Involuntary treatment, insufficient support: Riverview patterns continue post-closure

Riverview closure's impact on homelessness Escalating street homelessness in the Downtown Eastside is often blamed on the closure of Riverview Hospital. That's not the whole story.

It’s been more than a decade since the Riverview Hospital closed its doors for good and one thing is clear: The pattern of treatment, discharge, and insufficient post-hospitalization care continues throughout the province.

In fact, patient advocates warn that B.C. involuntarily detains more patients now under the Mental Health Act at various facilities than were treated at Riverview during its peak patient population of 4,700 residents.

The cycle began in the late 1980s, when the New Democrat government of the time adopted medical advice that urged a life lived in community rather than institutions for those with mental illness, but those with first-hand knowledge say it happened far too quickly and led to the establishment of a homeless population in Vancouver’s Downtown Eastside.

“Back in 1989 and the early 1990s, suddenly the orders were given from Victoria to downsize Riverview as much as possible and they actually gave the hospital quotas on the numbers of patients to discharge to the community,” said Dr. John Higenbottam, who was clinical vice president of Riverview at the time.

“It didn’t matter what their needs were, basically (the government said), ‘Get’em out.’”

Veteran CTV News journalist Mike McCardell filed hundreds of stories on Riverview Hospital and the many patients who were victimized by predatory drug dealers in the Downtown Eastside, where they could afford to live in cheap rooming houses.

“It was a pipeline (from Riverview) … people left, there was nowhere else to go, so they got on a bus and came down here,” he said, emphasizing the provincial government had promised adequate housing and support that didn’t materialize.

“Drug dealers would say, ‘Here, I’ll give you this pill that’ll make you feel really good,’ and I saw that happen hundreds of times.”

FORCED TREATMENT AND TRAUMA RESPONSE

In light of the growing encampment in the Downtown Eastside and stranger attacks, there’s been public discussion about using the old Riverview lands and possibly some of the buildings to treat the large number of people showing signs of serious mental illness and drug addiction.

But an advocacy group for patients is raising the alarm that thousands of people are already undergoing forced treatment under B.C.’s Mental Health Act at more than 70 institutions and hospital departments across the province, a practice that’s nearly doubled in the past 15 years while street homelessness has continued to escalate.

“We never stopped involuntarily treating or detaining people simply because of Riverview’s closure in 2012,” said Laura Johnston, legal director for Health Justice.

“In fact, we detain and involuntarily treat far more people now than we ever did at the height of Riverview’s institutional population.”

In its own “Pathway to Health” report, the Ministry of Mental Health and Addiction acknowledges “B.C. has the country’s highest rate of hospitalization due to mental illness and substance use.”

Johnston points to the long waits and considerable expense for mental health or addictions treatment – unless someone is in crisis – as a paradox, since people often can’t get care until they’re ill enough to need hospitalization – and possibly commitment under the act – which leads to a dangerous cycle that could be fuelling B.C.’s statistics.

“People who have had those experiences of involuntary treatment can carry that trauma and harm with them,” she explained. “So, if they need help again or if they feel like they might want to reach out and get support – instead they might be so afraid of being made involuntary and being in involuntarily treatment again that they avoid contact with health and social services, and we sometimes see really strong alienation from health-care services.”

DOCUMENTED ONGOING FAILURES OF SUPPORT

Reports to government in 1994 found “transition issues around discharge planning” at Riverview, and a 1991 report warned that “adequate facilities have not been provided in the province’s communities, hospital care is fragmented and there is a lack of psychiatrists and clinical psychologists.” Despite this, when the BC Liberals took power, post-hospitalization supports for psychiatric patients did not improve.

“They didn’t have the housing, didn’t have the social supports, didn’t have all the kinds of things people would need to enact recovery and to live their lives,” said Marina Morrow, a York University professor who studied B.C.’s mental health landscape in her years teaching at Simon Fraser University.

“That’s been a consistent gap across all of the decades.”

Higenbottam agreed, noting that the medical community has agreed since the 1950s that institutionalization is not a long-term solution for the mentally ill, those struggling with substance use, and especially those with both, since there are still too few treatment facilities for those with concurrent disorders.

“You have to have the housing because the hospital is just a node, really, on going back to the community, and that’s how it should be,” he said in an interview on the UBC campus, where he’s a clinical associate professor of psychiatry.

“It might be a longer-term node at a specialized Riverview-type of facility because these are complex care people, but there needs to be a path to go back to the community – and they need to be supported there.”