B.C. needs low-barrier youth housing amid record-high toxic drug deaths, providers say

Last year, 354 people under the age of 29 died from illicit toxic drugs in B.C. Service providers say there is a critical, unmet need for low-barrier housing and harm reduction services for younger people.

According to the BC Coroners Service, the number of lives lost in this age group last year is the highest it’s ever been. There were 29 deaths among those under 19, and 325 among those between 19 and 29 years old.

While adults who use substances can access low-barrier housing and shelters, most youth options prohibit drug use, require participation in programming, and impose curfews and other rules. Covenant House Vancouver, the largest housing provider for those aged 16 to 24, is one of those options. While their street outreach and drop-in programs offer harm reduction supplies, naloxone kits, drug testing, and safety planning for youth who are using. But those youth can’t access their emergency shelters or longer-term housing programs.

Chelsea Minhas, Director of Clinical Services, says the organization is set to open a low-barrier program called Sanctuary in the coming months.

“There are young people in front of us right now, and they’re dying, and we have a responsibility to provide them with the care that they deserve.”

“This is truly a way for us to bring them inside. It’s beyond a drop-in program. It’s a residential program where they can come inside, we’re not going to have a curfew, if they don’t come home one night, it’s not like automatically their bed is gone. It doesn’t have the same expectations as a lot of other youth programs in terms of creating goals immediately. This is about keeping that population of young people safe.”

Low-barrier, complex care housing needs to consider unique needs of younger people

The province announced a new complex-care housing program in January, with sites in Surrey, Abbotsford, and Vancouver. It says the approach will address the needs of people with overlapping mental-health challenges, substance use issues, and acquired brain injuries.

“These first four locations will serve approximately 100 people who need enhanced support beyond what is provided in existing supportive housing,” the announcement from the Ministry of Mental Health and Addictions reads.

Minhas says she thinks the move to offer complex care housing is significant, but youth-specific projects are also desperately needed.

“Not only do we need those forms of housing, we need a portion of all the new announcements to be targeted towards young people, because we’re seeing them die in unprecedented numbers and we cannot continue to allow that to happen,” she said.

“There’s a lot of ways that housing can support keeping people alive from illicit substances … It’s really important that these service providers have a continuum of care that starts right when a young person perhaps is not ready to talk about change in terms of their substance use. We have to be there for them then — building relationships, utilizing harm reduction principles —  to make sure that they understand that they are worthy that they are worth it, and that these organizations are going to meet them with unconditional love and absolute respect.”

There are a number of reasons young people might not feel safe or comfortable in mixed-age housing, Minhas explains. Trauma from being abused, exploited, or mistreated by adults is one, particularly for youth who have been in or aged out of foster care. The lack of staff training in the development and specific needs of youth or younger adults is another.

Peer support worker Kali Sedgemore agrees that having youth-specific sites that are low-barrier, with on-site support similar to the complex-care model would be a good step.

“How it will stop overdose deaths is that they will have access to one-on-one support workers, not just having no one there for you. A lot of the supportive housing that is out there now — you’re independent, pretty much.”

Like Minhas, Sedgemore says it’s vital that housing designed for youth who use substances takes into account their unique needs. They think consulting the youth who are intended to benefit from these programs would go a long way toward helping make that happen.

“They’re the ones who are going to be living there. Why not give them the choice and opportunities to build it how they want to build it?” they said, adding the fact that some programs have time-limited stays is one thing they know is not working for many young people.

“Housing is a good step because housing can get you stable but it can take a while.”

What does it mean to offer low-barrier programs? 

Directions Youth Services operates Vancouver’s only 24/7 drop-in centre for youth who use drugs. It is open 365 days a year.

Marnie Goldenberg is the vice-president of programs for Family Services of Greater Vancouver, which operates the program. She explains what it means to operate a low-barrier program.

“We’re working really hard to make sure that we don’t make demands on young people, aside from getting their needs met. Those are the demands that ought to be attended to,” she says.

“We need to provide services and supports that they seek, not what we believe is best for them. It means listening deeply, building relationships and connection, and supporting a person to come to a place of realization that they matter.”

The organization also operates a Directions Youth Haven, a five-bed emergency shelter for youth aged 16 to 19.

“One of the fundamental principles in that program is to acknowledge and support people, even where they are engaging in substance use, and to work with them in the ways that they wish for folks to work with them.”

But Goldenberg says there is a dire lack of options for young people after they turn 19. Many of those who access services at Directions have been in and aged out of foster care.

“We know there’s a very significant housing crisis in Greater Vancouver. And it is one that is felt on a really extreme level by young people and young people, especially those who were in ministry care. Many of their supports, their financial status is terribly compromised when they hit 19 or shortly thereafter. In terms of housing supports, they need affordable housing that is stable, that they are not going to be at immediate risk of being evicted when they make mistakes because they’re young and they’re going to make mistakes — we all do,” she said.

“The kinds of supports they need, have to be comprehensive and need to work from a place of understanding that these are young people who may have a lot of trauma in their lives, both past and current, that they’re struggling with complex mental health challenges, substance use challenges, and frankly, they haven’t experienced a lot of connection in community that’s reliable, and long term. Building, that kind of support, lessening that kind of isolation takes time and a lot of attention.”

Goldenberg, Sedgemore, and Minhas all say, in addition to housing, the services available for adults need to be expanded to cater to youth.

“All of our substance use services across an entire continuum, from detox to treatment, to the distribution of harm reduction supplies, to safe using sites ought to be considering the unique and specific needs of young people,” Goldenberg said.

While not every person who uses drugs will want or need treatment, Minhas says there are only 100 beds in B.C., and there need to be at least 1,000.

She and Sedgemore both say overdose prevention and supervised consumption sites have prevented countless deaths among adults, and there is a dire need to make these available to youth.

“In order to save lives of youth, it’s a lot of complex things that need to come together — it’s not just housing.”

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