The most chronic offenders in Vancouver's Downtown Eastside incur public service costs of more than $5-million every year yet see no meaningful signs of improvement, according to a new study from Simon Fraser University.

The findings suggest that this subset of about 300 people needs targeted, intensive supports to escape the "revolving door" of the corrections system and health and welfare services and to produce positive outcomes, said research lead Julian Somers, an associate professor in SFU's faculty of health sciences.

The findings also reflect a shift in the problems afflicting the impoverished neighbourhood from HIV and hepatitis-related illness to a combination of mental-health and addiction issues, and which Vancouver Coastal Health hopes to resolve with a new strategy for the area announced last year and now slowly rolling out.

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The SFU study is the first to examine the average costs incurred by individuals in a specific Downtown Eastside population: those who use the most public health services, are most dependent on income assistance and who served the most days in custody or community supervision.

Researchers identified 323 people who met these criteria among more than 14,300 offenders sentenced in Vancouver's Downtown Eastside at least once between 2003 and 2012. Of this smaller group, 216 sentenced to community supervision each incurred average public service costs of $168,000 over five years; 107 put into custody averaged $247,000 over the same period. Health-related costs for both groups were more than $80,000 a person, primarily associated with hospital admissions.

Put together, the cost of services for both groups amounted to $26.5-million over five years. This figure does not include other costs such as emergency room visits, police or courts.

The study found that 99 per cent of these high-frequency service users had been diagnosed with at least one mental disorder and that more than 80 per cent also had a substance abuse issue.

Dr. Somers said the emergence of these complex, co-occurring disorders in the DTES as a phenomenon is relatively new, and will require changes to Downtown Eastside services.

"I believe it's now a challenge for government to modify existing services – which appear to work relatively well for many people – so that they can better support the specific needs of people who are in the sub-population with multiple serious health and social problems simultaneously," he said.

Ronald Joe, associate medical director of addiction services at Vancouver Coastal Health and a Downtown Eastside physician of more than 20 years, said the health authority is embarking on "a completely new strategy" in recognition of the neighbourhood's changing needs.

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Two decades ago, it had one of the world's highest rates of HIV transmission; today, pervasive crystal methamphetamine use has caused the rates of mental-health issues to soar.

"We recognize that a lot of the services that were created were in response to, originally, some of the prior problems in the Downtown Eastside – including the HIV epidemic and the Hepatitis C epidemic," Dr. Joe said. "There has been a significant improvement in that area, but now we have a situation in which the mental health and the addictions have come to the forefront. Essentially, the challenge has changed."

Crystal methamphetamine use has increased about seven-fold since 2010, according to preliminary data on people who use Insite, Vancouver's supervised injection site.

Changes planned under Vancouver Coastal Health's DTES Second Generation Health Strategy include a new system that allows people to get help with mental health and addiction problems more quickly, and a pilot project to improve transitions from acute care.

Dr. Somers also praised initiatives such as Vancouver's five assertive community treatment teams, which meet clients where they are; Housing First, which provides homeless people who have mental illnesses with stable housing; and the redevelopment of Riverview Hospital as a mental health and addiction treatment centre.