VANCOUVER - The provincial government may need to create an institution for severely mentally ill people with a propensity for violence, but it still needs to do more work to understand the scope of the health care crisis that is gripping the province, Health Minister Terry Lake said Friday. As a result, Lake says he can’t support a call from Vancouver Mayor Gregor Robertson and Police Chief Jim Chu for a new 300-bed secure facility for the province’s most violent mentally ill people, who are responsible for a dramatic increase in random and violent attacks on unsuspecting citizens. Chu and Robertson held a news conference Friday saying mental health issues in Vancouver have reached a crisis level and called on the province to make major changes to protect the public from an increasing number of violent incidents. Lake said he’s being told there is new evidence that some of those with the most severe mental health issues are also suffering permanent brain damage from the use of highly-damaging drugs such as crystal methamphetamines. That’s different from the kinds of mental illnesses in the past that would have landed a person in the now-closed Riverview Institution. “Nothing is ever simple, of course, but what I am learning from people who deal with this population is that we may be dealing with something quite different from what we’ve seen in the past, and that is long term, permanent brain damage, acquired brain injury, if you like, from the long-term use of drugs like methamphetamines,” Lake said. “We have spent hundreds of millions of dollars in community treatment and facilities for people who came out of Riverview. But I am told that the population the chief and the mayor are worried about is not the same population that would have been housed in Riverview in past practice.” Robertson and Chu said severe mental health issues in Vancouver have become so serious they are now on par with the crisis the city encountered at the height of the HIV/AIDS epidemic a decade ago. Police are finding that one in five cases they respond to now involve a person with severe mental health issues. Since January 2012 there have been 96 serious incidents, including one 15-month period in which 26 people were attacked in 11 separate incidents, Chu said. In most of those cases, they involved people who police had multiple interactions with under the Mental Health Act. “As we talk about this issue, we should not stigmatize those with mental illnesses,” Chu said. “A very small portion commit violent crimes, and we have definitely noticed a disturbing trend in the last year.” In one of those cases, a man viciously beat three elderly women, kicking and stomping each of them in the head. In another case, a man walking his dog was stabbed multiple times and was eviscerated, with his internal organs being visible to responding officers. In a third case, Chu said, a mentally-ill person stabbed an innocent woman at a convenience store so hard that the knife broke off in her head.

“The trend is alarming and currently poses the greatest risk of an unprovoked attack on everyday citizens in Vancouver,” the VPD said in a background paper. “These attacks have included vicious beatings, stabbings and a shooting, and have involved on occasion very young victims, including newborn twins.” The number of cases in which police apprehend people under the Mental Health Act has risen by 23 per cent this year over last year. “The problem is getting worse. We now have a mental health crisis on our streets,” Chu said. “The police are becoming the first point of contact for those who are severely mentally ill and that is wrong. These people require health care, support and medical treatment, not the justice system.” Robertson said the government’s downsizing and eventual closure of Riverview in the 1990s was partly to blame for the dramatic rise in people living in the Downtown Eastside with mental health issues. But he also said more potent drugs, the rise of crystal meth and the province’s failure to open new treatment facilities have all exacerbated the situation. Dr. Patricia Daly, the chief medical health officer for Vancouver Coastal Health Authority, agrees that permanent brain injury is now a factor for some people with severe mental health issues. “What we have been seeing in the Downtown Eastside through researchers and what we are now able to characterize and identify is that brain injury is a significant component of mental illness within that population,” she said. But she said it is too early to tell how the health community should deal with this increasing dynamic and she doesn’t yet agree that a 300-bed ward is necessary. “No, I don’t know what future resources might be needed in terms of in-patient beds as opposed to outpatient resources. I think the minister has it exactly right,” Daly said. “We need to best determine how to deal with people who have brain injury and it may be more difficult to treat. We’re committed to working with the police and the city, but we don’t have a specific number that (should be institutionalized).” Robertson said research shows at least 300 of the 2,000 classified as “severely addicted mentally ill” people in the city require institutionalization. More than 670 are not getting medication or are being under-medicated, he said, leading to an alarming rise in random, violent attacks on people. “The chief and I are issuing a public call around a situation that has reached a crisis point in Vancouver,” Robertson said. “It’s one that we have grappled with for a number of years, but it has escalated to the point that we need to go public and state clearly that today, Vancouver is embroiled in a public health crisis due to untreated, severe mental illness.” The mayor and police chief’s concerns come as the Union of B.C. Municipalities prepares to deal with a motion from Maple Ridge calling for the reopening of Riverview. In addition to opening a 300-bed secure facility, Robertson and Chu want the province to also increase support to a special police and health care Assertive Community Treatment reaction team; open a crisis centre at a Vancouver hospital dedicated to treating the severely mentally ill; and put more staff into BC Housing facilities that are home to mentally-ill people.