By Marvin Ross
Poverty and homelessness are two hallmarks in the lives of the mentally ill in addition to what is often poor health care. The one thing that the Covid pandemic illustrated in Canada is the lack of a proper safety net for this group. The Canadian government acted swiftly to help support people who lost their jobs, small businesses and landlords as the result of the lockdown. The disabled have been ignored.
Ontario, where the monthly support for the disabled comes to the Dickensian amount of $1169 (barely enough to rent an apartment), managed to give some people all of $100 a month extra for four months. The Federal government promised an additional $600 one time grant but only to those who have a very hard to get disability certificate from the Canada Revenue Agency. That money has still not been allocated.
As a result, there is considerable talk of a guaranteed annual income for people to ensure that everyone can live above the poverty line. That is years in the future if ever. Spain was the only country to actually try to implement such a plan although recent reports suggest they are having problems implementing it. The logistics of such a plan are fairly basic and would do much good for many as I’ve discussed elsewhere. What is of immediate concern is that those with serious mental illnesses that come on in late teens and early twenties like schizophrenia live in terrible poverty and suffer from considerable homelessness or live in substandard places.
If the ill individuals are lucky, they have family who care for them at tremendous financial expense to the families let alone the emotional and psychological stress. An international survey conducted by the The European Federation of Families of People with Mental Illness (EUFAMI), paints a horrible picture of what families go through. In Canada, families spend an average of 15 years in that role and 1 in 3 are at the breaking point. Most feel stigmatized by professionals and ignored by doctors, nurses and social workers.
This is the reality which results in many with serious mental illness living on the streets, in shelters, begging for change at busy intersections, being arrested and transitioning into drug use. Thanks to Covid, there are now a couple of tent cities established in my own community because people have nowhere to go. The solution, of course, is long term and multifaceted. This is what is needed off the top of my head:
- coordinated planning that involves families who today are mostly ignored
- suitable medical services for the mentally ill which should include hospitalizations that are of sufficient length to stabilize patients. Too often, because of bed shortages, patients are discharged before they are ready and to little or no community supports or housing.
- Adequate income so they may live with some dignity and not on a stipend that is about 40% below the poverty limit.
- Affordable housing that matches the needs of the client (from heavy support to as much independence as required)
Adequate income can and should be achieved either by a sensible disability system or a guaranteed minimum income. A compassionate society should provide to those who are either born disabled or develop a disability with a reasonable income so they can enjoy what life has to offer – adequate housing, nutritious food, entertainment, clothing, transportation, etc.
Ontario has the most generous disability payments in Canada and yet the level is, for a single person, all of $1169 a month. If the disabled person lives in a full service group home (room and board), the money goes directly to the private operator of the home and the resident is left with a little over $100 a month for clothes, self care products, bus fare, entertainment, and other purchases. These are nothing but modern day versions of the Victorian workhouses. Is it any wonder we find many of these residents begging for change on our streets?
Supported and independent housing options vary where they exist but, in keeping with the current focus on combining mental illness and addictions together, some of these options combine both residents in the same projects. The characteristics and the needs of both clients differ so they should not be combined. Psychiatric facilities often separate the two into units for people with specific mental illnesses (schizophrenia, bipolar, etc), units for those with both a mental illness and a substance abuse, and units for substance abusers.
That separation does not carry over into community service and housing. One drop in centre that I heard of just recently combined the two groups and, as a result, were evicted from the church facility they rented. Seems that the neighbours were upset that the addicts were shooting up in the area. A supported housing complex that I am familiar with combines both and is a disaster. The mentally ill with no addiction problems are not happy. Drug use is rampant and there have been numerous overdose deaths in the past two years along with a number of overdoses where the person recovered.
The agency that runs the facility calls it a harm reduction building so ignore the drug use and supply naloxone kits for overdoses. However, the Harm Reduction Coalition defines it as incorporating:
“a spectrum of strategies that includes safer use, managed use, abstinence, meeting people who use drugs “where they’re at,” and addressing conditions of use along with the use itself. Because harm reduction demands that interventions and policies designed to serve people who use drugs reflect specific individual and community needs, there is no universal definition of or formula for implementing harm reduction.”
I’m not sure how much of this the project does but I do know that the activity of those with addictions is disruptive to those who do not use substances.
If we are going to build more appropriate housing for people (and we should), it is imperative that we design for the specific needs of the people who are going to live there with appropriate supports and with input from families. It is, after all, families who support their ill relative and bear the burden of providing financial, emotional, and medical support. As mentioned earlier families are stressed out and need to know that their ill relatives will be properly cared for. To be somewhat blunt, they want to die knowing that all will be reasonably well.
I’ve just been looking at a needs assessment and action plan for what is called a justice focused mental health supportive housing project in Toronto. All involved in this are research staff from agencies such as the Canadian Mental Health Association, various corrections and addictions groups. No family to bring a measure of reality to the process.
I also have to wonder why they focus on those involved with the justice system. I’m not saying they have no needs but they point out that 25% of applicants for supportive housing in Toronto are involved with the justice system. Should supportive housing not start with the largest group who need the service like the 75% who are not involved with the justice system? They also point out that many in this group are discharged from jails or rehab facilities with nowhere to go making their need urgent. But that problem is the same as those without criminal or drug activity who are discharged from hospitals.
What made me chuckle was the suggestion that they might be able to rent units in regular apartment buildings for their clients. That naive suggestion took me back to my previous life as a government planner. I was on a working group looking at how to best deinstitutionalize what used to be called the retarded from institutions into the community. As I recall, that particular institution was for problematic people with serious behavioural problems. At the time, there was a glut of condos on the market in Toronto and one of the group thought it would be a good idea to try to rent or purchase surplus condos to be used as community group homes.
That person offered to go visit some real estate agents who specialized in condos to see if that would be possible. She returned to the next meeting to say that she was not greeted well by the agents who practically threw her out of their offices.
The other naive bit in this plan is that the housing “can be met with Housing First –i.e. direct access from homelessness to housing, minimal preconditions, no “treatment first” rule, independent tenancies, and de-linked supports.” I think this aspect of Housing First is absurd and the best example is the one I gave from my book in my obituary to DJ Jaffe. In that case of Mrs Brown, she was put directly into housing from living in the gutter at E 65th St and 2nd Ave and performing her bodily functions on the street.
It did not work and it won’t for most people.
What we need is rational planning for the mentally ill and the addicted but what we have is a hodge podge of plans and schemes that do little good. That is why we are in the mess we are in and few get any help.