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About 1,200 volunteers signed up to help with the Metro Vancouver count, such as Celine Mauboules, seen here on March 4, 2020.

JOHN LEHMANN/Handout

The man is asleep, huddled in a blue sleeping bag and using a suitcase as a pillow.

Celine Mauboules walks up, retreats, then approaches again when he stirs. She doesn’t like to wake people.

“Hi. I was wondering if you’d be willing to participate in a survey?”

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He says yes, and Ms. Mauboules – acting managing director of homelessness services for the City of Vancouver – begins.

As she ticks boxes on her form, similar scenes were playing out across the Lower Mainland. Vancouver has been conducting an annual count of homeless people since 2010, but this year’s took place as part of the Metro Vancouver Homeless Count. The region-wide count has taken place every three years since 2002.

Conducted by the B.C. Non-Profit Housing Association, the Metro Vancouver count began in homeless shelters on the evening of March 3 and continued with outdoor counts on March 4, when The Globe and Mail accompanied Ms. Mauboules on an early-morning route that began at Vancouver Public Library and took in Victory Square, near the Downtown Eastside.

Homelessness isn’t hidden here. There’s a tent city in nearby Oppenheimer Park and people sleeping on the sidewalks of Hastings Street.

It’s still dark when Ms. Mauboules spots a makeshift shelter on some concrete steps. When she first calls to whoever is inside, a man yells and curses in response.

She offers him a granola bar. Eventually, the survey gets under way. It takes a few minutes to figure out there’s another, younger man in the tent. He also agrees to take part in the survey.

People who take part in the survey are not required or asked to provide their names and The Globe agreed to not name individuals or photograph them as a condition of observing the count.

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About 1,200 volunteers signed up to help with the Metro Vancouver count, which also includes North Vancouver, Surrey and White Rock. Preliminary results are expected in April.

The 2017 count found 3,605 people who were homeless in Metro Vancouver, up 30 per cent since 2014. Thirty-four per cent of respondents identified as Indigenous. Experts say the increase in homeless numbers reflects a host of factors, including expensive housing, untreated mental illness and young people “aging out” of government care and struggling to find a foothold as adults.

Agencies involved with the count wrestle with the wording and number of questions. Better data can result in improved services, but it’s tough to get someone who is cold, hungry or shaking from withdrawal to spend 30 minutes on a survey.

This year’s consists of 25 questions, including a new one that asks whether the respondent has an acquired brain injury – one that happened after birth through accident, violence, an overdose, stroke or brain tumour.

B.C. declared a public health emergency in response to overdose-related deaths in 2016 and health authorities are dealing with the effects of an increasingly toxic drug supply. A January, 2020 update from the B.C. Centre for Disease Control described a “high occurrence of neurological injury in the provincial overdose cohort” and flagged the need for more research.

Before that, a University of British Columbia-led study last year found more than half of homeless people had a history of traumatic brain injury and almost a quarter had a brain injury that could be classed as “moderate or severe.” (The UBC study looked at 38 studies published between 1995 and 2018 from six high-income countries – Canada, Australia, Japan, South Korea, the United Kingdom and the United States – that included people of any age who were homeless.)

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The UBC researchers were unable to determine whether brain injuries contributed to homelessness or the other way around, but said the findings suggest stable housing might lower the risk for traumatic brain injuries.

The effects of a traumatic brain injury range from a mild concussion to a severe impairment that affects speech, mobility or memory.

When Ms. Mauboules poses the brain injury question to the man in the blue sleeping bag, he props himself up and runs a hand through his hair, showing stitches on his scalp. The details of the injury are foggy.

In the courtyard of an office building, Ms. Mauboules meets a young Indigenous man carrying a sketchbook. He’s been homeless for about three years. Asked about health challenges – like many questions on the survey, this one includes multiple options, including addiction, illness and learning disabilities – he says he has mild fetal alcohol syndrome and maybe some other cognitive impairment.

“No doctors have ever signed off on it, but I feel like a do have a disability. I just don’t know what it is,” he says.

Ms. Mauboules gives him the address of a housing service centre and urges him to stop by for help.

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Near the end of the survey, people are asked what caused them to lose their housing.

Most can cite a specific event: a divorce, a job loss, an injury.

The man in the blue sleeping bag says he’s been homeless since the city shut down the Balmoral Hotel, a single-room occupancy (SRO) hotel in the Downtown Eastside closed in June, 2017 over health and safety concerns.

The city found new homes for many tenants, but the man says he didn’t get any help, even though he insists he had been paying rent. (Relocation efforts focused on people who had tenancy agreements, not guests or visitors.) The building remains closed, as does another SRO across the street, the Regent Hotel, which the city ordered closed in 2018. Both buildings are owned by the same owners, who have filed a court challenge to the city’s plans to expropriate the SROs for $1 each.

One young man, pushing a bike and wearing a hoodie pulled over a baseball cap, says he’s willing to answer questions, but asks Ms. Mauboules to move to a spot less visible from the street, saying he doesn’t want to draw attention.

Once the conversation starts, he’s happy to talk, saying he has grown accustomed to people looking past him.

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“You two are probably the only two who will speak to me all day.”

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