Nuanced. - 164. Dr. Julian Somers: Tackling Addiction, Homelessness & Political Hurdles

Episode Date: August 12, 2024

Aaron Pete discusses the key to addressing addiction and homelessness with acclaimed clinical psychologist Dr. Julian Somers, exploring his transformative work, the clash between science and politics, and potential solutions inspired by global strategies.Send us a textThe "What's Going On?" PodcastThink casual, relatable discussions like you'd overhear in a barbershop....Listen on: Apple Podcasts   SpotifySupport the shownuancedmedia.ca

Welcome back to another episode of the Bigger Than Me podcast. Here is your host, Aaron P. Addictions, homelessness, and mental health issues are impacting people across North America. These impact First Nation communities more than most. I believe it's important that we approach these conversations with humility, understanding, respect, and a desire to do better. My guest today is a clinical psychologist, and we talk about where we are, how we got there, and how on earth do we get out and start to support individuals struggling with these complex issues. My guest today is Dr. Julian Summers. I'm so honored to be sitting with you today.

I read your article. I started diving into your work, and I was really fascinated because it seems like it's a tough conversation to raise. It's a very delicate topic. but first, would you mind introducing yourself and the work you do? Yeah, and Aaron, I'm delighted to be with you here. You wrote a fantastic note, very, you know, which struck me as so open-minded and curious as well as well-informed, so podcasters out there that want to, you know, be successful, follow what this guy's doing.

So, yeah, in terms of, you know, where I'm coming from, I'm a clinical psychologist, and I started at the very beginning of my career focusing on addiction. That was because of the people I was working with. And the first was a psychologist named Bruce Alexander, who developed a theory of addiction. And then I went to work with a guy named Alan Marlatt, who was a clinical psychologist like me, and was very focused on what was then a new practice known as harm reduction.

And the philosophy behind that. So I, following completion of my training in Canada and the U.S., I started working clinically and then doing research on addiction, training clinicians. I taught in UBC's medical school and in other settings. And I focused on research because I realized fairly early on that working clinically, I could spend multiple careers and not make much progress in terms of, of the need that was already apparent in the late 80s and 90s. So I switched to research, and I've been incredibly fortunate,

just unbelievably fortunate to have opportunities to try things out on a large scale, so large randomized control trials with people who are living homeless, living with almost constant involvement with our justice system, our health care system, not getting better, and being part of a, I guess, almost a generation now of researchers and clinicians who have developed an alternative way of helping people that is, for a variety of reasons, having a very, very difficult time getting implemented. It's almost as though we have an allergy to changing how we go about helping people. So it got to the point where my efforts to advance awareness of these alternatives that I've only contributed to, but along with many others, that that wound up leading to a kind of like a backlash, like silencing. And that's kind of where I've been the last few years, I'm no longer able to do the work that I was doing.

and I'm instead speaking with people like yourself, speaking with community groups and anyone who's motivated to have the conversation. Fortunately, many people are about, well, what is all this evidence about alternatives? And why are we doing things that seem not really to be helping? There's so many questions that come from that. The first, I just want to make sure we understand your background a little bit more

so that people understand the work that you've done. You were involved in two of the largest controlled randomized studies. Can you talk a little bit about those? Sure. So the two main areas of intervention that I've focused on for about 20 years now involve people who are living homeless and involved with courts and corrections. So one was one set of comparative studies involved interventions that originated in courts, so like drug treatment court or community court compared to, you know, regular court.

The one that you referred to there was now it's really the world's largest project investigating in a comparative. way, what are the differences between alternative ways of helping people or responding to people who are struggling with addictions, are struggling with homelessness, and struggling with other forms of mental illness? And that project we called At Home Cheshawah. I led the two randomized trials that were based in BC, and we were mainly focused in downtown Vancouver in terms of where we met people. Those trials lasted for about six years and showed in very clear ways the differences between supporting people the way we're currently doing it and it's really the same way we were doing it back then, about 10 years ago now, was the middle point. And an alternative that focuses

on what the Portuguese described as social reintegration, an approach. that's very oriented to helping people find ways back into communities, back into society that they choose. So it's not telling them what to do, but enabling, giving them options that include pathways into healthy communities, healthy buildings, workplaces, almost all want to resume paid work when we meet with them. And a large proportion about a quarter have kids under age 18 that they're separated from. And the fact that they're homeless and separated from not only kids but other people that really matter to them is an ongoing kind of silent aspect of their suffering.

But once they establish a degree of stability, reconnecting becomes a really powerful motivator and is one of the illustrations, I guess, of reintegration. So we did that work. published a lot of papers based on it, showed in BC where there's evidence of people who need exactly this type of opportunity. Because we've been doing it so long, we have comparative costing studies and other evidence that would help make kind of the business case for why we should be doing this, apart from the fact that it helps people far more effectively. And despite all of that, we remain quite fixated on delivering services that don't help are very expensive and that are

increasingly demonstrably harmful. So that's back to where we are. Yeah. The last piece around your background is I just want to hear about why you got into this work. What made you interested in being a clinical psychologist and then that educational pathway. Cool. Well, I started off interested in physics, and I had been, I had kind of an unusual path, I guess you'd say. So I was adopted, and I had a really hard time fitting into families that I was living with. I dropped out of school, and then I was struggling with my own mental health as well as substance use. and I was moved away to another family out in the country. This is in rural Colorado, southwest Colorado.

And I lived with them for about three years and realized early on that working for $6 a day or something like that was not a sustainable path for me. So I've had to figure out if you get back into school. And I read a lot and I became quite nerdy, I think, if I was to look at myself today, a very nerdy kid. What pulled you in that direction? What made you interested in learning so much more?

I thought it was somehow really attractive to develop abilities that I could apply with nothing more than my body and my voice or the things that you take with you. so I didn't need, so I didn't have any money. So I limited myself in a way to all the things you could do. If all you had to work with were your hands and your spirit and the things that we have always with us. Strengthening your mind. Yeah, yeah. And I could go to libraries and those were, you know, that's free. I think it's still free.

I'm pretty sure it's still free. And you can go into libraries and or these days, of course, the libraries come to you. Open your notebook, right? you can read like everything everything you can you can learn languages and so i thought well i i've lost some time by by virtue of dropping out of school but i can easily make up that time because very few of the people i know who are even adults have read a lot of what is considered kind of classic material to learn from, inspirational things to learn from, informative things. So I thought, okay, well, this is actually, like, I don't know why more people aren't doing

this was kind of my thought process, like, because this is, you know, it's free, and it doesn't take a lot of physical energy, you know, you can do it, you can do many hours a day of reading and writing. So that's kind of how I got back into school. And because of that path, my some of my professors thought, well, this guy's, you know, like he's probably risky to work with, but he's also kind of interesting. And that was the case when I met my first mentor, Bruce. And he happened to be a psychologist in the area of addiction. But I saw that he also was an incredibly, I shouldn't say also, like to compare him to me, but I saw that he was at a much more mature stage of, you know, of his life and his career. He was doing the things that I thought were really helpful to me and kind of cool.

He had an encyclopedic knowledge of the history of psychology and especially the history of addiction, how people have talked about addiction. So I felt this immediate, I don't know, inspiration from Bruce. And he was very kind to me. And I think partly because I was adopted, I hadn't really landed in any kind of a, you know, I didn't have a family per se, but I didn't really know who my group was. And Bruce's kindness, and then after that, Alan's kindness, Alan Marlatt, really gave me the sense that, wow, there's a community here of people that are very caring of younger members, very, and not all of them, of course, but there are, there is that. that ethos in academia all around the world. You know, of course, you go to places where the senior people eat their young,

and that's, you know, that happens too. But it's also possible to find people who are very nurturing, very caring, and that was my good fortune. Interesting. The reason that I wanted to start all of that with your background is because the topic we're going to discuss is a political topic now. It's left, I would say, the scientific realm. It's become two-sided.

I've seen some of the people who have been interested in speaking with you, and they do come from one political side of the aisle more so. Not all of them, but like there's this interest from more conservative people to have these conversations, and then it almost seems two-sided when I think being curious is both sides should be looking at ways to help these people. This shouldn't become a political one-sided issue or the other. These are people and their lives and they need the support and we need to remove all of the rhetoric and just figure out what is actually going to tangibly help these people. I see this with my own First Nation community as well. The people who are grandstanding on TV rarely are the people who are actually developing solutions to improve the people's lives. And I'm in community seeing the improvements we're taking. And then I look at the political leaders who are talking about it. And it's so, it's two

different worlds. And I want to re-connect these worlds so we can talk about it and have like just a scientific conversation about how we can help people get through this and kind of remove the idea that if you're against, say, safe supply or something, that means you don't care about people in poverty. Like that's, these are the positions that I feel like have been formed. And then we're trying to figure out how to fit ourselves within these positions when the positions are arbitrary. They're political in nature. We can just look at what's the evidence, what's going to work? And then let's all agree that's do this based on an evidence-based scientific approach where the science has led us. And I do feel like from our conversation prior

that perhaps your team, your community of psychologists may have not been supporting you. You're saying more people are interested in talking to you from maybe podcast or this world. Could you talk about just your perspective on where we are? Am I correct in my analysis about where we're at this has become more of a political conversation i that's been my experience as well i i you know just sitting here nodding as you were speaking i i i see that for sure and i also share your observation uh that that's uh not an optimal frame excuse me for how we should be discussing these issues they they shouldn't be capital p politicized So, you know, I kind of stumbled into that whole political realm.

Starting in the mid-90s, I had opportunities to begin working with governments. And most of my involvements were with public servants. And I kind of avoided the elected officials. First of all, they came and went. and the public servants were their sources of advice. So I was sort of a step removed. I was working with and at times advising public servants, who then in turn advised, if they were a senior,

they were then advising ministers and other members of government, elected members of government. And I thought when we had an election here in 2017, if I'm not mistaken, a new Democratic Party, a left-of-center party was elected after several years of more right-of-center parties. And I thought, wow, the timing is excellent that there's sort of a...

Because I thought left-of-center would mean more likely to be interested in humanistic types of opportunities for progress and social issues. and maybe even because they were new a willingness to engage in some change and it turned out I could not have been more wrong and I was asked to provide some briefings

to senior members of government and so I said things the same types of things that I'll say to you and that I've written about and there was a very, very hard sort of rejection of what I was saying So we were forced to pack up basically our lab, destroy data. And I experienced some, you know, what we call canceling through officials and scientists who are affiliated with the provincial government.

So it was very, really a terrible time. And I, you know, I lack some kind of a filter because I didn't see it coming. What was the rejection of the science? like how you were gathering the data? Like, what was the rejection? Well, what I've learned was that I provided a briefing to senior officials that was a kind of a summary of what did we learn in those randomized trials? What are the implications for things we could be doing differently and maybe more effectively

to help people? And that involves both helping people who are living in crisis, but also preventing people from entering into those situations in the first place. and I didn't know at the time that the government had already committed to a large expansion of the services that we were already doing. So my recommendations were kind of doomed from the start. They had already put in place the budgeting and all of the planning. The machine was already moving.

It was moving, exactly. And so one week after that, SFU, where I work, received a letter. saying immediately Summers group has to destroy all of their data, which goes back more than 20 years, but you have to destroy it all. So it was a very, and this came through the public service, right? I don't know exactly, you know, the backroom discussions, but the timing is pretty clear, and there was no indication of anything like that previously. In fact, we were in the process of rebuilding the database for a new project that had already been cleared with government. So it was hard not to interpret it as a reaction to what I had said,

part of which included that because we had these data now for many years and we'd use them in interventions showing what's possible in terms of the magnitude of reducing people's hospitalization or reducing their involvement with courts and corrections, we had those kinds of benchmarks. One of my recommendations was, hey, why don't we use these data? to evaluate new government investments, see how close we're getting to what's been shown to be achievable. That was a bad message because the people I'm speaking to already knew that the government was committing to growing things that we had shown were not that effective. So me saying and we can evaluate what government is doing is kind of like I'm just a living liability.

because I'm declaring that we have the ability to show a year from now, two years from now, that what you guys are doing isn't working. Well, that's not a very sense, you know, I didn't have the intel to put all that together, of course. But in hindsight, you know, I really was walking into a bit of a trap. So part of the reason I tell this story is that the the door to working more with public servants

closed and it also closed in terms of working with the elected government because they were both equally kind of opposed to what we had been doing so that meant that because the issues that I've been working on

have become more relevant to the public I think that's really the main reason that the same issues have become politicized mainly they are relevant to people's votes now same issues and we can talk about First Nations people's experience of homelessness, poverty, the annihilation of culture and traditions,

the related mental illness, and the likelihood of problems with substance use, which overlap with other signs of hardship like intergenerational strife, having children in care. So all of these things we can see as being powerful indicators that we need to make changes, and we don't. We simply don't. Now we see that drugs are the leading cause of death among young people, 10 to 19, and two-thirds of them are or were in provincial care. So the magnitude of these issues that have been simmering, more than simmering, seriously harming people for decades have and I guess what I'm trying to say in all of this

is that the advice that I've been giving for decades has been more or less the same. We've had more evidence, we have our own experiences, but we had evidence from other places, and now it's become, it's touching so many people that it's become capital P political So now for the first time, opposition party leaders, provincially, federally in Canada, are taking a real interest in these things, not because anything substantive has changed in the underlying problems, but it's boiling over to such an extent that, hey, so many people are touched by this, this could influence how. elections are determined. So now for the first time, I'm talking to elected candidates or people

who are aspiring to be elected candidates and not so much to public servants, at least federally and here in BC. So it's kind of an odd reversal for me. I want to get back in a little bit back into how Premier E.B. and like how that government back then, it would have been John Horgan, how that all came about, but I just, I do want to touch on this. My concern is what I'm seeing, and the reason I was also interested to speak with you, I don't love the rhetoric I'm hearing from Pierre Polyev either. Bail, or jail not bail, these moves are equally concerning. It's, we've tried those policies as well. Big time. They don't work either. And so how do you feel about that approach or what you're hearing federally on this issue? I agree with you. Um,

And the main dynamic that we've fallen victim to, or one of the main ones, now for almost 100 years, has been a swing between interpreting problems involving substance use and addiction more generally as either a medical problem, a biomedical problem. so people refer to addiction as a disease, or as a criminal justice problem, a moral failing of some kind. We go back and forth. And what my mentor Bruce outlined, I think in very compelling detail, is that neither of these are effective, neither one.

And our long stay in this purgatory of back and forth is precisely because neither is actually very helpful. So how does that get to somebody like, you know, the leader of the Conservative Party or the leader or any of the aspiring elected officials? I think that there's an opportunity. Maybe for the first time in Canada to be involved in conversations with elected leaders that allow their positions to evolve. Basically, there's a curiosity. We've seen it in some leaders already, so in Alberta. No leader is going to be attractive to everybody.

But a few years ago, Jason Kenney as Premier and currently Daniel Smith have created a lot of space in their own agendas to look. learn more about how to prevent addiction and other forms of mental illness, and also how to help people reestablish lives once they've experienced those syndromes. It's an ongoing process. But the main change that I'm encouraged by is the fact that leaders, including Pierre Polyev, appear, I'll say this from my limited experience, appear sincerely interested in learning more. So what actually happened in Portugal, for instance?

This is a road I know that he's been down. And how would we replicate the effective things in Canada, given our governance models, the fact that we have provinces and territories, as well as different, and of course differences in culture, yes. But how could we adapt those? So then he gets his staff thinking about, okay, how could we do that? But it starts with what actually worked. We've, a few years ago, only three years ago now in BC,

we saw a large report prepared by the provincial health officer asking for a dispensation from the federal government to allow for possession of drugs. That report makes reference to Portugal and other jurisdictions, but in a way that is completely clueless, really, I mean, it's not a report that's going to age well because it more or less waves a hand that Portugal achieved great things

by decriminalizing drug possession, and then it sort of waves a hand at some other things, things. But if you listen to people or if you, you know, if you do any kind of a serious analysis of the Portuguese national strategy and what actually worked, decriminalizing possession is a very, very small part of what they did that resulted in change. So the shift from sort of grabbing onto Portugal, almost like a marketing slogan, as your rationale, and instead looking much more thoughtfully at the details of the plan, what worked, it doesn't guarantee that what a leader does or a politician does is going to be dramatically different. We all know that people can say one

thing to get elected and do other things once they're in office. But we also have to do what we can to try to create change. And one thing we can do is with candidates for office, for high office, get them interested in learning the substance of issues, get them to go on record before they're elected, saying what they understand to be the pathways to success. Things like, you know, jail, not bail, or, you know, that's kind of a quip. It doesn't really tell you too much. But when people are talking about a commitment to a recovery-oriented system. Okay, that actually says something. That says something. If you're going to achieve progress by implementing something like that, that has a lot of implications for how you're going to

govern, and it makes it pretty easy for people who've been listening to you to then say you are or you are not following through on what you said. I think that's incredibly important. Do you you think this is a solvable problem? Do you think that we could address addictions and homelessness in a meaningful way? Totally. Completely. In BC, it's infuriating that we're so backward. Right. We have, you know, so we have, we are such an important regions of ecosystem in, in, in, on our planet. And the people, as part of that, we are incredibly, incredibly important. We have so much area and beauty. We are able to communicate with one another.

And we have resources that we must work as stewards of for the good of everyone. Right now we're doing like crazy things. like shipping Western crude oil offshore to be refined and we're buying some of it back. That's crazy.

That's crazy economically. It's crazy from a resource stewardship standpoint. It's crazy from a safety standpoint, environmental safety. So we have a lot of opportunity to be much

better. And for ourselves and for future generations to establish a way of what does it mean to be a British Columbian. We know it costs, we've known this for some time. It costs as much to support people year over year while they are living in crisis, including homelessness. It's about $55,000 per person per year, on average. It costs about the same to provide people with immediate pathways back into society with support and effectively rescuing them immediately from encampments, from street scenes where predation and other forms of harm are just facts of life. It's incredible how much we've lost sight of the truth that, the truth that

you know, less than 100 years ago was global. I'm talking about the Nuremberg trials and the aftermath of the Second World War, when we realized collectively that there must be international laws, there must be commonly held commitments to human rights because if we turn our backs on those things, we are not only being unjust, we are sowing the seeds of conflict. That's kind of what we've been doing here in B.C. We are exposing people to forms of degradation and abuse and vulnerability,

and it's not because it costs less to do that than to help them. You know, so we absolutely can do far, far better. And, you know, the, the path we've followed coming out of COVID, many people were inspired during COVID. I was that we're going to come out of this and we're going to build back better. We're going to use this enforced pause to devote serious thought and planning to building back better. And we haven't done that at all.

We've built back worse, if that's possible. So, you know, the trap we somehow need to excise ourselves from is the trap of only finding potential solutions within the sort of the paradigm that we're in right now. safe is what's been called safe supply is essentially providing pharmaceutical alternatives to people who are living in desperate conditions they are the people living

currently in encampments many are living in First Nations communities I was recently in Port Hardy and talked to many people living they've been kicked off the reserve in many cases. Some of them were taking drugs onto reserve. And the social conditions that are responsible, if we talk about core issues, the social conditions

that are responsible are very clear to see. People have no opportunities for prosperity, for really being engaged in their culture, to be connected with their kids, just incredible, incredible psychological. burdens. And so the main problem with what's been referred to as safe supply is that advocates have not been referring to the modifiable and quite obvious core issues and have instead advocated for a commercial and even free market. market response, which is let's make drug companies the dealers instead of gangs and narcos.

That's not likely to work, first of all, and several people have written about why that's not likely. But it's also possible to see that as offensive because it is papering over a series of social problems that we must address. We cannot afford to simply medicate people living in despair. The Stanford Lancet Commission warned against the pharmacological sedation of poverty. And that's really the looming threat and what we've seen evidence of in BC's recent experiments with decriminalized possession and providing, making a public supply of addictive drugs, people, for various reasons, the drugs that they're able to receive are not the preferred drugs of the people that are eligible to get

them. And so sensibly, they either sell them or trade them. And that's been a known activity for many years. It didn't start with what we call safe supply. So that, that actually has the additional risk associated with it diversion to who and does it create down does it create additional harms it's telling I mentioned earlier that the government was not in favor of us continuing to have our measurement capabilities but it's also telling that they chose to introduce both of these measures decriminalized possession and a public supply of drugs without any ability to measure foreseeable consequences, including diversion. So we wrote about this in 2021 that there was this risk.

An easy way of checking it over time would be to have some kind of traceable component in the drugs that are dispensed so that if they're seized by police or if we're monitoring our groundwater, we can see, okay, are these drugs showing up elsewhere in places where they shouldn't in high schools or, you know, other places? And there was no effort made to hold themselves accountable in these ways. So it's a, you know, at least with COVID, which came along at around the same time, we went through the appearance at least of conducting randomized trials on vaccines and seeing whether they appear to be safe and appear to be effective in this case we didn't do

anything it's it's it's mainly been sustained by by by rhetoric and dogma and what seems yeah what seems like you know in it's in its best form maybe kind of a misguided belief that because the war on drugs, as we know that, because that hasn't been successful, the alternative should be a legal and regulated market for everyone. That's a little bit like saying that because gun control hasn't eliminated gun deaths, we should have an open and regulated market for guns. There are a lot of, there's a lot of room in between those two extremes. Okay. So I have two more quick questions for you. One, you've dedicated your life to this work to understanding these issues and trying to help people. I imagine you've met so many people

struggling in these circumstances. And not often do government policies play a direct role in people's lives. Like, we can talk about the carbon tax. Yes, it has these impacts on how you pay at the grocery store. Yeah, it's like a little bit removed. These problems are more complicated and there's 15 different reasons why. This is a moment where we can look at these people in these circumstances and say we could address this. We have a responsibility to address this. It's the provincial governments that are responsible for in large part addressing this issue. Yes. And we don't feel like it's getting solved. Like I don't talk to anybody who feels like we're doing a terrific job on this on this file. Yes. And so what is it like to know that there are

tangible solutions, that this is real people's lives. This isn't, do we do a bigger carbon tax or small? Like where it's like a little less personal, these are people's lives and it feels like we're playing politics. Yeah, it does. Yeah, well, you know, conversations like this one, I think are an important part of what we need to do, all of us, talking with one another, um talking in ways that um where we're conscious of of having an open mind you know where we're because that the divisiveness that you've referred to it's it we can't all assume that it's separate from us so how do we play a role in that and that's some that's hard to see i find it hard to see but i i know what it's like to practice being open minded

I know what that's like to listen and listen to people who disagree with either what I've said or what they think I've said so that's a real opportunity we have to develop a greater sense of solidarity tangibly things that we can do

involve there are a number of areas and I've tried to articulate some of the things that we could be doing starting, you know, tomorrow. And others have done similar work. I'm, you know, I'm not, I'm part of a chorus, really. But my focus has been on B.C. Can I ask, how can people follow your work?

I think X is good. So that's one modality. Online, there are some videos. I've had a lot of support just getting messaging out. And Summers Syke, so my last name, S-O-M-E-R-S-P-S-Y-C-H.com, and also on YouTube, the same thing, SummerSyke. Those would all be ways of having a look. The, yeah, the Stanford Lancet Commission is another big group.

And it's one that people in BC won't necessarily have heard a lot about. They spent two years examining the opioid crisis in Canada and the U.S., came up with a long list of recommendations. And the reason I think our government has avoided this report like the plague is they, in addition to listing all the things they said we ought to do or could do, they said there are two things that we shouldn't do. One is we shouldn't be providing a pharmaceutical source of drugs to people in the hope of displacing the illicit supply, and they explain why. And the second was, and we shouldn't consider dispensing drugs to people from like a vending type machine, automated dispensing. And we do both of those things. In fact, our former provincial health officer became the co-owner, or he established an opioid company, poised to, follow through on safe supply and his deputy formed the an opioid dispensing machine company

and so there these are ideas that have attracted a lot of interest among within our government within the small circles of people to the point where they appeared to believe that developing these as businesses was part of a better future It turns out, I think, to have been a horrible mistake and also just a bad look to be advocating for policies while also developing corporate interests. So we need the courage somehow to persuade our leaders to spend differently. That's kind of the main thing. And it's not as though large swaths of people would suddenly be out of work. the same people working in mostly in not-for-profits around BC need to be supported to provide

services that are effective for people and so same people and when I've had the opportunity to talk to not-for-profit leaders about this type of change they have been strongly supportive we put together a what we called a call to action a few years ago it involved 12 not-for-profits, supported by their executive teams, to all shift from what they are doing, which is kind of a scattershot approach that is mainly responsive to what the province is willing to spend for some area of need. And instead, to be delivering services that are based on evidence of what kinds of intensity and mix of support has been shown.

shown to be most effective for people who have a certain complement of needs. So it begins with triage and assessment and then a matching process. They all got behind that. We looked at where's the evidence of need in BC. So this document, this call to action, summarizes all of this, came fully budgeted and was submitted to the government. And I think that's the last thing I heard from David Eby was the syllable O, when i handed it to him and that was that was the last time we've uh we've had any kind of communication

but it but it didn't it didn't go anywhere the uplifting side of it is that people in positions of responsibility share the desire to do things better more effectively more professional more accountable measure what we're doing compare it to benchmarks that have already been established how close are we getting where are we doing better how can we learn from what those people are doing. So this is the kind of the opportunities for improvement that we're essentially just sort of leaving out of the equation completely. Landlords and employers in the private market are hugely important partners. Remember that most of the people were losing to poisoning are young and unemployed. So if we're to meet them where they are

and talk to them, we already know that most will say, among the things they want, a healthy, safe place to live at a job. Those will be right up there for almost everybody. Okay. How are we going to do that? Well, in the current system, we've got various

well, they've got this motel over here or this low barrier place over there. What about employment? Oh, yeah. Well, no, they have a team that does graffiti removal through the low barrier. Okay, that's not really a job. It's not a, we've restricted ourselves to what can be done through publicly funded and publicly

administered entities, and we've essentially turned our backs on the private sector. This is not meant to be like a conservative shout-out, by the way. I'm saying that the long-term course of helping people establish wellness involves living in a decent place, which probably means having a regular private apartment or condo or someplace, and a job. which is likely not a government-funded job, but a job in the private sector. So, again, we're turning our backs on some of these opportunities for partnership. And if we're willing to shift our focus and develop these partnerships, spend differently, not more, we can do immensely better. Amazing. Julian, it's such an honor to sit with you.

I appreciate everything. I hope to have you back on because there's so much more to discuss. I love that, man. But so many insights, I appreciate you. Me too. Thank you so much. Amazing.