Tag Archives: Supportive Housing

Housing for the Disabled in Ontario – A Barbaric Cultural Practice

By Marvin Ross

During the 2015 Federal election in Canada, the Conservative Party thought they could win support by proposing a tip line where citizens could call and report the barbaric practices of presumably their immigrant and likely Muslim neighbours. It was not well received and the Conservatives lost the election.

We do, however, have barbaric cultural practices in how we treat the poor, ill and disabled citizens among us in Ontario. Last Spring, I wrote of the pitfalls of supportive housing from the experience of my family member being exposed to murder, addiction and trafficking. That was followed by a more theoretical one by Dr Dawson. The agency in question renovated old and abandoned buildings into very acceptable housing for those who needed it at affordable rates but then failed to adequately support the residents. The consequences of that is described in the linked articles.

The latest outrage was that one of the residents of that particular supported housing buildings died in his sleep and his body was not discovered for 7 days. It seems that no one noticed that the poor man was not seen even though dinner is served to residents, the staff is comprised of nurses, addiction counselors and others and they talk of wrap around support. Actually, a staff member did check his apartment a day before he was formally found and initially said he was asleep in bed, that there was an odour coming from the apartment but closed the door and walked away. Later, it was claimed that she knew he was dead and that it was so traumatic for her that she ignored it and did not report it to anyone or even call 911.

An outside health agency that the gentleman (Michael Miller) was involved with was concerned when they had no contact with him so they asked police to do a wellness check. That was when his body was discovered but it was in such an advanced state of decomposition that the coroner was not able to determine a cause of death. Michael’s mother told the agency that she was going to the local paper and was asked not to as that would “shame residents”.

When confronted by the press, the director claimed he opposed her going to the press “for the sake of our tenants, for the sake of our elderly, to stop stigmatizing vulnerable people.”

That makes no sense to me and if there is any shame, it belongs to the organization.

As bad as all this is, it pales in comparison to other residential facilities for the mentally ill, disabled and elderly where the service is nothing but barbaric!

The Toronto Star did an investigation into what is described as a grey area “where no one is in charge of proactively making sure these facilities provide a minimum standard of care to an ever-growing number of at-risk residents.” This sector exists because  “homeless shelters, hospitals and rehabilitation centres across Ontario run out of room and affordable housing options start with years-long wait-lists, …. unlicensed facilities have become increasingly popular places to park marginalized people.”

The Star expose dealt with a chain of such homes throughout Southwest Ontario called Supportive Living . Take a look at their glowing website and then compare that to what the Star found in its investigation. The pictures will disgust you. Residents are of various ages and health conditions and many have mental illnesses and/or addictions. Others are older people with dementia or physical conditions who cannot find a placement in long term care.

The majority of the residents receive financial support from the Ontario Disability and Support Services Program and payments are made directly to the landlord to cover room and board. The amount paid ranges from $745 to $1095 a month depending on the region. There was a 5% increase in that allowance recently. The residents themselves get around $75 a month for their personal needs. Thus far, three attempts have been made to impose legislative standards on these homes but those bills never got past 2nd reading in the legislature. One of the attempts was accompanied by 44 municipalities supporting the effort. A fourth private members bill has just been introduced.

The Toronto Star’s sister paper in York Region, Metroland, recently reported on a group home in rural Newmarket north of Toronto for adults with physical and cognitive impairments. One of their residents was killed by a passing car while wandering the roads unsupervised. Local drivers have been warning about the elderly wandering the rural, unlit roads for years to no avail. One driver reported in 2017 that she almost hit an elderly man on the highway at night. He was dressed in pyjamas and “His entire backside, all the way down to his feet, was covered in dried feces.”

She went to the property to get help and found  “many low-functioning residents with very high needs and little supervision”. This is but one of 22 such homes in that region that get subsidies from various levels of government to “look after” those who can’t afford better. Numerous calls from various individuals and organizations to investigate these places have been ignored.

Barbaric is the only word to describe what is happening and is being allowed to continue.

Now, in its wisdom, the Ontario government has decreed that patients in hospitals awaiting long term care placement, rehab, home care, mental health services or complex care can be moved against their will to wherever there is an opening. Even if your family is nowhere near where they want to send you and you have a fragile spouse with no car and not able to use public transit, that is where you go. Take it or pay the hospital per diem ($400) normally covered as part of our health benefits. The homes with vacancies tend to be the for profit homes as, during covid, they had a much worse mortality than did the not for profit or the municipally run homes (See table 2).

I would appreciate comments from those of you outside of Ontario on what the situation is like in your jurisdictions. Ontario, after all, has the largest share of the total Canadian GDP at 38.59% or $891,811 million compared to the other provinces and territories.

Surely, we can do better.

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Guest Blog – Addictions and Mental Illness: Five Years On, We Still Need To Stick Together

By: Angie Hamilton, Executive Director, Families for Addiction Recovery (FAR)

Once again, thanks Marvin Ross for this opportunity to respond to The Pitfalls of Supportive Housing, Part 1 and Part 2. This feels like déjà-vu. In 2017 I wrote Addictions and Mental Illness: We Need to Stick Together in response to  Addictions and Mental Illness Do Not Belong Together, Part 1 and Part Two.

David Ross, and everyone else living with mental illness, addiction or both, deserve a safe home and community. We have health laws and a Mental Health Act that are supposed to keep people with a “mental disorder” safe from themselves and others, and others safe from them. Sadly, these laws, as currently drafted and/or applied, are not keeping people safe.

It is not the job of those who are afflicted to fix these laws and how they are applied. It is the job of our governments, those who elect them, and the health care professionals who are responsible for interpreting and applying these laws. And there is growing recognition within the medical community that they have not been providing those with addiction the same protections under the Mental Health Act as those with other mental health conditions.

So, it is discouraging to see those who struggle with addiction being blamed and stigmatized for this sad state of affairs, especially by a psychiatrist. I have attached a response from two members of FAR’s Advisory Board, one an addiction medicine physician and the other a psychiatrist, which explain that addiction is a treatable chronic illness, like other mental health conditions. They also explain that concurrent conditions, where a person has an addiction and another mental health condition, are very common and that both conditions need to be treated together.

A recent Guest Essay in The New York Times by a member of their editorial board illustrates that:

  • addiction is a pediatric illness;
  • most continue to view it as a moral failing or lack of willpower;
  • addiction psychiatry did not become a subspecialty until 1993;
  • few psychiatrists are trained to treat addiction;
  • a functioning, evidence-based system of care for addiction does not currently exist;
  • those with concurrent conditions are less likely to get any treatment; and
  • addiction receives only a fraction of the resources expended on other mental health conditions.

In Part Two, Dr. Dawson states that those with severe mental illness are vulnerable and easily victimized by “unscrupulous addicts and dealers”. Are those who also struggle with addiction not doubly vulnerable and at risk of being victimized? In fact, Marvin Ross refers to seven deaths at Parkdale Landing. One was natural causes. It is entirely possible that all of the other six deaths were of those struggling with addiction; three were suspected overdoses, two were suicides and one was murder, presumably of Michel, who used substances.

This raises a question about the state of our drug policies that further harm those with addiction. Decriminalization of the possession of drugs for personal use, together with strict regulation, would help address some of the concerns raised about supportive housing. The federal government has started down this path by decriminalizing possession of drugs for personal use in BC. Other jurisdictions will likely follow. Safer supply programs are an acknowledgement that one of the best ways to protect people who use illegal substances from overdosing is to ensure that they receive a regulated supply. In fact, it is the increased toxicity of the drug supply that has been identified as the cause of the increase in overdose deaths, not an increase in addiction.

Shockingly, acute drug toxicity has been the leading cause of death of Ontario youth aged 15-24 since 2017. This equates to roughly 1 in 4.5 deaths in this age group. The second leading cause of death is asphyxiation. Let that sink in.

Where we can agree is that those who struggle with a severe addiction and who are in early recovery are often not safe in the community where illegal and legal substances are easily accessible. A locked psych ward, however, is most likely not what they need. We need appropriate residential treatment facilities available on demand. Further, if they are not seeking treatment but meet the criteria of harm to self/others under the Mental Health Act, we need to amend that Act to ensure that a locked psych ward is not the only place that they can receive the care that they need. For example, for youth this could be a therapeutic boarding school.

Response from Dr. Mel Kahan, Addiction Medicine Physician

I am an addiction physician. I would like to address several errors in The Pitfalls of Supportive Housing, Part 2. The author states, “While we do not have a specific and effective treatment for addiction…” In fact, there are a number of highly effective treatments for addiction. For example, Opioid Agonist Treatment with methadone and buprenorphine has been shown to markedly reduce opioid use and its consequences, including overdose deaths, suicides and hospitalizations. Anti-craving medications such as naltrexone have been shown to improve drinking outcomes and reduce alcohol-related hospitalizations.

The author seems to believe that addiction is a lifestyle choice, not an illness or a disorder. On the contrary, there is strong evidence that genetic and neurological factors play a key role in the development of addiction. People with a strong family history of alcohol use disorder are far more likely to develop an alcohol use disorder themselves. This is, in part, because they have a different neurological response to alcohol – they have a higher tolerance to the effects of alcohol and they enjoy it more than the average person. Of course, psychological factors play an important role; people who have had a traumatic childhood are more likely to develop a substance use disorder. But this is also true for mental illnesses such as clinical depression.

Addiction is, at its root, a disorder of volition. Drugs of abuse “hijack” the brain’s reward pathway, causing the executive functions of the brain to drive the person to seek drugs. Other physiological processes, including tolerance and withdrawal, perpetuate and worsen addictive behaviours.

The author claims that the merging of addiction and mental health means reduced funding for mental health care and treatment. This is not true. Both mental illness and addiction treatments are dramatically underfunded relative to their impact on mortality, morbidity and health care utilization. Private donors and governments underfund mental illness and addiction treatments for the same reason: Stigma. Reducing funding for addiction treatment will not result in more funding for mental illness treatment, but it will severely harm the mentally ill. People with mental illnesses often use substances to control their symptoms, yet their substance use can worsen their symptoms and reduce compliance with treatment. Patients with both mental illness and addiction need effective, high-quality treatment of both disorders.

Mel Kahan, MD CCFP FRCPC

Medical Director

META:PHI program (Mentoring, Education and Clinical Tools for Addiction: Partners in Health Integration)

Response from Dr. Tony George, Psychiatrist

First, people with serious mental illness like schizophrenia, bipolar disorder, PTSD and chronic depression have high rates of addictions – cannabis, cocaine, opioids, alcohol thus worsen their psychiatric illness, and lead to poorer outcomes including quality of life. Therefore, treating these conditions together is essential, and thus it behooves us to build a mental health treatment system that embraces addictions as part of the mental disorder.

Moreover, there is substantial evidence to support the assertion that addiction (the negative psychosocial consequences of drug and alcohol misuse) has an involuntary component, which CAN be successfully treated by medications and behavioural supports (e.g., addiction counselling). This is especially true for serious addictions (e.g., opioid use disorder) and concurrent mental and addictive disorders. While there is a voluntary (choice) element to drug use, it is clearly overcome when this progresses to an addiction (e.g., a substance use disorder, as defined by the DSM-5 of the American Psychiatric Association).

Tony P. George, MD FRCPC

Professor of Psychiatry,

University of Toronto

Clinician-Scientist, CAMH

Scientific Advisor, Families for Addiction Recovery (FAR)

The Pitfalls of Supportive Housing – Part One

Marvin Ross

Parkdale Landing CATHIE COWARD/HAMILTON SPECTATOR FILE PHOTO

Operating supportive housing is not easy as my family has learned the hard way. As the headline in a recent Hamilton Spectator expose stated:

“Hamilton’s Parkdale Landing was to provide safer supportive housing — but then a murder happened”.

The subhead said “A look inside Indwell’s Parkdale Landing, where drug-dealing visitors have posed such challenges the non-profit says it will never build another home like it.”

This is the link to the story which is behind a paywall but if you have a Toronto Star account, you should be able to read it.

Indwell is a Christian charity that buys up properties and renovates them into very nice residences for the homeless and/or those needing a place to live because of disabilities. The acquisition and renovation they do well but from my own personal experiences, that is all they do well with the $14 million in grants that they get from all three levels of government.

Indwell had been highly recommended to us and so my son applied, waited 3 or 4 years, was interviewed after a visit by us and his caseworker from St Joseph’s Hospital Schizophrenia Outpatient Clinic. He was accepted and moved into a very nice brand new bachelor apartment when Parkdale Landing first opened in September 2018. In November, he woke up, exited his apartment and was met by a hall full of police and forensics personnel as his neighbour across the hall had been found murdered and hog-tied in his bathroom.

OK. Stuff happens wherever you live but this turned out to be the start of a horrendous living experience. Drug use, prostitution, drug dealing, violence, threats, were all regular occurrences and staff were helpless. My son had break ins, stuff stolen, threats and little was done by staff. I have a chronology of much of my correspondence with staff in a PDF file including my snarky comment that I hope the person who stole my son’s medication blister pack gets some use out of his Abilify (an antipsychotic).

Staff admitted there were problems and they were working on them while the police told me that Indwell did not do enough to make the building safe. Indwell said it was all a police matter and one desk sergeant wondered why anyone would live there. One cop offered to take my son to a safe place for the night on one occasion.

At one point, residents circulated a petition asking that a security guard be employed but they were turned down. There is one there now.

When the Spectator reported on the trial in November, 2021, all that my son had reported was verified and staff at the Schizophrenia Outpatient Clinic told me they were stunned. This is the link to that article which may still be behind a paywall. Here is some of what was testified to in court:

Nearly all residents and visitors who have testified admitted to being drug users and, in some cases, dealers.

Security video from the hallway in the 28 hours leading to Michel being found shows people going between units at all hours.

Suzanne Maye knocked on Michel’s door asking for a morphine pill.

He didn’t give it to me because he only had one left,” she testified. “There was a homeless guy there. I think, George.”

Maye told the jury she was high that night and her memory is hazy.

Crystal meth. I was up for two or three days … I don’t remember yesterday, never mind three years ago.”

Early on the 30th, David Herak — a drug dealer then — knocked on Michel’s door while Beverly Staines watched. Opassinis let him in.

Staines, high on crack and owed $20 by Michel, wanted in too.

I tried to squeeze in, but I got shoved out.”

Herak came out barely a minute later. He had seen Michel and knew he was dead.

I had mentioned the Indwell problems to the editors I’ve worked with at the Hamilton Spectator and then contacted the reporter who covered the trial. After the guilty verdict, she told me she wanted to write an article about Indwell once the person was sentenced. She mentioned that she always thought Indwell did good work and was now shocked to learn what was really going on.

Meanwhile, Indwell put up a new building next door for people who were more independent and my son moved there into a one bedroom. The problems are not as bad but they are not great. I did request police statistics for both buildings under freedom of information which were used in the Spectator article and are shocking.

In Parkdale Landing from Sept 2018 to February 24, 2022, there were 1,261 emergency calls to the building or one per day. The most frequent was ambulance. 103 criminal charges were laid mostly for fail to comply with a probation order and there were seven deaths – one murder, two suicides, two overdoses, one natural causes and one undetermined but likely an overdose.

In the new building from December 2020 to February 24, 2022, there were 302 emergency calls, 21 criminal charges mostly fail to comply and no deaths.

My son, David, is quoted in the article and said:

I wanted a place where people with drug addiction problems and mental illness can live happy and more productive lives,” he says. “There was a murder. There were overdose deaths from heroin. There were fights. There was a suicide.”

I wanted to keep things quiet. Low key.”

People were always going door to door, knocking on the door and shouting about drugs. There were some really bad times there.”

He says visitors caused problems at Parkdale. “They’re homeless and they’re crashing at their friend’s house.”

Go out at the wrong time of day and you’d be assaulted for $5 in your pocket. If I went outside for a cigarette, I wouldn’t feel safe.”

He felt that way despite police being at Parkdale on an almost daily basis, he says.

Ross didn’t witness anything the night of Michel’s murder. When he opened his door the next morning, there were police officers in the hall. When he learned what happened, he says he felt “disturbed, not safe.”

Ross never really knew Michel, but he was friends with another tenant who died of a drug overdose at Parkdale.

I didn’t belong at Parkdale,” Ross says. “They lump mental illness and drug and alcohol addiction together. That’s just stupid. It’s not working.”

Since the article appeared, he has had some residents thank him for what he said and one person told him that he would like to move but he has nowhere to go.

Indwell has been trying to evict some tenants but has difficulty doing so I’m told but, given that they screen potential residents, they should be doing a better job of it. Since that article appeared, there was a stabbing at the back door of the building. One person was arrested but the badly injured victim ran off and the police are looking for him.

This is not the way to run supportive housing and, as a taxpayer, I resent the amount of money given to an agency that cannot get it right. One lawyer I consulted wondered why residences like this are not inspected by some level of government who fund them and that is a very good question. Do our ill relatives not require the assurance of safe, proper housing to live in?

Indwell promotes its housing as harm reduction but from what I’ve seen, that means lectures on the safe use of drugs and the supply of naloxone kits. Since all their bad publicity, they are now saying that their homes provides enhanced programs that wrap tightly around the tenant. I’m not sure what that means and there are no examples on their website but it is something they should have been doing from the outset.

The one thing that they should not have been doing is mixing residents with different problems and needs in one place. People with serious mental illnesses with no illicit drug use (like my son) are quite different from those with addictions.

Stay tuned for Dr David Laing Dawson’s comments on this and similar situations coming shortly.

And, as this is mental health month, please take a look at our  Discount on All Our Top Rated Kindle Schizophrenia Books. See https://www.prlog.org/12915487.html

Housing First or Treatment First? The $64,000 Question.

Marvin Ross

Or, what comes first, the chicken or the egg. Homelessness is a growth industry over all of North America and is likely being made worse by Covid. Most of the homeless, however, are in that situation because they suffer from untreated mental illness, addiction or both. I really don’t think that anyone would dispute that but what almost everyone misses is that the solution lies in proper TREATMENT. And ongoing TREATMENT AND SUPPORT.

In Toronto recently, the police moved in on a homeless shelter near a soccer stadium to dismantle it and scatter the residents. This is happening in many cities in North America but what made this unique is that supporters came out to try to thwart the effort. Toronto Star columnist, Heather Mallik, reported that protesters came out, fought with police and got arrested trying to prevent the homeless from being moved.

She commented that:

“So why do social justice activists want the homeless to stay put? Because some homeless people say they do, even if they are unwell and hardly the best judge of their own welfare? Protesters, not as woke as they think they are, were arrested for trespassing and assaulting cops rather than doing something useful and taking people into their own home. I’m not sure what cause protesters ultimately serve although they are cement-based certain that it is admirable.”

Earlier, another Toronto Star columnist, Rosie Dimanno, spent a night in a homeless camp in another Toronto park and the experience scared her. As she said, the homeless are examples of the twin urban plagues of mental illness and housing shortages. Our solution tends to be to find shelters wherever they can be found like in underused motels and other such venues.

But without treatment to deal with the untreated mental illnesses and addictions, this will not work. A recent article in the Los Angeles News made that point very persuasively. Paul Webster, the founder of Hope Street Coalition points out that pouring money into the problem is a waste and is a poor substitute for treatment:

The use of terms like “supportive services” and providing housing for those with “mental health disabilities” and “addiction disabilities” make it seem that the needs of the mentally ill and addicted will be met. But the seriousness of chronic, life-long illness like substance use and schizophrenia and related brain disorders, defy being lumped in with economic hardship; they need a whole different approach focusing on housing combined with clinical treatment and intensive supportive services.”

My own knowledge of a supposed supported housing project in the city I live in is a perfect example. The organization which gets millions from governments to put up housing totally fails when it comes to supports. The buildings I’ve seen are beautiful but nothing is done for the tenants other than to say that for those with substance abuse its philosophy is harm reduction.

From my view through a resident, the harm reduction consists of lectures on safe drug use and passing out naloxone kits. Shortly after the building opened, a tenant was murdered and there have been assaults and one rape that I am familiar with. Overdoses are common, frequent and there have been numerous deaths. And while there is no one definition of harm reduction, it:

“encompasses a range of health and social services and practices that apply to illicit and licit drugs. These include, but are not limited to, drug consumption rooms, needle and syringe programmes, non-abstinence-based housing and employment initiatives, drug checking, overdose prevention and reversal, psychosocial support, and the provision of information on safer drug use. Approaches such as these are cost-effective, evidence-based and have a positive impact on individual and community health.”

A recent article in Psychiatric Times points out that Canada has implemented three very novel and successful harm reduction strategies involving providing safe pharmaceutical grade heroin, pharmaceutical grade injectable hydromorphone and supervised consumption facilities.

Had this agency supported these strategies, a number of lives would have been saved.

But then, the other problem is that the building houses those with a drug problem and those without but with serious mental illnesses. The mentally ill without drug use are left to fend for themselves in an environment that, at times, is violent and where there is considerable illegal activities needed to support illicit drug habits.

What is happening today is an enormous regression from how supported housing worked, in this city at least, a number of years ago. Hospitalized mentally ill were kept in hospital long enough to be fully stabilized. Today, they are discharged far too early because of the lack of beds. Before, when discharged, their transition to housing involved a specialized team of nurses, social workers and rehab specialists to ensure adequate support when life skills were deficient and continuity of treatment.

No model currently exists for those living in the community or who are homeless and probably not being adequately treated. For them to be successful in housing, they need proper supports and continued treatment. The addicted tend to be manipulative, criminal and potentially dangerous in order to support their drug habits. Putting the two together is a recipe for disaster and no one wins.

Money spent on the program is wasted when it does not have to be that way. I should also add that my latest information is that marked and unmarked cruisers sit for hours watching the building. Another wasted use of resources and expense.