Mental Health Care for Homeless Youth: A Demand for Action and Equity

Canadian Observatory on Homelessness, York University
April 06, 2017

For many years, we have known that youth experiencing homelessness face significant mental health challenges. However, it wasn’t until the release of Without a Home: The National Youth Homelessness Survey (2016) that we learned about the national scale of this issue. The mental health findings of this pan-Canadian study are shocking:

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    Media Folder: 
    85.4% of homeless youth were experiencing a mental health crisis
  • 42% of homeless youth reported at least one suicide attempt
  • 35.2% of homeless youth reported at least one drug overdose requiring hospitalization

This data makes clear that we are failing some of the most vulnerable young people in our country. The time for change is long overdue.

Based on this study’s findings, today the Canadian Observatory on Homelessness and A Way Home Canada launch a policy brief on mental health care for homeless youth. In it, we call on federal, provincial, and territorial governments to address the mental health challenges faced by youth who are homeless in Canada. We argue that this requires two key actions on the part of Canadian governments:

  • Federal implementation of a youth homelessness strategy embedded within the renewed federal investment in homelessness, with a special focus on mental health and wellness.
  • Provincial and territorial implementation of provincial/territorial strategies to prevent and end youth homelessness, ensuring that the mental health needs of youth at a high risk of homelessness and experiencing homelessness are addressed both through these targeted strategies and the federal mental health transfer funds.

In the policy brief, we offer six key recommendations to guide government action (outlined below).  Immediate action, with targeted funding at appropriate levels, is necessary if we expect to address the structural issues and systems failures that are driving youth homelessness and the mental health challenges this group faces.

Falling Short: Mental Health Supports for Homeless Youth in Canada

Numerous studies have shown that the majority of homeless youth experiencing mental health issues and severe mental illness are not receiving any form of treatment or care. For many youth who are homeless, this is an issue of access. 

Young people who are homeless in Canada often struggle to access appropriate services that are equipped to support the co-occurring mental health and addictions challenges they often face. Mainstream services are often inaccessible to youth who are homeless because they have been designed for youth who are stably housed and have natural supports. Age restrictions also create barriers for youth experiencing homelessness, and drug-using youth experiencing homelessness particularly struggle to access services.  According to a large Vancouver study, 64% of street-involved youth reported difficulties accessing health and social services.

Without intervention, homeless youth experience worsening outcomes for their housing, health, and wellbeing. In the absence of mental health supports, these youth are also more likely to develop addictions or substance abuse issues in their efforts to deal with the stress, violence, and stigmatization of living without a home. Unfortunately, Canadian homeless youth mortality data speaks to these shortcomings, with studies that suicide and drug overdose are the two leading causes of death for young people who are homeless. 

The Relationship between Mental Health and Homelessness

Housing status and mental health are inherently linked, and that both are connected to broader structural conditions such as poverty. When a young person faces challenges to accessing secure, adequate, and appropriate housing, they are more likely to face mental health challenges and experience greater difficulty accessing timely, high-quality mental health care. The reverse is also true – youth experiencing mental health issues face unique challenges in obtaining permanent and appropriate housing, including discrimination based on their mental health status.

This close connection between mental health and homelessness means that interventions to address mental health must include housing, and housing interventions to address homelessness must consider mental health and wellness.

Mental Health and Homelessness as Equity Issues

Many of the findings of Without a Home: The National Youth Homelessness Survey demonstrate that both mental health challenges and homelessness are equity issues. Our study found that particular groups of youth are more likely to become homeless, face adversity prior to homelessness, experience greater challenges once on the streets, and experience homelessness for longer. For example, results showed that homeless youth who experienced the greatest mental health challenges included LGBTQ2S youth, Indigenous youth, and young women. This study also found that homeless youth who face the greatest mental health challenges are more likely to:

  • Have experienced adversity prior to becoming homeless, such as physical and sexual abuse or neglect,
  • Become homeless at a younger age, and
  • Experience chronic homelessness and have multiple experiences of homelessness.

Importantly, particular groups of youth, specifically LGBTQ2S youth and Indigenous youth, and more likely to become homeless at a younger age and have multiple experiences of homelessness.

These findings underline something we have known for a long time – access to housing and health care in Canada is in part determined by systems and structures of discrimination and disadvantage based on class, gender expression and identity, sexuality, ethnicity, race, (dis)Ability, and citizenship, among other identities. The inequity manifests itself both within the mainstream housing and health care systems, as well as within the homelessness sector. For example, research has demonstrated that LGBTQ2S youth who are homeless often experience homophobia and transphobia when trying to access services, and studies demonstrate that Indigenous youth are more likely than other homeless youth to have difficulty accessing health services and addiction treatment.

These findings demand action to not only address the mental health and housing issues facing youth experiencing homelessness, but to disrupt the system failures that contribute to inequitable access to housing and health care, including mental health care. 

Time for Action: Why Make an Investment Now?

It goes without saying that all governments and policy makers wrestle with competing claims on their time, resources, and priorities. For those of us seeking political change on urgent social problems, we must be able to answer questions that these actors often ask, such as

  • Why should we invest now?
  • Why should we prioritize investment in this social issue when there are many others that are similarly deserving? 
  • Can this investment address other governmental priorities?
  • What levels of government, and what departments or ministries, are responsible for addressing this issue?

There are at least three key reasons why we should invest now in an integrated systems approach to mental health care for youth experiencing homelessness: 

1. We are Facing a Mental Health Crisis in Canada

  • Approximately 20% of Canadians experience mental health issues (6.7 million Canadians) (MHCC, 2016).
  • 520,000 people living with mental illness in Canada are either homeless or vulnerably housed (MHCC, 2013).
  • In Canada, suicide accounts for 24% of all deaths among 15-24 year olds (Public Health Agency of Canada, 2002).
  • The wait times for mental health care continue to put many children and youth at risk. For example, only 31% of child and youth mental health agencies in Ontario are able to meet the Canadian Psychiatric Association benchmark for wait times (Schizophrenia Society of Ontario, 2008).

2. Investments can Build on Political Momentum at the Federal, Provincial, and Territorial Levels

  • In Budget 2017, the federal government expanded and extended the Homelessness Partnering Strategy
  • Most provinces and territories have established new metal health transfers with the federal government, who earlier this year announced a 10-year, $5 billion investment in mental health services. These new funds provide provinces and territories the opportunity to invest in mental health services for marginalized youth. Importantly, Budget 2017 identified one of the key indicator’s of success as “Shortened wait times for mental health services to help children and young persons under the age of 25 in need of support.”
  • Increasing numbers of communities across Canada are adopting youth homelessness strategies, many of which seek to address the health and mental health challenges faced by youth who are homeless
  • A ‘Systems’ of Care approach has been adopted in some Canadian communities that support strategic and planned approaches to ending homelessness. For example, Alberta’s plan to prevent and end youth homelessness advocates for a System of Care, as does Calgary’s Ten Year Plan to End Homelessness. More recently, the Ontario government also committed to a more integrated response when it announced support for up to nine “one-stop” youth hubs for youth experiencing mental health challenges.
  • An investment in youth mental health will not only reduce youth homelessness, but will contribute to other federal, provincial, and territorial policy priorities, including: illness prevention, youth unemployment, infrastructure, federal-provincial-territorial partnership, and Indigenous issues. 

3. Investing in Mental Health is Cost-Effective

  • The economic cost of mental health problems and illnesses to Canada is at least $50 billion per year in lost productivity – 2.8% of Canada’s 2011 gross domestic product (MHCC, 2016).
  • The economic burden of mental health is enormous compared to other diseases. In Ontario, for example, the burden of mental health and addictions is 1.5 times that of all cancers, and more than seven times that of all infectious diseases (Ratnasingham et al., 2012).
  • Improving a child’s mental health from moderate to high can lead to lifetime savings of $140,000 (MHCC, 2013).

What should we do?

In our policy brief, we outline the following recommendations for federal, provincial, and territorial action that are necessary to drive positive change for youth experiencing homelessness and mental health issues: 

Recommendations for Government

Government of Canada

  1. Federal leadership in the development and implementation of a National Youth Homelessness Strategy to prevent and end youth homelessness, supported by a targeted investment.
  2. Federal prioritization and support for systems integration at the provincial, territorial, and community levels to address the mental health needs of youth experiencing homelessness.
  3. Federal support for program models that focus on prevention and rapid exits from homelessness for youth, within which strategies for addressing the mental health needs of youth should be embedded.
  4. Federal adoption of a youth-centered approach to addressing youth homelessness, grounded in human rights.
  5. Federal commitment to addressing the unique needs of diverse youth experiencing homelessness, as reflected in both policy and funding.
  6. Federal adoption of a national research strategy focused on youth homelessness in order to advance an integrated systems response, within which a mental health strategy is embedded in all elements. 

Provincial and Territorial Governments

  1. Provincial and territorial development and implementation of strategies to prevent and end youth homelessness, supported by a targeted investment. 
  2. Provincial and territorial prioritization and support for systems integration in all efforts to address the mental health needs of youth experiencing homelessness.
  3. Provincial and territorial support for program models that focus on prevention and rapid exits from homelessness, within which strategies for addressing the mental health needs of youth should be embedded.
  4. Provincial and territorial adoption of a youth-centered approach to addressing youth homelessness, grounded in human rights.
  5. Provincial and territorial commitment to ensuring that all provincial, territorial, and community strategies and program responses address the unique needs of diverse youth experiencing homelessness.
  6. Provincial and territorial knowledge development and data management specific to youth homelessness in order to advance an integrated systems response, with a special focus on youth’s mental health and wellness.

Kaitlin completed her PhD in Social Work at the University of Toronto where her research focused on Canadian homelessness, activism, and social change. She recently joined the COH team at York University as a postdoctoral fellow. Her postdoctoral work focuses on knowledge mobilization and research impact in the area of homelessness.

Kaitlin has worked on research teams addressing a range of social justice issues, including gender equity, cyber bullying, sex trafficking, arts-based programming with youth experiencing homelessness, and social assistance in Canada’s North. Using her background in the arts, Kaitlin also runs jewelry making workshops for women experiencing homelessness and owns a jewelry company called Fierce Deer, through which she employs folks who face barriers to entering the work force.

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