This post is part of our Friday "Ask the Hub" blog series. Have a homeless-related question you want answered? E-mail us at firstname.lastname@example.org and we will provide a research-based answer.
Dear Homeless Hub
Many times when I come across a person who appears to be homeless, he/she also seems to be mentally ill. In your experience, have you discovered that most homeless people are also dealing with a mental illness of some sort? If so, is one kind of mental illness more prominent than others?
Niagara Falls, Ontario
Mental illness is often misunderstood in our society, and this is particularly true as it pertains to people who are homeless or street-involved. It can sometimes be challenging to determine how many homeless people have mental health issues and what types or substance use issues because of the lack of research and data. It is also a challenge to determine whether the mental health issue or substance use caused the person to enter homelessness, or whether these issues arose from their experience of being homeless.
In 2007, the Canadian Institute for Health Information published “Mental Health and Homelessness” report that outlined a number of studies on mental health. There was some general information, but they mainly focused on Post-Traumatic Stress Disorder (PTSD), schizophrenia, substance use and depression. Studies have found that as many as 29% of shelter users have met criteria for one of several mental illnesses including: anti-social personality disorder (along with depression), PTSD or psychotic disorder.
Post-Traumatic Stress Disorder: The same report drew attention to research of homeless youth that found 24% of youth met the criteria for PTSD. Additionally, 40% of youth who met the criteria for Substance Use Disorder also met the criteria for PTSD.
Schizophrenia: There are also overlaps with schizophrenia. One study in Toronto of 300 shelter users found 6% had a psychotic disorder (including schizophrenia). Another study with 124 shelter users in Vancouver found that 7 out of 124 shelter users (nearly 6%) had schizophrenia. This is a significant increase when compared to the general population diagnosis rate of 1%. Substance Use - Throughout Canada, the well-being survey found that 1 to 4% of Canadians have suffered from issues with substance dependence. Several studies have looked at substance dependence and homelessness. A study in Toronto found 68% of shelter users reported a diagnosis of dependence sometime in their life. A study in Vancouver found 44% of homeless adults used non-prescription drugs in the past month. A study in Edmonton found 55% of youth had reported using at least one of the following four drugs in the past year: cocaine, heroin, amphetamines or tranquilizers.
Depression: Throughout Canada, 14-17% of women and 7-10% of men have been diagnosed with depression. In a study conducted in Ottawa, 39% of male youth experiencing homelessness reported symptoms of depression, compared with 20% of male youth who are housed. A separate study, also conducted in Ottawa, found 33% of adult males experiencing homelessness reported having difficulties with mental health; 20% had depression.
The Mental Health Commission of Canada (MHCC) estimates that between 25 to 50% of homeless people in Canada have mental illness. Out of those with severe mental illness, up to 70% also have difficulty with substance abuse.
MHCC also found that 520,700 people with mental illness are inadequately housed and up to 119,800 people with mental illness are experiencing homeless. Despite these high numbers, there are only 25,000 supportive housing units currently available across Canada.
The interim report (Sept 2012) from the At Home/Chez Soi project administered by MHCC states: “Over 900 individuals from our shelters and on our streets who have not been well served by our current approach are now housed in adequate, affordable and suitable settings. Eighty six percent of participants remain in their first or second unit (as of August 2012). At 12 months those in the Housing First intervention had spent an average of 73% of their time in stable housing. In contrast, those in treatment as usual (TAU) spend only 30% of their time in stable housing. This creates the possibility of better long term health and social functioning outcomes for individuals who have histories of trauma and poor health. Once housed many are beginning to take advantage of the safer places and the opportunities that are created to make better life choices – including pursing opportunities to engage in part or full-time employment.”
As you can see Kerry, it’s hard to get an exact fix on the numbers. What the research does tell us is that there is a strong link between homelessness or insecure housing and mental health issues. Certainly, research has proven that a Housing First approach to solving homelessness – no matter what an individual’s issues are – allows a person to stay housed and to address their other issues over time.
For more information on the relationship between homelessness and mental health visit our Topic - Mental Health.
Housing stability. Rapid re-housing. Prevention. Diversion.
These were the words that guided discussion at the first of four service provider consultations hosted by the City of Toronto’s Shelter, Support and Housing Administration Division last week. The consultations are a welcome opportunity to inform the City’s Five-Year Housing Stability Plan and the public’s annual $650 Million investment in housing and homelessness.
For some, these terms are full of meaning. But I can’t help wondering whether our discussion somehow missed the mark. What if the foundation for the City’s housing strategy was a single, simple goal:
Everyone has a home.
Starting with a single syllable
We’re not used to basing city policy on single-syllable words, and certainly not words that are as personal and emotion-laden as “home.” How could such a word guide funding decisions, or inform program evaluations?
For fun, I spent a happy summer afternoon looking for answers outside the housing sector, skimming definitions of “home” in everything from women’s magazines to children’s essays to poems. I discovered four themes that seemed surprisingly pertinent to the consultations:
Home is where you can settle in. According to the poets, children and magazine readers, it’s not about how long you stay in one place or another. It’s about whether a place is yours to keep as long as you want. It’s home when you can live and plan your future, secure in the knowledge that you will not be arbitrarily evicted or forced out because you can no longer afford to live there.
Home is where your people are. Sometimes “your people” are your own family or friends. Sometimes they are simply the people you feel comfortable around, because you share a common culture or language, belong to the same social strata, or share similar life experiences.
Home is where you are safe. It is a refuge and a sanctuary. It’s where you can protect yourself from not just the violent or the thieving – although that is essential — but also from the tiresome, the mean-spirited or the nosy.
Home is where you can be yourself. In the magazines, “being yourself” seems to mean lounging in old T-shirts and flip-flops, staying up late and never mind the dishes. It gets trickier when “being yourself” involves bugging your neighbours, turning your apartment into a fire hazard, or drinking yourself to death. But I think there is an important principle here: home is not so much the place where you “get your act together” as the place where you don’t have to act at all.
From happy sentiments to housing strategy
What might a housing plan supported by the pillars of settling, belonging, safety and being yourself look like?
For a lark, I tried scoring each of the most common housing alternatives against these four pillars. I discovered, of course, that almost every answer was, “it depends.” I could think of non-profits and co-ops that foster a deep sense of belonging, and others where intrusive rules make it impossible to be yourself; shelters that were safe, and those that definitely were not.
Nonetheless, the exercise helped me look at housing options from a different perspective. I started asking questions such as:
Are general emergency shelters actually better than the street? Both offer opportunities for belonging; neither allow people to settle in; neither are safe. But the street has one big advantage over shelters: you can be yourself in a way not possible in a (necessarily) rule-bound shelter.
Could shelters improve their advantage over the street by investing heavily in safety, or by reducing rules to the absolute minimum? Or should the City be shifting its funding to smaller specialty shelters, such as women’s or youth shelters, where the potential for belonging and safety are higher?
Is transitional housing really part of the housing system? It was transitional housing’s focus on self- improvement that stood out on my score card. It made me wonder whether it should be recognized as part of the health or education system – a sort of school residence while you learn skills or recover from an addiction – and be funded and regulated accordingly?
Can we replicate the advantages of social housing in private buildings? Permanent non-profit and co-op housing scored well on all four pillars, but we also know in this market it is costly to build.
Subsidies in private buildings could offer similar advantages, but only if we dropped our notion that housing allowances are time-limited aids. The threat of losing one’s subsidy is the antithesis of settling – especially at a time when incomes are declining, not rising, across Ontario. We’d also need to stop parachuting tenants into buildings that are out of their comfort zone – away from their social circle and the services that keep that circle alive.
Evaluation? Ask the people who live there
And how would the City evaluate whether an organization is providing a home, or a path to a home? It could start by asking the people the organization serves.
Tenant and client surveys tend to be under-used. I can understand why. Many tenants and clients have trouble completing questionnaires, individual interviews are time-consuming, and the results can be hard to quantify. But I know no truer measure of a policy outcome than the testimony of the people it is designed to serve.
Simplicity and science
Am I proposing that city policy be driven by popular culture rather than solid research?
Certainly not! But I can’t help noticing the poets, children and magazine readers have hit on many of the findings confirmed by research and reflected in the City’s own philosophy: the proven benefits of self-determination, choice, autonomy, stability, security, and community.
This may be one time when simplicity is not “dumbing down.” Instead, it may be the best way to get at the heart of our work.
Reposted with permission from Opening the Window.
Toronto’s homeless population continues to grow, according to the interim findings of the city’s Street Needs Assessment 2013. Toronto reports 5,219 people who were homeless in 2013, up slightly from the 5,169 in 2009 and up 5% from the 4,969 people reported homeless in 2006.
In percentage terms, the biggest increase in homelessness is in violence against women shelters (an increase of 108% since 2006); correctional facilities (up 51% since 2006) and city homeless shelters (up 8.7% since 2006).
Toronto’s Street Needs Assessment uses a method to count homeless that is challenged by some academic and other experts. However, it represents perhaps the most comprehensive snapshot of homelessness in Toronto, and – since the same methods have now been used for three separate counts – it provides information on trends over time in homelessness.
Among the key findings reported in the interim report:
- People who are homeless on Toronto’s streets are outside for an average of 7.5 years, far longer than any other category of homelessness.
- The number of street homeless in Toronto is up 24% since 2009, but down 39.1% from 2006. This suggests that the social and economic impact of the post-2009 recession may have had an impact in boosting street homelessness.
- More than one-third of street homeless are Aboriginal, even though Aboriginal people represent a tiny fraction of the overall Toronto population.
- More than 15% of street homeless claim military service.
- Almost one-in-five homeless youth identify as gay/lesbian/bi/trans/queer, and about one-on-ten of the overall homeless population identify as LGBT.
- The share of seniors in Toronto’s homeless population has more than doubled since 2009.
- Virtually all homeless people (93%) want permanent housing – shattering the persistent myth that people who are homeless ‘choose’ to be homeless.
- About half the homeless population are on the city’s record-breaking wait list for affordable housing.
- Fully 81% of homeless people have lived in Toronto for more than a year – shattering another persistent myth that Canada’s largest city is a “magnet” for homeless people.
While overall homeless numbers are trending up in Toronto, recent homeless counts in Calgary – which has adopted an effective 10-year plan to end homelessness – show that the growth in homelessness in that city has stopped. Vancouver Mayor Gregor Robertson has reported that preliminary results from the latest Vancouver homeless count show a significant drop in the number of street homeless.
Reposted with permission from The Wellesley Institute.
A new Homeless Hub blog feature, running usually on Mondays (it will run Tuesdays when there is a holiday or breaking news story) will be our weekly round-up. It’s our attempt at synthesizing and capturing some of our stories from the past week. We’ll share those that seemed to attract the most attention, as well as those that we think were overlooked. As always, follow us on Facebook and Twitter to stay informed on a daily basis.
Here are some highlights (good and bad) from the past week:
- The full State of Homelessness in Canada: 2013 report has been translated into French. The Executive Summary and the infographic are aussi disponsible en français.
- The City of Toronto released the interim results of their 2013 Street Needs Assessment on Wednesday. Watch this space tomorrow for a blog from Michael Shapcott, of the Wellesley Institute, analysing the results. Some key points:
- Outdoor homelessness has increased 24% since 2009 and overall homelessness has increased by 1%.
- 15.6% of the outdoor homeless population claim Canadian military service. This is twice that of the total homeless population (7.2%).
- Nearly 20% of homeless youth identify as a part of the LGBQT community, more than twice the rate for all age groups. 9.5% of the total homeless population identify as being part of the LGBTQ community.
- The share of seniors in the homeless population has more than doubled since 2009. 10% of the homeless population is 61 or older, compared to 4.7% in 2009. A further indication of the aging trend is the fact that those aged 51 and above represent 29.1% of the homeless population, compared to 19.6% four years ago.
- The PROOF report about food insecurity in Canada continues to get a lot of attention. The numbers, while not surprising to those of us in the field, are certainly scary. One of the researchers, Naomi Dachner, wrote a blog for us about the topic that highlights some of the issues. The report received a great deal of media attention as well. In an interview with the Vancouver Sun Valerie Tarasuk said, “In 2007 [Newfoundland’s] household food insecurity rate totalled more than 15 per cent, and now it touts the lowest rate in the country at just over 10 per cent. They're the only province that has shown a steady decline." CBC New Brunswick also has a great summary video about the report.
- In related news, the Canadian Medical Association released a report on Tuesday “Health Care in Canada: What Makes Us Sick?” This report based on a series of town halls with more than 1000 participants found that poverty was the main issue affecting health inequality in the country.
- We released five research summaries on Monday related to Hepatitis in recognition of World Hepatitis Day on July 28th. An interesting stat: Homeless people in Toronto are 29 times more likely to have Hepatitis C. The five research summaries were further summarized in a blog written by Faculty of Environmental Studies MES student Isaac Coplan. The one that seemed to get the most traction was “The Tragedy of Dying Homeless.” This study found that:
- Deaths among homeless people occur at higher than average rates.
- There are higher rates of AIDS, cancer and Hepatitis amongst the homeless population.Homeless people often face barriers to healthcare treatment including poverty, substance us, lack of a phone, address and transportation.
- The Wellesley Institute also released a health-related report, “Rising Inequality, Declining Health: Health Outcomes and the Working Poor”. This research found that there is a strong correlation between health, income and employment. Those who are better off financially and more job secure have better health overall.
This is our first instalment of the Friday "Ask the Hub" blog series. Have a homeless-related question you want answered? E-mail us at email@example.com and we will provide a research-based answer.
Dear Homeless Hub
I saw an article in NOW Magazine last week that said the city was going to redevelop Seaton House and make more of the beds permanent instead of shelter beds. The City of Toronto just released its findings for the 2013 Street Needs Assessment and the number of people sleeping on the streets has gone up! Shouldn’t we be adding more shelter beds instead of taking them away?
~Confused in Toronto
You’re right, it’s very important to understand the math behind homelessness. Too often, politicians and policy makers get focused on the solutions –building safe, secure and affordable housing with needed supports—and forget about the current state of affairs. While the housing is important, so is making sure the needs of people who are currently homeless get met.
As our recent State of Homelessness in Canada: 2013 report pointed out many people are homeless for only one night and 29% are homeless for less than a month. But, at least 200,000 people are homeless every year and across the country at least 30,000 are homeless every night. That means, as a country, we need to provide 30,000 beds a night until we have sufficient housing to meet demand AND we’re able to stem the flow of people into homelessness.
That’s the key point really. It's not as if we have a finite group of homeless people and once enough housing is built to house them, homelessness is over. New people become homeless every day. We need to address the upstream issues that are leading people to become homeless. Prevention is a big topic and one that we will be focusing a lot on over the next while here at the Hub.
But let’s look at the Seaton House numbers and the new Street Needs assessment numbers the City of Toronto just released. The city’s early report on numbers of the 2013 Street Needs Assessment show that both overall and street homelessness have gone up in the past 4 years. 24% more people are sleeping outside and 1% more people are homeless in Toronto, according to the count. Unlike most Alberta cities, and many others across the country, which are seeing significant drops in both categories, Toronto is seeing an increase.
|Location||Count||Share of total||Count||Share of total||Count||Share of total|
|Violence Against Women (VAW) shelters||171||3.4%||306||5.9%||356||6.8%|
|Health & treatement facilities||275||5.5%||223||4.3%||236||4.5%|
Source: City of Toronto, Street Needs Assessment Interim Report
Shelter operators have told me that they are running at almost full capacity, especially since July 2012. Another report in NOW magazine from March of this year, showed that, “shelters are operating closer to 100 per cent capacity than was previously thought, and are using beds on a daily basis that are supposed to be reserved for emergencies.”
According to the NOW article you mentioned, Seaton House has “543 beds, 240 are used as emergency shelter, and the rest are part of long-term care, harm reduction and infirmary programs.”
Since the goal of the redevelopment is to create more permanent housing, NOW points out, “emergency beds would be reduced from 240 to roughly 96. According to the report approved by council, the 140 men left over would be ‘absorbed into transitional housing programs or the emergency shelter system.’”
So, this is where we run into fuzzy logic and faulty math. Tonight, there will be close to 240 men using Seaton House. Tomorrow night there will be close to 240 men using Seaton House, and a few of them will be different. Next month, there will be close to 240 men using Seaton House and a significant percentage of them will be different. So there won’t be “140 men left over” as the report says, there may be several hundred.
The city’s move to build transitional and permanent housing units is important and a key step in solving homelessness, but there won’t be as stark a decrease in need as the city is predicting, unless significant prevention and homelessness reduction strategies are established in the interim. There is time; the ground-breaking isn’t until 2017 after all.
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The analysis and interpretations contained in the blog posts are those of the individual contributors and do not necessarily represent the views of the Canadian Observatory on Homelessness.