“We clearly need more long-term mental-health care,” Jang said in a phone interview. “We know that there are so many people in the Downtown Eastside who don’t see or have any contact with mental-health professionals at all. So the emergency ward is very much becoming primary care. That is something that has to change.”

Jang was responding to information provided at the Straight’s request by Providence Health Care, which operates St. Paul’s Hospital, and Vancouver Coastal Health, which runs Vancouver General Hospital. The statistics show that during the first six months of this year, the two hospitals together saw 5,110 people experiencing a mental-health crisis admitted and 3,703 visits for substance-misuse problems such as a drug overdose. The comparable numbers for 2014 are 4,895 mental-health emergencies and 2,830 cases of substance-misuse issues.

By the end of 2015, these numbers are projected to surpass 10,220 mental-health emergencies and 6,146 substance-misuse incidents. Taken together, that translates to an increase of 76 percent compared to 2009.

Over the last five years, the Vancouver Police Department has observed a similar rise in the number of apprehensions its officers make under the B.C. Mental Health Act. In 2014, officers detained 3,010 people under Section 28 of the act, which allows police to take into custody an individual deemed mentally unfit and a threat to themselves or others. That’s up from 2,278 in 2009. During the first six months of 2015, the VPD made 1,510 Section 28 apprehensions.

Jang, who sits on the Mayor’s Task Force on Mental Health and Addictions, said what’s needed to reverse these trends is greater involvement by the province. He reiterated a call for more long-term-care beds that Mayor Gregor Robertson has made repeatedly since declaring a “mental-health crisis” in September 2013.

The B.C. Ministry of Health declined to make a representative available for an interview.

In recent years, the province has allocated money for mental-health-care infrastructure. For example, in January 2015, it announced that an addition to VGH will open in 2017 as the largest facility for mental-health and addiction services in British Columbia. However, the city has said what’s required to address the problem in Vancouver is 300 “long-term and secure mental health treatment beds” and, in September 2014, warned that the province was falling short of that number by 250. (The province has made small numbers of new beds available—nine at St. Paul’s Hospital, for example, and 14 on the Riverview grounds in Coquitlam. But the majority of funding is going to replacing outdated facilities.)

Mark Levy is the medical manager of the VGH psychiatric-assessment unit. He told theStraight the statistics match what he’s observed on the ground.

“It does put a strain on resources,” Levy said in a phone interview. “There really hasn’t been an increase in in-patient beds to any significant degree. We do run into situations where we are in a crisis mode and we have to accommodate patients that are in the emergency room.”

Levy emphasized the numbers make clear there is a problem. But he also said they include good news, explaining that they’re at least partly the result of changing attitudes and a shift away from the justice system in favour of health care.

“People who might have been taken to cells in the past are seen by an arresting officer as suffering from a mental-health issue,” Levy said. “Now, rather than charge them—as long as it’s not a serious offence—they will bring them to hospital.”

He suggested the next step should be making more mental-health care available in communities where people live, so they receive treatment before their mental health declines to a point where they end up in an emergency room.

“These are chronic problems,” Levy said. “Are people best treated in a hospital or should we try to do whatever we can to help them deal with their problems while they are residing in the community?”

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This article was originally published in print and online at Straight.com on August 19, 2015.