Thank you.
Thank you for the opportunity to present today. I am here representing Vancouver Coastal Health.
I've been a nurse for the past 35 years, and I've had senior leadership experience in health care. Most recently, for the past 11 years, I've been leading the public health response to the public health crisis on the downtown eastside.
Vancouver Coastal Health delivers a broad range of health care services. We have an operating budget of approximately $2.4 billion, and we serve over a quarter of the population of British Columbia. We invest over $110 million a year in the treatment of individuals with mental health and addictions issues. For every dollar spent in harm reduction, four dollars are spent on treatment.
The goal of our mental health and addictions services is first and foremost to keep people alive, second is to prevent the use of harmful substances, and third is to assist people to stop the abuse of all substances.
I'm here today to take you through a little bit of history. I'm here today to talk about a public health emergency that was announced in September 1997 in the poorest neighbourhood in the country, a neighbourhood that has an overrepresentation of aboriginal peoples, a neighbourhood that has 10 times less access to family physicians than any other neighbourhood in Canada, a neighbourhood that has a mortality rate 14 times the rest of the province, and a neighbourhood where people live in single-room occupancy hotels that have no access to handwashing or toilets. It's also home to 4,600 IV drug users. Ten years ago it was home to several epidemics--hepatitis A, hepatitis B, hepatitis C, transferrable TB, and overdose deaths--and the primarily underlying epidemic of intravenous drug use.
This is the context in which the supervised injection site came to exist. It was a public health response to a health emergency akin to a third world disaster zone. Traditional health care wasn't working to stem the tide; an innovative continuum of health care services was required.
The supervised injection site, known as Insite, is part of that solution. In June 2000, the Vancouver Coastal Health board of directors voted to support the supervised injection site as a vital part of our continuum of health care. The decision was a product of extensive consultation and research, which led us to believe that there was a public demand for safe injection sites in Vancouver. Such a site would assist Vancouver Coastal Health in meeting its health care mandate of providing appropriate and necessary health care to all the populations it served. The supervised injection site would facilitate contact with high-risk IV drug users, provide us with the means to reduce the spread of disease and deaths, and allow clients to access health care services and other social services.
The supervised injection site is operated by Vancouver Coastal Health in partnership with the Portland Hotel Society. Insite provides a clean place for people to inject drugs under a nurse's supervision. Insite offers clean injecting equipment and safe injecting education, which helps reduce the risk of transmission of infectious, blood-borne diseases like HIV/AIDS and hepatitis C. Insite offers treatment of wound infections and TB, inoculations for pneumonia and the flu, and access to addiction counselling and treatment on demand.
While clients of the supervised injection site may not choose to immediately access all the health care services offered at Insite, regular attachment to this health care facility, where clients develop trusting relationships with health care providers, makes them more likely to pursue detox, addiction counselling, and treatment.
Vancouver Coastal Health's direct experience in treating marginalized people with chronic addictions is that few people move to abstinence overnight. Few people go from being vulnerable and marginalized to becoming fully engaged in treatment and care. Few people get better without help and support.
Insite serves as a low-threshold access point for treatment services. For many people, Insite is the door from chronic drug addiction to recovery, from being ill to becoming well.
Vancouver Coastal Health has recently opened Onsite, which is directly upstairs from Insite, so that Insite clients can access treatment on demand with no wait time. Onsite provides transitional housing, home detox, a day treatment program, nursing care, one-on-one counselling, and support to Insite clients who are homeless and want to stop using drugs.
In addition to Insite and Onsite, over the last five years Vancouver Coastal Health has opened four other first-point-of-contact health care services. They are designed to be accessible to people whose chaotic lives and complex mental health and addictions issues make it practically impossible for them to access traditional health care services.
Currently, we're involved in the development of a 100-bed, long-term residential treatment facility for the clients of Insite who have both mental health and addictions issues. Without a doubt, the health care needs of people living in the Vancouver's downtown eastside are complex, and no single intervention is enough to transform this community--