As Vancouver city hall continues to struggle with its promise to end homelessness, a new study provides evidence for the first time that the majority of people in the Downtown Eastside didn’t start off in that distressed neighbourhood — but came from other cities and provinces.

The Simon Fraser University paper, to be released today, tracks the movement of a group of chronically homeless, drug-addicted and mentally ill people during a 10-year period. It finds that by the time they were living in Vancouver’s inner city, their interaction with expensive social services had skyrocketed.

“Over the 10 years ... participants’ use of community medical services and hospital services each tripled, while criminal convictions and welfare receipt doubled,” says the study, Migration to the Downtown Eastside.

The research suggests that if more services were available in other cities and provinces, these people could have received help at an earlier stage in their descent, rather than waiting until they hit rock bottom in the Downtown Eastside, said SFU professor Julian Somers, the paper’s lead author.

“Given they are moving, at the same time things become worse, can we decentralize the focus of intervention to the communities where people seem to be (initially) at risk?” Somers, who has done extensive research into the dual diagnosis of drug addiction and mental illness, said in an interview.

“We don’t want to focus our efforts on addressing these co-occurring disorders by starting with people once they are in the Downtown Eastside.”

The study goes back a decade in time to track the movement of 433 people before they joined federal research project At Home/Chez Soi, which plucked mentally ill, drug-addicted people off Vancouver streets and gave them housing and extensive support services. At Home/Chez Soi, which ended in 2013, concluded the majority of participants improved their lives after getting a home and some stability.

When they joined the project, 52 per cent identified their home as the tiny Downtown Eastside neighbourhood; but medical records show that a decade earlier, only 17 per cent lived in that community.

During that same decade, the number of participants who called other parts of Vancouver home remained stable. The influx of Downtown Eastside residents, the SFU study shows, came from other areas of B.C. and “unknown” medical jurisdictions, which include other provinces.

By tracking medical, justice and social service records, the study also proves the participants’ lives became more desperate over that decade. In the year before joining the At Home project, the participants, on average, used community medical services 50 times (up from 17 times a decade earlier), spent 12 days in hospital (compared to just three days 10 years earlier), collected nine welfare payments (up from five), and had one criminal conviction (compared to an average of one half).

The researchers conclude the participants migrated to the Downtown Eastside to access the services there — shelters, free food, drug treatment and non-judgmental medical services — but also struggled in a place riddled with illegal drugs, seedy housing, crime, poor health and poverty.

“Despite the high concentration of services and supports in the Downtown Eastside, members of the current sample experienced significant personal decline rather than recovery,” says the study, the first to examine geographic migration and long-term changes in service use among chronically homeless, mentally ill adults.