When we look at social and supportive housing projects currently planned for Vancouver and the information that has been made available by the City and by Vancouver Coastal Health with respect to these plans, there is little comfort to be had that any consideration has been given to risk management.
A competent risk management plan should follow these 5 steps:
- Identify the Hazards
- Evaluate the Risks
- Develop a Plan to Control the Risks
- Implement the Plan and Document Actions Taken
- Monitor and Evalulate the Success of the Plan
Each of these five steps in risk management is presented below with some questions about how each step is being applied, or not applied, in the context of the facility that Vancouver Coastal Health has announced for the site at 16th and Dunbar. These questions also apply to other facilities currently planned for Vancouver and other cities. Given how far along in the planning and development process the site at 16th and Dunbar has come, it is shocking that more of these questions have not been answered. It is certainly not from a lack of people asking.
It does not take much imagination to think of a few of the risks that such a facility might introduce. It has been shown that severely mentally ill patients, particularly those addicted to drugs, or with a history of drug or alcohol use, do pose a significantly elevated risk of property crime 1 and violent crime 2 (including sex offences 3). The proposed site at 16th and Dunbar lies at the centre of a residential community predominantly populated by young families and seniors. What efforts have been made to define the type of people that will reside at this facility and to analyse how those people will interact with the existing community? How much objective data has been collected from similar facilities in the region and is that data relevant, current and complete enough to be statistically significant?
The key question to be answered from an evaluation of risk standpoint is: how will the residents of this facility be selected (and conversely, who will be excluded and under what criteria will they be excluded). Until that question is answered, it is not possible to quantify the hazards that this facility might introduce into the neighbourhood. A recent report from the City's own Police Department points out the futility in dealing with some of the most difficult individuals. Case examples in that report illustrate that community treatments simply do not work for some individuals, and yet the report also bemoans the dearth of institutional mental health care with the capability of dealing with such cases. So how can we be assured that individuals who cannot be successfully treated in the community will not be routed to this facility when there is enormous pressure to put them somewhere? And if the intention is to exclude such individuals, then what is the risk that some will slip through the cracks?
There has been no information offered on how individuals will be screened for this facility. Vancouver Coastal Health has not made available a list of criteria that will be used to define the categories of individuals targeted for this facility. There is also no protocol outlined for how candidates will be evaluated at the front end, how they will be monitored while in residence, or how they will be identified and reassigned if experience reveals that some individuals do not meet the entry criteria after all.
Implementation of a risk management strategy costs money, but it appears all the money is going into construction with little devoted to operation. When money gets tight in our short-sighted society, risk management is usually the first thing cut from the budget. If Vancouver Coastal Health cannot spell out in detail what their risk management plan is, then how will they pass it down to the one or two people that will be stationed at the facility? Are the proposed staffing levels and training going to be adequate for the implementation of a comprehensive risk management plan? Will anyone on site be reporting directly to the Risk Management Committee?
How is Vancouver Coastal Health going to define, gather and evaluate data in a meaningful way? Upon assuming his role at the head of the City’s Civil City initiative, Geoff Plant acknowledged that in BC, we currently have no reliable system or criteria for collecting meaningful data about the homeless either inside of or outside of treatment. So how are we going to document the success or failure of this facility? Why is the facility going ahead before we are able to track what we are doing? How will we measure success when we do not even have a benchmark?
While good intentions are to be applauded, they alone are not enough to bring safe and effective results. These tough questions must be answered before these facilities are approved and operating. Vancouver Coastal Health should be able to answer these questions and provide the community answers as to how they intend to manage the risk . This should be a transparent process with publication of this plan and the results of monitoring and evaluation posted on their website.
Published March 28, 2008.