About half of Downtown Eastside residents who experience chronic homelessness and serious mental-health issues migrated to the neighbourhood from elsewhere – but despite the high concentration of services and supports in the area, they suffered significant personal decline.

Those are the findings of a new Simon Fraser University study, which also found that the number of people in the Downtown Eastside who come from outside of Vancouver has risen significantly in the past decade, to 52 per cent from 17 per cent. Researchers arrived at these numbers by surveying 433 residents of the Downtown Eastside who met criteria for chronic homelessness and serious mental illness, examining the location of each participant over the past 10 years before recruitment for the survey.

The data bolsters anecdotes from Vancouver police, who have hypothesized that such populations are drawn to the area because of the high concentration of low-barrier services, lax attitudes and a reduction in stigma surrounding mental illness.

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In the fall of 2013, Mayor Gregor Robertson and then-police chief Jim Chu said the city's mental-health situation had escalated into a public-health "crisis."

Research lead Julian Somers, an associate professor in SFU's faculty of health sciences, said the migration could be attributed as much to the availability of low-barrier services in the Downtown Eastside as to the dearth of them in the smaller communities the participants were leaving.

The findings also illustrate the Catch-22 of people gravitating to the Downtown Eastside for its services but then being exposed to a high-risk setting with issues such as substance use, crime and poverty.

The key is to interrupt that trajectory, Dr. Somers said. "The implications are that we need to consider intervening earlier, and moreover, that where we think about intervening may not be geographically where these problems appear to be most visible."

Dr. Somers cited as examples Kelowna and Prince George, two of five cities in which the province launched a Homelessness Intervention Project to provide life skills, employment training and other services to homeless people. Kelowna and Prince George have since launched Assertive Community Treatment teams to help with issues around mental health and substance use as well.

Ronald Joe, associate medical director of addiction services at Vancouver Coastal Health, said the health authority has its own data as well, based on people who access health care while in the Downtown Eastside.

"Our general sense is that approximately half of the population are long-term residents of the Downtown Eastside and the other half are transient," Dr. Joe said. "We're seeing an approximate turnover of 15 to 20 per cent each year – people we've never seen before. We're making an equal presumption that 15 to 20 per cent are moving out."

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The doctor said there are strategies to connect service users in the Downtown Eastside with recovery programs elsewhere.

The total population of the Downtown Eastside has remained fairly stable at about 15,000 for at least the past seven years, Dr. Joe said.

A separate paper released by Dr. Somers this week found that chronic criminal offenders with the highest overall use of public services incur costs totalling more than $5-million every year, yet see no meaningful signs of improvement.

Those findings suggest that that subset needs intensive supports to escape the "revolving door" of the corrections system and health and welfare services and to produce positive outcomes.

Vancouver Coastal Health is currently rolling out its Downtown Eastside Second Generation Health Strategy, designed to address the shift in problems afflicting the impoverished neighbourhood from HIV and hepatitis-related illness to a combination of mental health and addiction issues.