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In 2014, Vancouver emergency departments recorded an increase in the number of people experiencing a mental-health crisis for the fifth year in a row.

St. Paul’s Hospital and Vancouver General Hospital together saw 9,790 emergency mental-health visits last year, according to statistics provided to the Straight by Providence Health Care. That’s up 4.8 percent from 2013 and marks a 50.2-percent increase since 2009.

Both hospitals’ emergency rooms also had more substance-misuse cases. In 2014, there were 5,660 drug-related visits, up 11.6 percent from the previous year and an increase of 103.7 percent from five years earlier.

“Our stats keep going up,” said Dr. Bill MacEwan, head of psychiatry at St. Paul’s Hospital. “There is a lot of things that Vancouver Coastal Health and St. Paul’s are planning to try and address this….They realize this has got to be dealt with better.”

In a phone interview, MacEwan described factors that have contributed to these increases, not all of which are negative.

Compared to police in other jurisdictions, he said, the Vancouver Police Department has proven reluctant to push for the incarceration of people with mental-health challenges. “Chief constable Jim Chu, his ideology is: ‘It’s a better thing to treat people who have mental illness or addiction than to put them into jail.’ ” (On December 30, the Straight reported that Vancouver police similarly ended 2014 with a record number of emergency interactions involving a mental-health component. There were approximately 3,025 VPD arrests under the Mental Health Act last year, up 32.8 percent since 2010.)

Secondly, MacEwan suggested Vancouver’s relatively moderate climate means the city serves as a home to a disproportionate number of mentally ill people who are homeless.

Another factor, MacEwan continued, is the extent to which people who suffer with concurrent disorders—a mental illness and an addiction issue—have “clustered” in one small area: the Downtown Eastside. “People who have a mental illness are more prone to addiction, and people who have an addiction more commonly have difficulties with mental illness,” he explained. “The two things feed each other.”

MacEwan drew attention to an academic project called the Hotel Study. According to a December 2013 article the research group published in the American Journal of Psychiatry, of 293 Downtown Eastside single-room-occupancy hotel (SRO) residents monitored, 95.2 percent were substance-dependent, 61.7 percent were injection-drug users, 47.4 percent were diagnosed with psychosis, and 45.8 percent were found to have a neurological disorder.

While the study looked at 293 people, a project summary states that group represents an estimated 3,000 SRO tenants living in the Downtown Eastside and facing similar health concerns.

“Staggering numbers,” MacEwan said. “And they’re all within a block and a half of each other. You don’t see that anywhere else.”

Series: Chasing a crisis

Part one: Vancouver police still seeking help to prevent a mental-health crisis

Part two: Amid a mental-health crisis, Vancouver care providers revisit the debate on institutionalization

Part three: Vancouver service providers fail to get ahead of a mental-health crisis

Part four: B.C. prisons lock mentally-ill offenders in isolation

Part five: Vancouver's ill and addicted lost in a mental-health care maze