Research Matters Blog

York University; Canadian Observatory on Homelessness
September 26, 2016
Categories: Topics

The first week of October marks Mental Illness Awareness Week, an initiative coordinated by the Canadian Alliance on Mental Illness and Mental Health to promote the reality of mental illness to all Canadians. The stigma against mental illness is strong, thus it is important to provide a snapshot to demonstrate what mental illness truly looks like, who it affects and how it can be addressed.

According to the Mental Health Commission of Canada:

  • One in five people in Canada will experience a mental illness in any given year, with a cost of over $50 billion to our economy.

  • 70% of adults living with a mental illness say their symptoms started in childhood.

  • 60% of people with a mental illness won’t seek help for fear of being labeled.

  • 500,000 Canadians, in any given week, are unable to work due to mental illness.

  • One in three workplace disability claims are related to mental illness.

These figures provide just a quick overview of the level at which mental illness affects the general population of Canada. Of particular concern, however, is the ability for individuals to access treatment and how accessibility varies across gender, race, age, sexual orientation, location and socio-economic status, such as whether an individual is facing homelessness.

Research shows that people experiencing homelessness tend to have poorer mental health and have higher prevalence of mental illnesses than the general population. For some, mental illness along with other structural issues such as a lack of adequate income, access to affordable housing, health supports and/or the experience of discrimination may result in homelessness. For others, mental illness may develop and/or worsen as a result of experiencing the stressors of homelessness, such as being at greater risk of criminal victimization, sexual exploitation and trauma. However, not all people who are homeless report a mental illness. Individuals experiencing chronic homelessness (homeless for a year or more, and most often for a long time) are usually the most affected, where 35-50% have schizophrenia, 38-48% have manic depression or bi-polar disorder and many experience concurrent conditions as well. Substance use and addiction is also highly prevalent, where one study in Calgary found that 80% of chronically homeless individuals faced issues with addiction.

Services available

Access to mental health services in Canada varies from each province and territory. Generally, seeing a psychiatrist requires referral via a family doctor and is covered by provincial and territorial health plans. Individuals may access services of other mental health professionals within the community such as counsellors, helplines, social workers, mental health services within educational institutions and psychologists. These services, however, are not covered by provincial or territorial health plans but may be offered at no cost if operated through government-funded hospitals, clinics or agencies. Mental health services delivered through private practice such as a psychologist or psychotherapist are also not covered by provincial or territorial health plans. In Ontario, for example, fees for private psychologists or psychotherapists practitioners may range from $40-$200/hour.   

Barriers to service

Despite the various service options available for mental health care, access to care for some individuals can be a significant challenge.

For instance, an Ontario study found that wait times to see a psychiatrist via family doctor referral was approximately 50 to 60 days. Furthermore, wait times may significantly impact those who face lower socio-economic status. One Toronto study found that individuals from affluent backgrounds with less severe psychiatric disorders had regular access to psychiatric treatment and often accessed treatment without a referral. On the other hand, individuals from a lower socio-economic status and experiencing more severe and persistent mental illness had longer wait times and received less treatment.

In addition to wait times, individuals who are unhoused and facing mental illness tend to face quite a few barriers to accessing the services they need:

  • People experiencing homelessness and mental illness are admitted to hospitals 5 times more than the general population, with mental illness accounting for 52% of ER visits.

  • 25% of homeless individuals cannot access health care or treatment due to missing health cards, no proof of health insurance coverage or cannot afford prescriptions for medication.

  • Only 45% of individuals experiencing homelessness have a family doctor (compared with 94% of the general population), acting as a barrier to care considering a family doctor referral is usually required to access psychiatric services.

  • When accessing the ER, studies have found that unhoused individuals with addiction issues often face stigmatization due to the criminalized status of certain illicit substances.

  • Individuals facing mental illness and homelessness might also face barriers of ageism, racism, sexism and discrimination when visiting the ER.

  • Indigenous peoples experiencing homelessness in particular have found issues with accessing services due to racism and lack of cultural understanding on the part of health professionals.

  • Homophobia and transphobia are cited as barriers to care, where LGBTQ2S individuals may feel stress, anxiety or fear in disclosing their sexual orientation with their physician due to fear of being ‘treated’ for their sexual orientation, rather than their mental health needs.

  • Accessing care is particularly difficult for those in remote communities, where individuals cite long wait times, difficulty finding or booking a family doctor and an inability to afford transportation to larger cities as barriers.

  • For homeless youth, difficulty in navigating health care systems, distrust of adults, stigma associated with homelessness, fear of judgment and fear of being reported to child welfare services all act as barriers to accessing services.

What can be done

In light of the barriers to mental health care discussed, critical and effective work is being done by several community agencies to combat the issues highlighted above. For instance, organizations that utilize a Housing First approach demonstrate the most promising results in providing, addressing and alleviating mental illness among individuals experiencing homelessness.

A Housing First approach simply means providing unhoused individuals with homes without being contingent upon ‘readiness’ or sobriety. Housing First also incorporates choice and self-determination, harm reduction, social and community integration and individualized support services (such as providing mental health services), all of which are key to providing an effective and realistic response to homelessness. Indeed, evidence shows that securing stable housing is associated with reduced psychological distress among homeless individuals and plays a role in supporting individuals recovering from mental illness.

Not only has Housing First been successful in improving an individual’s mental health, but it is also the most cost-efficent option. One study found that the cost of ‘housing’ an individual in jail, hospital or shelter system were the most costly options, ranging anywhere from $13,000-$120,000 per person per year. Alternatively, supportive and transitional housing as well as affordable housing without supports were the most cost-efficient options, ranging from $5,000-$18,000 per person per year.

Housing First Case Study, Streets to Homes (S2H) Victoria BC

Initiatives like S2H (Street to Homes) that utilizes a Housing First framework in addressing chronic homelessness in the Greater Victoria area have had promising results. For example in 2012, 73% of their residents who went through the program are still housed and 63% of participants received increased access to mental health and addictions supports.

Despite the prevalence of mental illness today and the barriers that particularly individuals of lower socio-economic status face, several community groups and health practitioners are making great strides in addressing issues that affect a large portion of Canadians. However, like any social issue, a multi-faceted approach that includes combating the stigma around mental illness, making access to mental health services prompt and efficient as well as creating secure and stable employment and affordable housing are all critical steps that need to be taken to guarantee a high quality of life accessible to all Canadians.

Visit the Canadian Alliance on Mental Illness and Mental Health to learn more about Mental Illness Awareness Week and what you can do to help.

Canadian Observatory on Homelessness/Homeless Hub: York University
September 23, 2016
Categories: Ask the Hub

The following question came from Natalie D. via our latest website survey: “What is the effectiveness of non-Indigenous organizations in meaningfully supporting Indigenous people? Is there a need for the homelessness sector to support the development and delivery of programs that are culturally relevant?”

In Canada, the social services sector is known for being dominated by people who are white and middle class. (In one U.S. study, researchers found that while most social service agencies served 2/3 people who were visible minorities, the majority of staff were white and of European descent.) And according to Statistics Canada, the social service sector is 77% female. Given the country’s vast diversity, especially in major cities, many employees and service users are from non-Western cultures. So the need for employees and on a wider scale, entire organizations, to be aware of cultural differences, is absolutely necessary.

Groups that tend to be marginalized—non-English speakers, racialized communities, newcomers, and those experiencing homelessness—tend to have poorer health outcomes than others. This is also the case for Indigenous peoples in Canada, who are over-represented in the homeless population, and are more likely to live in poverty than people who aren’t Indigenous. All of these factors lead to a great need for services that are accessible and culturally relevant.

Organizations that primarily employ people who haven’t been marginalized can still serve others, but generally: the more diverse the organization, the better. In healthcare research, there’s evidence showing that: “Current prevalent models of health and social service provision, which largely reflect white, middle class values, do not effectively meet the needs of ethnically and racially diverse groups.” Indeed, Indigenous groups and organizations have been saying this for some time. This, combined with the importance of self-determination and holistic care for Indigenous people, has inspired the creation of many independent, Indigenous-led social service organizations.

When white-dominated organizations make efforts to meet cultural needs, service use tends to increase. One 1986 California study found that “…a culturally compatible approach to services was effective in increasing utilization. Several program components were identified as the best indicators of increased utilization: language and ethnic/racial match of therapists and clients, and location of services in the ethnic community.” A more recent study in three British Columbia communities concluded that more culturally appropriate services are needed for Indigenous peoples.

It makes sense that when service users can understand and access services that use would increase—but it often requires making large organizational changes and focusing on “cultural competency” or “cultural safety.”

The rise of cultural awareness and competency

In the 1980s, many academics began writing about the need for “cultural competency” in social service organizations. Betancourt, Green and Carrillo (2002) define cultural competence (in health care) as: “…the ability of systems to provide care to patients with diverse values, beliefs and behaviors, including tailoring delivery to meet patients’ social, cultural, and linguistic needs.” They defined the main barriers to culturally relevant care as:

  • Lack of diversity in health care’s leadership and workforce.
  • Systems of care poorly designed to meet the needs of diverse patient populations.
  • Poor communication between providers and patients of different racial, ethnic, or cultural backgrounds.

To address these barriers, they recommend meaningful community involvement, assessments and evaluations; and adopting practices like tracking language preferences and making them available (whether through staff or interpretation services). While their work took place in the U.S., such definitions can be expanded to Canadian social services, where organizations face similar issues.

In 2016, Wong and Omori wrote that: “The purpose of cultural competency is to make healthcare services accessible, acceptable, and effective for all people, regardless of their cultural background.” Their study addressed homelessness as its own unique culture, and advocated for healthcare workers to be aware of broad trends (like higher instances of cardiovascular disease), but also to learn from each individual about what’s important to them and what matters in terms of their care.

Concept map of issues discussed in the Our Health Counts study: poverty, housing, impacts of colonization, government responsibilityMaking services culturally safe

More recently, many academics and reports are using the term “cultural safety.” According to the Nursing Council of New Zealand (2005):

Cultural safety is defined as effective practice determined by the individual and family. “Unsafe cultural practice comprises any action which diminishes, demeans or disempowers the cultural identity and well-being of an individual (From: Understanding Cultural Safety: Traditional and Client Perspectives).

Most literature on cultural safety focuses on its importance with Indigenous peoples, who face unique challenges due to ongoing colonization. In a 2016 study, Oelke, Thurston and Turner proposed a framework to address structural violence against Indigenous peoples. They found that best practices included:

...ensuring cultural safety, fostering partnerships among agencies, implementing Aboriginal governance, ensuring adequate and sustainable funding, equitable employment of Aboriginal staff, incorporating cultural reconnection, and undertaking research and evaluation to guide policy and practices related to homelessness among Aboriginal peoples.

The Our Health Counts study from Hamilton, Ontario, was conducted by Indigenous organizations and also cited cultural safety as an important factor in healthcare. The writers also recommended emphasis be placed on Indigenous-specific services, as well as support for self determination. (The concept map from that study is pictured right, illustrating the different topics connected to social and healthcare services.)

In terms of housing services, challenges go way beyond policies and structures. In her article on cultural safety, housing and health, Christensen (2016) points out that the concept of “home” is different for many Indigenous people:

While ‘home’ is conceived of and experienced in different ways between and within the ethnic and cultural bounds of the Dene, Métis and Inuit, certain elements, like the land and the family, thread them together. Keeping in mind these shared components in Indigenous senses of home reveals the broader significance and meaning of Indigenous experiences of ‘homelessness’. Attacks on the family and on Indigenous homelands through colonial processes of domination and dispossession are therefore deeply implicit in Indigenous experiences of homelessness. In interviews and focus group discussions, the concept of ‘home’ was never limited to four walls and a roof: home was also closely linked to positive, healthy relationships with family and friends, physical and mental health and wellbeing, strong cultural ties, and self-determination.

Furthermore, public housing policies also contribute to homelessness for Indigenous people. Those wishing to stay with family or friends in public housing are often forced to leave after two weeks, else the original tenant(s) may get evicted. Another policy that causes issues is that when children are apprehended by the child welfare system, parents are no longer eligible to stay in family units. In Christensen’s words: “Due to the dismal numbers of single-adult dwellings in public housing in the NWT, the apprehension of children into child welfare often leads directly to the homelessness of parents.” Other interviewees from her work include women who move from their rural communities to Yellowknife, where their children live in foster care, in hopes of remaining close and regaining custody—which also often leads to homelessness.

Christensen proposes the following changes (and more) to make housing services more culturally appropriate:

  • Flexible housing policies that let tenants self determine their needs.
  • Services that not only address physical homelessness, but also spiritual homelessness.
  • A focus on integrated approaches to rebuilding parental-child relationships.
  • Meaningful and continuing involvement of Indigenous governments, ensuring a better emphasis on Indigenous knowledge and practices being included in policies

In other words: acknowledging cultural differences and the consequences of colonization, and changing housing services accordingly, are an important step in improving housing outcomes for Indigenous peoples.

“Nothing about us without us”

Being aware of cultural and historical differences is important, but not as crucial as including service users (in this case, Indigenous peoples) in design, delivery and assessment of services. A lot of the work I do as a social worker in-training is in harm reduction, where “nothing about us without us” is a cornerstone of how we build and run various programs. This message is applicable to any group of people in need of such services, like newcomers, Indigenous people, drug users, and people experiencing homelessness in general. Homelessness itself is a culture, one that includes survival tactics and other strategies/practices that people who haven’t experienced it may not know much about—so it’s important to get input from and employ people with that experience.

The Homelessness Resource Center (HRC) makes similar recommendations in its guide on building culturally competent services for LGBTQI2-S youth. As Youth on Fire is quoted:

Hiring staff who identify as GLBT sets a positive tone for the space. When almost half our members are queer, it is really important to have staff that identifies the same way. You can put up a poster or change the rules, but the best way to signal that you’re a safe space is to have someone on staff who is GLBT. It also helps the young people trust the rest of the staff, because acceptance is now signalled as a genuine priority.

Along with hiring staff from within communities, the HRC recommends seeking staff who are open-minded and willing to learn. Not everyone will have the same lived experience, but a true commitment to learning and growth can go a long way to ensure services are accessible and safe.

Inclusion not only allows service users to find employment and be involved in how programs and services are run, it gives organizations the required lived experience and input they need to make said programs and services more effective.

More resources on cultural competence

Image: Our Health Counts

This post is part of our Friday "Ask the Hub" blog series. Have a homeless-related question you want answered? E-mail us at thehub@edu.yorku.ca and we will provide a research-based answer.

York University
September 20, 2016

There is good news in Canada.  The federal government has recently launched a welcome consultation process to inform Canada’s first National Housing Strategy. Among the list of potential outcomes, the Government has indicated a desire to ensure “homelessness in Canada is rare, brief and non-recurring.” While it is good news that the government sees addressing homelessness as a key part of the National Housing Strategy, it does raise a question: “How exactly do we make this happen?”  

Herein lies an opportunity to reimagine our response to homelessness; to innovate. While in recent years we have welcomed a shift from simply managing the problem of homelessness to working harder to move people out of homelessness through Housing First, there is still a need to do more.  In other words, it's not enough to simply wait until people fall into homelessness and experience declining health and well-being before we help them. If housing is in fact a right (and Canada is a signatory to many international treaties and conventions that declare this) it is not good enough to wait for people to be in deep trouble before we respond to their need.  Instead, why don’t we do something to prevent people from becoming homeless in the first place?

That is the realm of prevention.  In the United States as well as Canada there has long been a reluctance to really address homelessness through preventive measures.  Part of the problem is a lack of clarity about what homelessness prevention involves.

A true homelessness prevention framework is a multi-faceted, layered approach. While working upstream to prevent new cases of homelessness is a key facet of prevention, a more nuanced prevention model is required to effectively address homelessness.

Defining Prevention

Based on well-established public health research, there are three categories of prevention: 

  1. Primary Prevention: Addressing structural and systems factors that more broadly contribute to housing precarity and the risk of homelessness.
  2. Secondary Prevention: Strategies and interventions directed at individuals and families either at imminent risk of homelessness or who have recently experienced homelessness, such as early intervention and evictions prevention.
  3. Tertiary Prevention: Supporting individuals and families who are chronically homeless to access housing and supports, thereby reducing the risk that they will become homeless again.   

A Typology of Homelessness Prevention

The Government of Canada asks “How can federal, provincial and territorial governments and other stakeholders better support Canadians who are homeless or at risk of being homeless?” The answer lies within the five categories of prevention:

  1. Structural Prevention
  2. Institutional Transition Support
  3. Early Intervention Strategies
  4. Eviction Prevention
  5. Housing Stabilization

The 5 types of prevention

Embracing Prevention in the National Housing Strategy

In early 2017, the Canadian Observatory on Homelessness will release a robust Homelessness Prevention Framework. The framework will serve as a roadmap as we collectively embrace prevention-focused responses to homelessness. However, we need not wait. Now, while the Government of Canada is shaping the National Housing Strategy, is the time to commit to homelessness prevention.

Take, for instance, structural prevention. How might this contribute to the goals of the National Housing Strategy?  

Indisputably, an effective National Housing Strategy must confront the large-scale structural drivers of housing instability and homelessness. The most obvious structural contributor to homelessness is the lack of affordable housing. Increasing the supply – a cornerstone of the proposed housing strategy – is an essential pursuit.

But within our proposed prevention framework, structural prevention goes beyond affordable housing. Complementary solutions to address other structural causes of homelessness – such as poverty reduction, violence reduction and anti-discrimination work – are required.

By embracing strategies that mitigate the economic and societal conditions that contribute to homelessness, the National Housing Strategy will prevent new cases of homelessness - our best avenue to ensure homelessness is rare, brief and non-recurring.

However, we know that structural prevention alone won’t solve homelessness. The National Housing Strategy must embrace a more inclusive definition of prevention.  Institutional transition support, for example, is required to prevent the systems failures that lead people leaving institutional settings (hospitals, corrections, child protection) to become homeless. This type of systems-based prevention requires a collaborative effort, one beyond the confines of the traditional housing and homeless-serving sectors. Thus, the opportunity within the National Housing Strategy is to provide a framework that urges public systems to be accountable for housing outcomes, while acknowledging that they require adequate resources to do so.

Then, when homelessness cannot be prevented upstream or at the systems level, we need policies, practices and interventions that allow individuals and families in crisis to access the support they need. Here, early intervention strategies – such as family mediation and domestic violence victim support – are required. For the National Housing Strategy, this means a commitment to crisis housing and shelter diversion, an evolution from our traditional overreliance on emergency shelters.

Ideally though, the National Housing Strategy will endorse a robust evictions prevention strategy – the fourth strategy within our proposed Homelessness Prevention Framework. Doing so will reduce the need for crisis interventions in the first place by preventing instances of homelessness that result from financial or conflict-based evictions.

And finally, an effective National Housing Strategy will concede that despite best efforts, homelessness, today, still exists. Thus, the strategy must include solutions to improve housing stabilization, and ensure that those who have experienced homelessness will never experience it again. A commitment to Housing First (and other proven models of accommodation and support) is an obvious way forward.   

Our Next Steps

The National Housing Strategy is an opportunity to turn prevention into practice. We must do more than react. We must strategize, innovate and invest until we have prevented homelessness. By doing so, we will send a powerful message: No one should experience homelessness.  

The Canadian Observatory will soon submit a response to the #LetsTalkHousing consultation Our recommendations will include more discussion on the role of prevention, in addition to a set of recommendations jointly drafted with the Canadian Alliance to End Homelessness. The latter will also be available in the forthcoming State of Homelessness in Canada 2016.

What role should prevention play in the National Housing Strategy? Share your thoughts with us using #LetsTalkHousing and #LetsTalkPrevention. 

Mapping complex intersections

We know that youth who are homeless or under-housed face a daunting mix of challenges including trauma, family conflict, discrimination, income insecurity and barriers to education and employment.  We suspect that youth with intellectual/developmental disabilities (IDD) (including learning disabilities) are a particularly vulnerable group of youth that experience homelessness. They face the same challenges as non-disabled homeless youth, as well as additional disability-related challenges, including unique barriers to education and employment (based in assumptions about (in)ability) that may limit future possibilities. This is especially so for youth whose disabilities are not immediately apparent or disclosed, are un-assessed, and/or unaddressed.

Youth with disabilities are, however, a significantly under-reported and under-analyzed part of the homeless population – research literature is notably sparse. In large part, this is because homelessness and disability are treated as discrete experiences with unique populations requiring unique interventions. That youth with IDD might experience homelessness has yet to be adequately acknowledged. The result is that population-specific housing, educational support, and employment services operate in siloes and homeless youth with IDD remain largely invisible.

The “Partnering for Change” project has stepped directly into this poorly understood intersection.  Our intent is to systematically map the intersections between IDD, education, and employment among youth who have experienced homelessness.  Our end goal is to identify system-wide gaps and opportunities to develop interventions, improve policy and expand research. The inclusion of disabled youth experiencing homelessness (as co-researchers and as participants) will facilitate the relevance of the research.

Working with partners

This project is built on partnerships and is funded as a Partnership Development Grant by the Social Sciences and Humanities Research Council.  Partnerships have been developed with agencies in the youth homelessness, disability, education and employment sectors in three sites; Niagara, Hamilton and Toronto. Each site also has a local advisory committee. Importantly, the project is also partnering with co-researchers – youth who self-identify as having a disability and as having experienced insecure housing – who are members of the local advisory committees and are also assisting with data collection, analysis and dissemination.

Project commitments

Through the mobilization of this partnership, we aim to achieve 5 specific research objectives:

  1. Determine scope: Assess the extent of disability among homeless youth in the 3 project sites.
  2. Deepen understanding: Characterize complex intersections between disability, homelessness, education and employment.
  3. Identify possibility: Identify prospects, possibilities, hopes and expectations of/for disabled youth experiencing homelessness for housing, disability supports, education, and job sustainability.
  4. Make connections: Map referral pathways and access to services available to homeless youth with disabilities; identify prospects, possibilities, hopes and expectations for agencies working with disabled youth experiencing homelessness.
  5. Build for the future: Establish a Learning Community drawing on members of the research team (including co-researchers with disabilities), partner agencies from the various sectors, and participants to bridge silos between systems and services, and work together to promote active, meaningful and successful participation of homeless youth with IDD in the labour market and society.

Learning from our partners, service providers, and homeless youth with IDD

Three streams of data are being collected at the three sites:

1. Quantitative Data on the prevalence of IDD among homeless youth

The project is working with partner organizations to collect quantitative data on youth who are using their services to try to determine the prevalence of intellectual, developmental and learning disability among homeless youth and homelessness among youth who have a disability.  The project is also introducing additional questions into intake surveys to provide additional information about the prevalence and nature of disability among youth experiencing homelessness.  We hope to collect, clean, and link five years of intake surveys collected by partnering agencies to create research-ready data sets, allowing researchers and partners to examine existing data. 

2. Environmental scan

In this part of the study we aim to map the referral pathways and access to services available to

homeless youth with disabilities.  Interviewing service providers in all four sectors (disability, homelessness, education, employment), we are examining intake processes, eligibility criteria, referral processes, access to assessment of disability, bridges (or their lack) between and within sectors and agencies, gaps in service, and things that are working well.  The result will be a series of maps of how youth navigate between sectors, how sectors interact with each other, and the overall system configuration.

3. Qualitative Data on the intersections of disabled youth’s experiences of education, homelessness and employment

In this component of the project we are drawing from conversations with key informants (front-line workers) in the disability, employment, education, and homeless sectors. We are also talking to disabled youth experiencing homelessness. Each of these interviews is conducted by a pair of researchers; a non-disabled research assistant and a co-researcher with IDD. 

Qualitative interviews will focus on:

  • the complex ways disability affects experiences of homelessness, and vice-versa;
  • whether and how disability is a factor in becoming homeless;
  • whether and how disability affects access to and navigation of homelessness services;
  • whether and how homelessness affects access to and navigation of disability services;
  • the response of the education system to disabled youth experiencing homelessness;
  • how effective employment programs aimed at homeless youth are at providing opportunities for disabled youth experiencing homelessness to develop employment skills and experiences;
  • and how these cross systemic responses align with and support (or hinder) employment and careers aspirations for these youth 

This research project is in its second year and will soon have results from both the environmental scan and the gathering of quantitative data.  Qualitative interviews with disabled homeless youth are underway. We plan to disseminate these findings broadly and in a variety of formats.

Canadian Observatory on Homelessness/Homeless Hub: York University
September 16, 2016
Categories: Ask the Hub

This question came from Jose S. via our latest website survey.

Mobility issues often fall under the umbrella of physical disability, so before I answer this question, I’ll define disability and explore how it relates to homelessness.

A disability is a physical or mental condition that affects physical ability, understanding, learning or day-to-day functioning. The Canadian Disability Survey defines disability in ten categories: seeing, hearing, mobility, flexibility, dexterity, pain, learning, developmental, mental/psychological, and memory. According to the survey, physical disabilities are the most prevalent—pain-related (7.9%), flexibility (7.6%), and mobility (7.2%)—but people can have more than one type. The 2001 Participation and Action Limitation Survey defined someone with a mobility disability as:

…someone who has difficulty with at least one of:

  • walking half a kilometre
  • walking up and down a flight of stairs (about 12 steps) without resting
  • moving from one room to another
  • carrying an object of 5 kg (10 lbs) for 10 m (30 ft.)
  • standing for long periods.

And an agility disability as:

...someone who has difficulty with at least one of:

  • bending
  • dressing or undressing her/himself
  • getting into and out of bed
  • cutting her/his toenails
  • using fingers to grasp/handle objects
  • reaching in any direction (for example, above her/his head)
  • cutting her/his food.

Of the participants surveyed in this category, 72% reported having both mobility and agility disabilities; and 31,000 reported living without the special housing features (like grab bars, ramps, elevators) that they require.

Employment rates in Canada, by disability status

While anyone can become homeless, people with disabilities are particularly vulnerable. A 2013 report found that people with disabilities in Canada are twice as likely to live in poverty. As I wrote in a previous Ask the Hub post, this is due to a combination of barriers to employment, difficulties accessing social benefits, and an overall lack of affordable, supportive, and accessible housing.

In terms of how many people with disabilities also experience homelessness, there’s no concrete number. According to the 2012 Canadian Survey on Disability, 13.7% of people surveyed reported being limited in daily activities due to a disability. Meanwhile, The Center for Justice and Social Compassion estimates that 45% of all people experiencing homelessness in the U.S. have a disability or have been diagnosed with mental illness—a significantly higher number that suggests people with disabilities are over-represented in the homeless population. Furthermore, people experiencing homelessness have a high prevalence of chronic health conditions that may require housing accommodations and additional supports.

Housing needs

There’s no straightforward list of housing needs because these needs vary widely depending on the severity of type of mobility issues; as well as the individual’s wishes. Some people want to live as independently as possible, while others want to live with 24-hour care from friends, family, or attendants. However, existing literature does provide us with some important things to consider.

Needs in the physical environment can include wheelchair accessibility, but other modifications are increasingly required. A report on services in Bruce County, Ontario, highlighted a continuing demand for modified units:

Trends in the social housing waiting list show that, while there is a need for some wheelchair accessible units with features such as turning spaces within rooms, lower counters with knee space underneath, there is a greater need for modified units which meet less intensive physical impediments (i.e. ground floor units or units in buildings with an elevator). In addition, there is a need for modified units that can accommodate families since most family units are multi-floor townhouses. A more coordinated tracking system may assist in matching the need for modified / wheelchair-accessible units with current vacancies.

The same report noted that in rural areas, location of modified units is a huge factor. Waiting lists for preferred locations can be long, and a lack of efficient public transportation for people with disabilities makes it hard for them to access services.

Supportive services are often crucial for many people with mobility issues, who frequently need assistance with running errands, completing housework, and other tasks. Then there are the emotional needs: as a U.S. study of non-institutionalized adults found, mobility issues are associated with higher rates of fear, anxiety, confusion—contributing to lower rates of emotional wellbeing.

The writers of the Bruce County report present clustering affordable housing and supportive services—putting them close together—in more populated areas to make services more time- and cost-efficient, as well as easier to access.

Another important factor is modifying communication and service so that they’re more easily understood and accessible. A factsheet from the city of Waterloo, Ontario recommends making a few changes to how people work with service users with disabilities:

... appropriate communication techniques like speaking at eye level to individuals in a wheelchair, using clear and specific language, paying attention to responses, providing documents in accessible formats and using interpreters, diagrams and demonstrations as required.

When working with individuals with mobility difficulties who need housing, or accommodations made to their existing housing, this guide on interviewing around reasonable accommodation requests may be helpful.

We need more accessible housing

There is a severe lack of affordable, accessible housing. Affordability is a key issue, as many people with disabilities are in core housing need and living in poverty. A 2001 Canadian survey found that 18% of people with mobility/agility disabilities lived in core housing need—that’s twice the rate of people without disabilities (9%). Those who are eligible for social benefits often have a hard time getting them. Even then, the rates are extremely low and leave people with little to live off of after paying rent.

In certain provinces and territories, there’s legislation requiring businesses to improve accessibility. Ontario was the first to pass such laws, and aims to be accessible by 2025. The laws apply to businesses with more then a few employees, educational institutions, and developers of “built spaces” like parks, government buildings and other public areas. While landlords have a duty to accommodate, not everyone follows through. Affected tenants would have to make claims via human rights code violations, which can be complicated and time consuming.

Getting accommodations isn’t always a straightforward process in social housing. One participant in the arts-based Women’s Stories: Aging, Disability, and Homelessness project described the difficulty of requesting changes to her unit:

I’m just saying in my building there’s no accountability to get things done ... They make it so that it’s a maze that you’re supposed to go up the chain of command, right? I need grab bars on so I can take a bath. So, you put your work order in and you wait around, a week goes by and you don’t hear anything and then you’re supposed to call and talk to a supportive housing worker. Now, most of these subsidized buildings have supportive housing workers. We still don’t know what that really means. So, you’re supposed to go to the worker and say, I put a work order in two weeks ago about this and I haven’t heard back. And she’s supposed to go to her manager, her supervisor and that supervisor is supposed to go to the supervisor of maintenance and it goes down. So, it goes up, up, up and down.

In order to meet the needs of people with mobility difficulties, a holistic and flexible approach must be taken. In order for that to work, we need more housing that is both affordable and modifiable according to individual or family needs.

While there is some government funding through CMHC programs to renovate or update existing housing, there are other services as well. For example, the Calgary-based organization Affordable Housing offers a variety of services for people with disabilities: homes in community, intensive housing (housing with support), and R.A.D. renovations, which helps people make accommodations to their existing homes.

More resources on accessibility in Canada:

 This post is part of our Friday "Ask the Hub" blog series. Have a homeless-related question you want answered? E-mail us at thehub@edu.yorku.ca and we will provide a research-based answer.

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