Supportive Housing and Failed Government Oversight

By Marvin Ross

There are two distinct groups in Canada who require help with housing – the poor for whom adequate places to live are too costly (affordable housing) and the disabled who not only need decent affordable places to live but who also need supports to help them (supportive housing).

We tend to mix the two up but I want to focus on supportive housing in this blog. Supportive housing is needed for those with both physical and mental disabilities . For those with mental illness, the 2016 Ontario Auditor General’s report states that providing supportive housing for people with mental health challenges who require housing makes economic sense. With the right housing and supports, people recovering from mental illness gain a renewed sense of dignity and hope, and can reintegrate into the community more successfully. Research shows that providing a home to people with mental health challenges can also help save money in the long run in hospital, prison and shelter stays, and in other ways as well.

Supportive housing “allows people to receive the supports they need to live independently in their own homes. Depending on people’s differing abilities and needs, they may use a variety of supports”. But, the auditor found that the Ministry, the Local Health Integration Networks (LHINS) and service providers do not have adequate information, systems and procedures in place to cost-effectively oversee, co-ordinate and deliver housing with support services to people with mental illness. They also do not sufficiently measure and publicly report on the effectiveness of Ontario’s mental health supportive housing programs.

The Auditor General had a long list of deficiencies which you can find here but what I found most crucial is this:

“The mental health housing program serves a vul­nerable group of the population. In order to ensure that agencies consistently deliver high-quality housing and support services to clients with mental illness, it is critical that the Ministry and the LHINs appropriately monitor these agencies and collect sufficient information about the program. We found that the sector still lacks outcome data decades after this was raised as an issue. As well, there is no provincial aggregation of client satisfaction surveys, complaints, serious incidents and best practices to identify practices worth sharing and areas needing intervention.”

The Centre for Addiction and Mental Health and the Canadian Council on Social Development put together a report to the Mental Health Commission and stated Canadians with mental illness who are unable to get adequate housing find this failure tremendously detrimental on their physical and mental health. This lack of housing also has a dramatic moral and financial costs to them and to their family members as well as financial pressures on the health care system itself.

They then point out that this does not have to be the case.

Over the past number of months, I’ve done numerous blog posts on one agency (Indwell) that has received almost $135 million dollars over a five year period and operates numerous supportive housing with no oversight from anyone that I can determine. In Hamilton, there have been two murders in their buildings, numerous overdose deaths, a couple of residents who died and were undiscovered for days, assault, drug deals, etc. In one of their buildings in Mississauga, some residents complained at a public meeting that they feel unsafe and that they get no support from staff. A survey carried out in another of their buildings in Hamilton found that 67% of their tenants live in fear. At one point, the elevator was out for days in that building and the tenants on the higher floors with mobility problems were trapped. Other tenants looked after them and walked the dogs for those who had dogs. An overdose on a higher floor meant that paramedics had to climb the stairs lugging their equipment and then taking the person down the stairs. He did survive. In a building in St Thomas, a resident or visitor blew up his apartment.  He was charged with: Two counts possession of a firearm or ammunition contrary to prohibition order, Arson – damage to property and Arson – disregard for human life

The Indwell Facebook page posted a comment about their work in Lambton County with one of their residents writing “I have a petition to remove X as program manager from st marks place in Kitchener with 22 signatures already because of the way she disrespects clients and refuses to repair there (sic) units will someone in management finally step in and talk to…”

Indwell removed the comment but you can see it here.

In the fiscal year ending March 31, 2023, Canada Mortgage and Housing gave this agency a little over $8 million. When I asked them about oversight, they replied:

“CMHC offers financial support to projects that meet our program criteria during the most critical step in residential project development, which is during construction. To clarify, CMHC does not oversee the day-to-day management of the projects that we fund and the responsibility for effective management rests with the owner of the building, as well as with local authorities overseeing tenant rights.”

But despite that statement, CMHC did fund Indwell and some researchers from Western University to evaluate the efficacy of their program at Woodfield Gate in London. This is the final report called Indwell: Making Supportive Housing Work For Canada’s Most Vulnerable. There are 66 one bedroom apartments in this building so there are at least 66 people who live there. However, only 20 people were willing to be interviewed for this study. In order to get as many people as possible including those with negative views, the researcher recruited people at a party with food in the courtyard and paid them $20 each to participate. They still only got 20.

This is not that unusual in research but researchers almost always make an effort to demonstrate that those included in the study were representative of all. This was not done so I wrote to the lead researcher in Mid March and asked “Were you able to determine if those 20 were representative of the entire population?” No answer.

One of the residents there, however, posted to Reddit that he was fed up with all of the problems in the building and Indwell’s lack of action and he was moving out.

I did raise concerns with the Hamilton Haldimand Brant Health Network (the responsible Ontario Health Team and former LHIN) and they said we have no oversight. Ontario did give $2.6 million to them in the 2023 fiscal year. In 2016, the Auditor General said as mentioned above:

“In order to ensure that agencies consistently deliver high-quality housing and support services to clients with mental illness, it is critical that the Ministry and the LHINs appropriately monitor these agencies and collect sufficient information about the program. We found that the sector still lacks outcome data decades after this was raised as an issue. As well, there is no provincial aggregation of client satisfaction surveys, complaints, serious incidents and best practices to identify practices worth sharing and areas needing intervention.”

The City of Hamilton contributed $125,000 to this agency in 2023 so I asked them about their monitoring. Their manager of social housing replied after numerous attempts on my part to get a response from the mayor. I had to eventually e-mail the mayor and every member of city council before I got this reply:

“The City of Hamilton does not provide operating funding to most of the Indwell buildings listed below.  Several, including the Oaks properties, do receive rent supplements.  Our rent supplement agreements do not require that we be informed of overdoses or deaths of tenants. Deaths would be reported to the coroner and police.”

The City neglected to tell me that they approved $1.2 million for high-level support services from Indwell for the King William project. This is from the Hamilton Spectator.

This lack of financial oversight by funders is very troubling and we should all be concerned. When a government or government agency gives money to an organization to do something, we should expect that they ensure that the money is being properly used. That does not seem to happen!

The problem with Indwell is that they seem to have very lax admission requirements which are not published. Residents include people with serious mental illnesses, those with active addictions, people with physical disabilities and people on probation or parole. Those with mental and physical disabilities should not be mixed in with active drug users or those with recent criminal convictions. It is well established that those with serious mental illnesses tend to be the victims of violence. According to the American Addiction Centers, addiction is strongly associated with violence. According to Dr Dawson “Conflating mental illness and addictions has caused a paradoxical shift. It has allowed us to absolve addicts of personal responsibility for their addictions and, at least tacitly, blame the mentally ill for their illnesses.” When I got freedom of information arrest records for two of the buildings in Hamilton, many of the arrests were for fail to comply with a probation or parole order.

I’m not picking on this agency as they are not unique. I’m told that quite a few of the supportive housing locations in Toronto have similar problems. And, according to CTV News, the Shepherds of Good Hope in Ottawa are having problems. Residents in Ottawa’s Carlington area are fed up with the rise of crime since the Shepherds put in a supportive housing unit there. The neighbourhood is already home to three buildings that offer support for Ottawa’s vulnerable population, and plans are in the works to open up a fourth. A public meeting with the agency in December became very heated and residents felt they did not get adequate answers to their concerns.

These conflicts and problems can be avoided if the agencies used common sense and had strict rules for who they accepted. In many cases, there do not seem to be any rules (or advertised rules) and the mentally ill and physically disabled are lumped in with those with active addictions and histories of violence and criminality. Funding agencies need to set rules and to inspect on a regular basis. Imagine if long term care facilities got government money and had no operating rules or regular inspections.

Fortunately, not all supportive housing is badly run. I was recently invited to tour two facilities in the Toronto area belonging to the Reena Foundation and its affiliated group, Chai-Tikvah which supports people and families with mental illness. One of their facilities is a six-plex in a residential area of mid-town Toronto with 3 units and 10 people expanding to 6 units and an additional 10 people. Each apartment has a private room for the resident in a communal setting. It is staffed 24/7 and the goal is to “support the residents by addressing their recovery and well-being goals, helping residents to develop and maintain life living skills, such as cooking, cleaning and hygiene practices”.

Potential residents must:

• be stabilized, i.e. interacts in a non-harmful manner.
• Does not pose a risk to self/others/property, i.e. does not use derogatory language and is not verbally or physically abusive.
• Must be physically healthy, i.e. not requiring daily nursing care.
• No recent history of substance abuse (alcohol or other drugs).
• No history record of indictable offenses (such as assault, arson or charges pending).
• No chronic history of violence toward other people or property, and no recent attempt at suicide.
• Must have a psychiatrist and established acceptable regime and treatment plan to deal with psychiatric illness.
• Is willing to participate in individual and group chores, i.e. cooking, meal clean up.
• Must voluntarily enter home on a contractual basis.
• Must be willing and able to learn basic living skills, such as personal care, and co-operative and community living.
• Must have some source of income and be capable of meeting some programme expenses.
• Must be willing to accept encouragement and support from staff toward exploring flexible options for weekday activities.
• Must be able to benefit from a supervised home, in a way that they can improve their sense of well-being, self-esteem, and reach a higher level of functioning. This will enable the member make the transition to a more independent living arrangement.

The other facility I visited was one of Reena’s buildings in Thornhill. Reena supports people with autism, developmental disabilities and mental health and physical challenges. I visited one of their intentional community residences defined as “a place where tenants who have chosen to live in the building and the agencies supporting them are committed to creating one community of support. While elements and units may be led or dedicated to servicing a subset of tenants, all are part of one community. This approach to community is intended to reduce stigma and separation amongst tenants, the staff and volunteers who share in their lives.”

The building is clean, bright, busy with activities and with proper security. A fob is required to get into the front door but there is also a manned desk to ensure no unwanted people enter. Outside of regular office hours, there is security at the front door. In contrast, Indwell has fobs for its residents but no reception and no monitoring of visitors. The residents often allow others in, lend their FOBs out and many end up living at Indwell for months, even though the lease only allows a guest to stay for 2 weeks.

The Reena building I visited had a garden for residents to grow things, an activity room with large comfortable chairs, TV and pool table. Plus a small gym with numerous exercise machines and an indoor track that can be used by walkers, people with walkers and others. The day I was there, it was busy.

The other essential is that Reena has an Individual Support Plan for each resident where goals were determined for the purpose of maintaining health and well being. Also, at Reena people do not have to worry that a fellow tenant is not compliant with meds as there is  transparency about monitoring meds which gives everyone peace of mind. I’ve never seen this done at Indwell based on my son’s experiences from 2018 on. To get him out of Parkdale Landing, I had to get my lawyer to write them a letter. His next building was a bit better but still problematic especially since he was totally impacted when a fight broke out in the lobby down the hall from him and about 10 police cars were needed. Staff told me they were not our tenants. With the help from staff at the Associate Minister of Mental Health’s office, he is now in an older building for people who need less supervision and it is quiet with no obvious drug use or dealing. The only problem is that the one elevator is broken and has been for about 5 days with no indication when it will be fixed.

Supportive housing can work well if the group setting it up takes care to pick the right candidates and operates it properly and if there is proper oversight from government officials. The fact that there is little to no oversight, is negligent in my opinion.