Lorimer Shenher was a Vancouver cop for 24 years before finally leaving the force with a PTSD diagnosis. He warns many B.C. first responders aren’t receiving the help with mental health that they need, in part because of a difficult claims process at WorkSafeBC.
Lorimer Shenher estimates that less than five percent of B.C. first responders who need help with mental health ever ask for it. That’s only a guess, he said in a telephone interview. But it’s an educated one.
Shenher was an officer with the Vancouver Police Department for 24 years, before leaving the force with a diagnosis of posttraumatic stress disorder (PTSD) in 2013. He’s also the author of That Lonely Section of Hell, a book about the investigation of women missing from the Downtown Eastside and the prosecution of serial killer Robert Pickton. The book recounts Shenher’s lead role in that investigation, and the debilitating toll it took on his mental health.
In a telephone interview, he discussed the challenges that B.C.’s first responders—firefighters, police officers, and paramedics—can encounter on their way to getting help with conditions such as PTSD.
Shenher argued that because relatively few first responders who ask for help, WorkSafeBC should make it as easy as possible for them to receive it.
“I think there are much higher percentages of people in those professions that need help that aren’t asking for it,” he said. “When they do finally acknowledge to themselves that they are struggling, it takes a huge amount of courage and faith to put a claim into WorkSafe.”
Yet roughly half of B.C. first responders who do file a mental-health claim with WorkSafeBC do not receive the assistance they are looking for.
According to WorkSafeBC data first reported on by the Tyee and updated for the Straight, for the period July 2012 to December 2015, only 51 percent of 277 B.C. first responders who filed a mental-health claim saw their case approved. (These statistics exclude the RCMP and Transit Police.)
In a telephone interview, Jennifer Leyen, director of special care services for WorkSafeBC, emphasized those numbers do not mean 49 percent of claims were rejected.
She supplied a statistical breakdown showing that of 136 first responders’ mental-health claims not approved, 15 percent were stamped “no adjudication required”, which means that paperwork was only filed for “informational purposes” and did not include a claim for health-care costs or lost wages. Another 32 percent of disallowed claims were suspended, meaning the applicant dropped out of the claims process before a resolution was reached.
Leyen also emphasized that the acceptance rate for mental-health claims filed by first responders was significantly higher than that of all mental-health claims. That number was just 26 percent.
“We accept a significantly higher percentage of first-responder claims than we do any other employer group,” Leyen said. “It is double.”
But she conceded WorkSafeBC accepts a smaller percentage of mental-health claims than it does of the claims it receives as a whole (the bulk of which involve physical injuries). According to Leyen, the acceptance rate for all WorkSafeBC claims hovers around 91 or 92 percent.
“Because the mental-health legislation is very specific about what gets accepted under this part of our legislation, there is much more adjudication required,” she explained. “And we do have a higher disallow rate.”
Leyen noted that changes enacted in July 2012 broadened the scope of mental-health claims deemed eligible for WorkSafeBC compensation. Whereas the rules once said an individual had to be on the scene of a traumatic event—a car accident, for example—now they also cover mental-health challenges that can result from what WorkSafeBC calls “work-place stressors”.
Shenher benefited directly from that legislative change. His claim was initially rejected on the grounds he had not spent time on the farm where Pickton took his victims. It was only accepted by WorkSafeBC when it was reviewed again under the revised legislation.
“I understand how difficult it is to get your head around how PTSD manifests itself,” he said. “It is really weird, the things you can do, the things that you can’t do, the things that trigger you, and the things that are okay. It’s different for everybody.”
At the same time, Shenher questioned whether there’s a need for an arduous review process of mental-health claims. He suggested there’s already such a degree of stigma around mental health, especially in the tradition-bound environment of a police department, that only people with a very pressing need for help ask for it.
Shane Simpson, NDP MLA for Vancouver-Hastings, worked with first responders to draft a private member’s bill that would see WorkSafeBC handle first responders’ mental-health claims with a “presumptive” approach.
“For somebody who was diagnosed with that [PTSD] who is a first responder, the claim would be accepted immediately, without any further processes, unless there was a glaring reason to review it,” Simpson explained in a telephone interview.
He said he introduced that bill last March, but, without government support, he doesn’t expect it to go anywhere.
Simpson maintains that a presumptive approach to mental-health claims is important because a mental-health challenge is very different from a physical injury. He said a condition like PTSD can make the WorksafeBC claims process seem especially daunting, hence the organization’s high percentage of suspended mental-health claims.
“One of the challenges with PTSD is, it’s an area where, because of people’s health condition, they get frustrated,” he said. “And numbers of them don’t follow through to the end of that [WorkSafeBC] process, because of their level of depression.”
The Tyee’s May 20 article presents the stories of several first responders who struggled with long and difficult processes of filing mental-health claims with WorkSafeBC. Shenher recalled how hard the process was for him before his claim was finally accepted in 2012.
“And when you get denied—” Shenher paused. “It’s devastating.”
The Portland Hotel Society’s Coco Culbertson is concerned about changes to health-care in the Downtown Eastside coming at the expense of non-medical programs that are often preferred by clients distrustful of larger institutions. Travis Lupick photo.
David Ogilvie has created artwork since his childhood, but it wasn’t until he was 66 years old that he sold his first drawing. At a café on Main Street, the artist gave credit to Gallery Gachet, a space on Cordova Street near Columbia.
“The modest success that I’ve gained has been at least partly due to them,” Ogilvie said. He recounted that in 2015, Gallery Gachet gave him his first proper exhibition and, soon after, the Capilano Review made an offer for a series of his work.
Ogilvie said it can be hard to explain the difference this made in his life, and similarly difficult to explain the health benefits that Gallery Gachet provides to the Downtown Eastside. But he argued that its impact on mental health in the community is significant.
“Without Gallery Gachet, I don’t think I would have gotten this far,” he said. “I might not have made it at all.”
For 22 years, the gallery has operated with support from the provincial health ministry. But in September 2015, Vancouver Coastal Health (VCH), the regional care provider in charge of that money, eliminated Gallery Gachet’s $132,000 in annual funding.
The cut was the first of many moves VCH has begun as part of its “Second Generation” strategy for health care in the Downtown Eastside. The plan is described by VCH as no less than a “system transformation”. As the name Second Generation suggests, it represents the most significant revision of health care in the Downtown Eastside since VCH’s inception in 2001.
Already five years in the making, Second Generation entered an implementation phase last February. That is scheduled to continue through to October, with an official launch planned for the following month.
What’s at stake is almost $60 million that VCH spends every year on the health of Vancouver’s most marginalized residents, those of the Downtown Eastside.
A September 3 VCH media release lists a host of new mental-health and addictions services planned as part of Second Generation. That document and related materials describe a renewed emphasis on clinical services and integrated care delivered with a low-barriers approach that is heavy on peer involvement. The release warns that programs not falling within this focus on clinical applications may be discontinued.
“VCH contracts without a clear health mandate or those offering stand-alone services without formal connections to health care services may not be renewed,” it reads.
Critics of the plan argue that such a tight focus on medical and psychiatric programs will come at the expense of services that, though less formal, are no less beneficial.
Ted Bruce was interim executive director of the Portland Hotel Society for 14 months before he retired in August 2015.
“There is a need for clinical services but there is also a need to balance the clinical services we provide with some of those other, softer, support systems, which are just as important,” he told the Straight.
Portland operates Insite, North America’s first supervised-injection facility, plus 19 social-housing projects throughout the Downtown Eastside.
“What’s important to any population—and, particularly, these folks—is social inclusion, the ability to build community amongst themselves, and the ability to support each other,” Bruce explained. “The kind of programming that has long-term vision—of not just a clinical service but services that build inclusiveness and community—it’s a very important. But that’s often what is not happening when there is an emphasis only on the clinical.”
Bruce stopped short of direct criticism of Second Generation but added: “There are some things that VCH needs to think long and hard about.”
VCH’s chief medical health officer, Dr. Patricia Daly, is quoted in the September release acknowledging that the transition may encounter resistance.
“This is just the beginning of a long-term strategy for change in the Downtown Eastside that will evolve over time,” she said. “We know not everyone will agree with the changes being made, but as health care providers we know that services in the Downtown Eastside can be improved”.
Three organizations lost in the shuffle
Gallery Gachet was the first nonprofit to lose funding.
On April 7, VCH announced that a second organization would be dropped in the shuffle: the Drug User Resource Centre (DURC), a drop-in across the street from Oppenheimer Park that the Portland Hotel Society has run since 2003. DURC previously received $634,000 a year from VCH.
On May 13, in an email to the Straight, VCH named a third: ARA Mental Health, which offers advocacy services for people with mental-health challenges in a building at Pender and Beatty streets. The organization, founded in 1996, has received about $220,000 in annual government funding the past few years.
VCH has extended support to both DURC and ARA to continue operating while they seek new sources of funding, but only through to the end of this summer.
To be sure, VCH services in the Downtown Eastside are expanding by a number of measures. The clearest of these is funding. VCH has said it is increasing what it spends in the neighbourhood by $4 million a year, bringing the annual total to $59 million. There are also extended service hours coming to a number of existing clinics and an entirely new addictions-treatment centre tentatively planned for Powell Street.
Of course, Gallery Gachet’s take on Second Generation focuses on the money it lost to allow for those programs to expand.
“The pattern that I would say seems to be becoming clear,” said Cecily Nicholson, the organization’s financial administrator, “is that there is a lack of attention to preventative means, social, and tertiary services—services that are not directly clinical but are also completely necessary.”
She described Ogilvie’s story as typical of the gallery’s membership, many of whom struggle with mental-health challenges.
“Like the fellow who just brought in his sculpture last week,” Nicholson said. “These are people who are isolated in SROs—very poor housing conditions—but with wall-to-wall art in their rooms. And they have not been able to share it. That is a common narrative.”
She warned that as VCH moves to fill gaps in its system, it is this population that’s at risk of falling through new cracks that open up.
A state of extreme anxiety
For this article, the Straight spoke with some two dozen people employed by VCH-funded nonprofits and the clients for whom those organizations provide care.
Several people who have spoken to the Straight on a regular basis in the past refused to go on the record for an interview about Second Generation. They cited fears of placing funding in jeopardy. Some pointed to nondisclosure agreements that are now routinely built into contracts with VCH and even applications for VCH contracts.
Those and other conversations revealed a community in a state of extreme anxiety for the changes that are coming.
Coco Culbertson is in charge of housing, community, and peer development for the Portland Hotel Society, one of the few nonprofits that was willing to comment on the record for this story.
She noted that it is still early days in the rollout of Second Generation, and she stressed that service providers don’t yet fully understand how the plan will change health care in the Downtown Eastside.
“It remains to be seen,” she said. “And I think it’s important we stay in discussion with VCH.”
At the same time, Culbertson expressed concern for a focus on clinical services coming at the expense of community programs that she maintained—although perhaps not involving a psychiatrist in a lab coat—do improve people’s health.
“From the PHS Community Services Society’s perspective, nonclinical, nonmedicalized, and noninstitutional approaches to care are at the heart of what we do and why we’ve been successful in engaging thousands of people every day in the Downtown Eastside,” Culbertson said. “I would hope that VCH will continue to value those interventions.”
Marion Allaart is executive director of the Vancouver Area Network of Drug Users (Vandu), a nonprofit founded in 1998 that was instrumental in the fight for Insite. Asked about Second Generation, Allaart’s response was representative of other nonprofit employees who only spoke off the record.
“We’ve been expecting them to come for us for a long time,” Allaart told the Straight.
Service improvements throughout the community
VCH’s mental-health and addictions programs in the Downtown Eastside are overseen by Andrew MacFarlane, operations director of community health services (inner city–east). In a wide-ranging interview at VCH headquarters at West 6th Avenue and Cambie Street, he began by outlining the problems that VCH aims to address with Second Generation.
“We’ve, historically, not been great about being low-barrier and accessible for vulnerable people,” MacFarlane said. “Between 9 a.m. and 4 p.m. doesn’t work for a lot of people that have chaos in their lives.”
At those locations, he said, doors will soon be open 12 hours a day, seven days a week.
A second complaint VCH heard in its consultation phase for Second Generation was of a system heavily burdened by its complicated structure, where services are isolated from one another in ways that prevent many mentally ill people from receiving care.
“We had programs that were really siloed,” MacFarlane said. “If you saw a mental-health clinician somewhere, then you had to walk somewhere else to a primary-care doctor, who may or may not be in the loop on what is happening with your mental-health treatment.”
To address that problem, new “integrated health-care teams” will deploy at those three locations and others to offer more holistic care, he continued.
“We have a model that we’re implementing that is about having one care team that is really interdisciplinary with a single care coordinator at the centre of it,” MacFarlane said. “Each client will have a designated care coordinator, which will provide a single point of contact for other care providers and agencies.”
Second Generation will also bring a whole new point of access to the Downtown Eastside: the Railtown Centre for Addictions (a working title that could change). VCH declined to reveal a location for the building but multiple sources told the Straight it will likely open on Powell Street east of Oppenheimer Park. VCH will run the centre itself (as opposed to contracting it to a nonprofit). It is scheduled to open this fall.
MacFarlane described the Railtown Centre as a low-barriers medical hub for people with addiction issues.
“This includes an interdisciplinary team, an on-site physician, pharmacist, nurses, and evidence-based psychosocial supports such as social workers, counsellors, peers, and financial workers,” he said.
He noted it will also involve a drop-in component that, crucially, will allow people to connect with addictions services without having to make an appointment or work their way up a wait list.
Through all of that, MacFarlane maintained that harm-reduction programs such as needle exchanges will continue to be a “core competency” of VCH’s work in the Downtown Eastside.
He said that Insite, the city’s only low-barrier supervised-injection facility, has already seen its hours shifted to open earlier in the morning. MacFarlane added that VCH also hopes to soon see supervised injection occur at additional locations. “We are actively pursuing approval to go ahead with that,” he said.
Feedback falling on deaf ears?
For Second Generation, VCH conducted an extensive consultation process that lasted longer than two years.
It commissioned three lengthy papers that presented Downtown Eastside residents’ views on what they want for the community. Today, VCH points to those documents as evidence the Second Generation rollout is following the advice of the people it serves.
At the daily street market on the unit block of East Hastings Street, the Straight asked one of those papers’ authors, Ann Livingston, if Second Generation’s implementation fits with the community feedback she presented in her report.
“Hell, no,” she replied. “I don’t think they’ve looked at it at all.”
Livingston, a cofounder of Vandu, argued that Gallery Gachet and DURC, though not perfect, made people feel welcome and a part of decisions related to their care.
“The things that make the most difference in people’s lives is being welcomed, having autonomy, and having power,” Livingston explained. “Trauma-informed services should be accessible. People should feel welcome. They shouldn’t have to buzz to get in; they shouldn’t have to be a client; they shouldn’t have to give their name….That’s a model for trauma-informed services. But that seems to have been dropped.”
Support for change
Livingston and other Downtown Eastside residents interviewed for this story also raised serious questions about the first big winner in the funding shuffle that’s come with Second Generation: Lookout Emergency Aid Society. She criticized the group’s record on harm reduction in Surrey, where it previously operated as Keys Housing and Health Solutions under the direction of Fraser Health Authority. Livingston took issue with restrictive hours for harm-reduction programs and a past requirement for needle exchange to happen on a one-for-one basis (since abolished).
When DURC lost $634,000 in annual funding from VCH, Lookout gained about $200,000 to allow it to extend hours and expand services at a drop-in centre called LivingRoom, located on Powell Street just east of Oppenheimer Park.
In a telephone interview, Lookout’s executive director, Shayne Williams, defended the organization’s harm-reduction services in both Surrey and Vancouver. He said harm reduction will also be a big part of expanded programs at LivingRoom, though he added it was too early to say exactly what shape those will take.
Williams did, however, note the new LivingRoom will fit with VCH’s stated emphasis on clinical applications. “It certainly won’t be hardcore clinical,” he said. “But the focus will be to be proactive. To help folks get connections to care, to VCH services, to other, more clinical services, and to be that kind of entry point for folks.”
Stephen Finlay is executive director of ARA Mental Health. Despite VCH eliminating funding for his organization, he was largely supportive of Second Generation.
“For many years, everybody has complained—and rightly so—that clients get shuffled from door to door,” he began. “Vancouver Coastal Health listened to that. And they are trying to set up this service so that there is less of that.”
Discussing cuts to his organizations and others like Gallery Gachet and DURC, Finlay alluded to an issue larger than VCH. He pointed out that the health-care provider no longer receives annual budget increases like it once did.
Budgetary constraints
A review of VCH’s annual reports shows Finlay is correct.
In 2009, the B.C. Ministry of Health gave VCH a seven-percent increase to its total operating budget. Since then, there’s been a downward trend in the amount of annual increases. In 2010 and 2011, the increase was three percent each year, then four percent in 2012, two percent in 2013, and three percent in 2014. Then, in 2015, provincial contributions to VCH were reduced by one percent from the previous year.
Since 2010, the change in ministry funding for VCH has averaged plus–two percent per year, barely keeping up with inflation, let alone costs associated with new technologies and aging baby boomers.
Asked if this situation has put a squeeze on services in the Downtown Eastside, VCH’s director of strategy deployment, Natasha Golbeck, remained upbeat.
“We’re always challenged in health care to do more with less and to be increasingly efficient and thoughtful about where we spend resources,” she said. “We are not doing more with less; we’re doing more with more.”
Pressed on whether or not VCH is preparing to eliminate funding for other programs beyond Gallery Gachet, DURC, and ARA Mental Health, Golbeck responded: “The things that are going to be lost have already been lost. At this point, we have made the reallocations that we’ve needed to make.”
The Ministry of Health did not make a representative available for an interview. Quoted in a VCH media release, minister Terry Lake threw his weight behind the Second Generation.
“Change is never easy, but we know it’s desperately needed in the Downtown Eastside,” he said. “Many residents increasingly struggle with chronic conditions and changing addiction issues, but a lack of integration between health services creates barriers to accessing treatment. I applaud Vancouver Coastal Health for making the changes needed to improve patient care in this neighbourhood.”
Losing space
DURC, expected to close by the end of the summer, is a low-barriers community centre that serves as a safe space for alcoholics and people addicted to hard drugs, including stimulants such as methamphetamine and crack cocaine. It offers laundry and showers plus harm-reduction services such as a crack-pipe vending machine and a managed-alcohol program that lets severe alcoholics brew their own beer.
Each Friday afternoon, the managed-alcohol program convenes at DURC for a regular meeting called the “Drinkers Lounge”. What’s said there is usually confidential (as with Alcoholics Anonymous meetings), but the group permitted the Straight to attend on April 29 on the condition that names be withheld.
Participants explained how the program saves people from drinking Listerine and hand sanitizer across the street in Oppenheimer Park. The homebrew they make at DURC is safer, and the Friday meetings allow DURC to connect members to health services, including detox and rehab.
The April 29 meeting began with a roll call of the 35 people in attendance. Next there was a round of happy birthdays, followed by a reading of the group’s rules and mandate. To conclude the meeting’s opening, people were asked to stand for a moment of silence and invited to recite the names of friends or family who had recently passed away or gone missing. One by one, 16 names were called out.
Moving to an open discussion, the topic of the day was DURC’s pending closure and VCH’s reallocation of funds to the Lookout drop-in centre called LivingRoom.
“Where are we going to go?” asked a man in the back. “The City of Vancouver doesn’t want us on the streets around here. They don’t want us in the park. They’re doing this to get rid of us.”
Liz Evans founded the Portland Hotel Society in 1993 and served on the organization’s executive management team for 20 years before she resigned in 2014. She declined to speak specifically on Second Generation, but expressed concern for marginalized people losing the spaces where they feel comfortable.
“If you’re living in a tiny SRO room, 120 square feet, where all you have that’s yours is a sink and a fridge, then having a café to sit in is meaningful,” she said. “And it just feels like space is being lost.”
On May 6, the Portland Hotel Society’s interim executive director abruptly stepped down. Pending the appointment of a new leader, Coco Culbertson is acting as a spokesperson for the organization.
She voiced concerns about the pace with which the Downtown Eastside is changing but maintained that it has learned to take care of itself.
“This community has always had a strong voice when it gets together,” Culbertson said.
An independent body has found transit police should be cleared of any wrongdoing in the December 2014 fatal shooting of a 23-year-old First Nations man named Naverone Woods.
Today (May 16) new details were released about the death of Naverone Woods, a 23-year-old First Nations man who was shot and killed by transit police in December 2014.
A report by the Independent Investigations Office of B.C. (IIOBC)—which cleared the officers involved of any wrongdoing—includes a time line for the shooting. It notes that one of the first officers on the scene at a Safeway in Surrey fired the shots that killed Woods within 60 seconds of their arrival.
At 8:03 a.m., Woods entered the Safeway, according to the report. At 8:07 a.m., 911 received a call wherein Woods was reported to be stabbing himself with a knife.
Two minutes later, at 8:09 a.m., two transit police officers arrived and entered the Safeway. That same minute, two shots were fired and Woods was on the ground.
He was pronounced dead at Royal Columbia Hospital at 9:27 a.m.
Helen Slinger is a Vancouver-based documentarian whose recent film Hold Your Fire focused on police shootings involving a person experiencing a mental-health crisis. She told the Straight that the time line of the Woods shooting resembles many cases she reviewed for her film.
“It is very much a pattern,” Slinger said in a telephone interview. “Police are going in too fast, too hard.”
In researching Hold Your Fire, Slinger and fellow journalist Yvette Brend read hundreds of coroner reports from across Canada. In B.C. alone, they found that between the years 2004 and 2014, 28 people were shot and killed by police or RCMP while experiencing a mental-health crisis.
“After two years of research it took to do that documentary, it was the one thing that finally, really jumped out at me,” she said. “That in so many of these high-profile police shootings of persons in mental distress…police just do not take the time to back up.”
High-profile cases
Stringer listed off a number of fatal police shootings that she described as similar to the Woods case in that officers fired their weapons within less than three minutes of their first encounter with their suspect.
In November 2014, Vancouver police officers shot and killed Phuong Na (Tony) Du less than two minutes after they arrived to apprehend him at the intersection of Knight Street and East 41st Avenue.
In July 2013, Toronto police shot and killed 18-year-old Sammy Yatim within one minute of the first officer arriving on the scene.
In August 2007, a Vancouver animator named Paul Boyd was shot by police on Granville Street. Less than three minutes had passed since the first officer had intervened.
In 2004, Christopher Reid was shot by Toronto police, also within three minutes of their arrival.
Slinger also mentioned Robert Dziekański, who, although not shot with a gun, died after RCMP repeatedly tasered him almost immediately after meeting Dziekański at Vancouver International Airport in October 2007.
The pattern Slinger says she’s noticed in coroner reports from across Canada mirrors findings of the Straight’s own analysis for British Columbia.
In February 2015, the Straight published a review of more than 120 coroner reports that dated from 2007 to 2014. During that period, there were 99 incidents where someonedied during an interaction with police.
An update the Straight published in December 2015 looked specifically at deaths involving firearms. It revealed an increase in those incidents. And, echoing Slinger’s findings, the Straight’s investigation revealed that the first few minutes or even seconds of an encounter often meant the difference between life and death.
Difficult circumstances
The IIOBC’s report on Woods describes difficult circumstances for the first transit police officers who arrive at the Surrey Safeway that morning.
Multiple eyewitnesses are quoted there describing the young man as holding two knives, failing to respond when people tried to intervene, and repeatedly inflicting harm on himself.
Those anecdotes support one another in stating that police repeatedly shouted warnings before any shots were fired. “Drop the knife,”, “Get down,” and “We’ll shoot,” people heard the officers say.
The witnesses are also in agreement that Woods “lunged” or was “moving towards” the officers when they met him just inside the store’s entrance.
A Safeway security guard told IIOBC investigators he estimated the length of time officers had their guns drawn before firing was between 10 and 12 seconds.
Transit police spokesperson Anne Drennan told the Straight she couldn’t comment on specifics pending the completion of investigations by the Office of the Police Complaints Commissioner and the B.C. Coroners Service.
But Drennan emphasized that transit police officers receive the same basic training as every police and RCMP officer in B.C. She emphasized that this includes instructions on mental health and the appropriate use of force.
“Since January 2012, the province of B.C. sets binding standards to ensure that B.C. police officers are trained to use crisis intervention and de-escalation techniques,” she said.
The province requires that officers receive a refresher on those topics every three years. The IIOBC report confirms that both officers involved received that training in July 2014.
A larger problem
Doug King is a Pivot Legal Society lawyer who keeps a close eye on police-involved deaths. He told the Straight the fact that the IIOBC cleared the officers of any wrongdoing is actually indicative of a larger problem.
“We know that this is the legal standard, currently,” King explained. “That if you’ve got someone who’s presenting with an edged weapon and they are physically advancing on an officer, the legal test is, basically, that at that point lethal force is justified.”
King asked why the officers were not equipped with alternative weapons that could have been used without killing Woods. He noted the IIOBC’s report concludes with the same question.
Like Slinger, King told the Straight that details in the IIOBC’s report fit a pattern.
“I would say it’s almost déjà vu,” he said. “We see these cases where the officers are not able to contain the individual until the appropriate resources arrive.”
The family of Naverone Woods, a 23-year-old First Nations man who was fatally shot by transit police, is still waiting for answers about why guns were used.
December 28 marks one year having passed since the death of Naverone Woods, a 23-year-old First Nations man who was shot and killed by transit police at a grocery store in Surrey.
On the phone from Hazelton, B.C., one of two Interior towns where Woods grew up, sister-in-law Tracey Woods said the family is still waiting for answers.
“We just want to have some kind of closure,” she explained. “And to know that there was an investigation done, that this case wasn’t just pushed aside.”
Tracey, whom a neighbour described as “like a stepmother” to Naverone, said she has questions about what efforts were made to deescalate the situation before force was deemed necessary, and why guns were used at all.
“We always compare it to a big grizzly bear that they will shoot, put to sleep, and relocate,” she continued. “How come they couldn’t use a Taser or something rather than drawing their weapons?”
Woods was the eighth British Columbian to die in a police-involved incident in 2014, according to a database maintained by the Georgia Straight. So far in 2015, that number stands at 11, the most for any year since 2009.
Last February, the Straight reported that a stark pattern emerged from an analysis of dozens of deaths involving B.C. authorities dating back to 2007: of 99 police-involved deaths investigated by the B.C. Coroners Service or scheduled for investigation, 90 percent involved a mental-health component, substance abuse, or both.
Now a review of that database updated for 2015 reveals another pattern: as deaths have increased, so has the frequency with which guns were involved in those incidents.
In 2015, there were seven fatal police shootings in B.C. That was up from five the previous year, two in 2013, four in 2012, five in 2011, three in 2010, and seven in 2009.
Six of those seven shootings in 2015 involved the RCMP. That compares to two during each of the years 2014, 2013, and 2012, and four in 2011, three in 2010, and five in 2009. Fatal RCMP shootings were geographically dispersed across the province. One exception is Surrey, where RCMP officers have shot and killed seven people since 2009.
Josh Paterson, executive director of the B.C. Civil Liberties Association, said that, to an extent, the data simply speaks for itself.
“These numbers suggest a doubling of police-involved deaths in the last three years in B.C.,” Paterson told the Straight. “The number of people shot and killed by the RCMP have risen to the highest level in over 10 years. While these numbers don’t allow us to draw a conclusion as to why this is happening, they raise an alarm and require us to ask hard questions.”
The B.C. RCMP and the B.C. Ministry of Justice refused to grant interviews.
Steve Schnitzer is the police-academy director for the Justice Institute of B.C. He called attention to courses that focus on crisis intervention and deescalation tactics and how best to respond to emergencies involving a mental-health component. Those lessons were made mandatory in 2012 following the 2007 death of Robert Dziekański at Vancouver International Airport and the subsequent Braidwood Commission of Inquiry.
“That is a policing standard now,” Schnitzer emphasized. “It [training] changed significantly after the Braidwood commission report came out.”
Statistics compiled by the coroner’s service suggest that there is still room for improvement. According to the organization’s annual report for 2010, just 40 percent of coroner’s recommendations related to police-involved deaths were adopted by the agencies involved in those incidents (2010 being the most recent year for which such statistics were included).
Doug King, a lawyer with Pivot Legal Society, said there is one factor that can make all the difference in how a police encounter plays out: time.
“There is a huge correlation—based on our work and what we see—with police-involved shootings and first responders,” he said.
King explained that when police officers fire their guns, the weapon is almost always discharged by an officer who was first on the scene and during the first few minutes of a confrontation.
“To me, that indicates there needs to be better training and a greater emphasis on what someone can do to contain an individual until help can arrive,” King said.
The death of Naverone Woods remains under investigation by the Independent Investigations Office of B.C., a public body created in 2012 to examine police incidents involving death or serious harm. Once that review is complete, the case will likely proceed to the coroner’s service.
King said that investigation is one of three he’ll be watching in 2016.
The second, he continued, is that of Phuong Na (Tony) Du, who was killed by Vancouver police at the corner of Knight Street and East 41st Avenue in November 2014. The third is Hudson Brooks, a 20-year-old male who was shot by Surrey RCMP in July 2015.
“These three shootings are all really problematic, from what we’ve heard, and really beg explanations,” King said.
A new documentary scheduled to air on CBC examines a number of deaths involving police, including that of Paul Boyd (left), a Vancouver animator who was shot and killed in 2007.
Research behind a forthcoming CBC Television documentary includes new data on Vancouver police encounters with people experiencing a mental-health crisis. It suggests despite progressive training, many incidents still end with an officer deploying lethal force.
For the period 2004 to 2014, investigative journalists Helen Slinger and Yvette Brend analyzed hundreds of coroners’ reports from jurisdictions across Canada.
In British Columbia, they found evidence police or RCMP officers shot 28 people who were experiencing a mental-health crisis, Slinger revealed in a telephone interview. That was out of 72 such incidents for the country as a whole.
The filmmaker added that according to a “very conservative estimate”, nearly 40 percent of all fatal police shootings in Canada involved either a person with a mental illness or an individual experiencing a mental-health crisis.
Slinger noted distinct themes emerged in those coroners’ reports.
The first was that when a police officer did fire a weapon, that usually happened almost immediately after they encountered a person in distress. The second was that training could be clearly traced to make a notable difference in outcomes.
“It comes down to what happens before police arrive at the scene,” she said. “If you are trained to approach with a command and control attitude, that could very likely backfire with someone in mental distress.”
The documentary is called Hold Your Fire. It was produced by Bountiful Films and is scheduled to debut on CBC Television as part of the network’s Firsthand program on Thursday, October 22.
The hour-long film looks at a number of police-involved deaths across the country. Those include the case of Sammy Yatim, who was shot by Toronto police in 2013, and Paul Boyd, a Vancouver animator who police shot and killed in 2007.
With video footage of those deaths plus interviews with family members, Hold Your Firemakes the case that neither young man needed to die.
“The police were the cause of the violence that night,” Boyd’s father says in the film.
Slinger’s findings mirror those of the Georgia Straight’s own analysis for British Columbia.
During that period, it was found there were 99 incidents where someone died in the custody of the RCMP or police.
Of those cases, the Straight determined 17 deaths involved a mental-health issue, 59 involved substance abuse, and at least 13 involved both drugs and a mental-health component. (The Straight’s analysis differed from Slinger’s in a number of ways. For example, in addition to looking at cases involving a mental illness, it also included situations where a person struggled with a serious addiction issue.)
Again echoing Slinger’s findings, the Straight’s investigation revealed that the first few minutes or even seconds of an encounter often meant the difference between life and death.
It’s those brief windows that Slinger focuses on in her documentary.
“We started out looking for that moment, asking, ‘how do you pull back?’” she said. “And what I felt was really obvious is it is how the particular unit goes to that call that makes all the difference.”
Slinger said if there is one message she hopes people take from her documentary, it is that police officers need to slow down when responding to an individual experiencing a mental-health crisis.
Hold Your Fire presents tangible lessons for how that can be accomplished without significantly adding to the risks that police officers face on the job.
While Slinger described the Vancouver Police Department as a force where there is “still lots of room for improvement”, she also said it stands “among the most progressive police forces in the country in terms of their programs for people with mental illness”.
She suggested what’s at play within the VPD and other departments across Canada is a sort of competition between old and new schools of police training.
For example, the documentary explains that in North America, many departments train officers to respond with lethal force if a person perceived to be a threat moves within 20 feet of an officer. That lesson, which can be engrained to a point where it can play out almost as a muscle reflex, can come into conflict with training for how one can de-escalate a potentially violent situation without using lethal force.
“Vancouver has kept moving in that direction with a number of programs that are very progressive,” she said. “I think it just hasn’t made its way through the entire force yet. But I do think things are changing.”
In 2014, Vancouver police recorded an all-time high for apprehensions it made under the Mental Health Act, a law that permits officers to detain individuals deemed to have a mental disorder and to pose a threat to themselves or others. Officers apprehended 3,010 people under the act, a number that has increased each year, up from 2,278 in 2009.
Despite sometimes-shoddy conditions, residents of Downtown Eastside hotels have protested the gentrification of their neighbourhood and called for the city to protect that kind of affordable housing stock. Travis Lupick photo.
Downtown Eastside residents living in the city’s derelict hotels are dying at a rate more than eight times the national average, a UBC study has found. The risk is especially great for people living with a mental illness, even when that group is compared to people similarly living in poverty.
“The probability that an individual with psychosis would survive to age 50 is 68% compared with 94% for those without the diagnosis among marginally housed individuals,” reads an August 2015 paper published in theBritish Medical Journal Open. “Individuals with psychosis may face a greater than eightfold increase in mortality risk compared with those without psychosis.”
While those grim statistics may not come as a shock to those familiar with the impoverished neighbourhood, what’s causing many of these early deaths did surprise researchers.
The paper presents findings based on a sample of 290 men and 81 women who were recruited through Downtown Eastside single-room occupancy hotels (SROs) and Vancouver’s Downtown Community Court. The group was monitored from November 2008 to August 2012 and, during that time, 31 participants died. That’s a rate of eight times the national average. And for those aged 20 to 59, the mortality rate was 10 times the Canadian average.
Contrary to popular assumptions, researchers “did not find any link with HIV or substance addiction”, a UBC media release states. In cases where participants passed away, psychosis and hepatitis C-related liver dysfunction was “significantly associated with increased mortality”.
For younger participants under the age of 59, the situation is even worse. For that group of Downtown Eastside residents, the mortality rate was found to be 10 times Canada’s average.
“We were somewhat surprised because most people thinking about the Downtown Eastside think about HIV/AIDS or the possibility of overdosing on opioids like heroin,” said William Honer, one of the study’s co-authors and head of UBC’s department of psychiatry, quoted in the release. “Our system is not doing as well in getting treatments out there for psychosis and hepatitis C in this group, and it’s interesting that those two illnesses are causing risk for early mortality.”
It was discovered only one-third of the 173 participants diagnosed with psychosis were receiving treatment for that mental-health condition. And for the 57 people with an active hepatitis C infection and related liver dysfunction, not one of them was receiving treatment for that illness.
“Psychosis is an extremely prevalent issue among inner city populations and we need to address this,” said Andrea Jones, another of the study’s authors and an MD/PhD candidate in mental health and addictions research at UBC, quoted in the release. “We need to be ready to detect and treat mental illness in an integrated way that really meets the patients where they’re at. We need to improve the detection and treatment of psychosis and hepatitis C in marginalized people across Canada.”
The study was funded by the Canadian Institutes of Health Research and by B.C. Mental Health and Substance Use Services.
It states there are some 3,800 people living in SROs in the Downtown Eastside.
There are an estimated 2,000 “severely ill” SRO tenants not receiving the care they require for mental-health and addiction challenges, according to a September 2014 report of the Mayor’s Task Force on Mental Health and Addictions.
Vancouver Coastal Health (VCH) is the regional authority the province tasks with delivering the bulk of health-care services provided to the Downtown Eastside. It spends roughly $55 million a year in the neighbourhood. A February 2015 policy paper lays out strategies and specific recommendations for a “second generation” of health-care designed for the Downtown Eastside. It acknowledges that VCH has largely failed to keep pace with changing needs, and promises the health authority will adapt and improve.
In June 2015, B.C. Health Minister Terry Lake (middle) joined Vancouver health researchers for a walk through the Downtown Eastside, a neighbourhood that accounts for a disproportionate number of emergency mental-health visits seen by nearby St. Paul’s Hospital. Travis Lupick photo.
The B.C. Schizophrenia Society (BCSS) has said it has low expectations for a coroner’s inquest that will examine three deaths linked to mental-health issues that occurred over a four-month period beginning in December 2014.
According to the B.C. Coroners Service, all three individuals died shortly after leaving Abbotsford Regional Hospital, which is run by the Fraser Health Authority. The inquest is scheduled for May 16, 2016.
BCSS program and development coordinator Ana Novakoviccalled attention to a number of previous government reviews of similar deaths. She emphasized those were followed by recommendations that failed to prevent the three being examined next year.
“Since 2008, there have been three other coroner’s inquests into deaths involving improper monitoring and discharge of mentally ill patients in hospitals under Fraser Health Authority’s jurisdiction,” Novakovic told the Straight. “A number of improvements were recommended as a result of these inquests, but it seems that they are either inadequate or have not been implemented.”
According to a BCSS analysis, those earlier cases concerned Ross Allan, who died in April 2008, Jasdeep Sandhu, who died in October 2008, and Patricia Reed, who died in February 2011. According to their respective inquest verdicts, all three were admitted to Fraser Health hospitals for mental-health reasons and died while in the care of those facilities or shortly after discharge.
BCSS executive director Deborah Conner said she’s worried the review scheduled for May 2016 will find the three people who are the subjects of that inquest—Brian Geisheimer, Sebastien Abdi, and Sarah Charles—died under similar circumstances.
“My question would be: was there a treatment plan when these people were released?” Conner said.
In a phone interview, Stan Kuperis, director of mental health and substance use for Fraser Health, listed a number of mental-health-care reforms implemented in recent years. These include improved patient-transfer protocols, for example, and revised policies for discharging patients. In addition, Kuperis emphasized that Fraser Health pays close attention to coroners’ investigations.
“We have responded to all those recommendations within previous coroner’s inquests and have put changes into place in response,” he said.
According to Conner, the most troubling aspect of this series of events is that when it comes to mental health, Fraser Health is actually among the best B.C. service providers.
“There are similar problems everywhere,” she said. “It could very easily be happening in all the other regions.”
According to Fraser Health, during the 2013–14 fiscal year, its 12 hospitals throughout the Lower Mainland saw 30,305 emergency mental-health visits.
On August 19, the Straightreported that the number of emergency mental-health visits Vancouver General Hospital and St. Paul’s Hospital see together in one year is projected to surpass 10,000 before the end of 2015. That’s up from 6,520 in 2009.
Those hospitals—operated by Vancouver Coastal Health and Providence Health Care, respectively—have also dealt with high-profile incidents that followed patients leaving a facility after they were admitted for a mental-health issue.
In December 2012, for example, Nicholas Osuteye attacked three women two days after he was discharged from St. Paul’s Hospital. In February 2012, Mohamed Amer stabbed an elderly man the same day he was released from St. Paul’s. And in January 2012, Jerome Bonneric was charged with assault shortly after St. Paul’s let him go. (An external reviewof the Amer case resulted in 22 recommendations for service improvements.)
In a telephone interview, Dr. Bill MacEwan, head of psychiatry at St. Paul’s Hospital, explained how staff work to try to ensure nobody admitted for mental-health reasons leaves on their own or without a support system in place.
“The three key things for any individual that we always try for is a place to live, follow-up care, and support, where support can be a variety of things, from family to a mental-health team,” he said. “To get those three variables covered, that’s the general approach that we take.”
MacEwan stressed that’s not always easy, especially when an individual has no fixed address.
“It’s harder to track somebody and find somebody and follow up with care if you don’t know where they live,” he said. “For those individuals, to have them go into care, that becomes more difficult. Sometimes it’s a shelter.”
Conner said the problem is not insurmountable and primarily persists on account of a lack of political will.
“It’s not like we don’t know what has to happen,” she said. “Programs have been around for a long time. They have proven to be effective, and they have academic rigour. They just needed funding and consistency.”
In 2010 (the last year for which statistics are available), hospitals only fully implemented 26.3 percent of coroners’ recommendations, according to a department annual report.
The B.C. Ministry of Health did not make a representative available for an interview.
St. Paul’s has gained only nine new long-term mental-health care beds since the City of Vancouver made a call for 300. Charlie Smith photo.
Vancouver is experiencing a crisis in mental-health care that continues unchecked. That’s the conclusion Vision Vancouver councillor Kerry Jang draws from data covering 2009 to the end of June 2015, which show emergency mental-health and substance-misuse hospital visits have increased every year and are on track to hit a record high come December.
“We clearly need more long-term mental-health care,” Jang said in a phone interview. “We know that there are so many people in the Downtown Eastside who don’t see or have any contact with mental-health professionals at all. So the emergency ward is very much becoming primary care. That is something that has to change.”
Jang was responding to information provided at the Straight’s request by Providence Health Care, which operates St. Paul’s Hospital, and Vancouver Coastal Health, which runs Vancouver General Hospital. The statistics show that during the first six months of this year, the two hospitals together saw 5,110 people experiencing a mental-health crisis admitted and 3,703 visits for substance-misuse problems such as a drug overdose. The comparable numbers for 2014 are 4,895 mental-health emergencies and 2,830 cases of substance-misuse issues.
By the end of 2015, these numbers are projected to surpass 10,220 mental-health emergencies and 6,146 substance-misuse incidents. Taken together, that translates to an increase of 76 percent compared to 2009.
Over the last five years, the Vancouver Police Department has observed a similar rise in the number of apprehensions its officers make under the B.C. Mental Health Act. In 2014, officers detained 3,010 people under Section 28 of the act, which allows police to take into custody an individual deemed mentally unfit and a threat to themselves or others. That’s up from 2,278 in 2009. During the first six months of 2015, the VPD made 1,510 Section 28 apprehensions.
Jang, who sits on the Mayor’s Task Force on Mental Health and Addictions, said what’s needed to reverse these trends is greater involvement by the province. He reiterated a call for more long-term-care beds that Mayor Gregor Robertson has made repeatedly since declaring a “mental-health crisis” in September 2013.
The B.C. Ministry of Health declined to make a representative available for an interview.
In recent years, the province has allocated money for mental-health-care infrastructure. For example, in January 2015, it announced that an addition to VGH will open in 2017 as the largest facility for mental-health and addiction services in British Columbia. However, the city has said what’s required to address the problem in Vancouver is 300 “long-term and secure mental health treatment beds” and, in September 2014, warned that the province was falling short of that number by 250. (The province has made small numbers of new beds available—nine at St. Paul’s Hospital, for example, and 14 on the Riverview grounds in Coquitlam. But the majority of funding is going to replacing outdated facilities.)
Mark Levy is the medical manager of the VGH psychiatric-assessment unit. He told theStraight the statistics match what he’s observed on the ground.
“It does put a strain on resources,” Levy said in a phone interview. “There really hasn’t been an increase in in-patient beds to any significant degree. We do run into situations where we are in a crisis mode and we have to accommodate patients that are in the emergency room.”
Levy emphasized the numbers make clear there is a problem. But he also said they include good news, explaining that they’re at least partly the result of changing attitudes and a shift away from the justice system in favour of health care.
“People who might have been taken to cells in the past are seen by an arresting officer as suffering from a mental-health issue,” Levy said. “Now, rather than charge them—as long as it’s not a serious offence—they will bring them to hospital.”
He suggested the next step should be making more mental-health care available in communities where people live, so they receive treatment before their mental health declines to a point where they end up in an emergency room.
“These are chronic problems,” Levy said. “Are people best treated in a hospital or should we try to do whatever we can to help them deal with their problems while they are residing in the community?”
In September 2013, Vancouver police chief Jim Chu and Mayor Gregor Robertson issued recommendations to address what they say is a growing crisis of severe, untreated mental illness. Yolande Cole photo.
During the first half of 2015, the Vancouver Police Department saw a slight decline in the number of apprehensions its officers made under the B.C. Mental Health Act.
He says he didn’t have a purpose or even a direction. He simply travelled aimlessly, sometimes boarding buses, but usually moving on foot.
Nearly two decades passed that way.
“So many years lost,” reflects Flomo at a health centre in Liberia’s capital Monrovia.
At roughly the same time Flomo fell ill with schizophrenia – the diagnosis that was finally made in 2007 – Liberia entered 14 years of civil conflict that left 250,000 people dead and the country’s infrastructure destroyed. The few mental health services that did exist before the war were lost. Mentally ill people such as Flomo – who are often ostracised by their communities on account of stigma associated with diseases people don’t understand – were largely left to fend for themselves.
