Migration to the Downtown Eastside Neighbourhood of Vancouver & Changes in Service Use in a Cohort of Mentally Ill Homeless Adults: A 10-Year Retrospective Study
research has investigated the role of migration as a potential contributor to
the spatial concentration ofhomelesspeople
with complex health and social needs. In addition, little is known concerning
the relationship between possible migration and changes in levels of service
use over time. We hypothesised thathomeless, mentally ill individuals living in a
concentrated urban setting had migrated from elsewhere over a 10-year period,
in association with significant increases in the use of public services.
was concentrated in the Downtown Eastside neighbourhood of Vancouver, Canada.
(n=433) met criteria for chronic homelessness and serious mental illness, and
provided consent to access administrative data.
administrative data were used to retrospectively examine geographic relocation
as well as rates of health, justice, and social welfare service utilisation in
each of the 10 years prior to recruitment. Generalised estimating equations
were used to estimate the effect of migration on service use.
10-year period there was significant movement into Vancouver's Downtown
Eastside neighbourhood (from 17% to 52% of the cohort). During the same period,
there were significant annual increases in community medical services (adjusted
rate ratio (ARR) per year=1.08; 95% CI 1.06 to 1.10), hospital admissions
(ARR=1.08; 95% CI 1.04 to 1.11), criminal convictions (ARR=1.08; 95% CI 1.03 to
1.13), and financial assistance payments (ARR=1.04; 95% CI 1.03 to 1.06).
Migration was significantly associated with financial assistance, but not with
other types of services.
increases in service use over a 10-year period coincided with significant
migration into an urban area where relevant services were concentrated. These
results highlight opportunities for early intervention in spatially diverse
neighbourhoods to interrupt trajectories marked by worsening health and
extremely high service involvement. Further research is urgently needed to
investigate the causal relationships between physical migration, health and
social welfare, and escalating use of public services.
Below: Annual distribution of participants between LHA. BC, British Columbia; LHA, local health area; DTES, Downtown Eastside; VUP, Vancouver Unknown Place