The Downtown Eastside is all too often a one-way gate. People arrive in the drug-addled community and leave in police cars and ambulances. The Downtown Eastside, a narrow strip of a few blocks along Main Street bordering Chinatown in the city's centre, has existed for decades, but since the 1990s, what has always been a skid-row part of town degenerated rapidly.
Some blamed the closure of the Woodward's department store on the edge of the community and others said the decline was noticeable after the provincial government began phasing out beds at the Riverview Hospital in suburban Coquitlam.
Riverview opened in 1904 and in its peak in the 1950s, nearly 5,000 patients lived at the psychiatric facility. At the time institutionalisation was the norm, but over decades, governments and medical establishments moved towards taking mentally ill patients out of locked wards and into smaller group homes in communities.
But Riverview still stands, all 80 hectares of the site, its buildings surrounded by green, leafy parks overlooking a jumble of highways.
Only about 400 residents still live at Riverview today, the people inside at the time spread out to smaller communities around the province and a large number of former patients have found themselves now living in the Downtown Eastside.
An estimated one in every five residents there are mentally ill, many of them overlapping the one-in-three who have an addiction to drugs or alcohol.
The numbers and statistics are grim enough that regardless of official statistics, the emptying of Riverview flooded the Downtown Eastside.
Now Mayor Sam Sullivan has come up with an idea that at first glance is unthinkable, but is getting considerable support from community workers, albeit some guarded support.
Vancouver's mayor wants Riverview to re-open in parts, not the old decrepit buildings that are there, but the newer sections which would be turned into residences for people who need support.
This idea of re-institutionalisation is not about putting people back behind bars, says Mayor Sullivan.
'But I do believe there is a small percentage of people with severe mental illnesses that need to be in a more structured and caring environment that will get them away from abusive and violent people and get them out of the tragedy of homelessness they're currently in,' he says.
As part of his strategy to leverage the upcoming Winter Games in 2010 into making real progressive changes, especially in the Downtown Eastside, Mayor Sullivan has set up ambitious goals to reduce homelessness, aggressive panhandling and open drug market use by at least 50 per cent.
He insists re-opening Riverview isn't about bussing people out of the Downtown Eastside for a few weeks while the city is in the international spotlight during the Games. He sees the old facility as a place where people know where they'll be getting their next meals, have someone supervise their medication and have a warm bed to sleep in at night.
That's opening doors that have been shut. Mayor Sullivan is also hopeful his plans for a new substitution treatment programme of distributing legally available prescriptions to addicts will eventually lead to shutting the city's supervised injection site where users can inject illegal heroin under the supervision of health care workers.
What concerns people like Nancy Keough the executive director of the Kettle Friendship Society, an advocacy organisation for people with mental health issues, is whether this is a short-term plan or a long-term one.
'We have people who don't have a place to sleep so it's a complicated answer as to whether this is going to be a good thing or not,' she says. 'We need more supported housing, but we don't want this to be a place just to put people.'
Former Riverview patient Terry Boale, who lived there for two years, thinks some of the cottages may be suitable housing, but he fears any return to locked wards.
'That place is 15 kilometres from the Downtown Eastside and where many people's friends are living and that's where the drugs are,' says Mr Boale.
A safe enough distance on one hand that access is cut off, but Mr Boale speaks with a wary honesty, that some distances are never too far away.