Vancouver Coastal Health to revamp Downtown Eastside health services

published on March 31, 2015 by Frances Bula, in The Globe and Mail

Vancouver Coastal Health is undertaking a massive plan to remake health services in the Downtown Eastside to get rid of duplication built up over the years by layers of agencies providing health care to 10,000 people struggling with significant mental and physical health problems.

The system also needs to change because people are living longer, a result of past successes, health authority leaders say.

The authority spends $54-million a year to provide care in the three-square-kilometre zone, about 2 per cent of the $3.1-billion it spends on health care for the million residents of the whole region.

“We’ve said that we’ve got to do this differently,” said Rolando Barrios, a senior medical director who is heading up the effort to create what is being called a second-generation strategy.

“We’ve created a system where we have people working in silos.”

Part of the plan is to keep the city’s supervised injection site open longer hours so the region’s health care authority can ensure as many people as possible have access, given the unlikelihood that the federal government will allow any other sites to open. As well, Vancouver Coastal Health is looking at establishing a new, ultra-low-barrier methadone clinic.

The Downtown Eastside’s huge health system, often delivered through non-profits and scattered health clinics instead of in a traditional hospital, is cumbersome because services have been piled on top of other services each time the authority has tackled a new health crisis.

To illustrate the problem, Dr. Barrios said he had to call a meeting recently to deal with a single client, an older woman with dementia, who wanted to move out of her residential-care facility.

That meeting ended up involving nine people, including several separate case managers who were dealing with the woman in different clinics and housing projects. None had ever talked to the other before.

“We’ll certainly be aiming at better integration,” Dr. Barrios said.

The change to a second-generation system, outlined in a 42-page document now circulating in the community, includes everything from broad re-organizations to small but unusual new initiatives.

Among them: A place for people with alcohol problems to drink safely, mobile health services, housing projects that are set up to serve only targeted populations, a client database to share health information, support for research efforts to find a cocaine substitute similar to what methadone is for heroin users, and a new payment system so welfare cheques don’t all get delivered the same day.

Dr. Barrios said the health care system has achieved some successes, in spite of all its apparent complications. In the mid-1990s, authorities declared Vancouver had a public-health epidemic because the rates of HIV infection were as high as in parts of Africa.

That’s changed.

“When we look at the data, we are doing something right, because people are getting better.”

In fact, the success is causing part of the problem.

People are living longer, thanks to improvements in AIDS, HIV, hepatitis, and overdose care, so the challenge now is figuring out how to deliver complex medical services to an older population, as well as dealing with the usual group of younger alcoholics and drug users.

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Rolando Barrios

BC Centre for Excellence in HIV/AIDS

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Vancouver Coastal Health to revamp Downtown Eastside health services

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