Creating the Hard-to-Reach

(This article first appeared in the March Street Newz)

On December 6th, 2012 the Vancouver Island Health Authority (VIHA) put out a press release announcing the creation of two new service hubs after a year’s worth of planning between “health care providers, local government, police and community agencies” to “develop a renewed approach to delivering services that better meet the needs” of Victoria’s most vulnerable.


In other words, it was time for VIHA to repackage the same old tired service delivery strategy. The old strategy was for its Assertive Community Treatment (ACT) team to target what VIHA was then calling the “chronically homeless”. Under the fresh new strategy, VIHA promises that the “approximately 100 individuals…living with severe addictions and mental health challenges” will now be called the “hard to reach”.


Where are these new hubs going to be located? Why, at the Sobering Centre on Pembroke and the Access Health Centre on Johnson, two sites where people have been getting clean needles for years. And what service delivery model will VIHA use as the basis for its exciting new strategy? Why, the ACT team of course.


When our institutions take old neoliberal wine and try to pass it off as “new and expanded” we are no longer very surprised. After all, our institutions have been avoiding for years a social and political analysis of the conditions that produce the marginalization and trauma that makes some people “chronically homeless” or “hard to reach”.


But VIHA’s current re-branding effort marks a new low. For those who attended VIHA’s information session at the Fernwood Community Association on January 30th, it seemed clear that the old wine is not even getting a new bottle. Besides changing the label from chronically homeless to hard to reach it is hard to see how much at all is going to change.


VIHA representatives seemed anxious to mollify property owners by emphasizing that no new services will be offered at either location. The representatives only gestured towards ‘expanding’ these services. When pressed to explain what that means, one representative explained that ‘professionals’ will now be present at each site, a response which only served to offend the many workers from each site who were present at the forum.


What is also at stake in VIHA’s re-branding effort is that our institutions would like us to believe that neoliberalism is something that happens despite the careful, year-long planning efforts of our authorities. The sad irony is that the very institutions whose mandate is to look after people’s health are actually complicit in producing marginalization and trauma in the first place.


To dramatize this irony, think back to 2010, when the City of Victoria was considering whether to pass an amendment to the Streets and Traffic Act to empower it to evict tenters on Pandora Green and proceed with its gentrification plans for the 900-block. At the time, councilors heard testimony from various authorities on the issue, all of whom supported the amendment. One of these was Lori Duncan, an Assistant Deputy Minister at the Ministry of Health.


Duncan’s presentation focused on the work the ACT team was doing on Pandora Green to connect people tenting with government services. She was quick to sanctify the ACT team’s work: “Yesterday I was talking to one of the outreach workers. She told me, ‘I’ve been out six times because when I talk to people they are so high and unable to engage that I go out again and again.’” Duncan continued, “I can’t tell you how impressed I am with people who deal with this population. They have the patience of saints.”


Duncan did not seem to be aware of the irony that her presence at city hall was creating the very conditions to necessitate ACT teams in the first place. By coming to city hall and legitimizing the city’s eviction of tenters from in front of the main centre for social service provision in the city, Duncan was using her authority to further marginalize people who are homeless.


She was also saying a lot about the stigmatizing assumptions that authorities can have about the people who they are marginalizing. By referring to the ACT team workers as requiring supra-human capacities to do their job, she was implicitly dehumanizing the people ACT is meant to help.


This is one example. Sadly, too many others exist. In VIHA’s case, its failure to open a patient-centred safe consumption site despite overwhelming evidence that it meets people’s needs is another.


Over the next year, a new group called the Radical Health Alliance will be politicizing many more of the ways through which institutions like VIHA, the city, province and police produce conditions where people become ‘hard to reach’ and then stigmatize those very people. Through widespread, accessible publications and actions, the group aims to create new narratives about health access, marginalization and participation.


First up will be an analysis of Good Neighbour Agreements. Stay tuned for project info and opportunities to get involved. To learn more, visit: