Earlier this fall, Vancouver’s Gallery Gachet was notified that 100 percent of their funding from Vancouver Coastal Health (VCH) will be cut by December. With the implementation of VCH’s new DTES Second Generation Health Strategy Plan, the services provided at the gallery were no longer deemed to fall within VCH’s primary mandate of providing “core health services.”
Although VCH argues that Gachet’s resources will be reallocated to services targeting mental health and addictions more directly, the decision shifts resources away from a grassroots peer-run community organization that has been successful and effective for 21 years. Gallery Gachet is a platform for artists to speak their truths about their experiences with mental health and social marginalization. The gallery is a place for educating the public and promoting social and economic justice, while at the same time providing necessary support – such as housing advocacy, studio space, and economic security – to those who experience marginalization.
The cuts will impact the Gachet community most directly but the decision also has broader ramifications, reflecting a trend within VCH towards an increasingly limited definition of health care. They also come in the context of the continuous loss of affordable housing, increased policing, and accelerating gentrification in the wake of the City’s two year old Local Area Plan for the Downtown Eastside. Together these decisions and policies are contributing to the systematic displacement of people with disabilities in the DTES.
From funding cuts to housing
This isn’t the first time VCH has cut funding for successful organizations in the Downtown Eastside. Both West Coast Mental Health Network’s Peer Support Bridging Program and the Rainier Hotel had their VCH finding cut in 2013.
The Rainier Hotel was a heritage hotel bought and transformed into housing for women in the Downtown Eastside. It provided resources, support and a home for women with addictions and struggles with mental health, homelessness, histories of abuse or sex work, as well as other barriers. The treatment program strived to be non-punitive, holistic and self-directed, and was funded by Vancouver Coastal Health and the Portland Hotel Society.After four years of important progress for the women at the hotel, Vancouver Coastal Health retracted its funding in January 2013. The program, according to VCH, did not provide “the best possible health outcome” for the women at the Rainier. However, an evaluation done by the B.C. Centre for Excellence and the Portland Hotel Society not only showed that the Rainier met vulnerable women “where they’re at,” but also found that “61 per cent of participants [were] treated for health conditions they were unaware of before living at the Rainier, while 77 per cent have been connected with outside employment and training.”
There is no clear definition for ‘best possible health outcome,’ but it is undeniable that these numbers were quite good. VCH senior media relations officer, Anna Marie D’Angelo, told The Tyee that VCH is not turning their backs on these women by ending the program. The reason for the funding withdrawal, according to D’Angelo, is that “we don’t fund things that aren’t healthcare.” This is the same rhetoric employed by VCH in their withdrawal of funding for Gallery Gachet, despite years of support and proven positive health outcomes.
The funding cuts for Gallery Gachet and The Rainier Hotel both reflect VCH’s increasingly narrow definitions of health and mental health support. Both are examples of decisions that do not center the perspective of those participating and benefiting from the programs. Instead, the reallocation of funds gives more power to VCH to decide what is deemed ‘the best possible health outcome.’ This paternalistic power dynamic is unfortunately a common one in the DTES, especially towards people with disabilities.
These funding cuts to health care are part of a broader shift in the DTES and are deeply interconnected with the worsening housing crisis. Recently the City of Vancouver has worked to restructure the neighbourhood with catchy slogans of hope, such as “Healthy City for All,” in their newly-approved Downtown Eastside Local Area Plan (LAP). Just as the VCH cuts for the Rainier and Gallery Gachet have done, the LAP ultimately means less support for people with disabilities in the neighbourhood.
The significant need for health services in the Downtown Eastside has made it a hub for accessible health care, creating some of the most important services to people who struggle with mental and physical health. Many of these systems of support have been built by people of the neighbourhood and are not accessible elsewhere in Vancouver. Displacement from the proximity of these services due to the combination of housing inaccessibility and gentrification will have devastating effects for the people who rely on them.
Housing and mental health
In 2013, the Mayor and the Chief of Police announced a “mental health crisis” in the city of Vancouver. Soon after the announcement they created a task force on Mental Health and Addictions in an attempt to address this issue. The stated goal of the task force was to “convene researchers, senior government, community partners, people with mental health and addictions issues, and Downtown Eastside residents to address the critical need for a continuum of supports for the most seriously addicted and mentally ill.”
Yet the task force, comprised of 60 individuals, only included three DTES community members. The rest of the body was made up of mostly CEOs, psychiatrists and executive directors of nonprofit associations. Following nine meetings throughout 2014, the Task Force released its final report in September 2014, with its recommendations to the provincial government. The recommendations include more funding for the institutionalization of people with mental illness and more funding for joint VCH and VPD treatment models, such as the Assertive Care Treatment teams.
These recommendations were approved by Vancouver city council, but many DTES residents spoke out against the task force. In the Carnegie Newsletter, Carnegie Community Action Project staff King-mong Chan criticized the narrow focus of the report on institutionalization and policing as solutions to the “mental health crisis.” Skepticism was also voiced by locals about the effects of providing more money to the VPD, documented for its racial and poor-bashing legacy of police brutality. According to Tracey Morrison, president of the Western Aboriginal Harm Reduction Society, “they [the VPD] are bullies. They aren’t here for us. That money could be used for housing and mental health advocates.”
DTES residents have reason to worry about the involvement of the VPD in mental health matters. In 2014, mental health arrests (under section 28 of the BC Mental Health Act) have climbed to a five-year high in Vancouver, with 1,470 apprehensions made by the police in the first half of this year. That means an average of eight apprehensions every day in Vancouver. Under Section 28, an officer can arrest a person without charge if they are deemed a risk to self or others.
At a Carnegie town hall meeting, organized in response to the “mental health crisis” in November 2014, artist Karen Ward of Gallery Gachet, explains that an apprehension under section 28 occurs “when the police decide you have a mental illness.” Unsurprisingly, a recent VCH consultation with DTES residents found that community members clearly felt that “Vancouver’s criminal justice system often interferes with health care.”
At the same town hall, Ward elaborated that it is “rather alarming that the City Council is declaring a ‘mental health crisis’ without declaring a housing crisis.” Ward commented on the City’s lack of understanding when it comes to the interconnections between mental health and housing and elaborated that what people with mental illness really need is three things: home, income, and friends.
At the same townhall, Jean Swanson of the Carnegie Community Action Project echoed Ward’s message. “Over 800 people are homeless in the Downtown Eastside and thousands more live in inadequate, bed bug infested SRO rooms. It is not realistic to talk about mental health in the Downtown Eastside without talking about housing.”
These links between housing, physical health, and mental health were reinforced by the findings of the Vancouver Coastal Health 2013/2014 consultation with “health care consumers” in the Downtown Eastside. The negative health effects of welfare policies and homelessness generated a large number of complaints from a majority of the DTES participants in the study. Residents spoke out about “unsatisfactory experiences with VCH services,” criticized institutional supportive housing and healthcare services, and called for a new culture of “consumer input.”
The lack of affordable and accessible housing is a significant cause of homelessness and addiction, but it also increases disability and adds to mental distress. Indeed, a Vancouver Coastal Health report found that “housing mentally ill clients leads to decreased medical and psychiatric problems.” It is clear that the displacement of people living with disability perpetuates illness, yet the Local Area Plan only makes it harder for people with disability to access housing.
For instance, the Local Area Plan significantly undermines the definition of social housing, reducing it so that only one-third of social housing units will be made available at income assistance, whereas the rest will be equally divided between market rates and rents according to “Housing Income Limits” starting at $912 per month. This means that only one-third of the proposed social housing will be affordable to people with disabilities on welfare or Persons with Disabilities (PWD) benefits.
The DTES Local Area Plan and interlocking systems of discrimination
Although city initiatives in Vancouver are gradually beginning to recognize the impacts of colonialism, the city has made no effort to understand the effects of ongoing processes of displacement, child apprehension, and incarceration. As Victoria Bull, an Indigenous organizer with Raise the Rates, said, “How can we talk about Indigenous peoples’ mental health without talking about colonialism and the legacy from residential schools?” Planning processes like the DTES LAP fail to challenge the colonial forces which are at the root of disability for many Indigenous people.
Indigenous DTES residents have been demanding an Aboriginal Wellness and Healing Centre at the former Buddhist temple at Gore and Hastings, currently owned by VCH, but steps towards the centre have not yet been taken. So far the city has not provided a tangible, structured plan to improve housing or support to Indigenous people living with disability. The plan employs a vague language of Indigenous cultural revitalization in the DTES, which distracts from the massive lack of adequate support for Indigenous people, especially Indigenous people living with disabilities.
The displacement of Chinese seniors is also a critical issue that has not been properly addressed in the Downtown Eastside. Chinatown is multi-lingual and has a high proximity of ethno-specific health services, food markets, and resources, as well as economic opportunities for non-English speakers, all of which are foundations of support to Chinese seniors.
Despite the fact that the LAP-designated area includes the Chinese neighborhood, the new zoning in Chinatown will not require developments to include social housing. Token units of so-called social housing have recently been included in some development plans, but members of the Chinese community were appalled when they realized that “the majority of the so-called “social housing” would be inaccessible to them.” Considering that Chinatown exists due to a history of segregation and labor exploitation, it is very disheartening that Chinese seniors are being displaced once again at the hands of racism and the forces of economics.
The city’s LAP plan states that it aims to ensure that “[t]he area’s diverse cultural heritage is recognized and celebrated (including Aboriginal, Japanese-Canadian, Chinese-Canadian, labour movement, etc.).” Yet the plan fails to provide housing that is accessible for low-income Chinese and Indigenous people, especially those with disabilities. Rather than cater to wealthy new-comers, the plan should support low-income racialized members of the community who want to remain in the neighbourhood.
Disability and gendered violence in the DTES
The DTES LAP also provides recommendations for sex work, sexual exploitation, and the Missing Women Commission of Inquiry. These include recommendations such as increasing police presence and providing tenant rights awareness, with a specific focus on “vulnerable tenants such as women, sex workers, and LGBTQ+” people. As with mental health, there are serious ongoing concerns about the increase of police presence in the DTES due to the history of neglect and violence imposed by the VPD.
Commissioner Wally Oppal, who led the 2012 public inquiry into the murdered and missing women, stated that “[a]fter reviewing the evidence of the investigations, I have come to the conclusion that there was systemic bias by the police.” Organizations such as Pivot Legal continue to point out that the VPD has not implemented the limited recommendations of the inquiry. Yet, as mentioned, the City’s report on the mental health crisis calls for increased funding for the VPD and increased involvement of the police in dealing with mental health provision.
Such bias in police enforcement is enabled by colonial and heteropatriarchal structures. Not only do these structures impose racial, ableist and gendered prejudices, but they increases the risk of disability and stress on existing disabilities for those subject to such violence. A study from 2008 focusing on gendered violence against injection drug users in the DTES, for example, finds that “impairments in mental and emotional health result… from violent encounters include depression, anxiety, suicidal ideation, posttraumatic stress disorder, mood and eating disorders, and substance dependence.”
The same study highlights the gendered nature of violence in the DTES, where “[w]omen were more likely to be attacked by acquaintances, partners, and sex trade clients.” The relationship between gendered violence, health and disability are especially important when considering the prevalence of HIV/AIDS among DTES sex workers, which significantly increases the struggles of illness and disability.
The same power structures also result in the fact that men are more likely “to experience violence from strangers and the police,” according to the 2008 study. Although the study focuses on gender, it is important to foreground the relationship between race and police brutality, especially considering the countless accounts of unjust treatment of Indigenous people by the police in the DTES neighbourhood and throughout Vancouver.
Shifting funding priorities, growing gentrification, the deprioritization of social housing, increased policing, racism, and displacement from accessible health services and community are all key factors in the systemic discrimination against people with disabilities. Both the City of Vancouver and Vancouver Coastal Health have implemented changes that have shifted power and voice away from people with disabilities and into their own hands.
Gallery Gachet’s funding cut is not only devastating to those involved with the initiative, but is also symptomatic of a greater system of discrimination against people with disabilities in the Downtown Eastside. Clearly, with so much silencing and displacement, the city’s slogan of “Healthy City for All” does not include everybody.
 People with disabilities are people who do not fit the norm of societal understandings of ability, whether by neurodiversity, health conditions or encounters with systemic, interpersonal and/or internalized ableism, and are thus ‘disabled’ by their exclusion from society.