Advocates for the city’s most vulnerable are weighing the ups and downs of BC’s newest housing model as the province commits itself to bringing complex care to Victoria.

Upon release of the 2022 provincial budget on Feb. 22, Finance Minister Selina Robinson said complex care would receive $164 million over three years to reach another 20 sites in BC. The expansion will support up to 500 homeless or unstably housed people struggling with mental illness, substance use and brain injury.

“This first-of-its-kind approach will help stop the cycle of evictions, shelters, emergency rooms and jails for hundreds of people with complex-care needs,” Robinson said in her address.

Now that approach is officially coming to Victoria.

At a March 22 teleconference, Minister of Mental Health and Addictions Sheila Malcolmson said the budget will fund 100 “critical” spaces in Greater Victoria—consisting of beds and supportive housing services—in the coming weeks and months. At the intensive-care level, support is offered round-the-clock and may include physical, mental health and substance use care, food security support, medication management, overdose prevention and prescribed safe supply, and Indigenous cultural support.

At the housing level, services also include rehabilitation and community support, personal care and home management support.

While traditional supportive housing offers a narrower range of on-site social supports, complex care blends health-care and housing on a 24-7 basis to ensure residents have access to all the physical, mental, community and daily life services they need to function and succeed.

Malcolmson said Victoria has received an assertive community treatment team, while five urgent-care centres have opened in Greater Victoria to offer mental health and substance use services in the Westshore, Esquimalt, James Bay, downtown Victoria and North Quadra.

She added that funding for counselling programs has expanded to include four community agencies in Greater Victoria.

Leah Collins, chair of Island Health’s board of directors, said in the teleconference that the health authority would be “actively seeking qualified, empathetic and dedicated people to support the delivery of complex-care services who need it where they are at.”

Malcolmson said work is now underway to hire social workers, registered nurses, community health-care workers, peer workers and other health-care professionals.

“We are doing this for the first time and so we’re going to take the time to do it well, but we also recognize that there are people suffering right now,” she said.

More British Columbians have died from the poisoned street drug supply than from COVID-19 since the pandemic began in early 2020 and roughly 1,500 people lived on Victoria’s streets as of March 2020. 

In an interview, Mayor Lisa Helps said there is urgency to provide housing and health care to the city’s most vulnerable—and that the BC Urban Mayors’ Caucus “advocated really hard” to secure sites anywhere provincially.

The caucus has worked with the province on complex care plans since August 2021; ultimately Island Health will be responsible for providing the support. 

“The gaps are when people who have complex health issues, complex medical issues, complex mental health and substance use issues, are put into supportive housing and the assumption is that’s enough support, when obviously it’s not,” she said.

“The novel piece is really blending health and housing in a more integrated way.”

She said complex care will also benefit downtown business owners who, already struggling amid the pandemic, have complained of homeless people sleeping in their doorways.

“No one wants to walk down a street or open their business and see somebody really struggling with mental health and substance use issues,” she said.

Even after most people experiencing homelessness were offered housing, some still found themselves struggling without adequate support due to their complex care needs. Greater Victoria Housing Society executive director Virginia Holden said other groups like BC Housing will partner with local health authorities to structure and staff complex care for the homeless and unstably housed.

“There’s still a need to have this kind of higher service [and] higher support … for folks who have high barriers to be successful in the current housing that’s available,” Holden said.

But she noted that a single housing model can never serve all needs.

“You may need one type of housing now, but that doesn’t mean you need it forever.”

Holden said supportive housing operators may approach the GVHS with formerly precariously-housed clients. Together, they work to find housing that meets the clients’ current needs and helps them graduate to the higher-level complex-care model.

“If we see it as a larger spectrum or continuum, we all benefit,” Holden said, adding that moving more people into complex care will free up space in the current model.

The Pacifica Housing Advisory, BC Non-Profit Housing and Aboriginal Housing Management associations did not reply to requests for comment.

‘A sense of stability’

Nicole Chaland, a housing and homelessness researcher and the City of Victoria’s former homelessness advocate, said prioritizing housing itself “provides people with a sense of stability” and advocates for tenant rights and community integration.

“They sort of take the term ‘housing first’ and assume it means like, ‘Just get people inside; everything else will take care of itself,’” Chaland said.

On the contrary, she said the Housing First model starts by setting people up with teams that can help them work toward their own goals.

“The person has to be in charge of their journey out of homelessness,” she said. “They have to have their own motivation.”

Observers caution that not everyone suffering from the kinds of challenges that can be met by complex care will be eager to sign up. 

Regardless of stages in housing and health care, Jonny Morris, CEO of the Canadian Mental Health Association’s BC division, highlighted the element of choice.

“There aren’t a lot of folks knocking on the door of the mental health system to say, ‘I want to be voluntarily admitted,’” Morris said. “We need to have the most robust array of voluntary services before we can really truly contemplate any kind of routing toward involuntary care.”

Grant McKenzie, communications director at Our Place Society, believes some of his organization’s clients lack the capacity to make adequate decisions for themselves—and that the voluntary model creates issues for those unable to recognize they have hit rock bottom.

“We don’t want to take away anybody’s rights, and sadly that kind of means we’re going to struggle to actually heal the people who are most in need,” McKenzie said.

He said a team of complex-care workers will need to spend weeks convincing people on the street to seek help.

But for some Our Place visitors who are traumatized, abused, mentally delayed, or incapacitated, McKenzie said needs can extend far beyond the ability of an outreach worker.

He added the lifestyle of street survival can include stealing and possessing drugs and weapons, detracting from the community’s safety and tranquility.

“As soon as we can get someone stabilized, all of a sudden, they get out of that fight-or-flight, pure survival mentality … and that protects everybody.”

Forcing someone into support may only discourage them, says Janine Theobald, collaborative engagement director for the Greater Victoria Coalition to End Homelessness.

“Sometimes someone is in there having a psychotic break [and] they’re a threat to themselves or others,” she said. “Other times, someone’s just having a really bad day and just needs to have an opportunity to rest and not be in that state of crisis.”

Theobald says giving vulnerable people consistent boundaries in their life can help them learn to live safely and successfully again in their community.

“Every time there’s an act of violence or theft … they know what to expect in response to that,” she said.

Morris stressed the need to look beyond medical and psychiatric care and make support more accessible earlier on for those spiraling into illness, addiction and homelessness. That may mean adding new staff at a time when many Victoria agencies are already reporting staff shortages.

“I think the bigger question is, does the workforce exist and what efforts are being made to recruit, train and retain a workforce that can perform that work?”

At the teleconference, Malcolmson emphasized the need for complex care to remain on a volunteer basis.

“It is housing,” she said. “It is not institutional care.”

However, she added that there are options for people for whom voluntary admission isn’t going to work. 

“There are forms of involuntary care that already exist within our health-care system, and it may well be that there are better linkages between that and complex-care housing.”