not actually, as far as we know, being told that it’s a temporary policy. That’s what they’re learning to do. But it does have more to do, perhaps, with B.C. Ambulance staffing.

S. Bond (Deputy Chair): The system — if I might, Madam Chair — is all interconnected. You made that point about the need to have a coordinated approach and work across all of the various front-line workers.

I’m assuming that the challenges you have faced, as dispatchers… I don’t think…. The trauma that’s faced — is that one of the major retention issues? You noted that one of the big challenges is retaining the people who work in the system.

Can you just speak to if you’ve seen that increase during COVID, during the heat dome, those kinds of things? What are the big issues with retention?

C. James: There are a lot of challenges with retention. One of the challenges that needs to be overcome is just how difficult this job is and how complicated it is by default, even when we’re not dealing with clearly traumatic situations.

We’re dealing with human element, technology, multiple agencies. It’s very complicated, and a lot of people struggle, right from the start, to be able to fully comprehend the work that’s done and how to prioritize it. What I’ve seen is that, primarily, we have people who come in, and they’re trying to do this very challenging job. They still don’t fully have the experience to feel confident, feel competent in their jobs.

[9:25 a.m.]

Then they’re faced with these traumatic situations where it’s very easy to criticize the work you’ve done. Because you’re dealing with emergencies, it has to be very fast. It’s very easy to make minor and larger mistakes.

People who don’t have that foundation of knowing that they can do the job well are suddenly faced with a situation where it’s truly life or death. Now they not only question whether they’ve done the job properly, but they don’t have the psychological support that’s necessary to be able to process the incident, process their feelings, guilt or whatever the case may be.

Some of that has to do with staffing, where we haven’t always had the resources for people to do critical-incident stress debriefings after these incidents. We’ve had major incidents where multiple people are being impacted, where they don’t have the ability to take the time to go off the floor, debrief the incident properly, figure out a strategy for getting back to that place where they can comfortably do the job.

Also, right now we have, in some cases, mandated overtime. We already have a very thinly stretched staff, where people are routinely working pretty large amounts of overtime. They’re having to come in and work additional overtime, sometimes cancelling vacations or family plans. So that’s creating some strain as well.

We’re also losing people to centres that either pay better…. For example, Calgary is a similar centre. I think it’s one of the only centres in Canada that’s similar in terms of the coordinated response that they do as well as the geographic area that they dispatch for. They are paid something along the order of $15 more an hour, I believe, about 20 percent higher than we do, with a lower cost of living.

Or they’re moving to more local agencies like Langley or North Vancouver, where the pay is basically the same, but they’re only dealing with one agency. So it’s one set of policies. It’s quite a different environment.

D. Grant: We did a survey of our members, actually, because we were putting forward some solutions to the employer, and we wanted to have the backing of the voice of our members behind us.

The first thing they said that needed to be fixed was the workload and staffing. The second thing they wanted was front-line support, as you can hear from Carrie. She’s actually one of the team leads. She helps a lot of the new call-takers. So front-line support.

The third thing was pay. Because we’re struggling to fix the first problem, people can’t even breathe in between their calls. They can’t go to the bathroom. There are really difficult situations across the board, but we can’t just make people appear, right? So we’re focusing on the third element there. At least that’s something we can do to stop the flow of people that are exiting the organization.

T. Halford: Thanks for the presentation. When you talk about areas of British Columbia that don’t have access to these services, are you confident that we’re on a path to get that access to those services? Do you guys have a percentage of where we’re missing?

The second thing is: if we did get access, my indication is that we probably don’t have staff to support that access at this time, right? Maybe you could comment on that.

C. James: It’s by population, and you can correct me if I get this off. By population, it’s about 1 percent. But the geographic area, in the most recent report that I found, was almost 25 percent of the province, because it’s these really rural and remote areas, which is why different communities are impacted disproportionately.

In most of those regions, you can reach 911, but you have to dial a ten-digit number. The residents may be aware of that, but any travellers or visitors wouldn’t necessarily know that. Then there are also specific areas where there’s just no cell coverage, when you’re driving through a dead zone.

As to whether or not it’s coming, I don’t have an answer for that.

D. Grant: At one of the conferences, I had a long conversation with one of the telecom representatives, and they said that they were working on it. As to whatever extent, I don’t have the information available to me on the progress in covering the rest of the province with 911 service.

To break down the different responsibilities of a 911 operator, we have something called a queue agent, which is responsible for answering the question, “Do you need police, fire or ambulance?” and transferring that call to whatever agency.

[9:30 a.m.]

We’re finding that’s the easiest position to recruit for. Often we’re filling those positions with student employees who are able to do that on their off time and where we need it the most, on something like a Friday or a Saturday night. So in terms of being able to handle the 911 call volumes for these rural and remote areas, I think we’d be able to cover that.

The bulk of our work is…. When you see the service start to degrade, the first thing that you’ll notice is that the non-emergency times start to get longer and longer. I’m sure folks have seen some of the reporting on that, where it’s multiple hours in order to get through to the non-emergency line. The first indication is that the non-emergency times are starting to get out of control, kind of like a canary in the coal mine type of situation.

When it comes to 911 service, after the non-emergency lines start to get impacted, it flows over to the emergency lines. For example, a police call could take anywhere from five to 40 minutes, depending on the nature of the emergency or how far the response time is to get to that critical incident.

Then the 911 transfer…. Usually, before 2021, that transfer would take an order of seconds, anywhere between one and 40 seconds. More recently, it’s taking longer. But that’s the shortest part of the emergency response system when we’re talking about the length of calls.

That’s usually how we see the flow-through of these impacts. I think the key difference between us and B.C. Ambulance is that they don’t have a large number of non-emergency calls. We do.

D. Routley: Could you describe the training process? Both Trevor and I were on the committee reviewing the Police Act, and we heard some information about how difficult that process is, how long it is and how it essentially takes someone off…. It’s a hand-holding exercise. That being the case, how do you envision increasing the staff available at as rapid a pace as possible?

C. James: The training process is generally evolving pretty consistently. Right now, E-Comm is doing a pilot program through 2022, where they have implemented a few things that are quite different from in the past. The standard right now is one week of classroom training, and then people are signed off to do that 911 queue, where they do the triage of the calls, transfer them to police, fire or ambulance. That’s quite straightforward. There aren’t a lot of issues around recruitment or retention for those positions. They’re quite stable in terms of the numbers.

Then once they’ve been on the floor as a queue operator for a period of time…. This varies, depending on whether they’re student employees, in which case they’ll generally just stay in that position. But also, it depends on the availability of classroom space to move people into the police or fire call-taking training. That training is three weeks in the classroom, with specialized training staff. Then they go out on the floor, and it’s six blocks, which is four days on, four days off work weeks, which we have. Currently, they’re doing…. Normally, our shifts are either 7 a.m. to 7 p.m. for two shifts and then 7 p.m. to 7 a.m. for two shifts, or there are a few other standard shift patterns that we have.

That’s what we typically do with the training. They’ve adapted it. Instead of having people work those full nights, where we know that learning and retention diminish quite substantially, they have them doing a 12 o’clock to midnight shift pattern for the first couple of weeks, and then they move into a 3 p.m. to 3 a.m. shift pattern. So it’s six blocks of that with a dedicated…. They’re calling them peer coaches right now. That person is connected to them by a wire. They are able to hear everything the person says. They’re prompting them with what questions to ask. They’re supporting them as they get comfortable with the technology, learning our different software systems.

At the end of those six blocks, somebody is typically either signed off, and then they’re on their own, or they might be given a couple of extra days with somebody from training if things are just kind of not quite where they need to be. But that’s essentially it. From there, then they’re under the purview of the team leads, who monitor their calls and provide support as they can to try and get them prepared for their pre-technical and technical assessments, which usually come around the six- to nine-month mark. At the end of nine months, they’re finished their probation. They’re on their own.

[9:35 a.m.]

One of the challenges that we have is we don’t have a lot of front-line support, and some of that is because we need everybody to be actively taking calls or dispatching calls. We do have team leads. However, the team leads often have to take police calls, because our call volume is so high. When you consider that on the operations floor at any given time, you could have 30 to 40 call-takers having one team lead in order to provide support, and that team lead potentially being busy on emergency calls and unable to provide support, it’s fairly lacking.

There is that very secure bubble period, where they’re in that training umbrella, but at the end of that, they’re just kind of on their own. Hopefully, somebody is able to provide them support as they need it, in corrections, but it’s not a very secure or consistent support that’s provided.

D. Routley: It’s clearly a major obstacle to addressing the problem very quickly. Have there been any suggestions or ideas put forward as to how…? Are there any new ideas or suggestions out there that are being considered that might take us a little quicker through the process?

C. James: There are a few things that are kind of at play right now in that training zone, which we don’t always have full information on, because we’re not always invited to the conversation to make sure that our perspective is shared.

D. Grant: What I would say, though, is that I think last year, E-Comm hired over 100 new employees, and we’re on track to need another 100 this year. The year before that, I think it was about 100 as well. So they’re hiring an incredible number of people. It’s the retention problem that’s….

If we’re talking about 100 people…. In the PwC report, it was 150. So if we kept 100 percent of 100, we’d be well on track to fixing the service. It’s just the problem of retaining the folks.

C. James: To be clear, our numbers have not substantially changed at all between the retention issues. We’re still sitting at the same numbers as we were.

D. Grant: I think the employer was reporting in the news a couple weeks ago that we were 20 percent under where we were last year, so it’s a significant problem — retention.

D. Routley: Thank you.

N. Sharma (Chair): I have a question. I just want to start by acknowledging and thanking you for the work that you do. I know it’s probably been a really tough time to be answering people in emergencies.

I guess I wanted to understand a little bit more about the funding model that you operate under. It sounds like it’s municipal. I think you mentioned that there are property taxes and fee-per-call, or something like that. Then also, you mentioned about an amount of money that came in for staffing. Where did that come from? If I could understand that a little better.

D. Grant: It’s incredibly complex. In the reference document, in appendix A, it lists out the regional districts. I think, when we were talking earlier, we were talking about that first, should-be-40-second, triage call, where we’re asking you if you need police, fire or ambulance. That’s funded through those regional districts that you can see in appendix A of our document.

If you go to the next page, in appendix B is the police dispatch services. Those are primarily provided through municipalities. That’s through whatever funding mechanisms the municipalities have available to them. Usually that’s property taxes or whatever funding mechanisms that they would have at the municipal level. Sometimes the different cities or towns band together, and then they’re paying for it as a regional district.

Then, finally, in appendix C there is the fire dispatch services. That’s another amalgamation from whatever funding structures local governments have. You can see that there’s a number of regional districts that are grouped together — for example, the Fraser Valley regional district. They go in together. But then, obviously, the bigger cities, such as Vancouver, would be paying for it just straight-up for themselves.

Then each of these organizations — whether that be a regional district, whether that be a municipality — have a contract with E-Comm to provide the service. They can enter into just the 911 service through their regional district. They can enter in for a police dispatch contract through whatever arrangement they have, whether that be through the regional district or whether that be directly from the municipal government.

[9:40 a.m.]

I also understand that there are some other areas that have the province pay for their police dispatch services, so there are additional layers on top of that.

Finally, the fire dispatch service is the same. It’s municipalities and regional districts. It’s an incredibly complicated funding model.

When I started this job…. I became involved in the leadership of the union in, I think it was, May 2020, right at the beginning of the pandemic. A nice time to jump right into it. Each month I seemed to be learning something new about the funding model. It’s just simply so complex that you have to get all these people onside to go into increasing 911 service. It’s only until the problem comes to light that it gets reacted to. The funding model is really reactionary, and it doesn’t meet up with the inflationary demands of 911 service.

N. Sharma (Chair): So would the money that you talked about that came for increased staffing…? Where was that? Was that at regional districts? What was the…?

D. Grant: Yeah. It’s a combination of all of the above. The E-Comm board approved a $10 million increase for the operating budget. My understanding…. We haven’t been able to secure confirmation, but that has been supported by the municipalities and the regional districts.

We also don’t have any visibility to the board structure or the funding structure, so we don’t actually, as the union, know. That would be a good question for our employer — whether it has been fully funded. But our understanding is that it is.

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

C. James: One thing on that is that it was a one-time, 2022 only increase in funding. It wasn’t a long-term approval.

N. Sharma (Chair): So it flowed through the contract somehow. Okay, thank you.

Next up we have Shirley. Go ahead.

S. Bond (Deputy Chair): Trevor asked about rural, and Doug asked about training. I’m just wondering if you can explain mandated overtime. Does that suggest that a person, even when they have done a full shift, which we know are difficult at best — that they can simply be told they must work overtime?

Can you just walk through that issue, because I did hear that raised in the media this past weekend as well. Could you just walk through what mandated overtime is?

D. Grant: Obviously, it’s a terrible situation to be in — such minimum staffing levels that mandated overtime is a looming possibility for our members. It adds an incredible stress and burden to them on top of everything else that they’re experiencing.

What mandated overtime looks like…. There’s a provision in our collective agreement that says that on written notice, you could be required for overtime. It’s a last-resort mechanism to ensure that minimum staffing levels are met. What that looks like is that you’ll be working your two days, 12-hour shifts; your two nights, 12-hour shifts. And then on your last day, you’ll see a supervisor or a manager walk onto the floor. They’ll have a piece of paper. It’s a letter written to you saying that you’re required to come in and work another 12-hour shift on top of what you’re already working.

Frequently, our folks are putting in incredible amounts of overtime in order to meet staffing levels as they are right now. It’s just simply an unsustainable way to be continuing on. If you think about the competition for our very highly qualified, highly skilled members, just the possibility of the looming threat of forced overtime is a severe and grave concern about the sustainability of the organization on an ongoing basis.

It impacts people tremendously. I didn’t get much sleep this past weekend thinking about the folks that were on the front line taking those calls. It’s a terrible situation to be in where that uncertainty is persisting.

S. Bond (Deputy Chair): Can you just clarify? Has it been utilized? Have you been forced to work overtime? Have your members?

D. Grant: Yes. Yes, it has happened. It happened this past weekend, and it happened a few weekends before that, I believe, on Fathers Day. It’s a real thing that has happening.

M. Starchuk: Thank you for painting the glum picture that it really is.

I want to go back to the unattended transfers and where the — maybe the lack of a better term — hand holding before you can give it to a dispatcher, as a call-taker, and putting it into hold.

[9:45 a.m.]

Your number that you’ve come forward with is…. You’ve got 153 call-takers, and you want to see it go up by 125. But my line of thought is that if you increase your call-takers but you have no one to hand it off to, how does that increase?

As I understand the system right now, you’ve got the call-taker that’s there at 911, but you have nowhere to transfer it because B.C. Ambulance Service, that’s taking care of the overdoses, is already tied up. If we go ahead and do that front-end-loading of the call-takers, where does that come into play with the dispatch from B.C. Ambulance Service?

C. James: It’s definitely something we’re…. It is also dependent on B.C. Ambulance staffing in order to resolve that as an issue. But one of the things at E-Comm that we do…. Because we answer both that primary 911 call and we do our own in-house police and fire call-taking, our call-takers and 911 operators are often cross-trained to do both.

Police call-takers — and in many cases, the fire call-takers as well — do also take 911 calls. So when we’re getting an overflow of those 911 calls, that means that our call-takers are tied up on the line, waiting to transfer calls through, and they’re no longer able to answer the emergency calls that are coming through to the police and fire lines that they would normally be answering calls for.

I know there’s some information on how the difference of one person available, the delays that that creates. There’s a fair bit sort of outlining how one person would make this much of a difference in the delays, two people would make this much, ten would make this much. But in many cases, when we are what we call red-lighting, where we have more calls coming in than we have call-takers available to answer them, it’s not always B.C. Ambulance that’s causing those delays. We are pretty significantly short-staffed on our own.

That figure from the PricewaterhouseCoopers report of 125 additional call-takers being required was not…. That was prior to the heat dome, prior to B.C. Ambulance having their own staffing shortages. So it’s independent of that. I think it would be quite different if we looked at the numbers now with this additional challenge that we’re dealing with.

M. Starchuk: Just a follow-up so we make it clear. The committee is looking at, specifically, the overdose and the toxic drug supply. Part of the numbers that you’re presenting to us are to deal with police and fire, that are on that side. So it’s not specific that 125 will directly affect the medical side of things. A portion of it will.

C. James: Definitely. It’s not a direct response. But something that’s important to keep in mind is that a lot of the time, when passersby or staff of businesses call in for overdose-related calls, they don’t call the 911 line. They will call the police non-emergency line. They see a person who’s unconscious, and they’re looking at it as, “This is someone that needs to be removed,” as opposed to: “This is somebody who’s experiencing a medical emergency.”

We actually get a fair bit of those calls on our non-emergency lines. So even though it’s a B.C. Ambulance issue, those calls aren’t coming in through the normal pathway that would go there. So we still need that multi-faceted response where the fire dispatchers, the police dispatchers, are available to take those calls.

I don’t have any statistics on how many come through that way, but I know from personal experience that I’ve taken many calls where it’s clearly an overdose. Somebody clearly needs urgent medical attention, but I’m taking that call on a non-emergency police line. That’s kind of where it does play a more direct role in impacting the opioid crisis.

S. Chant: You talked about the training program, and you talked about sort of the at-the-elbow peer-assisted time. It seems to me that we don’t have anybody — we being us, you — that you can actually put on as a peer, which tells me that your retention is impacted right then, because somebody who’s going through this without somebody right at the elbow to say: “Well done, you. You got through it” and/or “Okay, let’s think about this….” That’s got to be very traumatic, for starters.

And a team leader for 30 to 40 people is not even reasonable. Unless you’ve got that peer support in place, you can’t do that.

Thank you for that outline. That concerns me. Thank you very much.

[9:50 a.m.]

N. Sharma (Chair): I just have a couple of questions here, and then I think that’s all of them.

My first one is…. I understand that your role is not to give medical advice on the phone. I just was really curious as to whether the opioid crisis has changed any of your training or responses or anything that shows up for your members. That’s the first question.

The second one is on the stopgap measure. Who holds that policy or decision?

C. James: In terms of training, there has been no change. I know there are legal implications if we were to provide medical advice when we don’t have the training. I think it’s probably fairly evident why there’s no capacity for us to have that additional training.

We have the exact same procedures in place, the exact same policies, the same support where we are literally just saying: “Stay on the line. Somebody will answer.” We are directed to tell people: “I’m not medically trained. I’m unable to provide you with any advice.”

D. Grant: About holding the decision on the 911 ambulance disconnect policy, it’s unclear to me who holds that. However, in the communications that E-Comm put out, both externally and internally, they said that they made the decision, holding public safety in mind.

I don’t know what procedures went into making that. I would assume that there was some sort of regional district consultation. However, that process is not transparent or evident to us.

N. Sharma (Chair): That’s very helpful.

Mike, you had a question. We have a little bit of time, so go ahead.

M. Starchuk: Thank you, Chair. With the advent of NG911, and with the theory that there’s a fourth button coming, with mental health being one of the resources that’s there, is 125 enough?

D. Grant: It’s interesting. The PwC report is about a 90-page document. In it, they outline a number of efficiencies that would hypothetically reduce the number from 125. We haven’t seen any of those efficiencies take place.

If we’re still maintaining current service levels, 125 was forecasted for last year. It might be even more, now that a year has gone by. I would expect that if that fourth option were to become a thing, it would have to go through another, similar analysis as to how many folks would be required to do that.

At the same time…. I think Carrie might be able to speak more to this. We do stay on the line with folks that are in mental health crisis. I’ll let you speak to it. Basically, there’s only one option for those call-takers when they are presented with such an issue.

C. James: Our 911 operators will transfer callers to whatever service they request, unless the caller is unsure. Somebody with a mental health crisis might ask for the ambulance service, in which case, they would stay on the line with them. If they ask for the fire department, the fire department would send them back to the police. If they weren’t sure what they wanted, we would have police respond, because when somebody calls through to 911, we have to make sure that their safety is ensured. So that, in almost all cases, will result in some kind of police file.

Police may go. They may speak to a mental health team. It’s kind of hard to say what will happen. It will depend on the history of the person as well as what specifically they’re saying when they’re on the phone with the call-taker.

If we had a fourth option, because that is a fairly large proportion of our calls…. In 2021, I think, check well-being, which is what these mental health calls will usually go up as on the police side, was the third-most-common police file that we generated in the dispatch centre. It is a very substantial portion of our call volume, whether it’s somebody calling in with a mental health issue, where they don’t know where else to turn, or whether it’s somebody else calling, saying: “I’m concerned for this person’s safety.” They’re all lumped into the same one.

It could substantially free up our staff if we were able to transfer them to somebody that has more training and more resources available to actually provide them with some assistance that might be more effective than somebody with a badge and a gun showing up.

N. Sharma (Chair): On behalf of the committee, I just want to thank you for coming here today, preparing such great materials for us to read and helping us learn from you and your experience. Thanks for all the work that you do, you and all your members.

D. Grant: Thanks so much for having us.

C. James: Thank you.

N. Sharma (Chair): We have about five minutes of recess, which is not much. We’ll start again at ten.

The committee recessed from 9:55 a.m. to 10:01 a.m.

[N. Sharma in the chair.]

N. Sharma (Chair): We’re back, and it’s my pleasure to welcome our next guest.

We have the Pacific AIDS Network, or PAN — Evin Jones, JD, executive director. Welcome.

And we have the Coalition of Substance Users of the North — Charlene Burmeister, founder. Welcome also.

I’ll do a quick round of introductions, and then it’ll be, I think, 15 minutes for each of you, and then we’ll have time after for discussion.

My name’s Niki Sharma. I’m the MLA for Vancouver-Hastings and the Chair, and I’ll just go to the phone here, where our Deputy Chair can introduce herself.

Go ahead.

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

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. I’m the MLA for Courtenay-Comox.

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

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

N. Sharma (Chair): Great. I’ll pass it over. I’m not sure who’s going to start, but go ahead, Evin.

Briefings on
Drug Toxicity and Overdoses
Panel 1 – Community
Outreach Organizations

PACIFIC AIDS NETWORK,
COALITION OF SUBSTANCE USERS
OF THE NORTH

E. Jones: Cheers. Thanks, Niki. Good morning, everyone. My name is Evin Jones, and I’m the executive director of PAN.

First, I just wanted to acknowledge that I am an uninvited settler here on the traditional unceded territories of the Musqueam, Squamish and Tsleil-Waututh Nations. Thanks so much for inviting us here today.

C. Burmeister: Good morning. My name is Charlene Burmeister.

I’d like to echo the recognition that we’re on the unceded territory of the Musqueam, Squamish and Tsleil-Waututh.

I’ll be presenting today as the founder and executive director of the Coalition of Substance Users of the North, or CSUN. It’s an alliance of people who use or have used currently illegal drugs. I’ll be taking some more time to discuss our critical work in the presentation.

I’d also like to mention that I have over 13 years of experience in peer engagement and leadership and hold several roles, including people with lived and living experience stakeholder engagement lead for the B.C. Centre for Disease Control. I’m the provincial peer coordinator for the compassion, inclusion and engagement project, which was a partnership between BCCDC and First Nations Health Authority. I also sit as a board member with the Canadian Association of People who Use Drugs.

E. Jones: Again, thank you, everyone, for the invitation to come and present today.

PAN is a network of over 40 community-based organizations, including peer-led organizations, working in every region across the province. We have members working in rural and remote locations and small urban locations as well as throughout Vancouver and the Lower Mainland. Our members are working on the front lines, addressing HIV and hepatitis C and also providing harm-reduction services and responding to the drug-poisoning crisis.

As we are now in the seventh year since the public health emergency was declared, we sadly see some all-too-familiar similarities and lessons that we could have and should have learned over the course of the HIV epidemic here in the province, specifically how stigma disadvantages people who use drugs and puts them in harm’s way — the disproportionate impact of overdose and overdose deaths on marginalized populations, including Indigenous peoples, poor people and homeless people, to name but a few.

[10:05 a.m.]

As a provincial network, we are attuned to the needs, challenges and, frankly, the heartache around the province of organizations and the peer groups working on the front lines. We advocate with and for our members, and it is our members who drive our work at PAN.

Our members are the experts on the ground, and their voices are key. Members like AVI Health and Community Services on Vancouver Island; ANKORS, working throughout the Kootenays; and Phoenix Society in the Fraser region, to name but a few; and very, very important peer-led organizations, like CSUN in the North. At PAN, we believe it is absolutely essential to listen to the voices of peers and people who have lived or living experiences of using drugs, as they’re the ones with the solutions.

When PAN was invited to present today, we reached out to CSUN to see if they would be willing to co-present with us. We wanted to take the opportunity to highlight CSUN’s work, their successes and their challenges, particularly as an organization that is working outside of the Lower Mainland, in Quesnel.

We know, hearing from our PAN members, how things for people who use drugs outside of large urban locations look very different than in the cities. So just to say, too, that the solutions and recommendations that Charlene is going to bring forward today very much reflect the solutions and recommendations of our entire membership at PAN.

C. Burmeister: I’ll just speak a little bit about CSUN. CSUN is an organization that was formed four years ago, which was the first drug user organization in the northern region. Through the work that I’ve been doing for, as mentioned, over 13 years, I recognized the value that drug user organizations brought to their community and recognized that we needed to move this towards the northern region.

CSUN is an organization that was really built out of necessity, recognizing the deep impacts on people who use substances and the negative consequences they faced in regards to stigma and racism and the other challenges, certainly from a rural and remote perspective. We are an organization that is built by and for people who use substances, both in past and present context. We’ve been doing a lot of the work that really should be falling on the shoulders of the health authority. We’re the first organization — the first place in our community — that had a publicly accessible OPS.

I just think it’s really important that we recognize that drug user organizations are doing amazing work around the province. Yet we are precariously funded, pretty much every day. I think it’s just really important that we’re recognized for the work we do and given the privilege and respect that we deserve and the funding that is necessary to continue with those services to create better outcomes for people who use substances.

I’ll turn it back over to Evin, briefly.

E. Jones: Thanks, Charlene.

We thought we would just focus our presentation and related recommendations on two key areas. The first one of those is what Charlene just mentioned there, talking about the situation of CSUN, and that’s around funding.

Community-based organizations, including user groups, have been shouldering a huge burden in terms of work, care and grief. Obviously, particularly in the last 2½ years, the challenges have been extreme, working with the dual epidemics. Our position, and what we hear often from our members, is that we need to have sufficient and accessible funding for the work happening on the front lines. The funding has to be sustainable.

Also, people need to be compensated — the staff and the peer workers — fairly. The other challenge is that we’re having a very competitive labour market. It’s very hard to secure good people to keep doing really hard work.

One of the challenges around the funding is that…. I think that when the NDP created a separate Ministry of Mental Health and Addictions back in 2016, there is no doubt it was done with the best of intentions. But one of the challenges is that we seem to have these multiple layers of bureaucracy. We have the Ministry of Mental Health and Addictions, which provides policy guidance, things like that. But then the vast bulk of funding for the province’s overdose response comes from the Ministry of Health. Then, in turn, the Ministry of Health funds the health authorities.

[10:10 a.m.]

The end result is that on the front lines, at the community-based level, the funding that is available is patchwork and insufficient, and it varies too much from one health authority region to another.

As mentioned, many PAN members are the sole provider or only one of a few that are providing harm reduction services in regional and rural communities, and members have consistently identified challenges with funding models or approaches from regional health authorities that limit their ability to be responsive to community needs in the face of the drug poisoning crisis. Things include short-term contracts, funding for time-limited projects with restrictive criteria with little room for community engagement.

Members also report that there are very few mechanisms for their involvement in the development and implementation of the overdose response, and there are no provincially applied policies in the delivery of harm reduction services.

Our recommendation is that CBOs and peer user groups like CSUN require consistent core funding and procurement processes to be able to sustain their work, retain staff and allow for flexibility to deal with whatever comes next. We ask the Ministry of Health to work collaboratively with the Ministry of Mental Health and Addictions to develop new funding approaches or models to support the front-line response to the drug poisoning crisis and essentially find a better way of resourcing the work on the ground.

C. Burmeister: I’d like to speak to the key message around expanding safer supply. We need to provide people who use drugs with true alternatives to the poisoning drug supply and other harm reduction services where they are needed. Our second key concern and set of solution recommendations pertains to the need to expand safer supply and offer up alternatives to the toxic drug supply. As you have no doubt heard already, there are some challenges with people being able to access safer supply as provided by the current risk mitigation guidance.

PAN surveyed all of their members twice and presented their findings to Minister Darcy and Minister Malcolmson from these surveys and from our regular meetings with members and allied organizations. We heard about the following challenges: lack of prescribers, especially in regions like the northern; too low of a dose available for people to start; the need for other options besides hydromorphone to be prescribed. People need to be diagnosed with a substance use disorder, and that can be a barrier.

Other things that were related to what we heard were about a lack of testing options for drugs, especially outside of the Vancouver area, and how stigma and criminalization of drug users leads to using alone and greater risk of harm. Municipal bylaws and policing practices are having a deadly effect. And lack of inhalation options. The need for inhalation options is dire, as smoking is now the most common method of illicit drug consumption.

Some of the solutions and recommendations that were born from this. We need to strengthen and expand the medicalized solution, building on the good work that came from the risk mitigation guidelines. This includes expanding the formulary of prescriptions that are already available. This includes options for inhalation.

We need to engage more prescribers, physicians, and develop more ways for nurses and nurse practitioners to be involved. We need to develop options for virtual prescribing, such as telehealth and Zoom, especially important for rural and remote regions. We can look toward the FNHA and their doctor of the day program.

We need clear direction from the province to municipalities to support more overdose prevention sites and witnessing where needed, not shut these down with municipal bylaws. We need to ensure that any new supportive housing or complex care housing has witnessing and other services on site to stop people from dying alone. We need key partnership with B.C. Housing in order to make this commitment.

I just want to continue a little bit about looking to CSUN’s work as a model of our success. We offer prescription alternatives through delivery. It is important to recognize that substances are delivered, so just mentioning that drugs are delivered. We have, certainly, systems where people can access substances and have them delivered to their homes.

[10:15 a.m.]

We’ve recognized that delivering the prescription alternatives has also really supported the success of people and the efficacy of their engagement with prescription alternative programs. It really stabilizes people who use drugs and moves them towards a better continuum of care. Especially, thinking about this, it’s not even happening in bigger cities. And then also to move towards a better dose in a quicker way, via titration.

We know that rural and remote areas are not getting the best outcomes due to isolation, like on reserves. FNHA peers are vital in this. We have ideas for weekly drop-offs to reserves around Quesnel. Engaging directly with their peers helps those who have been already harmed by the system, by oppression and stigma, and it is vital to their health care, social determinants of health and engaging with wraparound services. Peers doing intake forms and making applications also give medical staff more time to focus on their areas of expertise.

At CSUN, we’re working so that we can have many successes with the medicalized model, but we also need to support a call for non-medicalized solutions such as compassion clubs, where people can purchase the drugs they want knowing that they are safe and led by drug-user groups.

I’ll just lend it over to Evin for some final thoughts before we move to Q and A.

E. Jones: Sure. I think our key message is essentially that regardless of how, for example, safer supply might look in the province, we need to effectively engage the community-based organizations, the peer user groups and the folks working on the front lines. We need low-barrier outreach, peers and wraparound supports.

It is the community-based organizations and user groups that are often doing the heavy lifting out there. They’re typically the most under-resourced of all the organizations that are responding to the poisoned drug supply. That needs to be changed.

When we think about the work of CSUN, essentially, they started with nothing, and they’ve made something. It has been amazing to see the trajectory and the amount that they’ve achieved over the course of the past four years with, frankly, very little funding. They basically responded to a need, and they made something happen.

Bottom line, my final message as well is to listen to people like Charlene and other peers — people with lived experience who are using drugs — because again, they are the ones with the expertise and often the ones out there putting their heart and soul into the work.

N. Sharma (Chair): Okay, thank you.

We’ll go to questions.

S. Chant: Thank you for the work that you do. One really quick question, and then one slightly more, if that’s okay. Does PAN stand for something, or does it just mean “overarching”?

E. Jones: That’s a great question. We were formerly known as the Pacific AIDS Network, but we rebranded about a year ago. Our origins came from people responding to HIV. Then over time, our member organizations were increasingly working around hepatitis C and other STBBIs and providing harm reduction services.

S. Chant: To follow in a different way: Charlene, how do members get to you? How do people…? How do you do outreach that gets beyond the stigma barrier?

C. Burmeister: I think it’s important to recognize that drug-user groups have this unique way of engaging with people who use substances, because it is a place by and for…. Within our community, we’re pretty central, as far as substance users go, because access to substances, services and all of those pieces is kind of in the core centre of the community of Quesnel. People congregate within those areas.

It really is just open membership. Anybody who identifies as a person with past or present lived experience with illegal substance use can be a member of CSUN. We also provide harm reduction services within community. We have access to harm reduction supplies, naloxone education and distribution within community. We educate community partners. The Downtown Association and other organizations and agencies have asked us to train them and provide them with naloxone in community. We offer food services and clothing donations.

We have a program that’s called the prescription alternatives peer advocacy program, which is one of the programs that was built from the ground up by Jenny McDougall, who identifies as a person with lived experience. It was really born out of necessity.

[10:20 a.m.]

I just want to mention Laura Shaver; she’s also associated with VANDU. They have kind of worked out those programs themselves, like I said, out of that necessity. They’re really supporting people in communities.

Jenny goes out and engages people who use substances, who she already has a relationship with in community, and explains to them the substances that are available to them through prescription alternatives and then helps to support them to get to appointments. She picks people up. She delivers prescriptions.

I think those pieces, around having a person with lived and living experience doing that work, are the key to overall success. It really helps to remove those barriers and the stigma and the pieces that keep people avoiding services that have historically oppressed and harmed them.

The program that she’s running is just an absolutely beautiful concept. We’re working with researchers right now to try to figure out what that looks like and to support that to be expanded throughout the province and nation and, potentially, in other countries and stuff. The successes associated with it are just amazing, and it really comes from that expertise of a person with lived and living experience knowing what other people that are in that life journey need.

We offer training opportunities. I’d say 85 percent of the people that work at our office are people with lived and living experience. We build capacity. It’s really important for me to invest in future champions. We recognize that many people with lived and living experience are kind of the go-tos in this work. We’re draining them, and we’re asking a lot of them. So it’s really important to invest in those future champions.

It’s also important to note…. I mean, the money that’s being offered to peer-led and drug user organizations is clearly not meeting our needs. We are precariously funded.

I’m just really proud of the work that we’ve done in community for such a long time. It’s just by word of mouth. People get to recognize and know that they’re treated fairly and that there are opportunities for them. Our membership has expanded greatly. We started out. We would have ten, 15 visits at the beginning. We first had a bricks-and-mortar location about three years ago, and we’re now serving about 450 visits per month.

We’re really struggling with food security, as well, at this time. There’s just not enough funding to really implement leadership to expand programming and have the organization move to a really great place.

S. Chant: Artour, do we have a copy of the presentation, or did I miss it? We don’t have it. So maybe can we request…?

E. Jones: Sorry, we didn’t have it together enough. We’re going to provide our presentation after to the committee.

R. Leonard: First of all, I want to say thank you to…

Did you say you go by Evin or Jenn?

E. Jones: Yes, Evin.

R. Leonard: …Evin for bringing Charlene along, really walking the talk.

The expression that was going through my head is that it’s the nature of the beast. We’ve heard a lot around the need for inclusion of the peer voice and for peer organizations to…. The genesis of a peer organization, by its very nature, is not connected to government. If it was initiated by us, there would be issues around trust. There would be all kinds of things.

As I say, it’s the nature of the beast. If it’s going to be a strong organization, it starts from the ground up. I’m interested to see that progression.

I think there were champions that were on the ground that made it happen in the first place in Quesnel. It doesn’t happen in every community. So kudos to those who started CSUN. I love the name, the acronym. I’m not sure what I would apply the C to, but the idea of the sun is really a light shining in the community.

The question is: is that progression of peer support groups…? We’ve had presentations from organizations that have been going on for 12, 15 or more years. There’s a real strength there in their longevity. They grow, and they become more sophisticated. They become almost victims. You talk about all the different things that you’re doing now. You’re a victim of your own success.

[10:25 a.m.]

I’m just curious to see how that progression can be supported by government, to do the work that needs to be done and still maintain that grounding in community.

C. Burmeister: I think it’s important to note that drug user organizations are grassroots organizations. It really is born from the reality that people who use substances were alienated and isolated and actually were harmed by systems quite often.

It is also really important that we maintain our autonomy. Those are the pieces that we need to think about when being funded by health authorities and other government agencies. It’s that we are able to remain autonomous in our decision-making so that we can meet the needs of people who use substances.

Those are the pieces that are really critical. But without funding…. We know that dissemination of funds really comes from leadership of government and other pieces, so the reality is that we need funding. We need core funding. We need sustainable funding, but we also need to maintain that autonomy in order to make those decisions. Quite often systems don’t recognize or validate or value what our experiences are and what we know we need to be doing in community to support people for overall successes.

Yeah. Really valuable. Your insight and thoughts were bang on. Those are the pieces that I would like to highlight. It’s the reality that we do need to keep that autonomy, but we also do need funding. There really is no other place to go other than the systems of where funding does exist.

P. Alexis: You are aptly named PAN, because you have a bird’s-eye view of everything that’s happening at the same time. We don’t often get that, right? We don’t get that lens, where we can look at comparisons and all of that.

This committee is, of course, tasked with making recommendations. You said that there was a patchwork type of approach to funding. Health authorities weren’t necessarily even, as far as the services and funding.

I need you to elaborate and give us some examples so that we can look at this, if you could, please. We don’t often get this lens that you’re looking through. We get very specific things by area. Anyways, go for it.

E. Jones: Yeah. We meet regularly with our members, and often it’s the executive directors of the PAN member organizations who are at those meetings. What we’re hearing is really dependent on what health authority an organization is operating in. The kinds of services or the funding that’s available — that is on offer, that they’re able to secure from their health authority partners — can really look different. I think different health authorities have different procurement practices.

Often, too, the challenge is with the health authority, like the procurement practice for, say, figuring out: okay, what’s the HVAC system going to look like in 30 facilities? It’s the identical procurement practice and approach as contracting community-based organizations to do this really nuanced, very relational type of work with people.

That whole concept of the wraparound support and meeting people where they’re at is often lost. When you just have a medicalized approach, it’s like X number of widgets. For example, people can come in, and they can use a substance, but then they have to leave.

The challenge is with the health authority funding approaches. Again, depending on who is making those decisions, the procurement practices, often the funding is very time-limited. It’s like a year’s worth of funding, which is very challenging to develop sustainable programs.

Frankly, again, just to harp back on my thing about retaining good staff — whether they’re peer staff or other people who are allies and want to be involved with the work — with a really time-limited funding, it’s really challenging to retain people. So those are some of the things that are immediately coming to mind.

[10:30 a.m.]

We do consistently hear…. I mean, I’m not really sure if it’s appropriate to point fingers. For example, how Northern Health might be working, sort of contracting around harm reduction services, might look really different than, say, Vancouver Coastal Health. Some of that speaks to the capacity issues, as well, within the health authorities.

I know that everyone, across the board, at all system levels…. I truly believe that people who are involved in this work…. Whether at the health authority or a community-based organization or a peer-led group, everyone has good intentions and is trying their best within the scope of the system that they’re working in.

I think the other challenge is that there’s no sort of standard…. Say, for example, with CSUN, that there is something that could be working really well. Well, how do we scale that up? How do we look at how the work that’s being done and the best practices that are being developed here…? There’s no real way of scaling that up across our health system. There’s no real way of necessarily saying: “Okay. We want to sustainably fund this so we can make sure that this work can continue.”

CSUN is just an example, but I hear often from other organizations — like ANKORS, AVI, Phoenix — that the funding is very patchwork. Even when something’s working, they’re sort of having to scramble in order to make the programs and services sustainable.

I think part of that, too, is that the Ministry of Mental Health and Addictions and all of the smart people that are working there might see something that is working really well, but then, in turn, the Ministry of Health is the funding body, and then, in turn, the health authorities are the ones that are actually awarding the contracts.

What we’re ending up with is multiple levels of bureaucracy, again, of probably very well-intentioned people, but it’s really getting in the way of the work that’s happening on the ground and that needs to happen on the ground.

I hope that has answered your question.

P. Alexis: Thank you so much for your honesty. We really need to hear this so that we can make the best recommendations possible. So thank you so much for that.

S. Furstenau: Thanks for this very insightful presentation. Furthering what you’ve just elaborated on, Evin, maybe Charlene, can you give us some real-world examples from CSUN of work that’s been done but that has not been able to be continued because of that lack of sustainable funding? What are the implications of that patchwork and unsustainable funding?

C. Burmeister: Well, I think from the perspective of CSUN, I’m situated rather well and have been doing this work, like I said, for many years. So I have a lot of relationships and partners within health authorities and all kinds of organizations and agencies that support the work that we do.

I don’t think that there’s anything, to date, that we have not been able to continue to do, but it really is like securing small amounts of funding. Like: “Okay. We can go for another 20 weeks.” It’s really challenging, and recognizing in the northern region that peer engagement and drug user organizations…. CSUN, as the founder and executive director, was the first drug user organization in the north, and we now, since, have some more new and burgeoning groups throughout the northern region.

With all due respect, I think my perspective is a little bit different. I have allies within the health authority, but I also have people that are working within the health authority in leadership roles that are clearly resistant to supporting us financially or even validating and valuing us as key partners in policy- and decision-making and all of those other pieces.

My perspective as a person who uses substances can look very different. It can look like I’m supported some days, and then other days there’s actual resistance. I’m thinking about municipal interference and a lot of things that we’ve had to face in our community. It’s ongoing, but the reality is that funding is not sustainable, and I’m just constantly working to get little bits of money to keep us going.

We’re working on a skeleton crew. I’ve basically been working for three years unpaid. We know that non-profit society executive directors average $40 to $45 an hour. Many of our peers are also giving many hours of their time, because we know how valuable the work is, and it’s not okay. It’s not fair.

Other people are validated in their work by the pay rates that they get and are not expected to work for free. Certainly, thinking about the complex issues working in the middle of this crisis, and the vicarious trauma that peers face every day, and all of those pieces, it really feels unfair, but it is our reality.

[10:35 a.m.]

Sustainable funding could make all of the difference — and having the money to be able to have people in place to move the work forward in a really great way. Sometimes I feel like I’m doing CSUN a disservice, because I have a full-time job, plus I have full-time work with CSUN. So those are a lot of hours in a week.

I also feel like if I had the staff, we would be able to really expand and move that work forward in a beautiful way, like other drug user organizations have had the privilege of doing — thinking of VANDU and SOLID and ANKORS and REDUN, who’ve been around for some time. We’re in the infancy of our work, but I really hope that we can get there one day as well.

T. Halford: Thank you for the presentation. You talk about the challenges of sustainable funding and the challenges of navigating individual health authorities and how there could be different standards of practice and all that.

Inside of government, do you guys have a key…? Do you know where to go to help you navigate those issues — whether it’s the deputy minister, a ministry — or are you going to multiple places to try and make this all come together?

C. Burmeister: Multiple places. Definitely, we work with the overdose emergency response centre, which is offered $1.2 million, which is nowhere near enough to support drug-use or peer-led organizations. That money, this year, was split amongst 30 groups. There’s just not enough money available to us.

I go anywhere I can for funding, so through PHSA, there’s offer…. PAN gives us access to other funding opportunities. It’s piecemeal. Sometimes I’ll get $60,000. Sometimes I’ll get $70,000. Sometimes I get $25,000. Sometimes it’s $3,000. I just pull everything I can together and make sure that I’m paying peers before I pay myself, because I recognize the value that they bring to this work and that they deserve to be compensated. It’s unfortunately piecemeal.

T. Halford: That would be through multiple ministries?

C. Burmeister: Yeah.

E. Jones: Yeah. I would say, for PAN, we try and foster…. We have some very good working relationships with folks in the Ministry of Mental Health and Addictions.

Often, though, when we bring these concerns forward around funding or core issues, and we might try to approach the Minister of Health or the Minister of Health’s office or the Premier’s office, we’re often redirected back to the Ministry of Mental Health and Addictions. But then, the Ministry of Mental Health and Addictions doesn’t have the authority or the power to necessarily address the concerns that we have around the funding or the accountability structures. It’s like we’re in this loop.

Again, I do feel like people are doing their best, but that’s the challenge I feel — the division between the MMHA and the Ministry of Health.

C. Burmeister: I also think it might be important just to note that there are a lot of dollars going into treatment and rehab, and I think the system just wants to make people who use drugs people who don’t use drugs. It’s not going to happen. It’s not a reality, and it’s not effective.

Harm reduction itself and just meeting people where they’re at and supporting people who use substances to be people who use substances — I think it can look very different for people at different times. Communities quite often believe that people who use substances are those who they see living, potentially, in chaos, homeless. But that’s not the reality.

Many Canadians have good relationships with substances. We may not see them, but it is important for us to note that people are not going to stop using drugs, and we’re not going to treatment our way out of this.

S. Bond (Deputy Chair): Thanks for your presentation. I was interested in your comments about the opportunities to test drugs across the province and the inequity. Can you just speak a little bit more to what you would like to see? We certainly know that, like everything else, the services that are available for people across British Columbia are not equitable. It depends a lot on where you live.

Could you just speak to the issue of drug testing options — where they exist, where the huge gaps are and what you’d like to see change?

C. Burmeister: I’ll speak a bit from the northern perspective. I have a lot of knowledge, provincially, about what goes on. But thinking about the North, where I reside, there are two FTIR machines. One is in Prince George, and I believe the other is in Terrace.

[10:40 a.m.]

It’s at least an hour-and-a-half drive between communities in the northern region, thinking Quesnel to Prince George and then moving out that way. So it’s not respectful.

You’re right. It’s not equitable. We need access to drug-checking services. We need to really be thinking about the contamination of substances and where it’s shifting towards, thinking about benzos and fentanyl and what that testing can look like.

I think it’s important to note, too, that testing, even if it was equitable and accessible within our community, is just a tool in the toolbox. The reality is these are band-aids on bullet holes. We are not going to work our way out of this unregulated poisoning crisis by checking drugs, by trying to make people who use substances people who don’t substances. But I think the inequity is really important for us to think about, and that having options for drug checking is valuable, and many people would use those services. But the reality is that we still need to be providing regulated substances to people.

N. Sharma (Chair): Thank you. I have a couple of questions.

It was interesting. I was thinking a lot about how you’re putting together things that we’ve learned from different places about responses from your perspectives that you offered today. Yesterday we had somebody who’s a public health expert talk about how this, in a lot of ways, is “a wicked problem,” because it changes on the ground while you’re trying to respond.

One of the solutions to solving these problems is to have a set of principles and give people on the front line, kind of like you, the ability to respond. I thought that was interesting, because you’re kind of saying that, in a way of funding those front-line things.

Also, we were learning about how, through the health authority work that we did, the idea of the continuum of care that we offer across the province, and if we had a standard that said: “Here’s what we need in each area” — that that’s been worked on in some of the health authorities.

Then you could put it up to each region and say, “Do you have enough harm reduction? Do you have enough of whatever that continuum would provide?” — youth services or whatever; and then be able to really judge it as a standard for what needs to be doing, and then continue to make the investments to build that up in different regions.

I guess I was curious if you were a part of those conversations, or has that come to the northern region — about this idea of what a continuum of care looks like for the northern region or across the province? That was my first question.

Then my second one was about this…. You mentioned the at-home delivery of prescription — a safe supply. I’d never heard that in other areas. Maybe it happens. To me, that was the first that I’d heard that. One of the things we were learning was that a lot of people are dying at home, because they are by themselves — especially, particularly, a category.

I was just really curious about what that program looks like and how it works and what you’re able to provide that way.

Those are my two questions.

C. Burmeister: I think these conversations are happening quite often around what the continuum of care looks like. But I think the really important piece that is missing quite often is the philosophy of “nothing about us without us.” People with lived and living experience need to be embedded in the design delivery and development of any services which we would be accessing.

But I also think that peers need to be involved closely in the delivery of those services. That’s the piece that we’re seeing with our program at CSUN. It’s that the delivery of the medication — certainly when people are first getting on to them — is really the core to their success. And then we work toward stabilization where people can then go to the pharmacy and access on their own.

That is the piece that we are really seeing this uptake and upswing in — and great success in our community. If we look at what’s going around in the province, and specifically thinking about SAFER on the Island, those are the pieces where we’re really embedding a peer perspective in the model.

I think it’s important to note that that was born from just the necessity…. Sorry. I’m getting a frog here now.

Maybe, Evin, you can speak to that, while I collect myself.

[10:45 a.m.]

E. Jones: Of course. Take your time.

I’ll just lend to that first question you had, Niki, about this notion of the continuum of care.

I fully support it, provided it is, as Charlene said, informed by the voices of people with lived and living experiences. I think that it would be amazing if the province did develop some sort of standardized approaches or standardized level of expectation around harm reduction, service delivery and what is expected within each health authority region, while, at the same time, allowing for some on-the-ground flexibility.

When you think about how the province responded to HIV, we were seen, rightly so, as a global leader. We had this provincial policy called “From Hope to Health” around HIV, how the province was going to address HIV across the continuum of care — testing, treatment, support, etc. There were actual targets and expectations built into that. The health authorities had a certain level of targets that they had to meet around HIV and how they were responding. I think it really helped clarify what the expectations were, and the funding was attached to meeting those targets.

I think having some sort of clear direction from the province about what is expected would be helpful when it comes to harm reduction and responding to the drug poisoning crisis.

C. Burmeister: I really want to emphasize the value of the work that Jenny McDougall is doing in her prescription alternative program. Those delivery pieces, picking people up, taking them to their appointments, advocating at the pharmacy, advocating with the prescribing physician….

The really beautiful thing for Jenny, though, is that we have a prescribing physician who is amazing, who gets it, who understands. Those are pieces that are missing in other areas that we have resistance from prescribers. We know that inherently, doctors have been taught not to give drug users drugs. Many are really struggling with this concept of prescription alternatives and recognizing that what we’re offering today is not meeting the needs of people who use substances, thinking about the pieces that we talked about, about having options for inhalation. Stimulants are not really being supported in this process, either.

If I think about the program that Jenny’s doing, it is so amazing and valuable how she built that up, recognizing, as a person with lived experience, what people who are still using substances will need in order to be successful.

If you look at the numbers, in this really small community of Quesnel, of how many people are on safer supply, have been accessing the services, the efficacy rates of the continuum of their service, of accessing those services and the outcomes of people, it is actually amazing and fabulous. I can’t say enough about what our program looks like in community. This is not resonating in other areas. We have researchers, and even Northern Health themselves, recognizing how valuable that program is. They want to research it and implement it throughout the province and support that work.

It’s also important to note that Jenny has built this from the ground up. Many people are asking questions, and they want to share this. But I also caution Jenny that yes, we want to support other peers in their communities to be able to do the work that she’s doing to improve people’s health outcomes and all those pieces. But we as people with lived experience often experience where we share the knowledge that we have and the ideas that we have, and those are stolen and run with, and we’re kind of left in the lurch and not validated or recognized for the work that we do.

Those are pieces that people have to think about as well. But I think peer inclusion in any setting of health care or social determinants is so valuable to the outcomes of people who use substances. We inherently have internal stigma, external stigma, that we face. When you can sit alongside someone who identifies as either being on or has been on that path, it just really makes everything a lot easier for you to be able to feel supported in those processes.

N. Sharma (Chair): Go ahead, Doug.

[10:50 a.m.]

D. Routley: Thank you, Chair. One of the benefits, I think, of the fact that we started from zero, in a sense, around understanding the problem, even when it comes to housing and things like that, is that we get to design as it should be rather than simply renovate what’s there — unfortunately in one case, but positively in the other.

You mentioned amazing and fabulous outcomes, stories of people who have good outcomes because of harm reduction and safer supply — find their feet and function in partnership with their use. When we face community reaction to housing projects like a complex care housing project, it’s based in fear. But when you talk about positive outcomes, it generally helps the community come to acceptance and understanding.

I see this as kind of an opportunity, as we deliver services, particularly in places that haven’t had any services at all, that we can do it right. That’s the job of this committee. As we put half a billion dollars in, will it be…? How do we make it the most effective use of that money? How do we involve peers at all these different levels?

I see the value that you’re talking about, but you’ve also pointed out how difficult it is for you to flow along with the development of those programs. You end up on the ground reacting to an emergency, a crisis, and then the subsequent addressing of that leaves you out, in a sense, if it’s not designed properly.

I understand that part of the role of the Ministry of Mental Health and Addictions is to facilitate the design of these services. I’m hoping that we can find a way to invite participation and, you’ve said also, the involvement of peers in design, development and delivery of programs. So this is a crucial moment, in a sense, and recommendations that come from this committee could, perhaps, snatch that opportunity.

How would you like to see that look? How do you see it, assuming a role in the design, development and delivery in partnership with, say, Mental Health and Addictions?

C. Burmeister: I’ve been doing this work for quite some time and have been part of those processes. I have the privilege of being outspoken and not allowing myself to be tokenized or exploited or steamrolled. Not all people with lived and living experience have that privilege. But I have been part of those processes and will continue to be part, because it’s super important. And I hold accountability. I am the co-author on the best practice guidelines with the BCCDC.

Peer engagement is kind of the core of my existence, so I’m always that voice that is making sure that peers are treated with equity and equality and that they are celebrated and that their voices are upheld and prioritized in those pieces. So I wouldn’t say that it would be something new for me. I would think it would be a continuum of the work that I do and many other peers do within their leadership roles.

But I think we still recognize, and we’ve heard from peers around the province, that they don’t feel really respected and honoured in that work — almost like a check box, a tokenistic approach to that. We see that even through the decriminalization that came out.

The 2.5 was not a recommendation by people with lived and living experience. Most of what came from that was born from the ideologies of policing and others. So that’s a prime example of where people with lived and living experience were engaged in the process, asked to be part of that, but that our experience and expertise was not upheld in the outcomes. We see that often, and we just continue to advocate to ensure that our voices are heard.

I think it needs to be a priority of the organizations and agencies that are doing this work. The philosophy of nothing about us without us really needs to be taken seriously and literally in the way in which they engage and form service provision and those pieces that we may be accessing.

[10:55 a.m.]

We’re not seeing that to the extent that we would like or need it to be, from my perspective. I hope I answered the question.

D. Routley: Yeah. You did.

I mean, there’s a blank slate — nothing there — so we get to paint that picture. Ensuring that you are a part of that is an important aspect of this moment of opportunity, even though it’s because we’re in a crisis where there is virtually no foundational support.

Obviously, the social determinants of health, the housing and all of that is so important to the medium- and long-term outcome. But the immediate crisis — that’s where people are depending on you, on the ground. But I — and you, I think — don’t want to be left behind in that.

I think this is a really, really important moment of opportunity to engage and actually realize the integration of peers into all of these layers. Thank you.

C. Burmeister: Thank you for recognizing that and honouring that. I appreciate that you’ve captured that.

P. Alexis: I just want to go back to the number that you said, on average, visited the Quesnel office. It was 7,500. Is that what you said?

C. Burmeister: No. We have an average of 400 to 500 visits per week, and we have a population of 30,000 people.

P. Alexis: Sorry. I missed that. I’m sorry. I put down a seven.

So it was 400 to 500 per week.

C. Burmeister: Visits per month.

P. Alexis: Visits per month. Pardon me.

C. Burmeister: We’re in a very small conservative community.

P. Alexis: I know. I mean, those numbers, in itself, are very high. I know the North is experiencing a higher per-capita number of deaths as well. So I find the numbers just unbelievable.

Do you want to talk about the demographics of that or any perspective at all in that 400 to 500?

C. Burmeister: Well, I think it’s really important to note that we know that Indigenous populations are disproportionately affected overall. The reality is that CSUN serves…. About 65 percent of the population self-identifies as Indigenous. So recognizing that and really thinking about cultural safety and the pieces that are really important to be supporting our Indigenous population as well….

I do not identify as Indigenous, but it is really important to me, after all that I’ve learned in the five years that I worked with FNHA, that we need to create space and allow Indigenous people to lead what things need to look like for them, in the same way that we would when we’re talking about allowing people who use drugs to lead what things need to look like for them. So yeah, about 65 percent of the population that we see identifies as Indigenous.

We serve the population of people that are banned or barred from almost every other service in community, without issue or concern. I think that really is because, as a place by and for people who use substances, the organization is valued and respected in a way that other organizations may not be because of the kind of systemic harm that people have faced in the past, and their resistance.

It’s really hard to explain how a drug-user organization just kind of organically builds respect amongst each other, as a membership, and that it’s a place for people to build camaraderie and opportunities for education and to be part of the system and delivery of services that people need. I always say peer engagement is ugly and messy and beautiful all in one, and it really is, in many ways. But it is so valuable that it is an investment that I will not give up on. I think those are the pieces that are really important to note.

When we first opened up, many people weren’t aware. We didn’t do advertising. There was a lot of resistance municipally, within our community. I just recognize that I didn’t…. It wasn’t helping me to ask for permission in having collaboration with people who were resistant to harm reduction overall — publicly resistant to harm reduction — so I do my work despite. I do my work — I go around, I go over, I go under — because the reality is that the services that we are providing are life-saving. They’re life-altering for people who use substances, and that is the core of our existence and the reason why we do the work that we do.

[11:00 a.m.]

I think it’s important to note that we’ve created good relationships with neighbours. We don’t have…. It’s just a beautiful thing. It’s amazing to see.

We actually…. Although the health authority had funding for an OPS for almost three years and hadn’t opened one, we were the first ones to open a publicly accessible overdose prevention site within our community. The pieces that we’ve talked about are like having inhalation, all of those pieces. As a drug user organization, some things are don’t ask, don’t tell. It’s about saving people’s lives. Whatever we have to do to ensure people are safe and supported is what we do.

That’s that kind of grassroots, organic and having autonomy piece that is super valuable and important to ensure that we are meeting people in real time. If the substances in community take a shift and change and we’re seeing drugs that are really deadly or really harming people, then we can react in real time. That’s the most important piece. Taking directive from people who use substances in community about what’s going on currently and what they need is how we do our work.

N. Sharma (Chair): Okay. Thank you both, Charlene and Evin. We are out of time right now.

On behalf of the committee, I just want to thank you for helping us learn about your perspectives. That was really valuable. You could tell by the discussion that we all learned a lot. Thank you for all the work that you do.

E. Jones: Thank you for the invitation. Thank you, all of you. I know how busy you are. The time you’re taking on this — it’s so important.

C. Burmeister: Yes. I would echo that. I thank you very much for taking the time to recognize that we have to make some significant changes. Hearing from all of those that are involved is really vital to, I think, what your outcomes and recommendations will be. So I thank you very much.

N. Sharma (Chair): We’ll just take a quick recess, maybe a couple of minutes, and then we’ll start with the next one.

The committee recessed from 11:02 a.m. to 11:06 a.m.

[N. Sharma in the chair.]

N. Sharma (Chair): It’s my pleasure to next welcome Turning Point Recovery — Brenda Plant, executive direc­tor.

Welcome, Brenda.

My name is Niki Sharma. I’m the Chair of the committee and the MLA for Vancouver-Hastings. We’ll do a quick round of introductions.

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

T. Halford: I’m Trevor Halford, MLA for Surrey–White Rock.

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

M. Starchuk: I’m Mike Starchuk, MLA for Surrey-Cloverdale.

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

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

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

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

N. Sharma (Chair): Brenda, you have about 15 minutes for your presentation. The rest of the time will be for questions and discussion.

Over to you.

Briefings on
Drug Toxicity and Overdoses

TURNING POINT RECOVERY

B. Plant: Thank you very much. It’s an honour to be here, and I appreciate being asked to present.

As I was just saying to some of your esteemed colleagues, I’m normally much more organized. I would have had a PowerPoint. There would have been a terrific presentation, but we’ve just had some tumultuous times, as everybody has in the last year in particular. So I’m less organized.

I wanted to speak to you about three different things today. I appreciate the longevity, that this committee has been sitting…. I really hope that I’m not going to duplicate too much what you’ve already heard — and maybe present you with some slightly radical but maybe some other ways of thinking a bit outside the box.

I’m very fortunate. I sit on the expert advisory for the Ministry of Mental Health and Addictions framework committee. We’ve been doing that work for a few years. I always preface every comment by saying that I’ve been doing this work for 30 years. I’ve been at Turning Point for 17 years. I always say I’m old, but I speak from…. I’ve just been around, doing the work for a long time. I have, maybe, a different perspective than some of the younger people that are just getting into the sector.

I am going to speak on the need for an inclusive and comprehensive continuum of care. I know you’ve heard that excessively. I’ve read several of the presentations with my colleagues. But I’m going to start by telling a story about what I mean when I say a comprehensive continuum of care. It has almost become jargon. We talk about this thing, and not everybody understands.

I had the blessing of working in the United States for about 13 years. I was in the state of Hawaii, which is actually very advanced in their work around addictions and mental health. I was the director of all the youth addiction programs as well as the women’s domestic violence programs. Everything in Hawaii was always about multisystemic teams and comprehensive case management, which meant that every person that got into the system, be it through a domestic violence situation or through addictions and mental health, had a whole team of people. Every single person had this comprehensive case management approach.

I would recommend that as one thing to look at. I know it’s an expensive model, but that way, nobody gets lost.

[11:10 a.m.]

Too frequently…. At Turning Point, we’ve been doing this for 40 years. We run bed-based services. We have expanded exponentially. We have two sites in Vancouver, two in Richmond, two in North Vancouver. I believe we’re now in MLA Chant’s riding. We are trying to get a site open in Squamish, and we just…. There was a press release that came out. I don’t know if Campbell River folks saw it. We’ve got a big project on the go in Campbell River. I’m very grateful to both governments for affording Turning Point the opportunity to put more beds out there.

Recognizing the need for a continuum of care, I started writing grants and building a continuum at Turning Point, because I was waiting for it to happen, and it wasn’t happening. We started, I think, ten years ago. We built a drop-in centre.

This is the story of a guy named Don. Don was a heroin addict who was couch-surfing. Sick and tired of being beaten up by his roommates and being rolled and having his wallet stolen, he stumbles into our drop-in centre one day and gets some food and gets connected with one of our outreach workers.

Our outreach worker starts working with him to get him his ID, get him to see a doctor, get him on medication, get him on opioid replacement therapy, and it became evident that he needed residential or bed-based services, so referred him to our Richmond men’s program, where he stayed for six months.

After he graduated from that program, he moved into our brand-new, award-winning building in Richmond, Storeys, which is a non-profit consortium that came together to build supportive and affordable housing. It has won awards all over Canada, because it’s the only time that five non-profits have come together to build a supportive housing development.

He moved in there, and he has participated in our comprehensive aftercare program, which we created with no funding, and it means that people that have gone through our bed-based services are engaged in ongoing treatment with a certified addictions counsellor.

At the end of five years…. He just recently, six months ago, moved out. He’s now participating in our overdose prevention program, which is ongoing supports for people who have done all of our other levels of services. We started that program with a grant from the Beatty Foundation. He’s participating in that program as well as the alumni and aftercare program.

He has reconnected with his son after 14 years of being apart. He is living with his girlfriend. This summer, he’s riding his bike across Canada. That is what a continuum of care looks like. Oh, and he’s 71 years of age — pretty cool.

One of the problems in developing a comprehensive system of care…. I don’t normally bring show and tell, but I couldn’t resist, when we were talking — with my staff — yesterday about the presentation. One of the challenges with the addiction system here in the province of British Columbia is…. In my 17 years at Turning Point, I’ve had six different frameworks. I’m happy to share them all with you, going back to Every Door Is the Right Door, to Healthy Minds, Healthy People, the ten-year plan.

No disrespect to government, because I think you have the hardest job of anyone, and as some of you know, I have personal experience around that. Every time a new government comes in, they decide to start over, so everything that we’ve been doing and been funded to do — suddenly it’s changing again.

So here we are. Unbelievably great that we have a Ministry of Mental Health and Addictions, but now I’m going through all these books. We’re going through here trying to figure out where the system of care is. This group that I’ve been a part of for three years has laid out what they think will be the framework, but we’re still waiting for an action plan.

There’s a great document, and this is for bed-based services, that was created in 2010, which is the Service Model and Provincial Standards for Adult Residential Substance Use Services.

I sat on the committee that was responsible for rewriting the assisted living registry handbook. I was on that committee for several years. I kept saying: “We have a set of standards.” This is a really great roadmap, and we should use these to tell people how to provide services, because it really works. Definitely, it needs a little bit of updating, and probably some more harm reduction interventions included, but it’s a great framework, rather than a lot of people spending a lot of time, and us spending a lot of money just talking about it.

In developing a framework, we need to be at the table, at the ground level, developing what that looks like, because we’re the ones that are on the front lines working with these people every day.

[11:15 a.m.]

We are in the midst of a public health crisis. The band-aid approach, we know, doesn’t work. Having everybody operate in silos doesn’t work. One of the things that I would love to see…. There’s a significant lack of consensus on language between…. Nobody knows the difference between what abstinence and harm reduction and recovery and treatment all mean. You could get people screaming at each other defending what they think the definition is. We have to have agreed-upon language so that we all understand what we’re talking about.

My more radical idea, in terms of developing a continuum of care, is…. I consulted with some folks at B.C. Housing about this. I do believe we need to move people out of the Downtown Eastside. I think we’ve ghettoized the area.

A survey was done, I think five or six years ago, by B.C. Housing. I’d have to find out for sure. Forty-five percent of the people surveyed, who are living in SROs, said that if they were given the opportunity to live in a different community and have the same access to services, they would happily move out of the Downtown Eastside.

The number one feedback we get from all the people that go through Turning Point is that they feel safe. They’re grateful to be out of the circumstances they were in before they came to us. So that would be one thing to think about.

I’m not going to belabour the point about consistent funding. I think you’ve heard that. As you know, operator A in Surrey or Fraser Health could be getting $375 a day to do the exact same thing that Turning Point does for $90 a day. So that’s a huge problem.

The last thing I want to talk about is one that’s impacting Turning Point. I even said I wasn’t going to speak about Turning Point, specifically, but what the heck.

I’m not sure if you guys were around when Bill 16 was introduced in 2016. The minister then, Terry Lake, who I actually phoned and asked about this…. MLA Bond may recall Bill 16. It was brought forward to make changes to the assisted-living act. Having just been through something with a family member that was in an assisted-living facility…. It was changed so that seniors in assisted living could age in place.

The whole framework around assisted living was…. You couldn’t do more than two of these things called prescribed services. The minute you did more than two, boom, the person had to move. Well, that makes really good sense in seniors care.

My sister who, I just explained, passed away in March was in an assisted-living facility. Had she gotten out of the hospital needing more care, they would have had to move her out of her home that she’d been in for 12 months and into long-term care, which was completely disruptive.

What happened as a result of the changes to the assisted-living act…. The definition of “care” changed. This is a huge problem. It was changed because of seniors, but the assisted-living act and the Adult Care Regulations….

They didn’t know what to do with substance use services a long time ago. So they plunked this into the same act and the same regulations as seniors. Well, in seniors facilities, it makes sense that a senior would want a single room by themselves with a locking door and their own safe in their room. In addiction treatment, the last thing that you want is to provide somebody with an opportunity to use in their room, to overdose in their room, to have a locking storage compartment, a locking door.

We have to write for exemptions to have double rooms for all of our facilities. We think that’s the safest thing. People hold each other accountable. They support one another. They lift each other up.

A huge recommendation. Substance use services — I’ve said this for 15 years — need their own regulations, their own act. It needs to be separate from seniors. Licensing officers need to get trained about addiction, people with addictions. They don’t understand.

As a result of the changes to Bill 16 and the changes to the assisted-living act, new facilities that are being opened, such as we are trying to do in Squamish right now and we’ll be doing in Campbell River — we have two other sites that we’re going to be doing in Richmond — and going to get licensed are no longer getting licensed. They’ve done away with the prescribed services and said: “Everybody can do all the prescribed services you want.”

I’m running out of time.

It is the feeling, according to how things are written, that we should all, the people that do the level of care that we provide…. We should now be assisted-living facilities. However, my contracts with the health authorities say I have to be licensed. If I don’t get my licence in Squamish, there will be no public beds available for people to find addiction treatment in Squamish. I can’t become an assisted-living facility because my contract funding goes away.

[11:20 a.m.]

I’m in the middle of my third round of appeal on this. The same thing will happen in Campbell River.

This is the most disturbing part of the system of care in British Columbia: that it is taking extraordinary amounts of time and energy to try and open new facilities. I’m sitting on the possibility of giving the province of British Columbia possibly 120 new public beds for addiction services, yet I’m going to come up against this obstacle every single time. There’s a disconnect between licensing and the health authorities. There’s a disconnect in the province. Every jurisdiction does it differently.

I know the regulations inside out and backwards because I’ve opened so many new facilities over the years. I really would love to see…. I think you have the ability to set subcommittees or make recommendations for committees. I do believe there should be a committee put forward to start looking at regulations for substance use services so we get out of this mess of having to defend this.

I’m a firm believer in decriminalization. I’m a firm believer in safe supply. I believe that if we’re going to do these initiatives, they need to be part of the system I was talking about earlier, where we have the adequate supports in place. I’m not an expert on thresholds, and I’m not even going to try and go down that road. You’ve certainly had a lot of people speaking about that.

I think that it can be done. I’m optimistic it can be done. I’m hopeful that the outcome of the work you’re doing is going to present opportunities for the work to get done. I do sit on a phenomenal amount of committees, and we have, for 17 years, been talking about the same thing. You have an opportunity to make action happen, and in my small, little, humble way, I hope to get to be a part of that.

That’s it. Thank you.

N. Sharma (Chair): Thank you, Brenda.

We’ll go to questions and answers. Any questions?

Ronna-Rae, go ahead.

R. Leonard: I’ll just say wow.

B. Plant: I’m passionate.

R. Leonard: I thank you. My husband was an addictions counsellor. Through the decades, he said: “What goes around, comes around.” People would freak out that there was a new game in town. We went through the Heroin Treatment Act. I have a cup at home that says “heroin” on it.

So many different iterations of how to work through what somebody else referred to as the soft services, the ones that are hard to nail down regulations for. But I really, really appreciate your pinpointing one place where we can make change, which is in regulation. I think that sounds like it’s something very…. One size doesn’t fit all for all human beings.

I appreciate that you said that you support safe supply and decriminalization with supports. I think that’s the piece that has been missing in so many initiatives: to make sure that we deal, in a holistic manner, with this.

B. Plant: I think things happen in silos. There are the people that are the safe supply advocates doing their safe supply thing, but they’re not talking to the people that are doing outpatient work. They’re not talking to the people that are….

That’s what I mean by the comprehensive continuum. It’s that every piece…. I support — try anything. Good lord, try anything to save people’s lives. But do it together. There’s too much “we” versus “them.” I think that that’s…. You’re damned if you go get treatment. You’re damned if you don’t get treatment. You’re damned if you want abstinence. You’re damned if you want opioid replacement.

We’re all guilty of contributing to stigma in the language that we use to talk about the differences of services. It’s just: “Let’s just get help.”

R. Leonard: Can I ask about Turning Point itself? Is your treatment program abstinence based?

B. Plant: Back to my thing about definitions. You can’t use substances at Turning Point. That doesn’t mean you can’t be on opioid replacement therapy or on a benzo taper or on anything else. When we say “abstinence,” it means you’re not bringing drugs on property and using drugs or alcohol on property. Even if you do, we’ll work with you.

Our only discharge situation at Turning Point is violence, obviously. But if somebody uses on site…. They’ve been out, and they brought something back into the house. If they were a client that was compliant, they were participating, they were engaged in treatment, they had a counsellor, they were doing their therapy, and they were doing everything else….

[11:25 a.m.]

As long as they don’t put anybody at risk, we usually send them to bed to sleep it off, revamp their recovery protection plan and revisit it.

That said, we were founded 40 years ago this year by two recovering alcoholics. Jim opened his apartment up to some people who had no place to live because they couldn’t stay sober between meetings. He said: “Why don’t you come sleep on my floor?” Before he knew it, he had like 20 people sleeping on his apartment floor.

From there, they went to a house on 14th and Alder. That house got…. They had 26 people there. Then some business people got together with Grace McCarthy, who gave us a grant. We bought our two houses on West 13th across from city hall, which I find ironic. The mayor has never been there, and he really only has to walk about 50 steps. We’ve been there for 38 years, on 13th.

Back in the day, even when I started at Turning Point, the program for most of the places like us were that you did 12-step meetings and you basically had some rules about: “Don’t use, or you’re out. Don’t get violent, or you’re out.” We’ve all had to evolve.

Back to an earlier point, one of the things that I feel strongly about is that licensing is not recognizing — we need to get this message across, across the sector — the demographic of the people we serve. When I started at Turning Point, alcohol was the number one drug of choice, bar none. Now it’s 50-50 fentanyl and alcohol, and 89 percent of our clients are on medications for mental health issues.

We’re frequently serving people, at our level of care — technically, they should be in Red Fish — with schizoaffective disorder, with borderline, with bipolar. I don’t think everybody realizes who the people are that we’re serving anymore. I had to, without funding, go [audio interrupted] master’s level counsellors to do therapy because the people that we serve have such significant trauma. So this is a long time since sitting around doing AA meetings and saying: “Do your chores, or you’re out.”

In terms of abstinence, it’s really…. I love it when people say they’re client-centred, yet they have black-and-white rules that apply to everybody: “Use, and you’re out.” We’re client-centred. If you use, we recognize that lapse and relapse is a part of recovery. We’ll work with you. But if you’re somebody that’s just looking…. If you’re not respecting the program, not even trying, and you’re a pain in the butt for staff, not doing your chores, not showing up for groups, not meeting with your counsellor, then chances are that we’re going to discharge you. But even then….

Turning Point, by the way — I think we’re the largest in Canada. We have the most adult beds, I think somebody said. We have the luxury of: if it doesn’t work at one site, we can move them to another one of our sites. We frequently move people around if it’s a bad fit. It’s very rare that we discharge somebody, unless it’s violence. Even then, we’ll try and find a more appropriate level of care.

I hope that answered your question.

R. Leonard: Yeah, it does. I did want to ask, just to follow up…. One of the things that we’re hearing is that not all treatment is good treatment — that people who leave, particularly from abstinence-based programs, end up overdosing after they leave. I’m just wondering if you have any statistics on what’s going on with your clientele.

B. Plant: It’s why we created the overdose prevention program with private money. It was so that we could keep people engaged. Our program…. We’ll work with people that are discharged from our program that are opioid users or at risk of overdose. We have discharged clients still engaged in services.

I mean, I think, to me, it speaks to the need for regulations. With a lack of standardization, everybody gets to play by their own rules. While I agree that every program, every service should be unique and offer unique qualities, I think there should be some standards in place that say: “These are the discharge criteria.”

You are absolutely right. You know that detox has stopped, for a while, serving people who are opioid addicts, because the highest risk time for an opioid addict to relapse and overdose is after they’re discharged from detox. They get detoxed, and then they have nowhere to go because there are no beds available or no program or no housing or whatever, and they become more sensitive to the increased toxicity of the drugs. So they use; they overdose.

[11:30 a.m.]

Now the health authorities got stabilization beds, of which we have some in Vancouver and Squamish, where they can now serve opioid addicts in detox and literally, physically, get them to the site where they will then do seven to ten days of stabilization. It has been so successful in Vancouver that all the folks coming to us in stabilization have asked to stay in our program, despite being referred to another program.

Now, you can’t get out of detox unless you have a program to go to. I think we should be doing more stabilization beds, because clearly, it’s working. I’d be curious to know if the overdose rates from people leaving detox has gone down since they started that. I don’t know if they’re doing it in Fraser Health. That’s just in Vancouver. Again, I think if we have standards and regulations in place, we limit the operators being out there that are not providing good services, quality services.

I think — I had it in my notes, actually — that it would be terrific if we had a universal data collection system. Too often, to your point exactly, some community-based counsellor or community health clinic drops their client off at our door: “Thanks very much. See you later.”

I’m telling my staff: “You need to send them their treatment plan. You need to phone them once a week with an update. You need to keep them engaged the whole time the person is here, because if you have to discharge that person during the course of treatment, or even when it comes to discharging that person, you need their external team involved and aware of what’s going on.”

To your point about somebody being discharged, if you had a case management approach, whoever referred that person should be the person that picks that person up, so that that person doesn’t overdose and die. I don’t think anybody should ever be discharged from any program unless there’s somebody picking them up at the other end. I don’t mean literally; I mean figuratively — that there’s a counsellor or somebody — because otherwise, you are leaving it wide open for overdoses to happen.

S. Furstenau: There’s a lot to unravel here. It was great, because I think these are really important points. I’m looking at the stack of binders here.

B. Plant: Wasn’t that great? Show and tell. I had to buy a suitcase to bring them in.

S. Furstenau: It’s a very good visual aid. There’s a good metaphor there.

Six frameworks in 17 years, yet…. We’ve heard this before. We’ve heard this from the chief coroner. No evidence-based standards, regulations for addressing or for looking at addiction services. You’re really effectively painting the picture of what we should be expecting, but that that doesn’t exist. In these frameworks, where’s the accountability to government? That’s one question, about achieving these frameworks and how that has played out over the 17 years.

On the regulations, you just said it’s standards, regulations, data collection. What’s your advice for achieving that without…? We just heard, in our previous presentation, about the quagmire of bureaucracy, right? That bureaucracy is also a barrier to achieving outcomes. We’ve got something to unravel here, but how would you advise achieving those standards, regulations and — I agree — the data collection, so that there is an evidence-based assessment of what’s happening? How do we achieve that?

B. Plant: I also am chair and co-founder of the newly formed B.C. Addiction Recovery Association. Sherry Mumford…. I think Dr. Mumford is going to be presenting today at some point. I think entrusting the people that are out there doing this work to be engaged in coming up with a solution — this is the challenge. You know, the health authority is starting to take more services in-house, and it’s like: “Why are you doing that? You have really….” This is so bad of me.

[11:35 a.m.]

I’ve had the pleasure of knowing a lot of the Health Ministers — I don’t know Minister Dix — but I do believe that the health authorities have more power than the Ministry of Health. I mean, that’s sort of being cynical, but they’re running the show. They’re not reporting to government. They make the decisions. You have the problems where Fraser Health is doing something different, and Interior Health is doing something, and Vancouver Coastal Health, and then First Nations.

We’ve got to get those guys…. You’ve got to get everybody talking. But again, why not? I was one of the first board members of the B.C. Centre on Substance Use and have worked with them in Streetohome for most of my time at Turning Point. It’s so great, because everybody wants the same thing. But it’s again…. No disrespect to my colleagues at BCCSU. In fact, some of them sit on my board. But they came in here and told you that we’re all untrained and unskilled and that we don’t know what we’re doing. It’s like: “Wait a minute. That’s not true.”

I’m not in here touting the greatness of Turning Point. I’m in here saying that we need to work together. Nobody’s got the right answer is sort of what I’m saying. BCCSU — they’re great. Love them. They can’t come in here and say: “We’re the guys that have the answer.”

One of the health authorities is going to come in here and say: “We have the answer.” I’m saying: “Why not look to…?” I’m not saying the B.C. Addiction Recovery Association is the end-all, be-all. But we’re trying.

Get the providers that are doing the work at the table to say: “This is what we need.”

S. Furstenau: Can I just follow that up? There’s a difference between an association, which typically represents its members, versus, say, a regulatory college.

B. Plant: Correct.

S. Furstenau: Is that what’s needed? Does there need to be one body that has that oversight role, that is the regulatory and kind of accountability piece in this? I worry about an association.

B. Plant: I don’t think we should be the accountability piece. I think the structure of licensing is a good structure. I’m sitting on a committee now somewhere in Canada, trying to come up with regulations on how addictions programs should be designed.

There are so many people. It would be great to have just one universal set of standards. I don’t know what’s going to happen with the federal initiative. I can’t, I’m sorry to say, remember who it is off the top of my head.

I think if we’re going to have a Ministry of Mental Health and Addictions, maybe it should be with that ministry. In A Pathway to Hope, in the minister’s mandate letter and in the strategic goals, it talks about them taking over licensing, yet every conversation I have with their office is, “It’s too complicated for them to take it,” because of this current structure. If they take it, it means they’re getting seniors care. Seniors care doesn’t belong.

Maybe the idea is that you design what the regulation for substance use services and mental health services looks like, and then you decide where it falls. Leave it with licensing for now, but start pulling out the things that should be in place to appropriately standardize or regulate addiction care.

One of my frustrations is that we’re working with some of society’s most vulnerable people, and the licensing regulations are more concerned about the temperature of the water and how big the bedroom is and where the windows are located than they are about the programs we’re offering.

S. Furstenau: This is a significant concern as the growth of addictions treatment, counselling and all of this happens. But we are in an unregulated landscape in B.C., even when it comes to counselling.

B. Plant: I sit on the FACTBC. All I do is sit on committees. I’ve been on and off the FACTBC thing, which is trying to regulate counselling services.

I got my certification in addictions counselling 100 years ago in the state of Hawaii, and it was like doing a master’s degree. You had to have an undergrad degree and do, like, 3,500 hours. I had to present. I had to do a four-hour written exam and a two-hour oral presentation. It’s a major deal to get certified down there.

I went on and got other certifications here. It’s 2,500 hours and you do a practicum. I sit on the VCC advisory for the addiction counselling program. I’m screaming all the time, going: “You’re not training these people to be addiction counsellors. Let’s start with teaching them how not to collude, how not to enmesh. Teach them about ethics.”

[11:40 a.m.]

I would say: let’s worry less about where the governance and the regulation fall, and let’s start with looking at getting regulations for substance use services. I’m talking the whole continuum, from opioid replacement services, if those are going to be regulated, but certainly in bed-based.

There are no regulations that govern what you’re doing in outreach. There’s nothing. We hire registered social workers or master’s level social workers because that’s the model. That’s what best practice dictates. There’s no standardized model for outreach with people that are addicted.

Interjection.

B. Plant: Sorry. I’m not overly pro-regulate and make it so tight in a box that you can’t work within that framework. I’m just saying…. When you’ve got somebody who discharges somebody because they went across the street and drank a beer, versus you’ve got somebody who says, “Okay, well, go to bed and sleep it off….” How do people even begin to decide where to go to treatment?

T. Halford: Thanks, Brenda, for the presentation. In terms of demand for what…. I guess we’ll focus on Turning Point. That’s what you’re focused on. In terms of demand, is…? You guys are opening up centres, and I’m imagining they’re filling up quick. Do you have a wait-list?

B. Plant: I love the wait-list question. If you have people…. At Turning Point right now…. If all 23 clients in Vancouver went through Turning Point successfully, the last person on our wait-list would get in, in two years. I think right now, I have 46 people on our wait-list.

The Minister of Mental Health and Addictions keeps asking — it’s a question on one of the grants that we report on — how long it is between the referral and getting somebody into a bed. Well, it could be five days. If the day that a bed becomes available I phone all 45 other people and none of them are around, then all of a sudden it’s your lucky day. There’s an empty bed, and you can get in.

Roughly, you’re on the wait-list for two to three months. That’s roughly what I would say. We’re opening new facilities. We have no problem filling our current ones.

I don’t know where this business about empty beds…. I hear that in the media sometimes. Who started that? Whose beds are empty?

Oh, there is one thing. Sorry, I’ll be very quick.

Fraser Health and Vancouver Coastal Health…. We somehow got away from not having to do this. They make all the referrals. They control your intake of clients. I was trying to refer somebody to Peardonville recently, and I had to go through 55 hoops to get the referral to Fraser Health. They, then, work with the facility.

Turning Point has the luxury of…. Referrals come straight…. Detox phones us and gets people on the wait-list, community health care workers. They don’t have the bureaucracy.

That level of bureaucracy, I think, has not been good. If you had a universal data collection system, then the health authorities would know that their client is getting into care. I really can’t speak from experience because we don’t have this. Waiting for health authorities to place people in care may be causing a delay. I don’t know. It would be interesting to know.

P. Alexis: First of all, I was thinking that whatever was in the bag was your show and tell. It was, happily, the binders. I wasn’t sure what you were up to with your paper bag.

B. Plant: Oh, this is my muffin.

P. Alexis: Maybe that’s what you’re going to show us.

B. Plant: You thought I brought drugs.

P. Alexis: Anyway, thank you so much.

I just have a question about aftercare. Some of the different organizations that have presented have talked about the importance of aftercare and the services that they provide. Can you tell me about what you offer? I know you said that whoever picks up has to be responsible for the other side of it.

So many times we get: “Is it enough?” When constituency members come to me, they just say: “It’s not enough for my son,” or “not enough for my daughter,” to be in X amount of days. There’s nothing afterwards, kind of thing. Can you tell me a little bit about aftercare?

B. Plant: Yes. Let me also say…. There’s another good recommendation for you — that there should be grants and funding available. We’re all doing it with no funding specifically for aftercare.

I think, typically, aftercare consists of alumni meetings. You can come to the house once a week and participate in an alumni meeting.

[11:45 a.m.]

For us, what aftercare means is that you have access to a counsellor for the first three months after you leave. You’re encouraged to participate in the alumni meeting. If you are at risk of overdose, you’re encouraged to participate in the overdose prevention program. That program meets twice a week. They do groups. They do individual counselling sessions. Everyone has what we call a recovery protection plan. That’s in that program.

Regular aftercare…. They have an aftercare treatment plan. They talk to somebody once a week about what’s in that plan. Are they meeting the goals of that plan? It used to be that everybody asked about outcomes. How long are your clients sober for after they leave? Our outcomes are: do they have quality of life? Do they have a job? Do they have a safe place to live? Are they happy? How many times have they been to the hospital? How many times…?

These are the things we need to look at. That’s about shifting language away from the way we used to speak. I think comprehensive aftercare is in…. It’s about complete engagement for three to six months. If you look at John Kelly’s stuff out of the States, it’s: keep people engaged up to five years. That’s what we’re seeing, because we’ve built this affordable housing piece. The folks that we’ve had that are there are still clean and sober five years later, re-engaged in community, reconnected with family, working. I think we need to be funding what aftercare looks like.

I think in terms of constituents asking you about getting their child into care or a loved one into care, I would say to look for programs that offer aftercare and ask what the aftercare program looks like. Too often, at Turning Point, we’ll get people who are being referred to us from treatment, from a residential treatment program. That’s another story, but I would argue that we might as well be doing treatment.

They open them up in 30 days and expose all the trauma, and then they send them off to us for second stage, and we’re like: “You’re bleeding.” Again, if we’re creating new standardizations or creating programs and designing what programs should be looking like, I think we’ve got to be really clear about what the expectations are that you’re going to do in residential treatment versus supportive recovery, which is a term I can’t stand.

I’m a firm…. I was trained in ASAM criteria in the States. ASAM is a placement criteria. It’s the association of substances and medical something or other. We have an equivalent in Canada. But the ASAM criteria was created by Dr. David Mee-Lee. You can google it. It’s got terrific…. It’s way better than what we’re using here — and if not ASAM, something else for getting people into the appropriate level of care.

We get people into bed-based services that actually would be really great in an outpatient program if they were able to access safe supply and have an outreach counsellor. I mean, they don’t need to be in bed-based services.

I don’t pretend to know how difficult your job is or what all the solutions are, but I’ve been doing it long enough that these are the things I see that could make improvements.

M. Starchuk: Thank you for your presentation. I believe the last time I was at one of your galas, David Crosby was the guy that was on stage.

B. Plant: Oh, I knew there’d be a gala attendee in the audience.

M. Starchuk: So I’m aware, but my question is more about the ALR.

B. Plant: About which? Oh, ALR.

M. Starchuk: I’ve been in the sandbox with them, dealing with some of their regulations and how they apply them not only to seniors but to people with brain-based traumas and things like that, where they do need the extra care that’s there, and trying to create that second level for those people to have a base and fighting within the circumstances of what’s there. I agree with you. We need to categorize it completely differently. Where are you with those talks?

B. Plant: Well, ALR folks, the community care licensing folks, would argue that they’ve made the regulations now so that any level of service can fit in there. The problem is that if you’re in bed-based substance abuse services, you won’t get any funding to operate. So they’re saying: “You can have doctors. You can have psychiatrists. You can have therapists.” And I’m like: “I’m going to get $35 a day per client to do that.”

[11:50 a.m.]

I mean, there are assisted-living providers out there that are struggling since they introduced the new assisted-living handbook, which is really weird, because we were asked to participate in creating this document, and then lo and behold, it magically appeared one day as though it had been written…. So the thing was written by people that do not do this work.

I think you can’t…. There are going to be people that will succeed in an ALR setting, even people with acquired brain injury, if it’s an ALR setting that is run by the health authority, because they will have the funding available to do it. But the structure right now…. I don’t think there have been any new licences issued since the new ALR was passed and brought in. Certainly in Vancouver there hasn’t, because mine have been denied. I don’t know about Fraser Health.

I know that people are struggling with licensing. This is the other thing. We’re all trying to solve a phenomenal public health emergency here, yet this is a silly obstacle. This is what’s standing in the way — these weird…. For some parts of the service….

It shouldn’t be that hard. Turning Point has been operating for 40 years. All of our sites are licensed. If I apply for a licence, you would think our 40-year longevity, and the fact that we’ve run all these licensed facilities, would speak for something. No. “You don’t meet the new definition of care.” Part of the definition of care is vulnerable adults with disabilities.

In my appeal letter, I said: “I’m sorry. If you check, addiction is recognized as a disability not only in the province of British Columbia, but in Canada. So therefore my clients meet the definition of care. I will have a doctor on site, and I will have a psychiatrist, and I will have all these people. Here’s a letter from my contract manager saying: ‘Yep. Squamish mental health team is going to provide those services.’”

Sorry. I’m on my soapbox a little, but they’re notorious for sending their denial letters on Friday afternoon at 4:30.

Anyway, I think either they’re going…. The problem…. Licensing might say: “Well, it’s a health authority issue, because they’re the ones that won’t provide contracts for ALR providers.” So if the health authorities then say, or VCH, in particular, says: “Okay, Turning Point. Go start your application from scratch all over again, get registered as an ALR” — which will take me months to do the application — “and we’ll contract you as an ALR provider, give you the same amount of money, and you can go do this….”

Fine. Except that I know of at least 20 or 30 ALR providers in the Vancouver Coastal Health region that would be knocking on the health authority’s door going: “Well, you just contracted their beds. Where’s our money to contract ours?”

It just seems like nobody had…. They didn’t have a conversation about what the implications would be when they made the changes. When I asked the minister, former Minister Lake, “Did you have any idea what you were doing when that happened,” he was like: “It was all about seniors.”

I actually sent to licensing, in my appeal, the 17 pages of Hansard, and if you read the 17 pages of Hansard from April 16, 2017, or whenever it was, there’s not one mention of addiction services — not one. Yet it’s completely made it difficult to put new beds out there.

So we are going to have another gala, by the way. For those of you who don’t know, one of Turning Point’s famous things…. Have you ever been to our gala?

Interjection.

B. Plant: Oh, you were at Matthew Perry. We think he was three days clean.

So we got the idea…. This is just an interesting side note. We wanted to try and destigmatize addiction in the community and start showing the community that real people can have addiction issues and recover. Fifteen years ago we had John Larroquette as our very first speaker. We had about 200 people at the Four Seasons.

Since then, we’ve had Rob Lowe. We’ve had Alice Cooper. We’ve had Matthew Perry. We’ve had Martin Sheen. We’ve had Ashley Judd. So we’ve had all these celebrities. The government of the day loves our gala because I always…. You know, the Health Minister always gets to sit at the front, at the head of the room, or whatever. Judy Darcy has been to a couple of our galas and thought she was going to run off with Rob Lowe at the last one — or we all would have liked to.

My favorite, funnily enough, was David Crosby, because I was a huge fan of Crosby, Stills, Nash and Young. Normally, I’m not too overwhelmed by celebrities. But at dinner, I’m sitting with Chris Gailus on one side. I think Chris did that, or Randene. Anyway, Chris was there, and I’m there. No, it was Randene. I looked over at Randene, and I said: “Oh my god. I’m having dinner with David Crosby.”

[11:55 a.m.]

So you’ll hear about our gala and who our speaker’s going to be. It might be Michael Douglas and his son. It’ll be in the fall.

N. Sharma (Chair): Okay. I just have the last question. We have a few minutes left.

Thanks for going into such detail with different things. It sounds like — at the top of your presentation — you’re in the process of expansion with beds in different parts of the province. I just would love to know: what are the partnerships? How is that happening? You talked about some of the licensing issues, where you’re getting the funding, that kind of thing.

B. Plant: So we have, in all of our developments…. We have city of Campbell River. We have an MOU with them to develop land that they own, so it’ll be a dollar a year for 60 years. That’s how a lot of our projects work. We are going to B.C. Housing — I’d certainly like to know why they have no money — for funding, if not financing, to build. We have two other projects that…. Again, it’s the city that has given us the land to develop — a-dollar-a-year lease for 60 years.

Most of our developments…. I mean, that’s another…. We own all of our real estate through forgivable mortgages, meaning that once the mortgages are paid off at B.C. Housing, Turning Point will be sitting on, like, $50 million in equity. What’s terrific about that is we can then turn that into that many more facilities.

I think that a good question would be looking at models of how we can get these new facilities built without obstacles at the municipal level or the provincial level. But I’m a firm believer in partnership, which is why our building in Richmond has five non-profits in it. I’m not trying to build a Turning Point empire. I’m trying to put beds in the community to help people. So if that means I’m partnering….

Oh, sorry — Campbell River. A huge point about Campbell River is that Second Chance, a north Island recovery society, reached out to me a few years ago and asked if I would help consult in what they were doing. Two years in, they just said, “Heck, can you do it?” because we had more capacity, more experience. So it’s collaborative. We and Second Chance Society are going to build this new facility: 56 new beds. I already feel my journey ahead — unless, of course, we get regulations changed and things change.

N. Sharma (Chair): On behalf of the committee, Brenda, I just want to thank you for coming in and giving us the very passionate and detailed — long years of experience — discussion that we had today. We appreciate all the work you do.

B. Plant: Thanks very much to all of you. I didn’t mean to belabour the whole licensing thing.

N. Sharma (Chair): We’re going to recess until one o’clock.

The committee recessed from 11:58 a.m. to 1 p.m.

[N. Sharma in the chair.]

N. Sharma (Chair): On behalf of the committee, it’s my great pleasure to welcome Dr. Sherry Mumford from B.C. Addiction Recovery Association.

I’m really glad to have you here.

My name is Niki Sharma. I’m the Chair of this committee and the MLA for Vancouver-Hastings. We’ll just do a quick round of introductions.

We have the Deputy Chair, Shirley.

S. Bond (Deputy Chair): Good afternoon. It’s Shirley Bond. I’m the MLA for Prince George–Valemount, and I’m in Prince George today.

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

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

M. Starchuk: Mike Starchuk, MLA for Surrey-Cloverdale.

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

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

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

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

N. Sharma (Chair): Okay. You have about 15 minutes. As you noted, the timer’s right there. Then we have the rest of the time for questions and discussion.

Over to you.

B.C. ADDICTION RECOVERY ASSOCIATION

S. Mumford: I want to thank you all for the opportunity to present some thoughts and views on the substance use addiction system and how that plays a part into your topic of drug toxicity, which, of course, has been around for millions of years. It’s worse now, but there are more people using different drugs now for a whole bunch of different reasons. The topic itself is, I think, the reason why substance use and addictions evolved in this province to begin with.

I thought I would just start off saying…. I imagine you’ve all got the electronic copies of the presentation.

N. Sharma (Chair): Yes, they’re on our screens here.

S. Mumford: Okay. That’s great. I’m not necessarily going to go over it word by word. I just have some sections that I want to throw out, because I’m interested in your questions.

I’ve worked 30 or more years now in the addictions field, everything from front line up to various leadership positions, including addictions leader, a manager in a couple of different portfolios and a director in the mental health substance use for the Fraser Health Authority.

I retired from there about four years ago after putting in many, many years. The entire substance use continuum of services in the Fraser Health Authority was in my portfolio, and I had a long history of working in non-bed-based. I worked in detox. I worked in youth treatment. I was one of those people that came from the ground level up.

Not only that, I do have a couple of bachelor’s degrees, a master’s degree, and I have a doctorate. It’s in criminology and criminal justice. So I am also a criminologist, but I also took training, and I am a clinical addictions counsellor. When I retired, I decided that I would use some of my knowledge and skills to assist in building programs and making recommendations and taking on various contracts, the last one being at Kinghaven Peardonville.

I also want to thank you, Pam, for the assistance with the employment money that that facility really needed. That is one of the aspects of addictions that often gets overlooked, and that is that once people have gone through treatment, what do they do? Many of them never had enough skills, and any skills they had, they’ve lost. The employment is an important piece.

I thought that I would let you know a little bit about what I’ve done. I think my colleague, Brenda, who I saw downstairs, brought out five or six binders showing you the different frameworks that have evolved. The current one, which is the core framework, is one that myself and Dr. Brian Rush and Dr. Dan Vigo worked on here for the Ministry of Health and the Ministry of Mental Health and Addictions. It’s based on one that’s been ongoing now for about three years, which is called the national needs-based planning.

I have to say that these are all great models, but they always seem to sit in the position of being plans, and the action parts of what should happen don’t happen. So I just want to put that out.

[1:05 p.m.]

Now, the B.C. Addiction Recovery Association is fairly new. It started up, I think, somewhere, maybe, midway last year. The reason I say somewhere is because I didn’t actually take the contract on to be ED until late summer last year. I was involved in other work. It’s an association…. I think that a lot of service providers, in particular bed-based, really wanted to have some kind of organization to represent their NGO services. BACARA then kind of emerged, and that is who I’m representing today.

I’m not going to go over the goals and missions that I put in this document, because they’re there to read. I just want to get straight to the points.

The three important points for me are having a consistent, stable, sensible continuum of substance use services — which I know has probably come up many times for you from some of the other presenters — to talk a bit about funding and talk about recovery community centres, which are kind of, let’s say, a newly organized piece that’s starting to infiltrate services here in B.C. and is known particularly in the States — and internationally.

When we get to the continuum of substance use services, I can say that in much of the work that I’ve done — and I’ve done work projects all across Canada — B.C. has always been known for its very innovative and visionary approach to addictions. It’s known to take risks, to jump out there and to put a model together to try to address needs, especially needs that that arise and immediately become an issue.

Things like stabilization beds or STAR beds are one model, which is a kind of front-end-loading for individuals. They can stay for up to 30 days while they’re waiting to get into treatment.

A home and mobile detox model, which I developed out in Fraser Health, was to offset the huge, lengthy wait-lists in the more community-based…. In the hospitals here in B.C., we don’t really have detox beds. So these are community facilities that are owned and operated by health authorities. But the wait-list can be 200, 300 people a day. In my analysis, the majority of those people did not need that intensive level. But they did need something to deal with, let’s just say, their emotional withdrawal, which is a big factor.

ICM teams and ACT teams here and second-stage housing — the reason these are just examples is just to say that most provinces do not have these types of services. But in my work with Dr. Brian Rush on the national needs-based planning, we’ve introduced some of those concepts. I’ve gone to Manitoba and built their home and mobile detox. I’m working with the Maritimes to do the same. Stabilization beds — same thing. We’ve done a lot of really meaningful work.

But I think the issue for me is that it’s not consistently applied. In other words, Fraser Health had home and mobile detox. But no other health authority did, even though the research is there to show that you can not only lessen your wait-list by 50 percent, but what I found from doing analysis is that the presentations of these clients to the emergency departments, acute care, etc., was reduced by 70 percent. That’s a lot of reduction. Home and mobile detox does not cost as much as a bed-based standard building that has staff, with physicians, etc. It’s a unique model, but it didn’t go anywhere else.

STAR beds were the same thing. We started STAR beds up in Fraser Health. It’s taken a very long time now for it to kind of catch on. But it makes sense when somebody is leaving detox. What do you do with them? You put them on a wait-list for treatment beds, and they go back out on the street while they’re waiting, and guess what happens. It’s pretty obvious. Stabilization beds fill that gap in. Again, a couple of health authorities, but not everybody.

We have pieces and bits here and there for a continuum of substance use services, big gaps, not consistently applied across the health authority.

[1:10 p.m.]

You can imagine what happens for an individual who is travelling from the North down here to the Lower Mainland looking for a certain service component and finding out that it’s not available down here. So we talk about a Substance use continuum, but we have not taken the great plans that have been made here and applied them consistently across the province.

I would also say that my experience working in the health authority is that I believe…. I’ve seen it go up and down for so many years now, and currently I would say the health authorities probably believe they have more power than the Ministry of Health or the Ministry of Mental Health and Addictions. They don’t listen. They pretty much apply their own thing. They don’t even work together. Again, this all falls on the shoulders of our clients. So just to say that.

Now, the continuum, of course, has prevention, intervention and recovery services, which are all different types of treatment.

Funding. I just want to really quickly say…. This came up in a discussion ten years ago. The province started to fund the Downtown Eastside services till we all started to make jokes, calling it the Corporation of DTES and all sorts of things. People were moving in. Services were expanding. So what do you think happens to all the rest of communities — and all the rest of the communities that have people with addictions and overdose issues? They migrate down to the DTES.

We don’t have any of the type of level of services that we should have in some of the communities like Prince George, Kelowna, etc., to deal with these issues. We don’t have a continuum of care there because all our funding keeps on going down to the Downtown Eastside. So that community….

I mean, I was here eight months ago. I was born and raised here in Vancouver. Eight months ago I came. I came down Hastings, and even the changes in eight months…. I was horrified eight months ago, and now there is no word to describe what’s happening with people.

Imagine if you funded properly and you had a funding-based formula where every treatment bed that was licensed, which is another whole issue, and even run by a health authority were all paid the same amount of money — say, $220 per-bed day. Then anything else considered support recovery got this, instead of one health authority paying this, another paying that. They’re underpaid; they’re overpaid. Who paid what? I think having some sort of an idea about what that would look like….

I think the other thing to remember about funding is there are so many vulnerable groups in every community. Whether you’re talking about women…. I’ve had a lot of experience over the last year at Peardonville House with women with children under the age of five — the only such regulated treatment centre in B.C., by the way, that takes children under the age of five and, in my argument, the only one in Canada, to be quite truthful.

But what about funding? The funding is not enough to sustain and provide the services that need to be there.

The last main point is around this new concept of recovery community centres, RCCs. I think of recovery as when a person first steps into the treatment system, which could be detox, stabilization beds, treatment beds, support recovery. That’s all part of the recovery journey.

What happens when they get to the end of it? Well, we know housing is a problem. Some places have taken it upon themselves to build second-stage housing, an excellent model. Government does not fund it. That’s too bad. That’s a 12- to 18-month program that can be put in place for people.

RCCs don’t have to be bed-based, and they do provide individuals with the skills, the supports, introduction to support groups — everything they need to maintain their recovery. People can attend these services for an unlimited amount of time.

I think RCCs are new to this province, but they have no funding, so they rely on small grants or people just offering up their time. It’s very much a peer-driven model, which I think is excellent. I’m a professional, professionally trained. I see the value in having peer people involved in helping to maintain recovery, build recovery and wellness pathways. I think that is also something we should consider in the continuum of substance use services.

[1:15 p.m.]

I probably don’t need to say too much more. I have made some suggestions in my summary to do with those three topics. I think I’ll just say, again, thank you for letting me kind of spiel my piece of knowledge around the substance use addiction services. I’ll stop my blabbering at that point.

N. Sharma (Chair): Okay, thank you so much.

Questions, anybody?

P. Alexis: Thank you so much. Pleasure speaking to you. I know you’ve got vast experience.

Can you, because we know what’s wrong, tell me what’s right about some of the things that we’re doing? What’s working, and what do we need to embrace and not lose?

S. Mumford: Yeah. Look, when you ask me a question like that, stuff floods in. The first thing that I think is not helpful is having health authorities, because they don’t work together. I liked it better when I was in addiction services, and it was part of the government’s portfolio. There was more consistency. We had regions. Regions got together. So how you eliminate that inconsistency, or how the ministry informs health authorities that that is who they report to, and to get some consistency….

I would say, as I did in the beginning, that there have been some really marvellous things that have come out of British Columbia. There have been good attempts at writing standards. I’ve been involved in those committees, to try to get some of our, let’s say, lesser regulated services in line. There’s been some consistency that’s been attempted in collecting data, which is something we really lack provincially. We don’t have a really good system for that.

There’s also been a lot of support in B.C. from some people in powerful positions that recognize that substance use or addiction is not a mental health issue. They are two different, separate issues. They often coincide. I’m certainly not disagreeing with that. But even for someone with an addiction that suffers from depression, the depression could be the result of their drinking, their alcoholism. Once the alcoholism is under control, the depression goes away. I think that those things have been good.

I think the ministries have attempted — over the many, many years I’ve been in this field — to make changes. But for some of us that are still hanging around and don’t take retirement seriously, I would say that I don’t know how many times I’ve been invited to committees, along with some of my colleagues, where we’ve been asked for input on certain things, only to find out that that initiative has already been launched. Really, all they needed was to get a list of names on the back to say that we supported it. That’s kind of a backhanded thing to do. I think those things should have gone out to a broader audience.

Again, I will say that of all the provinces — and I’ve been across all of them — B.C. is ahead in terms of recognizing issues and attempting to address them as best they can. Even with the Ministry for Housing, the way it’s changed over the years now to be more accommodating to people who have addictions, I think that’s a really good thing as well. I think the attempts are there.

I think, depending on which government is in place and who the MLAs are, some listen way better than others. Some, I think, have recognized that addictions are a health issue, not a moral issue. It’s not that if you never drank, you wouldn’t have a problem. That is simply not true. But it still hovers around, as we know.

P. Alexis: Thank you so much.

N. Sharma (Chair): I have a question. You talked about the recovery centres, community centres. Can you tell us a little bit more about that — where they’re operating, what that looks like and how it shows up in community?

S. Mumford: Yeah. They’re so new that there’s only, I’m going to say, two or three that are around. The reason I know that is the Streetohome organization has asked BCARA to partner with them and to take the lead on some of these things. It’s a really new kind of area that I’ve started to do a lot of studying on.

[1:20 p.m.]

I know that there are a few Alano clubs, for example. There’s one here in Vancouver. I think one over in either North Van or West Van that has taken that model on.

Actually, what was really terrific for me to hear was that they’ve put the 12-step AA/NA models over here and said, “You are welcome to partake in those groups, but here’s a whole bunch of other mutual aid support groups,” because there were a lot of people that don’t abide by or believe in the 12-step AA/NA. I’m not saying that those groups haven’t done great work as support groups. A lot of people don’t…. They’re just not attracted. So now you’ve got this whole other kind of group — mutual group, SMART recovery, whatever — that you can attend.

Also, each one is individually doing some peer-driven training. It could be as simple as how to put together a decent résumé. Right? It could be, you know, something to do with if you had your own apartment, here are the sorts of things you need to know about this kind of grocery list. It could be something about emotional wellness. And it’s not a drop-in group. They run in a way that you sign up to take that group, then you come. It’s not a sort of drop in, “I think I’ll sit there.”

I also think there’s a place called — I could be wrong — Little House that’s developing, I think in Surrey…. I believe it’s Phoenix Drug and Alcohol Society that is putting that one together out in Surrey. I’ve also heard that Vancouver Coastal Health has now decided to start looking at putting that model in place as well.

That’s good, but again, it’s a semi-governmental kind of run, and people with addictions and people with mental health…. They have pros and cons about going into government or health authority–owned and –operated versus an NGO, which is a little bit more friendly.

If you know anything about the mental health clubhouses that are around B.C…. When I think about RCCs, I kind of think about that — very welcoming, multiple skills, speakers, but very peer driven. But again, I think there are only three or four that have started, and they’re in the Vancouver area. My hope is to try to spread them out to the rest of the province.

S. Bond (Deputy Chair): I was going to ask about the recovery community centres as well, but I’ll just ask my second question as my first.

You’ve referenced the work that’s being done, and you’ve referenced the planning model, which is the national needs-based planning model. You said it was being led by Dr. Brian Rush, and you point out that it has outlined the needed elements for continuous substance use and addiction services. Where does that plan reside in British Columbia? Your comment is that the plan is there, but where is the action?

It sounds like there is a blueprint for some of the concerns that we’ve been hearing about a continuum of care. It sounds like there may well be a blueprint. Where is that work in British Columbia? Is government looking at it? Just a sense of: if it’s there, who’s looking at it, and who is considering what the next steps or what work might be done with that model that’s been created?

S. Mumford: The national needs-based planning model is being funded through Health Canada, and I’m the B.C. rep, as well as Gerrit van der Leer. We have our last meeting in August, and then that final report will be written. I do know that Brian has…. Well, Manitoba has taken upon themselves to restructure their entire substance use system based on that model.

Now, what happened here in B.C. was that, through Gerrit van der Leer and the ministry that he works for, Dan Vigo was contracted to build a model. I sat on some of his panels and, in my opinion, the model he built was very heavily mental health–oriented. And when I sat in on the groups…. I was asked by the Ministry of Health and the Ministry of Mental Health and Addictions to do it, because nobody was at that table from addictions.

[1:25 p.m.]

That model has slowly morphed into — Brian and I have worked on it with Daniel quite a bit — the current B.C. model that is in the hands of the Ministry of Mental Health and Addictions and the Ministry of Health. The core framework part that Brian and I were contracted to do is finished, and the report for that core framework, based on the national needs-based planning, is sitting in the hands of those ministries.

I believe what they’re trying to do right now is…. Well, my guess would be they’re going to try to figure out what pieces to fund, because it does have Daniel Vigo’s pieces in it, which are, again, very heavy on mental health. It’s very professional, top-heavy.

It’s kind of been stalled. I’ve asked the ministry a couple of times if they could send Brian and myself the final report of the core framework. I haven’t received one, but Brenda showed me her copy when I was downstairs here just before I came up, so there must be a draft copy there available. It does have all of the components of a healthy substance use addictions continuum of services.

S. Bond (Deputy Chair): Thank you so much for that answer. I think that’s really helpful for us, as a committee, to explore. Hopefully, we don’t have to wait for a recommendation to do that. Perhaps, Chair, it’s worth a question to the Ministries of Health and Mental Health and Addictions at some point. They have appeared before us.

If this work has been done, has been contracted to be done, and provides a roadmap for a more effective continuum of care, I think it would be good for us to explore what the next steps are with that work that’s been done. So thank you very much for your response. I appreciate it.

S. Mumford: You’re most welcome.

S. Chant: Can you tell me what a STAR bed is, please?

S. Mumford: Yeah. I’m just kind of go off the tangent here. Somebody said to me one time, “How do you come up with these models?” and I said that I’d be sitting at home on a Friday night, bored. I’d get in front of my computer and start having these little, you know, “Gee, what if?” — plugging things in and then trying to think of words that would capture that.

STAR stands for stabilization and transitional access to recovery. Who knows where it came from. STAR beds appeared in the Fraser Health framework. We call them STAR beds because when we had the home and mobile detox….

When I did my first estimates, I thought 30 percent of the clients accessing that service would be people who had their own homes, and 70 percent…. It covered Fraser East only — that’s Abbotsford up to Boston Bar — so that’s what I thought. Where I was wrong was that it was less than 5 percent who had their own homes, and the rest were homeless, home-deprived, however. The teams would go out, meet you, bring you back in to Chilliwack, where the hub was. A physician would do your check-up. A physician would say: “You have to go to the bed-based one,” or “You can do the mobile,” or “You don’t need detox.”

If you did the mobile, we had contracted six women’s and six men’s beds at Kinghaven Peardonville and through Elizabeth Fry. That is where they would stay in STAR beds. They would do their detox — say, three to seven days — and then they could stay another 30 days after that.

During that time, usually…. If they were on a wait list for treatment, then they’d be able to go straight into treatment from there. Or maybe they don’t know if they want treatment, so one of the workers — the teams were a nurse and a health care worker — will talk to them about what their options are. Or maybe housing wants to come and talk to them, or maybe the ministry. But they were in a safe place, in an addictions facility, and they could stay there for up to 30 days.

STAR beds are now the same thing on the core framework I mentioned. They’re called stabilization beds. Those are the same things.

S. Chant: So the core framework that you’re talking about was implemented in…. I think I’m hearing half of Fraser Health.

S. Mumford: Yes. It was implemented in one-third of Fraser Health. There’s Fraser South, Fraser North and Fraser East. So it went into Fraser East — lots of rural and remote communities.

We also were able to entice…. The First Nations Health Authority was very interested in the model, so they put in about $1 million, I think. We hired a bunch of the Riverstone teams — it’s what we called it — and went out to all the Indigenous communities. Then they could do their detox in the home of elders, in their lodges, wherever that particular community wanted.

[1:30 p.m.]

S. Chant: Can we get a copy of the model as it was in Fraser East?

S. Mumford: I could certainly send that. To whom?

S. Chant: That would be great, just maybe to reconcile it with….

S. Mumford: Sure.

S. Chant: Send it to Artour. I’ll lose it.

Thank you.

S. Mumford: You’re very welcome.

S. Furstenau: Thanks, Sherry.

Can you elaborate a little bit, when you say having health authorities is not helpful? Can you give us some more information about that perspective that you have and what you see as what would be more helpful?

S. Mumford: I guess I can pretty much say what I need to say, even though I was well known to do that even while I was in the health authority. But they don’t work collaboratively.

Vancouver Coastal has a certain approach — say, a harm reduction approach — that they want to initiate to serve their clientele. They don’t want to share the model. It’s the same thing with Fraser Health. They don’t want to share the model. “See what we’re doing. This is our research behind it. This is what we think will work.” It’s just like they’re independent jurisdictions.

Even when I was in Fraser Health — and I sat on many provincial committees — I would always lobby for the Interior and the Northern Health Authority, because there was very, very little representation from there. I used to say: “Well, we’re leaving our brothers and sisters out up there. How would that work for them?” “Oh well. We’re getting the funding. We’re getting the funding.” And it’s true. They got a ton of funding in Vancouver Coastal. Fraser wasn’t too bad, even though it’s the largest geographical area. Northern, not much.

Mobile models work really well up in the Northern. No funding for it, really. Interior — I revamped their whole entire substance use framework for them about two years ago. Then on the Island here, there are no addictions treatment facilities that are publicly funded. Why? Fraser has more beds than anybody. Certainly, we could have gone over there with our models and said: “Here’s how we….” But nobody talks. Where would the venue be, where would they get together and talk anyway? I mean, you think about it. They do not. Nobody gets together.

The one thing I did in Fraser Health — and it’s been mentioned a couple of times in other committees in the last week or so, which I was very happy to hear — is I organized what I’m going to call rack meetings in Fraser Health. So the east had one, the north had one, the south had one. Why? Because when all addiction services moved over into health authorities, their communication was cut off from one another.

Then twice a year, I’d have what I call the tri-rack, and all three health authorities would come together for a full day. Everybody got to do presentations. We all knew what was going…. The continuum was smooth. Now I’m hearing that’s been broken up again, and it’s that communication.

So I say to you, again: what is the venue where health authorities get together and talk about what’s emerging, what the trends are, what kind of solutions, where funding…? There is none.

N. Sharma (Chair): Thank you. I have another question.

I’m really curious. You mentioned at the very beginning about just the overdoses always being an issue, over time, and that it’s not new. But we are also hearing a lot over the last little while about the increased toxicity of the synthetic opioids that are showing up, that are really new to the system — trying to get the level of potency into the smallest amount for the highest profit for the illicit trade — and that toll that it’s taking on people. We see it with a number….

From your perspective of the many years that you’ve had — you have this expertise and this experience that you’ve had — I’m really curious about your perspective on the current overdose crisis and the solutions.

You talked a lot about the systemic responses that are always things that are needed to repeat. But what is it about this particular crisis that you think — the particular responses we should have as a result?

S. Mumford: Well, from a health perspective, because when you ask me that question, my criminal, logical mind also kicks in…. But from a health perspective, I mean, if you had things like home and mobile detox and stabilization beds…. It’s not that you can stop people from using tainted drugs, which is not necessarily their fault. Although some people would say that individuals do use those drugs because some of them don’t want to live, and this is one of the ways they choose to go out.

[1:35 p.m.]

I remember in Chilliwack someone had a sign in the back of their truck, which said: “We’re so glad fentanyl is here. It gets rid of the homeless.” I nearly ran him off the road, but I couldn’t catch him. It’s something that’s very immediate for individuals.

Now, when we talk about that drug toxicity, what’s really interesting is the new and emerging research that says it isn’t just people that are homeless, that people that are homeless do have the opportunity to kind of watch out for one another. It’s people in the middle class, behind closed doors, that are taking these drugs. What do we do for them?

For them, there’s a lot of shame in coming forward and going into regular services to say, “Gee, I’m a heroin user” and whatever, because they’re working, maybe they have family or whatever. But if you had something that was like home and mobile detox — which I still say is good — and you had those teams everywhere, then you’d have these stabilization beds where people could get their heads together. They aren’t going through physical withdrawal but are trying to figure out the lay of the land — “Gosh, my wife was going into the ER; I nearly killed myself” — just to be able to have that emotionality.

From the criminological side, it’s interesting that you ask, because with a colleague of mine — whose name I won’t mention; he was an MLA for quite a while — we talked about provincial corrections. We both knew that at least 90 percent of the people who went in there, went in there because they had an addictions issue and had committed a crime. We thought: “Wouldn’t it be good to take the provincial correctional system and turn 90 percent of those into provincial corrections treatment centres, where individuals who were sentenced to whatever period of time would go in there?”

It would be a strictly — I mean, custodial but treatment program for addictions, not bringing in the SAM program, which is, I think, a few weeks long now or something of that nature. But the whole thing is a treatment program. With better money invested, you would be able to build skills in for those individuals. A lot of people that are into the toxic drugs do end up committing petty crimes.

Now, in terms of the toxicity itself, how do you prevent that? You can’t prevent it; I don’t believe you can. For people with addictions — certainly, I was a front-line clinical counsellor for years — the types of problems that they finally can identify and that underlie why they got into addictions are so huge — relationship issues, employment issues, issues of loss, issues of trauma. It just goes on and on. How you can get people to reconcile that, so that they can move away from the drug, is a big challenge. It’s not an easy thing.

It’s not easy, like dropping somebody into a 90-day support recovery, unregulated place, and they’re there for 90 days. The people that are in there providing services really don’t know how to, as I say, open the door to that trauma and then close it safely. A lot of people are going to have conversations. They’ve started to talk about a huge loss, and then the peer worker goes: “Okay, well, let’s end it there.” Then there’s that person with that raw wound, and what is he going to do? They’re going to venture out and use.

Putting those types of contaminants in drugs, in order to increase the cost of the drug to make better profits — that has been ongoing in every country for the longest, longest time. How you stop that: I guess you can increase the sentences, increase your vigilance. But for the people that are using it, you need some kind of more immediate response. A lot of times, getting them into good, regulated, full-service treatment means a wait-list of anywhere from three weeks up to, in some places, six months.

What do you do in the meantime? You have these very mobile services that you can build, with some professionals on that team and some accessibility to these beds, and they’re stabilization beds. I think it’s not going to solve the entire problem, but you’re certainly going to help a whole lot more people than are being helped right now.

N. Sharma (Chair): Thanks for that.

Any other questions, colleagues?

Go ahead, Mike.

M. Starchuk: You’re going to make me rethink the first four letters of my name for the rest of my life.

[1:40 p.m.]

When you talk about — what was the term? — RCCS, and you put them on one hand, the number that are out there. What’s the barrier to having other ones?

S. Mumford: Funding, basically. It’s funding. The three or four groups that are trying to launch RCCS, even having a call with them last week…. They’re trying to figure out where to get a grant. Where do I get a grant so I can offer this program or pay a stipend to the peer or whatever?

Grants are not that easy to come by anymore. Now everybody is competing for the same grants. Grants aren’t permanent. They’re a spot in the well, and then you’d better get working on your next grant.

If there was some type of funding mechanism that could be annualized, that could put them on to that continuum where they would be funded, where NGOs could be funded…. That’s the main thing. They have enthusiasm. Alano clubs were always 12 step. Some of them, now, are broadening the way…. They’re looking at other kinds of mutual aid, bringing in peers. It’s amazing to see that transformation.

The main obstacle is funding. Also, this is very new. This model is probably having the discussions, especially like…. Even with our membership in BCARA, it’s only the last few months.

Portugal is one place that uses them. I’m going to Portugal in November to present on the national needs-based planning as a B.C. rep, along with Brian Rush and a few other people. I want to see what the RCCS there look like.

The other thing that’s coming in or being discussed is what we’re going to call adapted therapeutic communities, which is a whole different story. I was never a fan of therapeutic communities way back. They’re very cult-based, in my mind. But the adapted version is a whole different thing. That’s the next thing coming up for BCARA too. We’ve been asked to take a look at that.

RCCS don’t take a lot of funding, but they need a funding stream.

N. Sharma (Chair): Ronna-Rae, go ahead.

R. Leonard: Thanks for your presentation. Thanks for bringing your life experience of working in this field.

The question that I have is…. You’ve talked mostly about abstinence-based treatment. We’re talking about people in recovery. People in abstinence-based…. We’ve had many presentations from people, even this morning, who are not interested in abstinence. They believe that they can live full lives. They need supports around…. That’s where the issue of safe supply comes in.

I guess the question that I have…. We also know, too, that there are folks who have had injuries and have become addicted and have challenges. They’re not necessarily related to all of the trauma issues. It’s physical. There are all these different factors.

If you had a dollar to spend on treatment…. We’ve invested an historic half-billion dollars into increasing mental health and substance use supports. We have a Pathway to Hope, which is supposed to be a roadmap for providing services. We’re all, obviously, still dealing with trying to bring it all together.

If you had a dollar between the whole continuum of services, how would you weight spending that dollar in terms of prevention, education, supporting people who are substance users? It’s a balancing act. How much more funding would make the problem go away? We wouldn’t have any more deaths due to an illicit drug supply.

S. Mumford: Let me tell you a couple of things. BCARA has partnered up with Pain B.C. They’re training some individuals in some pilot sites — Turning Point, Kinghaven Peardonville and others — to do a four- or five-week series called making sense of pain. This is to help those individuals who become addicted because they’re on pain meds.

[1:45 p.m.]

I think what I’m hearing from you there is…. Yes, you’re right. For people that have that level of pain, you can’t expect them to cease all drug use. I don’t believe that, for sure. They’re going to go back to using. They may go back to overusing their prescriptions, etc. I get that.

The second thing is…. I should clarify. I am not a big believer in abstinence only. I never have been. I’m very much for harm reduction. I’ve given input on the decriminalization coming up. I’m very happy around safe supply.

People talk about people with addictions. They don’t all fit in one box. That’s the reason why we have OAT therapy. Some people will never get off methadone. They’ll be on methadone lifelong. Some people won’t, right?

When you talk about the dollar, it’s…. For me, I’m going to say…. My experience with funding is that a lot of the funding that came from government was one-offs. When the crystal meth thing happened a few years back, which I did my master’s thesis on, all the money went into that, but the rest of the addictions fell aside. Here we are now. We have drug toxicity. We’re going to put all our money in that, but we’re going to forget about all the people that might have addictions to alcohol or other kinds of substances.

I still think that if there was a dollar, a quarter of that has to go to prevention and intervention. We want to stop people making the choices to go down that path. So let’s say prevention, intervention, even harm reduction.

I think 25 percent of that also needs to go into the front-end-loading programs I’ve just talked about, which I think are really important, and that is stabilization or mobilization of a lot of programs, particularly when you’re looking at northern B.C. How would that work? If you need access to a bed right now, we get you in right now. It’s a 30-day stabilization. Maybe research will show…. As those beds expand, maybe they’re 45 days, but they shouldn’t be any longer than that. They’re not programming. They’re not treatment. They’re stabilization.

I think 50 percent does have to go into what I’m calling the treatment and recovery system, and that includes detoxes. When I talk about the system of care, I’m talking about regulated, by the way. There are a ton of unregulated services out here. But treatment, supportive recovery and then, I would say, the RCCS. Now that you’ve gone through all of this, you need to have some way to sustain your recovery pathway.

Now, when I talk about treatment…. It was interesting when you mentioned abstinence. I worked for a long time in an out-patient clinic, and the last thing you need to do with someone in there is tell them that you need to be abstinent. When I first got into the field in the ’90s, everybody in out-patient said: “If you’re not going to be and commit to abstinence, you can’t come here.” That changed over time. So if you came to me and said, “Look, I don’t want to use alcohol anymore, but I’m not willing to give up my cocaine,” not a problem. Let’s work on what the issues are, right?

I think out-patient is quasi harm reduction/kind of an abstinence. It’s your goals. It should always be the client’s goals.

One of the main reasons why bed-based is abstinence is, if you look at the licensing regulations…. You can’t have people in there — and this has gone on forever — where someone says: “Look. I’m going to give up my heroin and cocaine. But when I go for my smoke break and I just smoke a little pot….” No, not allowed, not allowed, not allowed.

The regulations there should have been built by and written by people in the field, operating the services, and the clients and then brought forward to government to say: how does the lay of the land look here? So many times licensing has come into different facilities and applied the same rule differently depending on which community they’re from.

That’s how I would break it up. I would say our weak point is: what happens when they’ve gone through a treatment or even if they choose not to go through treatment? They don’t have any recovery services per se that are not bed-based that people can go to and attend. What are we doing at the front end in terms of…? We need a bed right away. We can’t get into treatment for three weeks or two months or whatever. Put them in a stabilization bed. That’s how I’d spend that $1.

[1:50 p.m.]

When I worked in Fraser Health, I said to my friend who’s in finance: “When the cheque comes to the health authority, how does it get broken down?” “Theoretically,” she said, “a quarter of that cheque goes to the mental health substance use portfolio, and two-thirds of that goes into mental health. So what substance use ends up with is a very small cheque.”

Now, I understand. There are hospitals to build, all sorts of specialized services. I’m not saying they’re not needed. If we’re going to really call addictions a health issue, then we need to be investing in it, and we need to invest in it using a funding formula. The beds are paid at this rate. Out-patient is paid at this rate. Blah, blah. It needs to involve a conversation with NGOs of the regulated accountable services that are out there.

That would be my….

N. Sharma (Chair): Okay. Thank you for all your very detailed and, clearly, very experienced answers that you’ve given us today.

S. Mumford: You’re welcome.

N. Sharma (Chair): We appreciate learning from you and the time that you gave us. I think there are no other questions for you.

S. Mumford: I was going to sit here all day and just chat, and here I am. I’m already done.

Great. Well, I very much appreciate being able to speak, especially for the BCARA organization but also just to share some of my experiences and not give you a bunch of statistics. I know you already have them.

Thank you very much. I will be sending, I think it was, the STAR model to Artour. Anything else that you might want from me, please do just email me. No problem with sending you other information. I think I’ve given you my email address somewhere. You have that.

N. Sharma (Chair): Yeah. Great. We appreciate that. Thank you. Take care.

Committee, we have until two. So we have a few minutes, about nine minutes, for a recess. Then we’ll be back at it.

The committee recessed from 1:51 p.m. to 2 p.m.

[N. Sharma in the chair.]

N. Sharma (Chair): Okay, we’ll get started. On behalf of the committee, I just want to welcome our next two panellists — Shawn Bayes, chief executive officer for the Elizabeth Fry Society of Greater Vancouver; and Susan Hogarth, executive director of Westminster House Society.

I just want to welcome you. We’re looking forward to learning from you.

My name is Niki Sharma. I’m the Chair of the committee and the MLA for Vancouver-Hastings. I’ll just go around the room and have everybody introduce themselves.

I’ll start with you, Trevor. Go ahead.

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

N. Sharma (Chair): Do you want to go ahead, Shirley?

Shirley is the Deputy Chair, just on the phone.

S. Bond (Deputy Chair): Thank you, Niki.

It’s Shirley Bond. I’m the MLA for Prince George–​Vale­mount, and I am in Prince George today.

M. Starchuk: Mike Starchuk, MLA, Surrey-Cloverdale.

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

S. Chant: Susie Chant, MLA, North Vancouver–Seymour.

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

N. Sharma (Chair): Sonia, I’m sure, will be joining us in a second here.

You each have 15 minutes to present, and then afterwards, the rest of the time will be for discussion. I’ll pass it back to you, and whoever wants to start can go for it.

Briefings on
Drug Toxicity and Overdoses
Panel 2 – Women and Family
Support Organizations

WESTMINSTER HOUSE SOCIETY,
ELIZABETH FRY SOCIETY OF
GREATER VANCOUVER

S. Hogarth: I would like to recognize that I’m a visitor to the Coast Salish territory, and I would like to thank the First Nations for their hospitality.

Thank you for this opportunity to present to the Select Standing Committee on Health as a representative of Westminster House and a citizen of British Columbia.

I want to take a moment to qualify myself as a professional in the addiction recovery industry. I have a master’s degree in business administration. I have extensive experience in the private and not-for-profit sectors, specifically addiction treatment, as the executive director. I’m also the treasurer for BCARA, and I am the treasurer for Recovery Day B.C.

I have read through the select standing committee proceedings and transcripts — not all of them, but a lot of them. But because of time, I will speak briefly about Westminster House Society and ask that, if you are curious, you visit our website for more information.

In summary, we’re a 48-bed program for women and girls, specializing in the trauma-informed addiction recovery program continuum. Westminster House operates at the intersection of private and not-for-profit. Our services are for benefit. We operate our funded beds at a $388,000 deficit per year. We are licensed by the Fraser Health Authority and are in the process of obtaining CARF accreditation.

Our staff team is trained in mental health first aid, basic counselling, naloxone training and trauma-informed care. In addition, our clinical staff are certified counsellors by the Canadian certification branch, the CACCF. They are addictions counsellors with diplomas in counselling and degrees in psychology. In summary, we are well equipped to treat addicted individuals.

However, we have a new, urgent need that needs to be addressed, specifically mental health challenges. For example, the opioid overdose epidemic has brought on a host of mental health issues for women, including the trauma of overdosing, death and near-death experiences as well as cognitive problems resulting from non-fatal overdoses that affect an individual’s brain due to lack of oxygen. For example, we recently treated a woman who overdosed 17 times in one month.

In addition, the COVID-19 pandemic brought on mental health challenges in women, including trauma caused by fear and isolation as well as anxiety and depression.

Accessing psychiatric support for evaluation for women who attempt and threaten suicide or engage in brutal self-harm is impossible. They are not adequately evaluated in the hospital setting. For example, last year, we had a 19-year-old girl who almost cut her hand off attempting self-harm and was taken to the hospital by ambulance. She was released three hours later, after being stitched up, and we were told to pick her up because she was not a danger to herself or others. However, when she arrived back at the facility, she attempted to jump in front of a moving car.

Despite my expertise and ability to access resources, I am also a person who has lost a family member to addiction, from a heart attack caused by fentanyl poisoning. While we sat in the hospital for five days, waiting for our loved ones to say goodbye and to donate her organs, we learned she had been admitted to the hospital twice that month for an overdose.

My personal experiences, as horrific as they are, are not uncommon stories to hear in my profession. Families are desperate, and so are we.

I would like now, to the best of my ability, to answer your questions. What action should the government take to address the ongoing overdose and drug toxicity crisis, and how can service be improved? I believe it’s through accountability, messaging and wraparound services.

[2:05 p.m.]

I mirror the opinion of my colleagues that stigma and discrimination are relevant factors in the current crisis, but I urge you to consider another realistic contributor that is not discussed openly for fear of retribution. Many individuals use alone because they don’t want to share their drugs. This is one of the facets of the baffling nature of addiction.

Additionally, some individuals are willing to risk an overdose and their lives and take poisonous drugs intentionally. Many don’t want a safer supply except to sell it and to obtain a poisonous drug supply. Drug addicts are selling Dilaudid 8s to obtain poisonous drugs. There are thousands of Dilaudid 8s on the streets of Vancouver.

Another fact is that many use the supply of their OAT and their MAT to maintain somewhat of a functioning level, but unfortunately, they then seek out poisonous drug supplies to intentionally get high.

Addicts need purpose, and part of the safer supply and OAT programs must include dissuasion tactics. Individuals need to engage in programs and must be held accountable to work or school or to a program that they choose. They need to be monitored daily to make sure they’re following their treatment program.

There are many free services available, and there’s been talk — and Sherry just talked about it as well — about recovery community centres for five, six, seven years, and they’re just starting to materialize now.

We have complicated factors in B.C. with illicit drugs. The problem is hard to solve, but it is addressable, and it can be resolved with systems, processes and accountability. Addiction is not that complex, meaning it doesn’t have many unknowns. Remission from the disease often requires several rounds and several pathways.

Some studies point to death in which methadone was the cause of death, yet there is no recently published data regarding the toxicology of the death and harm done by the increasing toxic and unpredictable illicit supply of drugs, seemingly because of the accountability for the treatment decisions that have been made. We are so far down the rabbit hole.

According to the B.C. Coroners Service, toxic drugs have claimed the lives of more than 150 British Columbians daily for 18 consecutive months. The statement from the coroner asking people using substances to exercise great care and use only a small amount and make sure somebody is handy is almost comical to people who have experienced addiction. However, the coroner’s statement only lends itself to the recovery advocate’s argument that the professionals leading the charge are grossly out of touch with the realities of addicted individuals who are intelligent, cunning and powerful manipulators and will stop at nothing to get what they want.

We are entering a dangerous time. The messaging is critical to prevention. We cannot imply that using drugs is safe or accepted. I suggest effective messaging utilizing social marketing campaigns to change behaviour.

Sidebar: we treat 14-year-old kids who are not scared. They’re not scared of the consequences, and they’re not scared of the poisonous drug supply.

Based on a patronizing approach of social marketing, I have some examples of social marketing campaigns, but I will just mention one: the price of crystal meth is your teeth. We need messaging illustrating consequences of addiction and bad behaviour and emphasizing solution-focused messages that promote long-term, sustainable outcomes. Ideally, if you’re on drugs, go to the hospital.

Harm reduction advocacy groups stigmatize recovery and discriminate against abstinence. These groups have victimized addicts. They do not need sympathetic pity and concern for their suffering or misfortunes. They need help. Ultimately, a percentage of individuals suffering from addiction and overdose humiliate themselves publicly, engage in extreme self-harm and participate in public drug use and crime.

Those who are hospitalized with critical addiction issues, such as a mental health crisis, severe withdrawal or overdose, are labelled addicts. The box is ticked, and the individuals are released almost immediately. Health professionals fail to consider that once an individual is administered Narcan, they go into immediate withdrawal. So what do you think is going to happen when they leave the hospital?

Wraparound services are needed to take advantage of the immediate opportunities. There are opportunities being missed, thousands of them a day, to be able to help these people while they’re in the hospitals, to support them out of the grips of addiction. And I mirror what Sherry says: put them into some kind of stabilization for an assessment. Don’t we want to know why people are using poisonous drugs?

Leslie-Ann was a frequent flier of all pathways to treatment. Leslie relapsed and overdosed and was admitted into Surrey Memorial Hospital where, according to her family, she was immediately released. She phoned them. Unfortunately, she used the pay phone in the lobby of the hospital to call her dealer and overdosed and died in the parking lot.

[2:10 p.m.]

In the transcript from June 21, R. Leonard asked: people who go to treatment come out, and they are more at risk to die? More important to know is why people who access a hospital for an overdose die or overdose again and again, affecting their mental health and the integrity of our health care system. You would expect that if a British Columbian accesses a hospital, they will get help for their health issue.

So to answer your question about improving care and how government and institutions can improve services, support and resources in response to the ongoing overdose and toxicity drug crisis, the answer is to circle back to the start of an individual’s process and provide wraparound services and opportunities to access services right from the start. They need to be held in the hospital.

Circling back to the concept of social marketing, nudging is a social marketing concept that proposes positive reinforcement and indirect suggestions to influence behaviour and decision-making by nudging individuals towards a preferred goal such as human health and well-being, whatever that may be for them.

For example, the province should consider investing in nudging strategies to reduce harm by dissuading individuals and to support adequate assessment. Nudging strategies will help influence treatment choices, improve outcomes, reduce damage to the province’s reputation and reduce drug overdose and deaths. I have a lot of examples of nudging. I just completed my master’s degree. I’ve been researching this stuff for two years.

The health authority is positioned as an expert. It can use wraparound services to redirect people to conform to the desired behaviour by developing conditions, social systems and environments in which people prefer to make choices for their benefit. The experts can nudge people towards mandated solutions, but it won’t happen in two hours, 48 hours or even 72. My 14 years of experience in this sector conclude that nudging individuals to make choices for their benefit can take up to two weeks. That’s why, at Westminster House, we have a two-week retreat period.

I’m not going to comment on the provincial budget. However, I’m sensitive to the issue. There’s no money for health care. Everybody is asking, and there’s not enough to go around. We are all fighting for the hand-me-downs. However, consider that that two-week assessment will save funds by avoiding readmittance to emergency, ambulance calls and death. Most importantly, we have to start utilizing what is already there. Continuing to build infrastructure is costly. There are hundreds and hundreds of empty beds in this province.

Housing second. Simply, the Mental Health Act urgently needs to be reviewed and subsequent placement of people in SROs. Walking through some of our poor neighbourhoods can easily be mistaken for a scene from a zombie apocalypse movie, with individuals unable to control their uncoordinated movements, stricken with flesh wounds and disease. Questionably, the treatment of this demographic of people is inhumane. Individuals often defecate on the streets, inject drugs into their bodies out in the open and lie unconscious on the sidewalks. What kind of a message is that saying to our societies? What is that saying to our children?

Many, many addicts can’t remember to eat, sleep, pay bills or even use a phone. Help is not offering a prescription, hotel room key and paraphernalia and saying: “Good luck.” Instead, it’s holding individuals accountable to their treatment pathway, whatever pathway they choose. Help is accountability for the medications prescribed, dispensed, administered and ingested.

Gaps exist because of the lack of understanding of what it’s like to be addicted. I argue that the research in this province on substance use disorder is influenced because the research will benefit the funders. They will get something out of it.

Providing a review of data on overdose toxicity, including drugs meant to reduce harm, would signal an urgent need to change the provincial response to addiction recovery because, despite all the medical interventions in British Columbia, the illicit drug problem worsens. Additionally, investing in tools available to track addiction treatment, such as My Recovery Plan, could be deployed in every licensed and registered treatment and recovery service in this province — all the pathways. I’m baffled why we cannot track this data.

Now we can see what’s going on. I suggest that the potential reason why addicts with opioid dependency cannot recover is because of the historical pharmaceutical intervention. That’s less obvious. But important gaps of not understanding how individuals think and behave while they’re intoxicated…. Wraparound services are needed for individuals who are seemingly trapped in the cycle of addiction. When the tiny door of recovery opens, it is closed just as fast by the principles of reducing harm.

[2:15 p.m.]

No matter what happens in this forum, there has to be an understanding that I am not the expert, nor are you. The experts are the people who have recovered and know the way out.

The Mental Health Act needs to be reviewed. People at risk of death should not have a choice to keep using illicit substances — period. It’s too expensive. It’s not solution-focused, and it only delays the inevitable.

Again, I’m happy to talk to you about Westminster House. As well, I have a lot more information. I cut this presentation down from 22 pages over the weekend, with the help of my friend Rebecca and my staff. I’d just like to thank you for listening to me.

N. Sharma (Chair): Thank you, Susan.

Over to you.

S. Bayes: Thank you for the invitation to join you on the Coast Salish people’s land.

My name is Shawn Bayes. As Niki said, I am the executive director, chief executive officer of the Elizabeth Fry Society.

What I wanted to do was to talk, really, about our work. We are the founding Elizabeth Fry Society, from which has grown the national movement across the country. Our work is dedicated to advancing the humane treatment of criminalized women and the development of programs and services that address the needs of deeply marginalized women and adolescent girls and the children of these women.

My comments today to you are centred around our gender-based plus analysis that provides responsive programs to address the reasons why people are criminalized and, as such, are programs that work not only supporting women to exit prison but to address substance use, homelessness, mental health and trauma and abuse.

Much of our work has been as a social innovator over the last roughly 85 years. We are the people who brought non-government group homes to our province for youth. We developed the methadone treatment program in 1959 in our province. We were an early adopter, a supporter of that. We have a long history in terms of working with prisons and bringing education and training into prisons, the separation of women and youth from adult men.

In talking to you about high-risk women and people exiting prison or other, I know that you will have heard much about the high risk of people exiting institutions for overdosing. So my comments to you are really addressed at sort of the context in which people live their lives who are struggling with addictions.

In our work, we see the effect of the toxic drug supply, both within the provincially sentenced population — which I am sure you have heard has continued to decrease as we have seen the loss of individuals — and through the continued loss of individuals here on the Downtown Eastside. We have an office here, at Hastings and Main. We are the largest provider of third-party administrated services for the Ministry of Social Development and Poverty Reduction for people on income assistance who are banned from government offices.

We are the largest provider of women-only addiction treatment services in the Fraser Health region, the largest provider of homeless shelter services for women, women-only homeless shelter services in the Fraser region. On any night, we house more homeless children than any other provider within the province. Our work is therefore really grounded in those experiences and what we see.

I want to talk to you, therefore, about the issues that women are struggling with and where we see there are gaps within the current system to support and address their needs and those of their children. I speak to you, therefore, about the regional health authority, bed-based substance use treatment programs, the B.C. Employment and Assistance program, programs for pregnant and parenting women and women in conflict with the law.

Many of the issues I highlight not only affect women, but I think they are a good example for you of where that impact is being experienced within the health system for people.

Many people assume that their health information is private. That is, however, not true for the poorest of the poor. Those on social assistance, individuals entering bed-based treatment programs operated by local health authorities, are routinely asked to provide their SIN, MSP and GA numbers. It is that information which is used by the ministry to verify the identity of the person served.

[2:20 p.m.]

That information is then used and stored in people’s files. Having been able to verify the individual as being a client on social assistance, a per diem is then paid to program providers.

The same is, however, not true for individuals entering bed-based treatment programs operated by the provincial health authority. If you are lucky enough to enter one of those programs, you do not have to identify yourself as an individual on social assistance, and that information regarding your personal health will not be recorded in your file.

The systems are inequitable, and they particularly affect those on social assistance who, by and large, attend regional health authority bed-based programs, which rely upon a variable- and fixed-based funding model. Payment of the per diem for those in receipt of social assistance is either through the ministry or you’re given an option to pay the $45 a day.

There are other kinds of models. Westminster House is one of those hybrids with privately paid and replacement fees for the ministry. There’s just a multitude of care models.

If you’re in an organization like EFry and you want to come, your choices are that you’re funded by the Ministry for social services, or the replacement portion of that fee is paid by you. It’s $1,350 a month if it’s just paid on that replacement basis. That amount is an amount that many people cannot afford to pay.

Fifty percent of female B.C. tax filers have incomes under $20,000 a year. Their income of roughly $1,665 a month would not allow them to enter treatment and to remain housed. With less than $300 a month, the choices they are faced with are significant, whether you’re on income assistance or whether you can afford to pay for yourself.

Secondly, while it’s possible to request that the shelter portion be maintained for those on income assistance, it is not inherently an occurrence. It’s not a policy. What that means is that we don’t inform people. There is no requirement to advise people, on their applications where they provide their informed consent for us to see if they can be funded for care…. Those forms do not provide information to clients about the forthcoming loss of their shelter funding or the ability to ask that it be waived.

B.C.’s high housing costs mean that many individuals on social assistance don’t live alone. Therefore, the loss of [audio interrupted] affects more than one, and we are seeing significant numbers of people lose housing. There is very little affordable housing, but we’re destabilizing housing units by having a variable funding model that removes from people their social assistance housing payment.

Secondly, it places people in crisis. They find out about it when the money is cut, and they’re forced into the position of having to beg for something that is seen as a privilege for them to have as opposed to a right, which they would have if they were in a provincial health authority–funded bed-based program.

Third, in providing the information to the ministry, as I have reported, it is routinely stored in case files. Therefore, requests for things like crisis grants are filtered through that with biases about substance use treatment and potential continued treatment. EFry, in its work as a third-party administrator for the ministry, often has questions asked about whether or not those requests for crisis grants are drug-seeking behaviours.

I think that the linking, for people, of income support programs with health information is particularly difficult and further exposes people to systemic bias and discrimination. As it relates to pregnant and parenting women, the financial framework I have described clearly impacts sole caregiving women and their ability to care for their children, both as it applies to their need to find a replacement caregiver and the housing destabilization and loss of housing for their children that occurs.

[2:25 p.m.]

EFry operates the Ellendale cradle, which accepts women with infants and their children up to age six. We also offer intensive, level 5 drug treatment. We have a full spectrum of care. What we see in that is that women have to choose between entering treatment or being able to care for their children.

Children, in the few mother-infant funded programs, are treated as appendages. There are no programs that are provided to support healthy child development, mother-child attachment. These children are impacted by substance use. Those children are losing the window of early brain plasticity that we can provide for them to meet their maximum potential, because there isn’t any opportunity for them to receive benefit while their mother is in treatment.

That’s a significant concern for us, because these are often children who don’t have primary health care. They don’t have a doctor, so they’re not identified until they enter school, at which point that early brain plasticity and their best opportunity to function to their best ability has been lost. Simultaneously, while there are no supports for these mothers and children, these women are also highly monitored by child welfare authorities because there is an assumption that they’re incompetent parents.

Lastly, individuals serving community sentences who are out on bail are not accepted into bed-based programs. It’s against the Fraser Health Authority policy. It’s also against Vancouver Coastal and most health authorities. Not all put it in writing as clear as Fraser Health does, and that’s, of course, because they have 14 prisons in their region. What that means is…. Similarly, people on remand cannot be released to a bed-based treatment program, even though lack of a residence is one of the primary reasons individuals are held on remand, and we have more people on remand than serving a sentence in our province.

One of the greatest periods for people to be highly motivated is at that time. Individuals who have committed crimes tend to do so under the effects of drugs and are highly motivated, then — facing the forthcoming consequences for decisions — to enter treatment. But they are barred from being able to do so, and we lose a real opportunity to be able to support people and change behaviours.

The structure of the system for people stigmatizes them and reduces the likelihood of seeking treatment. Women need holistic care, and they tell us that the model of care provided for them breaks up their families and places their parenting under increased scrutiny, particularly if they’re Indigenous or racialized, and that they exit from trauma or treatment into greater poverty and increased financial constraints upon them to make choices.

When seeking to access community care — such as through the ACT team, assertive community treatment — they are turned away, because their experiences of trauma and abuse, which is particularly common in Indigenous and racialized women, has resulted in an Axis II diagnosis. Axis II diagnoses are determined to be particularly treatment resistant, and therefore women are not accepted in those programs.

For all of these reasons, in October 2022 — not far — EFry stands to open a fully staffed, 6,500-square-foot, team-based, primary care clinic with allied health services, serving a patient panel of 3,000. We will do so in Whalley, north Surrey, the area of B.C.’s highest concentration of female-led, sole-caregiving families; Indigenous female-led caregiving families; children in poverty in our province; and the number of children by census tract — the greatest concentration of children.

As well, the majority of north Surrey residents fall within the most vulnerable 20 percent of people in our province struggling with deprivations related to situational vulnerability, housing instability and high ethnocultural compositions. It’s not surprising, I think, therefore, that Surrey has the busiest court for women west of Toronto. It is the community from which we are criminalizing women, and we are doing so because there are few resources that actually address the context which places them at risk and in need of support.

We have put our clinic there for all of those reasons and, in doing so, are providing individualized stock programming for women and children, which we have done for ten years at our own cost, because it is not recognized or seen as a legitimate need for those children. I have tried to explain why we see it as critical.

[2:30 p.m.]

For community-based substance use support, offer affordable housing and crisis emergency shelter. We’ve built a $34 million, 60,000-square-foot building, for which we raised 70 percent of the money. I hope never to do it again, because that’s insurmountable for a small women’s micro-niche organization, for us.

We absolutely feel that we cannot continue to move through a system that barriers women from being able to access care and condemns their children to the intergenerational legacy of abuse, mental illness, substance use and criminalization, as well as homelessness. Thus, for us, that’s how we have placed our work to be able to address it.

I’m happy to answer any questions you might have.

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

We have Pam. Go ahead, Pam.

P. Alexis: This is a question for Susan. We are all MLAs tasked with finding a solution to issues that we’ve been facing for years. I’ve asked this question of many others, because we’ve been at this since April. Tell me what’s working right. We got the message loud and clear about everything that was wrong, as far as your research indicates. Tell me about Westminster House and what’s working at Westminster House.

S. Hogarth: That’s an excellent question. I did not even think about that as I was writing my presentation. I think, for us, what’s going right is that we have that ability to continue growing. We have a really good board of directors that’s supportive of our growth, as we need to grow. We have a really good fundraising team, so we’re able to subsidize the government-funded beds.

The good news is that a large percentage of our women — I don’t have it offhand — stay clean and sober, and if they don’t, they have an improved life. Sometimes “clean and sober” means that they’re stable on their medication. Sometimes it means they’re completely abstinent. That’s a choice that they get to make in treatment.

For us, I think, we changed that model about six years ago. We used to be opposed to having an MAT, medication-assisted treatment, in our programs, and now we find that since we started to take people in with OAT and medication-assisted therapies, they are influenced by people who are abstinent and come off their medication on their own.

I think that’s a really positive sign that when you’re able to build recovery capital — I know you’ve heard about recovery capital from the Last Door and throughout the conversation — you really can change your life. If you’re physically healthy, if you’re mentally healthy, if you have connections with your family and peer support, if you’re engaged in educational opportunities or doing volunteer work and have purpose in your community, your life improves. I think that’s the good news.

There is hope, but from the perspective of me, as a student, I would say you guys need to stop what you’re doing and restart.

P. Alexis: Thank you for that. Appreciate it.

T. Halford: Susan, you just said…. What did you get your master’s in?

S. Hogarth: I have a master’s in business administration. I just completed it, so it’s really new. For the last two years, I’ve been researching addiction recovery and different types of treatment and how we can improve the systems. Most of this stuff is from a lot of my work.

We’ve got a really big problem here. The problem is the continuum of care. The continuum of care — we’re not talking about EFry and Westminster House. We’re talking about at the top of the chain. The hospitals are not doing their job. Health care providers are not doing their job. They’re sending people into withdrawal onto the street. You want to know how to stop the overdose crisis? Stop doing that.

T. Halford: I think that if…. What I’m getting at is that we’ve heard from a number of presenters — I think it’s been going on a number of years — that there seems to be a bit of a drowning in bureaucracy. That happens, and in different sectors.

Specifically, what we’ve heard from others today, and in previous sessions, is that you’re bouncing from spot to spot, and your cap in hand, going from funding to funding, ministry to ministry. That problem has been ongoing for a long, long time.

[2:35 p.m.]

In terms of your day-to-day activities and the service that you’re providing, you’re providing a service that is, ultimately, sometimes, life or death. You’re probably filling a lot of your day with trying to navigate a government system, right?

In that, are there any suggestions on how we break down those barriers, whether it’s accountability with health authorities? Like I said, it’s been going on for decades. But in terms of the health authorities — whether you’re dealing with Fraser Health, Interior Health — there are different policies, there are different programs, there are different funding models. So you’re at the mercy of particular associations, individuals.

If there was something that we could do, internally, in government, to make your life easier — and I’m not just saying that that’s with a cheque — in terms of trying to streamline things and let you guys focus in on what you need to focus in on, what is that?

S. Hogarth: I strongly believe in a provincewide system. We need to take the addiction treatment and mental health away from the health authorities, and it should be one system for all British Columbians. I believe you should be able to swipe your MSP card, because it is a health issue.

One of the things that we have…. We have funded beds. We have a, sometimes, one-month, sometimes three-month wait-list for funded beds in our centre, and we have private beds. We operate on 85 percent occupancy. We always have ten beds open.

The province needs to buy those beds. They need to buy those beds at a fair price and fill them with people, rather than keeping them on the wait-list. I know that to be true of every single service provider in this province. There are a lot of beds. It’s like: how do we get the access to them? We need to streamline it. It has to be a provincially run system. Everybody should be paid according to their tier, and it should be fair for everyone.

T. Halford: Last follow-up on that. You said subsidizing government-funded beds. What did you mean by that?

S. Hogarth: We have 14 government-funded beds, and we have 16 private beds. For our government-funded beds, in order for us to not have a two-tier health care system in our centre — because we have psychiatrists, doctors, nurses, wellness programs — we have to fundraise to subsidize those beds to keep them open.

You have to know something. The funded beds in our programs are the heartbeat of our organization. Many of the people who recover and stay recovered come from that funding stream. To give up those beds and on those people would be a crisis for this province. It’s up to us. As a service organization, we are responsible to raise that money, and it’s heartbreaking.

Then to be judged on our work and not doing a good enough job and somebody leaving and relapsing is heartbreaking, because we try so hard to be able to keep the roof over, feed people a nutritious meal and keep our staff. I have to pay a fundraising staff.

I really strongly believe we need a provincial system that’s funded by the province of British Columbia and that’s equal and fair to everybody. That’s heartbreaking — to hear that people can’t come out of the criminal justice system and get a bed in treatment. What’s that about? Why are we giving up on our citizens?

S. Bayes: Could I suggest that you also think, though, about a varied system? We have a one-system…. We have a model that has continued to exist since the ’70s, which is a bed-based system. A bed-based system requires people to exit from everything in their life — leave employment and everything else. Because of that, it’s a model that does not allow people to seek and get help when they recognize they have a problem and to be able to address it. We wait until people are at a point that they cannot function before we have intervention.

There are other models that provide for community health models — collective models that would allow people to have treatment and care, in after hours, on weekends, that would allow you to continue to work, that would allow you to continue to care for your children or care about your responsibilities, however they may be set out. But we don’t allow people to continue to go to university — say, if you’re beginning to struggle with substances — to do any of those things.

We’ve built a system that says that we will intervene at the lowest point of functioning. The only model we have is a bed-based system, and we require individuals to exit and not have contact with their external world. Much of what we know, though, about supporting individuals to be successful is that we do well when we enable people to be connected and deeply rooted in their daily lives.

[2:40 p.m.]

That’s what reduces recidivism, and when we sever that, that’s when we increase the risk for people. Our model does that.

S. Hogarth: If I could just speak to that, I agree with that statement. But I believe that there is a continuum of care and that many people do need a bed-based service, and many people don’t. I agree with what Shawn is saying — that we’re too late.

That’s where I go back to what I’m saying about the hospitals. It’s like there’s an opportunity that’s being missed, every single day, to step in, assess people properly and find out where they fit on that continuum. Do they need out-patient supports? Should they be on a safer supply? Should they be on an opiate agonist treatment? Should they go into bed-based services? Do they need a shelter? What is the service that they need?

But they don’t take the time to talk to the people while they’re in the hospital. They send them on their way. When they’re on the streets overdosing, they Narcan them back and send them on their way. When they’re in the hospital, those opportunities are being missed to assess and determine where the person fits on the continuum and to help them get better.

S. Bond (Deputy Chair): Thank you for the presentations.

I think the conversation that just took place between the two presenters is actually really critical. I just want to frame my comments by referring to something that, I think, Susan said — that we are not experts. We’re not. There is a huge sense of responsibility, as we listen and learn. I have said, over and over, it is a steep learning curve for me. I can say that with all honesty. We are not experts.

Even the conversation between the two of you recently points out to me that it isn’t about whether it’s a bed-based model or not or whether there are virtual supports. It is all of those things.

I think one of the things that I really appreciated being said was that, at times, there’s discrimination against abstinence-based programs. I’m no expert, but I would imagine that we need a complete variety of options to meet the complex needs of individuals who find themselves addicted. It isn’t one size fits all. I think that your conversation today really helps bring that home for us. It isn’t one or…. So I just wanted to say that I really appreciate that.

I also want to reiterate my concern about hearing again that organizations providing bed-based treatment options are subsidizing beds and that there are empty beds. We’ve got to figure that out. I don’t understand, necessarily, the complexity of that argument and why. But I know this: we have people who want that treatment and who need that treatment. So I continue to be…. Every time we hear from a provider that says they are operating at a deficit, I have to say that is incredibly difficult to hear.

I did want to speak to the issue that you raised about messaging. Again, it was Susan, I think. I think that there is a role and a need for there to be an awareness of risk. I understand all of the…. We’ve listened for days and days about the need to support people where they’re at. But I’d like to at least make sure we have a conversation about before they’re at that place.

I just was wondering if Susan could just speak. Her quote was that we’re entering dangerous times. We need effective messaging. And 14-year-olds are not scared; they’re not aware of the risks. So could you speak, Susan, again, to just some suggestions, ideas?

For me, this is a whole bunch of things. It’s prevention, education, treatment, recovery — all of those things across the spectrum. What does that look like? You talked about nudging, which I had not heard about, but as you explained it to me, I think that’s important. So a little bit more about the fact that we have to do a better job on the front end of portraying the risks and the honest potential consequences.

[2:45 p.m.]

S. Hogarth: Absolutely. Messaging is really important in these times right now, especially with the construction workers. They know the risk. Everybody knows that if you take drugs, you have a chance that you’re going to obtain a poisonous drug supply and you could have an overdose and die, but they do it anyway. We need to get curious as to why that is.

So sending some messaging out into the community…. You know: “Using drugs builds a faulty foundation.” And having some imagery about what that looks like. What is the consequence of a construction worker using drugs? What is it going to mean to them to stop? What is the risk there?

Another thing. I can’t stop thinking about Mothers Against Drunk Driving. They have a great social marketing campaign where they have the image of the drunk driver being arrested and taken away. That’s crystal clear what happens when you drink and drive. “Your brother, your neighbour, your sister, your aunt….” That says nothing, the stop overdose campaign. “Use safely. Don’t use alone.” What does that say about the consequences? How…? Why…? People aren’t going to make a decision for their benefit based upon that messaging.

We need to go deeper. You know, the price of crystal meth is your teeth. Show a youth with no teeth, because that is the truth. Yeah, illustrating consequences of addiction…. I mean, I have a lot of….

You know what? It was interesting. I was in a meeting the other day, and there was a construction worker who was sharing at this meeting. I’m also a person in long-term recovery, so I know how to get out. He said he was a boilermaker, and one of the things they do in the boilermakers is that every once in a while, they’ll take all of the staff out of these camps and take them to a movie. Then they’ll send drug-sniffing dogs in there, and they’ll find out who has brought drugs into the camp or who has got drugs in the thing.

The boilermaker shared how grateful he was to be clean when the union took everyone to a movie while the drug-sniffing dog checked all the lockers. He used to be one of those people who would have drugs in his locker. That is the imagery that you want to show the construction workers. That is what will affect them to think twice about picking up a poisonous, toxic drug supply, which is what it is.

Again, I just really feel like this province needs to get curious as to why people are doing it despite the consequences. We need to get to the root of the problem and find the best pathway. Maybe it’s as simple as some trauma therapy or something way in the onset, or maybe it’s a lot more complex.

For us, Westminster House is the middle ground. We don’t take the super complex issues that Elizabeth Fry would take. We try, but we’re not skilled in that area. There are so many great services in this province, and it’s getting people to that service.

We get our referrals for our funded beds from a thing called Agiloft in the Fraser Health system. We should have never received clients that are going to cut their hand off in self-harm. That should have been assessed properly in the beginning, and they should have gone to a support system that could manage that type of addiction and mental health.

So that’s what I’m saying. The biggest message I want you to hear is the missed opportunities that are happening in the beginning of the cycle of addiction.

N. Sharma (Chair): I have a question. Shawn, you mentioned quite a few very, very specific things about the systems and where it could be improved. I would first just ask if we could get that in writing somehow. I was trying to take notes of everything that you said, but I want to make sure that I have, like….

S. Bayes: I can email my speaking notes.

N. Sharma (Chair): Yeah, that would be super helpful.

One thing that we were learning was this really tragic statistic that Indigenous women are 9.8 times more likely to die of an overdose than other women. In your work and when you see that and how that shows up…. I just wanted your perspective on that and what might be needed to support that. I think that that was something that we learned that was pretty tragic.

S. Bayes: I talked to you about the ACT teams. Those are community mental health teams, and they deal with dual-diagnosis people, so individuals with substance use and mental health. They often go together, as people have ongoing substance use and move deeper into complex needs and enter into psychosis and whatever.

[2:50 p.m.]

The difficulty is that, as I mentioned, Indigenous and racialized women have very often been those who are trafficked, those who are used in the sex industries. Because of that, they have a high occurrence of having access to diagnoses. That means post-traumatic stress disorder, borderline personality, depression. Any of those diagnoses will see you barred from being able to enter the resource that we think is available for people. They cannot go.

If you look in Surrey, the SMART table, which is the table that brings together health, criminal justice…. There are police. There are educators. There’s everybody at the table to identify really high-needs individuals. Over 50 percent of the people identified are women. It is because there are few resources for them. That’s why we see Indigenous women. They are so often affected by trauma. They don’t have access to those community mental health resources.

If you enter a hospital…. Certainly, the issues with Surrey general hospital have been well documented — and the recent report that spoke to the issue of discrimination in our health care system. That’s another reason why people don’t access care. The link in our system with identifying individuals and then the over-monitoring and scrutiny of them, in terms of their parenting and caregiving, mean that people — women, particularly — are very resistant. They hang in until the last living minute.

They are the only people with their children. To get addiction support care, you have to give up your kids. They’re not putting their kids in care. They’re not doing anything to identify those children. So they don’t have access to care.

That’s the end of the spectrum we work in. We work with complex individuals. We work with polydrug-using individuals.

That work has to be really grounded in a recognition of that. That’s why we’ve been running Growing Great Kids, which is a program now starting to be used widely in B.C. in Indigenous communities. It’s used by the province of Manitoba in their Indigenous-responsive child welfare system. It has a great amount of ability to build that bond and support. That’s the first thing.

The second thing is…. We actually do bring in counsellors and care for our individuals. The primary health care is tied around the issue of having primary health care, enabling women to carry out their responsibilities and get health care and address those addictions issues. That’s really critical, because they are the ones who are dying.

N. Sharma (Chair): Thank you.

Go ahead, Ronna-Rae.

R. Leonard: Thank you for that answer. I would like to, first of all, thank you for the work that you do in your organization, for serving women and for identifying, particularly, the systemic problems that we have.

For the women who have been diagnosed, I would assume that the reason that they’re barred from having access to ACT teams is because there are supposed to be other services for them. Nothing?

What’s the reason that they’re…?

S. Bayes: No. They’re seen as treatment resistant. In other words, the provision of care is not going to provide a benefit as much as if you intervene for other individuals. They are not treatment resistant.

The work of Marsha Linehan, who is in Seattle, who does a lot of work with what’s called DBT, dialectical behavioural therapy, is particularly effective with women who have borderline personality disorder. So that’s Indigenous women, racialized women, women with trauma and abuse. The whole group. It works really well.

There are models. Part of the issue is…. It also labels women as manipulative, trying to engage their therapist and use that relationship. We have models that work. EFry has licensed psychologists, clinical counsellors, and we’ve been very successful in that. But in our province, we have not invested in those kinds of models of care. We have used other kinds of models of care. That’s, I think, been one of the issues.

[2:55 p.m.]

Gender-responsive health care is not available — period — really, I would say, for addictions and mental health. It’s not available for criminalized women. Nobody has ever heard anyone discuss a gender-responsive pre-sentencing report. Nobody has ever discussed whether or not you’re parenting or if you have other caregiving responsibilities, the impact of going to prison. It’s not built into the way we look….

We’ve built the system. It’s the same way as you legislate. You build legislation for the greatest majority. Homeless populations, substance users, criminalized women are the minority. You build the system for the greatest number of individuals. They’re male. The system has been built for the greatest majority — males, in those systems — and has not looked to provide the gender lens to provide the care.

N. Sharma (Chair): Okay. Any other questions, Members?

M. Starchuk: Thank you, Shawn, for what you’ve done and for what EFry does in Surrey. I do have a direct link with Vera. That’s out there.

I’m stuck on the benefits to children while the mother is in treatment. What is the barrier that’s there? What do we need to do so that we can…?

S. Bayes: From my position, we need to fund two staff. We’ve put them in. We’ve funded it, at about $240,000 a year, in that particular program.

We follow children for three years. We work with you and your mom, while you’re in treatment there, for up to nine months. Then we go home with you, right?

We don’t have any nurse practitioner models in our province. We don’t have the welcome wagon that I grew up with as a child, which went home with mother and baby and made sure everybody was getting along well. We don’t do that; we don’t have that. High-needs moms go home on their own.

We follow them. We work with them for that entire period of time, zero to three. Then they transition, if they want, to Growing Great Kids, which is another model.

That’s what it does. It literally does things like teach mom how to respond to children. It’s empathy-based cues. It teaches them to understand what developmentally should be happening. When that relationship has been severed, as with Indigenous families, they often don’t have that knowledge that we just think is inherent in having grown up in a family or having been involved in that kind of a relationship. That’s what they get, and that’s why it has been really well accepted within Indigenous communities.

It needs to be provided in those programs. It stimulates child brain development, and that’s what we need, right? For children born neonatally affected, their cortex is available. That’s your executive functioning, decision-making, impulse control, ability to have empathy and connection to other human beings. If you sever that, we already know what’s going to happen. We know who those people are when they’re adults. That’s why we have to intervene. For me, that’s why it’s critical. That’s where you will stop the intergenerational transference of addiction in families: right there.

We also provide it in our homeless shelters. We have addictions within our homeless shelters. We know that’s a population at high risk. The lack is for people, often, to recognize how they have been impacted by substance use, which has brought them to homelessness, and to make that decision to enter treatment. We have none of that built into homeless shelters in our province. It is a huge problem. We have a huge problem with homelessness, but we have not linked the two. We have not provided an integrated psychoeducational model that will assist us to do that.

We are the feeder for the system. We should be the feeder for the system. We should be the support that enables people to get resources, right then and there, and that enables them to be housed and to access community resources. For me, that’s the piece that’s really key and missing, I think. We have the money already invested in that system, right?

We run supportive housing programs. EFry runs the only two women-only supportive housing programs in our province, for women with complex needs. We have shelters. It’s one of our largest, next to health, in terms of the investment in bed-based programs. That’s where they are. So I think it is a place of intervention.

N. Sharma (Chair): On behalf of the committee, I just want to thank you so much for coming here today and for all the work that you do. We’ve certainly learned a lot, and we appreciate you giving us, very clearly, what your viewpoint is and what your perspectives are on what we need to do. It has been really useful for all of us. Thanks for coming in.

We need a motion, then, to adjourn.

Sonia and then Pam.

We will see you all tomorrow.

The committee adjourned at 3 p.m.