B.C. is home to a new tribe of mentally ill people.
They're nothing like the people who lived in the Riverview psychiatric hospital for all those years.
They are a new generation who are fractured by powerful combinations of mental illness, drug use, homelessness and severe physical breakdown.
A wide variety of studies and surveys indicate that at least half the people with severe mental illness in North America are also alcoholic or, increasingly, heavy drug users. Some studies put it as high as 70 per cent.
B.C. appears to be at the high end. Homelessness, which experts say acts like a corrosive agent on vulnerable brains, and widespread use of psychosis-inducing drugs like crack and crystal meth are propelling increasing numbers of the province's most fragile people into clinical psychiatric territory.
Bev Gutray, of the B.C. chapter of the Canadian Mental Health Association, says the estimate is that there are 12,000 people in B.C. who are both mentally ill and drug-addicted.
That number is growing every year. That doesn't take into account the people who don't show up in the statistics, because they've never been diagnosed or even gone for help.
And a growing chorus of psychiatrists, police, housing providers and health-care workers say that more of the same old solutions isn't going to work for this new breed.
They are saying Vancouver can't fix this crop of the mentally ill by just sending them back to traditional institutions. It can't cure its plague of addiction by just adding more places to get drug treatment.
Nor can this city -- or any other town in B.C. -- hope to disperse the ever-growing ragged armies of homeless, mentally ill and drug-addicted people by just building them places to live.
The old systems aren't working for that group because they were created to deal with people who had only one problem apiece, not everything at once, say those who try to deal with them.
Some are in such a dysfunctional state that even the idea of making and keeping appointments at clinics to get mental-health counselling is ludicrous.
At places like the Strathcona mental-health clinic, staff are already overloaded, seeing 125 people a day, almost every one of them with both a psychiatric and an addiction problem.
At other mental-health clinics or treatment facilities, there's still often a mindset from the past that sees addictions and mental health as separate categories.
So people who call are are told by mental-health counsellors to get off drugs before they can come in for psychiatric help. They're told by treatment centres that they can't be admitted if they're taking any kind of medication, including drugs prescribed for their psychosis or anxiety or other psychiatric condition.
In all but a few places that provide social housing, they're thrown out if their behaviour is too crazy or if they're using street drugs.
That means they're cycling constantly through city hospitals, shelters, streets, and jails, draining emergency-room and police resources.
The answer, experts say: The city and province need to construct a new form of care for the mentally ill of the 21st century.
"There's a cohort of hundreds, if not thousands, of people who are not being served," says Geoff Plant, the former B.C. Liberal minister who is now spearheading Vancouver's Project Civil City.
Plant, backed by the city's drug-policy coordinator, Donald MacPherson, has decided to focus a considerable part of the project's resources on this new, lost population. And even just getting them housing is not going to solve it, he says.
"I think the province is making significant movement on the housing front," Plant says.
But he added: "I am less confident that the extent of the health crisis with respect to these people with concurrent disorders has seized the attention of Victoria. Housing first is clearly a way of creating the conditions for help, but it's not enough for the cohort of the most egregiously ill."
At Vancouver Coastal Health, the two women who oversee the region's mental health and addictions programs, Lorna Howes and Heather Hay, say this new group is forcing the old systems designed for 30 years ago into trying to adapt.
At St. Paul's Hospital, there's almost a cry of despair.
St. Paul's opened a 15-bed psychiatric unit specifically to deal with dual-diagnosed people less than two years ago, but it is not nearly large enough.
"We are always over 100-per-cent capacity," said Dr. Richard Pico, chair of psychiatry at Providence Health Care, which oversees St. Paul's.
Pico said the hospital has plans to add 15 new beds soon, but added what also is needed are more resources in the community.
Building a new, workable system in the community is especially crucial.
Housing Minister Rich Coleman is making Herculean efforts these days to buy existing low-income buildings and to get money for new social housing -- all of it aimed at people with precisely these complex problems.
On Thursday, he announced the government's purchase of another six hotels in the Downtown Eastside, with the total amount of housing in Vancouver now targeted to the mentally ill and drug addicted standing at 16 hotels and 12 new housing sites for a total of 1,800 units.
But the non-profit groups who are going to be put in charge say there's a disaster in the making if 100 or even 50 people with complex problems are herded into one building without a solid system of mental-health care and staff who have the time to do more than just tread water. They know that from past experience.
"Having had a chance to run the Princess and the Vivian projects, we've been able to get a sense of where your tipping point is," says Mark Smith, the manager of Raincity Housing ( formerly Triage ), one of the few social-housing groups in the city that take on those profoundly challenging people.
"You do hit a maximum number, after which you just can't manage the chaos. Anything past that and you're just doing crisis work. You're making sure they're not being hounded by dealers, that the pimps aren't getting in to beat up the women."
That's echoed by Mark Townsend, Liz Evans and the people who work with them at the Portland Hotel Society, which runs several hotels in the Downtown Eastside that are seen as the housing of last resort for people kicked out of everywhere else.
Four years ago, they were given the Stanley/New Fountain Hotel -- a crumbling building between Blood Alley and the Army & Navy department store -- to run, with 80 of the people who had been living outside Woodward's in a tent-city housing protest as their new residents.
They were originally given no staff, then that crept up to enough money to pay for one person 24/7 to monitor the door, run the building, clean the toilets and keep a a lid on everything.
"It used to be absolute chaos here," says Erin Mathews, the petite and irrepressibly cheery woman who has been the Stanley's manager for the past four years. "Most people from agencies refused to come into the building."
The Stanley became a blight for the whole community. Police logged 521 calls from the building in one two-month period.
Now, four years later, Mathews says there's a world of difference.
There are more staff, so she's not doing everything by herself. Vancouver Coastal Health just created a roving health team for the Downtown Eastside hotels, which means there's a nurse in the building several times a week.
St. Paul's psychiatrist Bill Mac-Ewan has made it his mission to come into the Downtown Eastside three times a week, with the Stanley as a regular stop.
The mother of one of the boys living at the hotel raised $70,000 from friends and relatives to pay for lunch for everyone in the building to be brought in each day, from the kitchen of another Portland-managed building.
But it's all temporary, a patch job of charity and time-limited funding and superhuman efforts from people like MacEwan, says Townsend.
And if Vancouver is going to absorb 30 more buildings and 2,000 more people like the residents at the Stanley, there is going to have to be a lot more.
Tomorrow: There are small experiments and ambitious plans percolating in many places for how to treat this province's new generation of the mentally ill. There's a lot of hope for them, but how far will they go?
