Mental Health and Addiction Reform: An Expert-Led Cross-Jurisdictional Task Force

Motion on Notice – Mental Health and Addiction Reform: An Expert-Led Cross-Jurisdictional Task Force

Submitted by: Councillor Lisa Dominato

WHEREAS

  • Amid the ongoing COVID-19 global pandemic, Canada and the world are in the grips of an ongoing mental health and addiction crisis – one that ruins health, threatens lives, and hurts economies. The magnitude of this mental health and addiction crisis, on a societal and on a personal level, is profoundly overwhelming and continues to frustrate and defy most efforts to arrive at effective solutions and achieve more successful outcomes;
  • Mental illness and addiction affect people of all ages and backgrounds. The Centre for Addiction and Mental Health (CAMH) – Canada’s largest mental health teaching hospital and one of the world’s leading research centres in its field – cites statistics that show mental illness will affect approximately 1 in 5 Canadians in any given year, and that, by the time Canadians reach 40 years of age, 1 in 2 have – or have had – a mental illness. Approximately 4,000 Canadians per year die by suicide – an average of nearly 11 suicides a day;
  • The City of Vancouver is home to residents who continue to struggle with mental illness and/or addiction. Many lack the necessary supports within our housing and social services systems to thrive, especially amid the societal disruption resulting from COVID-19;
  • The City of Vancouver has taken various steps to reduce the harm caused by alcohol and drug use – and ensure that people get treatment – without sacrificing personal security. Council is working to:
    • promote healthy families and communities and protect child development
    • make sure individuals have access to services that help them lead healthier lives
    • reduce the spread of deadly communicable diseases, and prevent drug overdose deaths
    • recognize the need for peace and quiet, public order, and safety
  • Much has been written, discussed, studied, announced, debated, attempted, actioned and/or implemented over the course of several decades to address the challenge of our city’s – and our country’s – persistent and increasingly complex struggle with mental health and addiction issues, including the related struggle to provide affordable, safe housing across the housing spectrum in our city. Numerous examples of these actions, measures, plans, and strategies exist, and many people have noted and questioned the apparent lack of effectiveness and/or significant results flowing from past solutions and actions. Many see the approach as fragmentary and incomplete and are calling for significant change, particularly the need for governments at all levels to radically rethink how we deliver social services across the spectrum;
  • A representative (though not exhaustive) list of examples of the measures and actions taken and/or considered/recommended over the course of several decades in response to our city’s longstanding and increasingly desperate mental health and addiction issues ranges from the Four Pillars Drug Strategy in the 1990s to the creation of the provincial government’s Ministry of Mental Health and Addictions in 2017 to the more recent emergency measures surrounding the unsafe and deadly supply of street drugs and the resulting need for greater access to a safer supply of opioids for those suffering chronic addiction (NOTE: an expanded list of illustrative examples is included below in the endnotes); [i]
  • Despite the many response efforts to-date, we continue to have people living on the margins of life and death in our city who are in desperate need of better supports – those who are homeless or precariously housed, some struggling with personal trauma, untreated mental illness, addiction, and chronic health issues – while others in our city are increasingly feeling unsafe in their neighbourhoods, grappling with increased crime, threats and needles in parks and streets. Health experts and police alike continue to advocate that we have a public health crisis on our hands and as Chief Palmer recently noted, “Addiction issues should best be handled through a health-care system, not a criminal justice system,”;
  • Members of the public, frontline service providers, advocates, police, health, and housing leaders are increasingly and consistently calling for mental health and addiction treatment reforms that will address the urgent public health crisis, along with the increasing public safety concerns, including:
  • System navigation to connect vulnerable residents to appropriate services
    • Integration of wraparound supports and services as part of our housing framework
    • More treatment beds and a system for bridging the transition gap from detox to treatment, where long waitlists are reported
    • Increased treatment and recovery pathways
    • A centralized registry to enhance information sharing between agencies serving individuals who are homeless, accessing detox, seeking treatment etc.
    • A full spectrum of safer supply that is accessible to all
    • Decriminalization of drugs as a public-health response
  • On July 31, 2020, Councillor Dominato wrote to the Honourable John Horgan, Premier of British Columbia, expressing deep concern over “The growing challenge of homelessness, mental health, and addiction related issues in Vancouver” and the “emerging tensions” playing out in a number of downtown area Vancouver neighbourhoods. Her letter noted the ongoing struggle to find effective solutions which “obliges governments at all levels to radically rethink how we deliver social services across the spectrum.” In the letter, she made two urgent requests of the Premier and Provincial Cabinet to consider:
    • to expedite recently announced navigation centres to provide emergency shelter and wrap around services to people who are currently in need, and increase the proposed capacity of the centre from 60 spaces to 200 spaces
    • to support the establishment of a municipal-provincial-federal task force on mental health and addiction, with a mandate to review the current service delivery and outreach framework, including the interdependencies and coordination between different levels of government.
  • In recent months, in response to the global COVID-19 pandemic, we have seen the positive impact that all levels of government can have when they work together with urgency, intention, and coordination. Our province has emerged as a leader in the race against time, successfully implementing measures to flatten our province’s COVID-19 curve. Many observers have suggested a similar intentional and coordinated approach to mental health and addictions could be a game changer that would save lives and create pathways to greater health and resilience. Given the persistence and the crisis level of mental health and addiction issues in our city, our province, and our country, it is incumbent upon governments at all levels – now more than ever – to radically rethink how we deliver social services across the spectrum.

THEREFORE BE IT RESOLVED THAT Mayor and Council publicly call for, and endorse in principle, the establishment of an expert-led cross-jurisdictional (provincial-federal-municipal) emergency task force on mental health and addiction, the mandate of which will be to respond to the urgent public health and emerging public safety concerns manifesting in our communities and bring forward expert-informed (including lived experience), evidence-based, non-partisan recommendations and solutions; and

FURTHER THAT the task force mandate shall specifically include an examination and review of the current service delivery and outreach frameworks, including harm reduction, treatment, and recovery services, as well as the intersectionality of these issues with housing, and shall include an examination and review of the coordination between the various jurisdictions that proactively and reactively deliver these services; and

FURTHER THAT Council direct the Mayor, on behalf of council, to write to Premier Horgan and Prime Minister Trudeau to seek their leadership in establishing a cross-jurisdictional task force as outlined above.

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[i] The following examples are representative and illustrative (although not exhaustive) of measures and actions taken and/or considered/recommended over the course of many decades in response to mental health and addiction issues and the challenges that frustratingly persist:

  • Under former Vancouver Mayor Philip Owen, the Four Pillars Drug Strategy was adopted by the City in the 1990s.
  • Flowing from the Four Pillars Drug Strategy, Council unanimously endorsed a drug policy prevention plan in November 2005: Preventing Harm from Psychoactive Substance Use. The plan was the result of extensive research and diverse community consultations and the first of its kind at the municipal level in Canada.
  • In September 2013, the City of Vancouver, the Chief Constable of the Vancouver Police Department (VPD), and the Chair of the Vancouver Coastal Health (VCH) Board presented four urgent recommendations to the Premier and the Ministry of Health. This was to respond to a surge in people with severe, untreated mental illness and addictions at St. Paul’s Hospital, a dramatic increase in people taken into police custody under the Mental Health Act, and several violent episodes that indicated a major crisis in the health care system.
  • In September 2014, the Vancouver Mayor’s Task Force on Mental Health and Addictions completed the first phase of its work and outlined 23 priority actions in a report (Caring for All: Priority Actions to Address Mental Health and Addictions –September 10, 2014). This report was brought forward to Council on September 17, 2014.
  • In 2016, following a significant increase in opioid-related overdose deaths from drug poisoning, a public health emergency was declared in B.C. Since then, roughly 5,000 people have lost their lives to overdoses across the province.
  • The provincial government’s Ministry of Mental Health and Addictions was created in 2017 “to build a seamless, coordinated network of mental health and addictions services that works for everyone in B.C., as well as lead the response to the overdose crisis.” and in 2019 released a 10 year strategy: A Pathway to Hope: A roadmap for making mental health and addictions care better for people in British Columbia;
  • On December 18, 2018, Council approved a series of recommendations flowing from the Mayor’s Overdose Emergency Task Force, including:
  1. THAT Council commit the City of Vancouver to approaching the Provincial and Federal Governments to seek their commitment to enter into a new Vancouver Agreement that will provide an ongoing programmatic relationship and a shared commitment to a long term approach to addressing the overdose crisis. Within the context of this agreement, partners will work together to identify and plan changes to the health care system to enable a robust system of continuity of addiction treatment that includes culturally safe practices.
  1. THAT Council issue a formal statement of support for a clean drug supply and write the provincial and federal governments in support of health care system changes to enable this supply.
  • On July 24, 2019, City of Vancouver staff presented an update to Council on the implementation of the 31 Mayor’s Overdose Emergency Task Force recommendations approved in December 2018. The update showed completion of 14 proposed actions and progress on 16 proposed actions to that date, as well as eight new recommendations based on the ongoing engagement with the Vancouver Community Action Team (CAT) in response to the overdose crisis. A City of Vancouver media release states: “Despite the focused effort to prevent overdose deaths across the city, Vancouver continues to experience historically high numbers of drug poisonings as the overdose emergency continues.”
  • In April 2020, Health Canada proactively issued six-month class exemptions under the Controlled Drugs and Substances Act (CDSA) to all provinces and territories to establish new temporary Urgent Public Health Need Sites (also known as overdose prevention sites) within shelters or other temporary sites, as needed, to help people stay safe from overdose and respect physical distancing and self-isolation measures. The exemption provides provinces and territories with the flexibility to choose to establish other harm reduction activities with controlled substances, such as drug checking or virtual supervision of drug consumption to prevent overdose and overdose death.
  • On June 12, 2020, B.C.’s Minister of Public Safety and Solicitor General, the Honourable Mike Farnworth, released a statement in response to calls for reform of British Columbia’s Police Act. His statement noted that the 45-year-old act is out of step with the provincial government’s approach and the government’s work with police services on important issues including harm reduction and mental health. An all-party committee is engaging with communities and experts on how the 45-year-old act can be modernized and will examine the role of police with respect to complex social issues including mental health and wellness, addictions, and harm reduction; and in consideration of any appropriate changes to relevant sections of the Mental Health Act.
  • On July 9, 2020, the Canadian Association of Chiefs of Police (CACP) publicly called for the decriminalization of personal possession of illicit drugs and recommended that all police agencies in Canada recognize substance abuse and addiction as a public health issue. The CACP endorsement of decriminalization came in response to the fentanyl crisis and a poisoned drug supply that have devastated our communities and taken thousands of lives. CACP recommended that “enforcement for possession give way to an integrated health-focussed approach that requires partnerships between police, healthcare and all levels of government.” Similarly, they stated: “The compelling case for transformative change in Canada has been made by public health officials regarding how we respond to people experiencing a substance use disorder.”  
  • On July 31, 2020, Councillor Dominato wrote to the Honourable John Horgan, Premier of British Columbia, expressing deep concern over “The growing challenge of homelessness, mental health, and addiction related issues in Vancouver” and the “emerging tensions” playing out in a number of downtown Vancouver neighbourhoods. Her letter noted the ongoing struggle to find effective solutions which “obliges governments at all levels to radically rethink how we deliver social services across the spectrum.”
  • On August 5, 2020, the preliminary results for the 2020 Metro Vancouver homeless count were released. The count took place on March 3 & 4 and found 2,095 residents who identified as homeless in Vancouver (547 people were living on the street and 1,548 people were living in sheltered locations, including emergency shelters, detox centres, safe houses, and hospitals, with no fixed address).
  • On August 20, 2020, in response to the country’s increasingly toxic illegal drug supply, the Government of Canada announced more than $582,000 in funding over a 10 month period for an “emergency safer supply project” to help people at risk of overdose during the COVID-19 outbreak. It will provide “pharmaceutical-grade medication to people experiencing severe opioid use disorder and connect patients with important health and social services, including treatment, which may be more difficult to access during the COVID-19 outbreak. Additional supports offered include a harm reduction drop-in program, evidence-based information, supplies, food and referrals to other service providers.”
  • On August 25, 2020, the BC Coroners Service published updated reports on illicit drug toxicity deaths and fentanyl-detected drug deaths to the end of July 2020, with 175 illicit drug toxicity deaths reported in July – the third consecutive month with more than 170 suspected illicit drug deaths reported to the BC Coroners Service. The Chief Coroner noted deaths due to an unsafe drug supply continue to “surpass deaths due to homicides, motor vehicle incidents, suicides and COVID-19 combined.” To date, there have been 909 illicit drug deaths in 2020 in B.C. This compares to a total of 203 deaths (to August 25) in British Columbia due to COVID-19 since the beginning of the pandemic.
  • On September 2, 2020, Prime Minister Justin Trudeau was quoted by the CBC as saying he would not back the decriminalization of drugs as a public-health response to the country’s escalating opioid crisis. He stated that the decriminalization approach (raised as an option by advocates and medical officials across the country) is not a “silver bullet” solution and further noted that the government is prioritizing other options such as greater access to a safe supply of opioids.

Amending the City’s Municipal Election Year Operating Budget Policies and Principles

Submitted by: Councillor Dominato

WHEREAS

  1. The City of Vancouver is required by the Vancouver Charter, Library Act, and Police Act to produce a consolidated operating budget incorporating the separate internal budgets of the Board of Parks and Recreation, the Vancouver Public Library Board, and the Vancouver Police Board, and is required by Public Sector Accounting Standards to include the Vancouver Downtown Parking Corporation (aka EasyPark) in its consolidated financial statements;
  1. The City of Vancouver has a policy (Policy Number ADMIN-004: “Budgets – Operating”) which outlines the requirements for Operating Revenues and Expenditures, including authorization requirements. The policy applies to all Operating Revenues and Operating Expenditures undertaken by the City of Vancouver and is intended to supplement and provide operational clarity and promote best practices within the statutory requirements relating to budgeting as set out in the Vancouver Charter, Police Act, and Library Act;
  1. Section 219 (1) of the Vancouver Charter (“Director of Finance to report on revenue and expenditure”) states: “As soon as practicable in each year and in any event by April 30, the Director of Finance must prepare and submit to the Council a report setting out the Director of Finance’s estimates in detail of the anticipated revenues and expenditures of the city for that year.”;
  1. With respect to the requirement for the City to set an Operating Budget, Policy Number ADMIN-004 (“Budgets – Operating”) states, under section 2 (1.1), that “The Director of Finance is to present an Annual Operating Budget for the upcoming year as a report to Council in December of each year.” The policy further states that “On an exception basis, as determined by the Director of Finance, such as may occur in the year of a municipal election, an internal working budget will be developed by December of that year, and a budget will be adopted by Council no later than April 30th of the following year as required by section 219 of the Vancouver Charter.”;
  1. Additionally, Policy Number ADMIN-004 (“Budgets – Operating”) states, under section 2 (1.2), that “In any year in which the budget is not approved by Council before December 31st, Council may authorize expenditures as are necessary to carry on the business of the City until the budget is adopted, if the following conditions are met:
  • the amounts for that Budget Line Item does not exceed the amount for the Budget Line Item in the prior Annual Operating Budget, and
  • the expenditure is approved by at least two-thirds of City Council.”;
  1. There are clearly no statutory requirements relating to budgets, as set out in the Vancouver Charter, Police Act, or Library Act, that would necessitate the approval of a City of Vancouver Operating Budget in December of any year, including a municipal election year. An “internal working budget” can be developed by December of a municipal election year – or “In any year in which the budget is not approved by Council before December 31st” – and a final budget adopted by Council no later than April 30th of the following year, with Council empowered to authorize expenditures necessary to carry on the business of the City until the budget is adopted if the amounts for that Budget Line Item does not exceed the amount for the Budget Line Item in the prior year’s Operating Budget and the expenditure is approved by at least two-thirds of City Council;
  1. As a point of relevant comparison to the City of Vancouver’s budget policy, the section of the City of Toronto Act (CoTA) 2006 that pertains to Toronto’s “Yearly Budget” (i.e., section 228) includes an exception clause, namely subsection 228 (2), which states that “Despite subsection (1), a budget for a year immediately following a year in which a regular election is held may only be adopted in the year to which the budget applies.” [i]

THEREFORE BE IT RESOLVED THAT Policy Number ADMIN-004 (“Budgets – Operating”) Section 2 (POLICY STATEMENTS) be amended to better reflect the budget circumstances of a municipal election year and an incoming Council by striking subsection 1.1. under the heading “Requirement to set a budget” and replacing it with the following amended wording:

  • Section 1.1. “The Director of Finance is to present an Annual Operating Budget for the upcoming year as a report to Council in December of each year. In the year of a municipal election, an internal working budget will be developed by December of that year, and a budget will be adopted by Council in the year that it applies and no later than April 30th of that year as required by section 219 of the Vancouver Charter.”

AND FURTHER BE IT RESOLVED

  1. THAT Council direct staff to prepare a By-law for the consideration of Council to legally enshrine the intent of this motion, namely, that in the year of a municipal election an internal working budget is to be developed by December of that year and a final budget is to be adopted by Council in the year that it applies and no later than April 30th of that year, consistent with the requirements of section 219 of the Vancouver Charter, and
  1. THAT Council direct the Mayor to write to the Province to seek an amendment to the Vancouver Charter to enshrine a requirement on the part of the City to develop an internal working budget in the year of a municipal election (by December of that year) and a requirement for a final budget to be adopted by Council in the year to which the budget applies and no later than April 30th of that year.

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[i] Subsection 228 (1) of the City of Toronto Act (CoTA) 2006 states that “For each year, the City shall in the year or the immediately preceding year prepare and adopt a budget including estimates of all sums required during the year for the purposes of the City, including….”

Motion: Reallocation of Road Space to Support Shared Use during Pandemic

WHEREAS 

  1. The City of Vancouver declared a local state of emergency on March 19, 2020 in response to the global COVID19 pandemic;
  1. The Province has recommended physical distancing of 2 metres (6 feet) to prevent the spread of COVID19;
  1. The Province has also recommended the public continue to safely enjoy the outdoors, including local parks and public spaces;
  1. The Provincial health officer has commented publicly in recent weeks that partial street closures and one way travel/routing can be an effective way to enable physical exercise and safe distancing during the pandemic;
  1. Cities across Canada and around the world are undertaking measures to reallocate street space and roadways for pedestrians to safely exercise, access businesses and employment, while maintaining a safe distance due to the current pandemic;
  1. Vancouver City Council has previously endorsed motions to support slower residential streets and encourage safer shared use;
  1. The City of Vancouver and Park Board recently identified congestion in and around Stanley Park, and subsequently closed the Stanley Park roadway to cars and one lane along Beach Avenue to enable safe physical distancing during the COVID19 pandemic;
  1. The City of Vancouver has initiated a street reallocation initiative that focuses on Room to Queue, Room to Load, and Room to Move during the COVID19 pandemic;
  1. The ongoing pandemic necessitates that the City reallocate road space on an urgent basis now and develop plans for mobility and space use as part of our post-COVID-19 recovery and new economy.

THEREFORE BE IT RESOLVED THAT Council direct staff to expedite efforts to identify and implement appropriate reallocations of road space, such as high use greenways and streets adjacent to parks where space could be reallocated temporarily to enable safe shared use (pedestrians, cyclists, motor vehicles) and support safe physical distancing during the COVID-19 pandemic response, and

FURTHER THAT Council direct staff to communicate information to the public and businesses regarding the suite of street measures available to the City for reallocating space to support access to local businesses, to support loading and curbside pick-up, and to support physical activity and distancing in neighbourhoods across the city, and

FURTHER THAT Council direct staff to report back to Council in fall 2020 on refined options for mobility and public realm use us as part of the post COVID19 recovery and new economy.

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