The Central Okanagan Home Based Business Association - DOC by fic13267

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									A Sobering Summary….
By:     Christene Walsh, M.S.W., Drug Policy Coordinator
        The Regional District of Central Okanagan, October 2007

Objective:

To encourage the development of a Sobering and Assessment Centre, situated in the
Central Okanagan, for first stage engagement, assessment and basic treatment of
persons under the influence of alcohol and/or other drugs. This service would provide a
brief community „safe haven‟ for people at risk of receiving and/or causing further harm
to self or others.

Rationale:
Support the steps necessary to create a feasible and relevant continuum of care for our
local communities; intended to improve the overall „mental health‟ of our citizens. The
World Health Organization (WHO) definition of mental health {selected to define ‘mental
health’ in an August 2007 Canadian Institute for Health Information report on Mental
Health and Homelessness ~ documented a lack of housing, income and the ability to
cope, contribute to the onset and duration of homelessness} as;

Mental health is “a state of well-being ~
      in which the individual realizes his or her own abilities,
      can cope with the normal stresses of life,
      can work productively and fruitfully,
      and, is able to make a contribution to his or her community.”

People who generally experience addiction and other related health issues often ~
- Do not feel a general state of well-being,
- Often are unable to recognize his or her own abilities,
- Do not cope well with normal stresses of life, {therefore more likely to experience abnormal stressors}
- Tend not to work productively and fruitfully,
- And, typically are not able to make a contribution to his or her community.

Thus, these self-perception & functioning deficits significantly impact the health,
economics and environment within our communities.

Central Okanagan:
Target area is the Central Okanagan. The Regional District of Central Okanagan
encompasses the City of Kelowna, the Westside/Westbank {First Nations}, Peachland
and the area, District of Lake Country ~ with an overall population of 162, 276 (Statistics
Canada, 2006). Within the Regional District, Kelowna has been referenced as a quickly
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expanding city and, like other cities, has experienced difficulties addressing increased
addiction, poverty and homelessness. It was recorded on the City of Kelowna website
that the population for the City is approximately 106,707, noting an increase in residents
that has almost doubled over the last 20 years! Based on statistical estimates, the City‟s
population is expected to reach over 153,000 in the next 20 years. Other communities
within the Regional District are also experiencing population changes and, a breakdown
of current population estimates are; Westside electoral area of 28,972, First Nations
Reserve 7, 9 & 10 at 8,130, Peachland at 4,883 and Lake Country at 9,606.

Local Services:
Currently, identified substance abusers and their friends/family receive community
support and practical assistance from various local resources. For the most at risk,
services such as; Outreach Urban Health, the Kelowna Drop-In Centre, RCMP, the Boys
and Girls Club, Ministry of Employment & Income Assistance (MEIA), family physicians,
Canadian Mental Health Association ~ outreach, the Gospel Mission and Alexandra
Gardner House play a key role in responding to serious, overt affects of chronic
addiction. Other necessary supportive services such as the Alcohol & Drug Clinic,
Crossroads Detox/Treatment, The Ki-Low-Na Friendship Centre, Food Bank(s), local
Recovery Homes, etc., also contribute essential services in addressing addiction. Yet,
most agree, entry level, harm reduction [focused] shelter and other services for those not
ready or able {due to lack of appropriate options} to engage in healthier living warrants
further consideration.

The Central Okanagan appears to have limited housing and other resources that support
basic health and safety for people not in the action stage of recovery. Therefore, it is
essential that a „safe space‟ become available to initiate a low barrier, dignified entry into
formal as well as informal mental health and addiction services. Developing a local
Sobering Centre may help to build a foundation for a continuum of care that compliments
initiatives derived from the Premier’s Task Force, created in September, 2004 [on
Homelessness, Mental Illness and Addictions].

Homelessness:
For the purpose of this initiative, homelessness, as defined by the United Nations, refers
to both absolute homelessness {meaning individuals living in the streets with no physical
shelter} and, relative homelessness {refers to people living in spaces that do not meet
basic health and safety standards, including protection from the elements, access to safe
water and sanitation, security of tenure, personal safety and affordability}. It also
includes those who are „at risk‟ of becoming homeless (Community Plan: Reducing
Homelessness in Kelowna, 2003).

Addiction and homelessness are said to be closely linked when considering the
determinants of health, thus, measures to adequately engage substance abusers will
likely, over time, impact current levels of homelessness. In a local 2007 Survey and
Assessment of Homelessness in Kelowna, supported by the Poverty & Homelessness
Action Team, Central Okanagan, it was cautiously reported [as transient populations are
difficult to assess] in April 2007, 279 homeless persons were identified as being in the
area. It is assumed this survey did not capture „hidden homeless‟; those without housing
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yet able to locate alternate, though generally unstable, temporary shelter. It was further
estimated there will likely be about 500 homeless identified during the coming winter
months. Of additional relevance, it was noted on the City of Kelowna website that the
nights of stay at the Gospel Mission Shelter [for homeless men] was reported to have
increased 170% over the last 10 years ~ from 9,600 bed nights in 1994 to 26,000 stays
in 2004. Post further contact with the Gospel Mission, 2006 statistics for nights of stay
was disclosed as 24,800 ~ current capacities of 62 beds & 30 mats. Although Gospel
Mission numbers have apparently decreased from the 2004 count, overall, numbers
remain high. [During winter months, on nights when temperatures are deemed unsafe,
the Gospel Mission partners with a Salvation Army supported organization called “Inn
from the Cold” and they accommodate up to 20 {over capacity} individuals.] The Gospel
Mission also offers lunch to non-residents of the shelter, both men and women and,
recently announced serving an evening meal to approximately 200 people per day.
Please note, due to lack of staff & related issues, the Gospel Mission does not permit
admission of acutely intoxicated individuals.

A Now Canada service, Alexandra Gardner Women and Children Safe Centre, known as
„AG House‟ provides a 30 day, 20 bed low barrier, emergency women‟s shelter to
homeless women and, if needed, their children. Last fiscal year, NOW Canada disclosed
admitting 529 women and children to this shelter. Sadly, mainly due to capacity issues,
2,130 homeless women were unfortunately denied access. On average, AG House
indicated an inability to accommodate approximately 40 homeless women per week.
Also, the Kelowna Women‟s Shelter, as per website information, provided residential
services to 280 women and 172 children in 2006/07 who were impacted by violence or
other significant crisis ~ total of 4,800 bed stays. The local Women‟s Shelter also
recorded responding to 1,976 crisis, counselling and support calls within the last year.
Obviously, for a variety of reasons, homelessness along with substance abuse remains a
priority concern locally.

Unfortunately, addiction and homelessness also impacts our local youth. The Boys and
Girls Club currently operates a 10 bed youth shelter on Richter Street, close to the
downtown core. In 2006, the capacity was 8 beds and 2,220 bed nights were provided
to 154 individual youth. It was explained no youth were turned away due to
overcrowding; mats and cots were used to accommodate overcapacity when needed. It
was estimated 90% of the young people served presented with substance abuse and
approximately 45% had an identified mental health diagnosis ~ a higher percentage
suspected with undiagnosed mental health issues. The occasional intoxicated youth
who appeared to require medical attention due to health concerns were taken to
Kelowna General Hospital for further assessment. Adopting a „harm reduction
approach‟, intoxicated youth who did not require medical support were allowed to remain
on site, under the expectation further use or sale of drugs would not be tolerated.

The local Kelowna Drop-In & Information Centre is said to provide breakfast to an
average of 110 people daily. On site lunch is provided to about 85 people daily (again,
lunch is also offered at the Gospel Mission). Bag lunches are available to employed
homeless until they are able to secure other means to sustain themselves. Overall, the
Kelowna Drop-In estimates seeing up to 263 people a day, a steady increase from the
initial 50 persons reported as seeking assistance only 7 years ago! Unfortunately, due to
fiscal constraints, this resource closes daily at 2:00pm and is not open on weekends ~
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significantly limiting the intent of a community “Drop-In Centre”.

Over the last year, Outreach Urban Health has evolved via expanding accessibility as
well as service delivery to become a community hub for addressing health and related
issues for some of our most impoverished, mentally ill and/or addicted residents. It is
reported the Clinic currently has over 900 active client files and sees approximately 48
people per day. Estimates suggest most patients access nursing care (33% ~ wound
care, public health, etc.), followed by physician (26%), and then similar results for social
work (16-20%), Alcohol & Drug Counsellor (16-120%) and Mental Health (16-20%). Due
to concurrent disorders, there is logically an overlap of social services provided.

Misuse of Available Services:
When there are gaps in a continuum of care, it is expected some people will attempt to
access the most related service to meet their identified, immediate need. Therefore,
most community service providers have knowledge of intoxicated individuals who self
refer to Kelowna General Hospital Emergency, detox facilities and other services to meet
their most common need for basic shelter ~ a safe place to „crash‟, shower and receive a
meal prior to moving on ~ in lieu of an available resource whose intent is to provide safe,
low barrier accommodation for intoxicants. Hence, incidents of patient „AWOL‟ post brief
hospitalizations, recurrent admissions to detox and incomplete residential treatment
attempts may further demonstrate this activity. Services are also misused by the not-so-
obvious substance abuser; the person who appears able to maintain employment,
pseudo function in society and are still attached to family/social network. Often
substance related health and other issues are masked until, it seems to outsiders, the
individual‟s world „suddenly‟ falls apart.

Unfortunately, there are significant financial as well as environmental ramifications to
misusing community services as, for example, one day of a hospital admission is said to
cost up to $900.00. Yet, the most obvious concerns are, individual needs are not being
adequately addressed and, services are not as readily available for suitable referrals.
Individual behaviours may also be perceived as treatment „failures‟ instead of a crisis-
invoked attempt to problem solve/band-aid an immediate stressor. And, these „failures‟
may impact a client‟s future willingness/ability to engage if/when actually appropriate.
On a community level, advocacy for additional funding to increase the availability of
misused services may further perpetuate this issue, not help to resolve the root cause.
Therefore, a low barrier, safe shelter that is accessible for active substance users who
cannot gain entry or, not deemed appropriate for other resources appears needed.

RCMP may be accessed for substance related incidents of domestic disputes,
complaints of public disturbance, driving while impaired, etc. And, regardless if the
alleged is a first time offender or well known to police, containment in cells is not always
the most appropriate or helpful response. It was noted, in July 2007, 254 intoxicated
persons were lodged in police cells and, in April 2007, {described as a more typical
month}, 121 intoxicated persons were lodged in police cells. Many police services as
well as coroners reports in Canada and the United States are said to support sobering
centre initiatives ~ in an attempt to remove policing from the „business‟ of housing
intoxicants. Local RCMP superintendent Bill McKinnon commented:
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      “We fully support a Sobering Centre for Kelowna, only too often the clientele we come in contact
      are crying out for help and have nowhere to go. I personally believe a Sobering station would be a
      tremendous asset to the well being of the citizens of this community and relieve the burden we are
      experiencing in dealing with those men and women who are under the influence of substances.”

Focus Facility: The Sobering and Assessment Centre (S.A.C.)
Intent to provide entry level, low barrier withdrawal management services; similar to the
existing British Columbia resource ~ a 20 bed Sobering & Assessment Centre, under the
auspice of the Vancouver Island Health Authority {6-10 beds suggested locally}. This
Sobering and Assessment Centre (S.A.C.);

    Provides a short-term, voluntary refuge (up to 23 hours) for men and women who
     are under the influence of substances.
    It‟s intent is to provide safety, comfort and respect for people who need a
     temporary “home away from home” so they can get back on their feet.
    It‟s a place where people can go when they are not welcome at other services
     because they are under the influence of other substances.
    It‟s a place where people are free from being judged.

The goal is to treat clients with dignity, respect and compassion. When accepted by the
client, addiction (rehab) and/or social workers act as a referral source and/or liaison with
other community services to help clients address their immediate needs.

Population Served:
Admission is based;
    on having used alcohol and/or another substance within the last 6 hours,
    agreeable to admission (willing/able to settle down),
    medically stable.

The Sobering and Assessment Centre is available for active substance users over the
age of 19 yet, individuals in their late teens will not be denied admission.

Shelter at the Sobering Centre may be refused if the client becomes threatening, violent,
and/or doesn‟t respect basic safety rules. The local RCMP will be contacted if a person
refuses to leave the building. People may also be declined entry if deemed medically
unstable and in need of follow-up medical attention.

Staff:
The Sobering and Assessment Centre employs addiction workers, nurses, secretarial
and janitorial staff.

Description of Site & Program: Sobering & Assessment Centre
Upon entry to the building through purposefully large doors (to facilitate an escorted
police eviction or use of an ambulance stretcher if necessary), it is recommended the
reception area include curtained change rooms, bolted down chairs (for safety), an
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administration area (no client access allowed) and, a storage room to hold client
personal belongings in designated bins. There is a plug for a telephone that would be
situated behind the main desk when not in use.

Upon admission to the Sobering and Assessment Centre, the client is expected to
immediately change into supplied „hospital-like‟ pajamas before being assessed by a
registered nurse. Occasionally, the client is assessed prior to changing if there is
concern that the client may not meet their mandate ~ have used alcohol and/or another
substance within the last 6 hours, agreeable to admission (willing/able to settle down)
and is medically stable. It‟s generally accepted that once a client has changed clothes,
he/she has usually made a commitment to remain at the Centre for several hours.

Clients are expected to place all of their belongings in a bin provided and, staff does not
witness this action. Hence, clients are aware any contraband stored by them will be
available for their continued use post departing the centre. [It is suggested there be an
„airport like‟ table between the client and storage facility for sliding the bin for safe
keeping by staff.] The client‟s name is placed on the bin using masking tape for
identification purposes. The bin is only retrieved if the client wishes to do laundry and/or
is departing the Centre.

Nursing staff initially assess clients either in the front entry or, in a treatment room
(presents like a medical clinic room but contains two exits, one near the dormitories and
the other door connected to the administration area for safety reasons). Each client has
his/own chart containing notes the client‟s name, birth date and allergies at the top of the
page. It also records the date and time of admission, a check-list of substances used,
time of last use, recent injuries, alert & oriented, vital signs, suicidal ideation, plan (if
relevant), seizure risk and observation level. A Physical Assessment form, resembling
the form used by emergency room staff at Kelowna General Hospital, is also suggested
be completed along with comments on distinguishing physical features, any mental
and/or physical health conditions (list provided), next of kin, community supports, etc. An
additional space should also be provided to document arrival and departure time as well
as areas of potential risk & observation (such as self-harm). NO MEDICATION IS
DISPENSED ON SITE ~ clients own supply is taken under nurse supervision and then it
is secured in the client‟s bin. The nurse may provide wound care for abscesses and
potentially liaise with Outreach Urban Health for community follow-up {if not already
connected to this service and/or a family physician}.

Upon successful completion of the medical assessment, clients are then escorted to one
of two dormitory rooms ~ male or female ~ with basic (exercise) mattresses on the floor
used for sleep. Clients are provided with blankets (blanket warmer recommended) and
these rooms are monitored using video cameras as well as at least hourly staff physical
check-ins. (Although the room is not completely dark, staff may require the use a
flashlight to assist with observation as observed in hospitals.) Staff may communicate to
each other using good quality „walkie-talkies‟ ~ an apparently valuable and essential
communication tool.

Post waking, clients are able to shower, do basic laundry and have a small snack prior to
their departure. It is important to note that the showers should not contain any ledges
that a client may trip over & risk injury. Clients generally place their own laundry in the
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machines but, if the machines are in use some staff, at the permission of clients, may
start the client‟s laundry while they rest. If this practice is deemed acceptable, special,
needle resistant gloves should be provided for staff use and, tongues purchased for
lifting clothes. A „sticky note‟ is used as a nametag to label whose belongings are in the
washer and dryer. Snack bags are provided to clients containing simple foods such as
cheese/crackers, cookies, yogurt and juice. Extra juice/water may be provided for
hydration. It is assumed the client will access other available community resources for
actual meals. Clients are not able to smoke on site once they gain entry to the Centre ~
with the exception of one escorted smoking break during their admission. It‟s considered
likely, by the time a client is ready for another cigarette, it is usually time to leave.

Clients willing to engage and/or explore treatment options have an opportunity to discuss
their request with staff post waking and appearing sober. Centre staff may help facilitate
the client‟s transition from the S.A.C to other relevant resources such as detox,
stabilization, A&D counseling, etc. It was also noted that staff must be up-to-date
regarding available community resources re: meals, clothing, shelter, medical, etc.

Potential Community Partnerships:
It is recommended this type of initiative be funded & supported by a variety of relevant
community partners such as; BC Housing, Police Services and Ministry of Solicitor
General, Ministry of Public Safety & Security, Interior Health Authority, Ministry of
Employment and Income Assistance, Ministry for Children and Families, Regional
District of Central Okanagan, City of Kelowna, local non-profit sector, local business
community, United Way, Canadian Red Cross, etc.

The cost to develop and maintain this resource is dependent on the organization who
endorses the creation and management of this facility. If collaboration is available within
an existing service, then costs would obviously be lower than a standalone facility.
Regardless, financial consideration for professional staff, site (rent, heat, lights),
furniture, general office and health supplies, technical requirements ~ telephone,
computer/internet, & fax and nourishment will cost, an estimate from three hundred
thousand to about nine hundred thousand dollars respectfully.

Summary:

Other communities have already accepted the challenge and created humane sobering
facilities that provide safe and basic care to intoxicated and generally vulnerable people.
The motto of the Victoria Sobering and Assessment Centre is, “a safe place when there
is nowhere else to go”. Post the recent expansion of Outreach Urban Health services,
the development of a voluntary admission, Sobering Centre in Kelowna may be the next
realistic step towards assisting the more challenging, often difficult to engage, addicted,
at risk, mentally ill and/or homeless, clientele. A Sobering Centre program to help
reduce chaos and further harm for this most complex, multi-disordered, often homeless
clientele would meet an outstanding need. Thus, this centre may open a door for
identification and then eventual treatment of this usually (self-) neglected population.
pulation.

								
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