Category Archives: Homelessness

More on Homelessness and Mental Illness

By Dr David Laing Dawson

With seemingly intractable social/medical problems we tend to rant about them or offer sweeping, global, feel better (they make us feel better) but useless proposals such as “talk about it” for suicide, and more affordable housing or shelters for homelessness.

And we forget history.

In the seventies our community psychiatry teams (at least the ones I was involved with) made home visits, ensured patients stayed on their medication, intervened with landlords, and one team member was official liaison with all, what was then called, second level lodging homes.

In the eighties our Psychiatric Hospital formed a special team to help prepare patients for discharge and settle them in appropriate housing, and connect them with all the treatment and support they would need.

And this is the moment to intervene and to focus resources: preparation for discharge. Discharge from hospital, addiction treatment centers, and from jail. This is the moment to spend resources and money, finding, securing, settling in with all necessary supports. And those supports can include intervening with landlords, attendance at AA daily, a sponsor, a visiting nurse with anti psychotic medication in a syringe, community treatment orders, help with shopping, budgeting, ADL’s, peer support etc.

Many factors have combined to produce the current problem: loss of low skill jobs, epidemic of opioid addiction, lack of affordable housing, psychiatric treatment shifting to short stay general Hospital treatment and specialty outpatient clinics, and a well-intended but damaging shift to protection of individual rights at any and all cost, and an institutionalized denial of mental illness combined with a paradoxical acceptance of addiction being an “illness”.

(in this strange world of ours a man who believed he was born of the stars and a professor was deemed by the Supreme Court of Canada to be competent to refuse treatment though it meant he would be incarcerated the rest of his life, and another court reinstated a nurse who stole opioids from her patients to feed her addiction on the grounds that “her addiction was an illness”

Emergency shelters, delivering blankets and food to the homeless, clean injection sights, mental health teams working with the police, street homeless watch, a differently designed clothing donation box are all worthwhile band aids but if we want to actually make a difference over a long period of time we need to focus resources to help people through that difficult transition from hospital, treatment center, or jail into a settled housed life within a community including all necessary support to remain housed and stay on the medication that prevents depression, psychosis, or mania.

Some years ago while giving a talk in The Netherlands about treating “borderline personality disorder” I was told it was illegal for Dutch hospitals to discharge someone to the street. I don’t know the details of that illegality, and it is a bit extreme for our social contract in Canada, but we certainly could keep patients in hospital a little longer while a special team ensured successful housing and compliance with treatment post discharge.


Band Aids are not a Solution to Homelessness

By Marvin Ross

It’s winter in Toronto and, as can be expected, there is a cold snap. Not surprising of course but with every serious drop in temperature, the medical officer of health announces a severe cold weather alert so that agencies can look after the homeless.

The city opens special shelters so those poor souls do not freeze to death as often happens in the winter. The number of homeless in Toronto and other Canadian cities is a blot on our supposed safety net. Our solutions to homelessness are totally inadequate.

This past week, a poor woman sleeping in an alley in an attempt to keep warm was run over and killed by a garbage truck backing into the alley as the driver did not see her. As a consequence, one charitable group is handing out visibility sashes to protect the sleeping souls from this happening to them as well.

Shortly before this event, another woman died when she was trapped in a charity box used to collect clothing items as she had presumably gotten into it to keep warm . I find it totally disgusting to see the numbers of homeless in downtown Toronto sleeping on sidewalk grates in the financial capital of the country (Bay St) with all their possessions piled around them. They are invisible as humans as the bankers, stock brokers and other business types walk around them failing to see the human beings hidden under the blankets.

One year, driving into Toronto for a meeting, I watched as I was stuck in the rush hour traffic as a van pulled up blocking the curb lane. The driver got out with breakfast for the just waking up homeless on the sidewalk.

It is nice to have breakfast in bed wherever you are but this was and is a totally useless exercise. In 2018, the number of homeless in Toronto was 6000 but today it is 9000. Project Winter Survival (one of the many aid groups in Toronto) has been besieged with requests for survival kits this year: homeless aid groups sought 21,000 kits, up 60 per cent from last year. Jody Steinhauer, the founder of Project Winter Survival was quoted in the Toronto Star stating that “we need to put the pressure on the city of Toronto: open up 1,000 shelter beds, get people into housing long-term with support solutions so that next year at this time, we can be indoors and being proud.”

According to the Homeless Hub at York University in Toronto, “30-35% of those experiencing homelessness, and up to 75% of women experiencing homelessness, have mental illnesses. 20-25% of people experiencing homelessness suffer from concurrent disorders (severe mental illness and addictions). People who have severe mental illnesses over-represent those experiencing homelessness, as they are often released from hospitals and jails without proper community supports in place.”

One study carried out by McGill University in Montreal, found that it is costing over $50,000 a year to provide support to one homeless person without resolving the problem. These costs were comprised of services such as supportive housing, treatment for substance use, emergency department visits, ambulance trips, hospital admissions, police and court appearances, social assistance and disability benefits, and incarceration.

Matthew Pearce, the head of Montreal’s Old Brewery Mission, told the CBC that “homelessness is not the problem. It’s a symptom of a problem” and that “It’s a symptom of inadequate services for people with mental illness. It’s a symptom of inadequate options for affordable housing for individuals.”

The researchers said that there is a “need for a comprehensive response” to the problem, and the importance of preventing vulnerable people from finding themselves in that situation in the first place.

Yes, the homeless need to be kept warm and safe but they also need to have treatment for the conditions that allow them to become homeless in the first place. Until we start to do that as a society, we will only be putting band-aids on the problem not solving it.