Opinion: After decades of the mental health and addiction crisis, B.C. owes people a way forward

British Columbians have heard years of promises to reduce homelessness and improve mental health and addiction care. Yet suffering remains visible, help is hard to access, and concerns about safety persist. People are right to ask why we keep spending without seeing enough improvement.

That frustration deserves a serious response. We need a clear, coordinated plan that addresses gaps in care, connects services, and turns investment into safer communities, timely help and a lasting path out of crisis.

For decades, Vancouver’s Downtown Eastside has served as political shorthand for these challenges. Governments, strategies and funding levels have changed. Yet the same fundamental questions remain.

Today, communities across B.C. face visible homelessness, mental health crises, toxic-drug deaths and concerns about public safety. All of us deserve safe communities. Building them means ensuring people can access appropriate housing, health care and the support they need to build stable lives. Violence, untreated illness and preventable death should never be accepted as inevitable.

Yet we continue to debate housing, treatment, involuntary care and enforcement as separate solutions. These investments matter. But British Columbia needs more than programs. It needs a system that connects them reliably.

As provincial candidates put forward their solutions, voters should ask: What happens the morning after? After the encampment is cleared. After someone is involuntarily admitted to hospital. After someone completes treatment. After someone is released from custody.

Where does that person go? Who is responsible for what comes next? What makes the next crisis less likely? Until political promises answer those questions, we will continue investing in interventions while leaving people to fall through the gaps between them.

Housing, homelessness, mental illness and addiction intersect, but they are not interchangeable. A person who cannot afford rent does not necessarily need treatment. Someone experiencing psychosis may need far more than housing. Someone leaving addiction treatment needs a home that supports recovery.

Hospital admission and treatment must lead to stable housing and continuing care. Supportive housing must be connected to clinical services that match residents’ needs. And after an enforcement intervention, we should ask what has changed to make the next crisis less likely.

Too often, public policy celebrates the front door while paying too little attention to what happens next. When those connections fail, people suffer and public services bear the cost of responding to the next crisis.

B.C. needs a 10-year provincial plan to reduce homelessness, repeated crises and preventable deaths. It must survive elections and align housing, health care, treatment, corrections and community services around shared outcomes. Someone must own the result.

Today, responsibility is spread across ministries, health authorities, municipalities, housing providers, police, corrections and community agencies. Each answers for its piece. Who answers for the whole journey?

A designated provincial lead should coordinate the plan, resolve gaps and report publicly on progress. That role needs authority and funded commitments, rather than another layer of administration.

There is an old saying that Ottawa has the money, provinces have the power and municipalities have the problems. What people need is for all three to share the solution.

Municipalities can identify sites, enable development and champion local solutions. Federal and provincial governments must fund the response. But the province must hold the plan and answer for the results.

Start with a straightforward commitment: nobody should leave hospital, treatment or custody without a safe place to go. Meeting it requires housing capacity, funded transition planning and a named team responsible for following through. A referral is not a handoff.

Build housing that reflects people’s needs: affordable rentals, supportive and recovery-oriented homes and, where appropriate, settings with intensive clinical care. Every commitment to new housing or treatment capacity should include ongoing funding for the staff and services that make it work.

Prevention must be equally central. Strengthen income and rent supports, eviction prevention and early mental-health care. We cannot reduce homelessness sustainably unless we also prevent people from losing their homes in the first place. Measure results publicly. Are fewer people becoming homeless? How long do they wait for care? Are they staying housed, experiencing fewer emergencies and rebuilding their lives? Are communities safer?

B.C. already has promising approaches that connect mental health and addiction treatment, housing and continuing support. We do not have to start from scratch. We have to make those connections reliable and available wherever people need them.

We can build communities where fewer people lose their homes and help arrives before an ambulance is needed. We will still need shelters, hospitals, treatment programs and crisis services. Success will mean needing them less often.

Voters should demand a plan that makes communities safer, improves care, reduces pressure on our health system and shows results for the money we spend.

The test is what happens the morning after: a path forward, or a return to the same crisis.

Keir Macdonald is chief executive officer of Coast Mental Health.