“One misconception is that people don’t want to get better”
In recent years, there has been an uptick in public campaigns aimed at destigmatizing mental health. While these campaigns are undoubtedly important and have had a positive impact, there remains work to be done, especially when it comes to mental health and homelessness.
We spoke with two people who have experience working with the homeless population about some of the challenges that this group faces and how a Housing First model can help.
Mo Moore is a family doctor who runs a clinic out of a homeless shelter in St. Catharine’s, Ontario. In her clinic, she sees people with a variety of concerns.
“For some visits, I see some regular family medicine issues like diabetes and blood pressure control —things I might see in another setting — but I see a much higher proportion of complex mental health concerns, substance use concerns, complex physical health concerns, and chronic disease.”
Studies have shown that people who are homeless are more likely to experience mental health challenges than the general population. For some, these issues can precede the onset of homelessness. As the Homeless Hub notes, “people with poor mental health are more susceptible to the three main factors that can lead to homelessness: poverty, disaffiliation, and personal vulnerability.”
Mental health challenges can also contribute to homelessness or worsen with continued homelessness.
“Some people are quite forthcoming with the story of how they became homeless, and it sort of varies,” Dr. Moore says. “A lot of the time, people may have had a job and a family and may have gone through some sort of trauma which impacted their mental health, which led them to using substances to cope, and then the substance use sort of took over and they lost [things] they had because of that. I would say that is a relatively common scenario.”
Another common issue is supporting people’s mental health in shelters.
“Mental health wise, you are in a setting where you’re really just in survival mode, you are trying to get through your day. And a lot of people have a history of trauma and violence and sometimes that happens within shelter walls,” Dr. Moore explains. “You are looking out for your own. You are making sure your stuff is not getting stolen. It is really not a place where you can make any meaningful steps forward to healing when you are just trying to survive through the day, and I think that is a huge challenge.”
The justice system, homelessness, and mental health
Safiyah Husein is a senior policy advisor with the John Howard Society of Ontario (JHSO), an organization that has been operating in Ontario for over 90 years, and has 19 community offices across the province. JHSO provides “programs and services that help people affected by the justice system develop key life skills, navigate issues of criminal justice, and build productive futures after incarceration.”
Husein says that what a lot of people don’t realize is that mental health, homelessness, and justice system involvement are interconnected.
In 2018, John Howard Society took part in research project called Closed Quarters that looked at how the “criminal justice system fosters housing insecurity and contributes to homelessness, and the extent to which mental health and addictions problems are implicated in this.”
“It is sort of a cyclical relationship. We see that that mental health issues can result in justice involvement, which can result in homelessness and vice versa,” Husein says. “When we’re talking about mental health, we recognize that there is often a lack of mental health service providers in the community. There’s a lack of support. A lot of the time, for folks that are struggling with mental health issues, that can often be exacerbated by homelessness, but it can also lead to homelessness.
And then we know that those are also risk factors for criminal justice involvement, which can again worsen those issues.”
How a Housing First approach can help
Both Dr. Moore and Husein say they have seen Housing First approaches help people experiencing mental health challenges and homelessness to better be able to navigate those challenges and find a semblance of stability.
Housing First involves quickly moving people experiencing homelessness into stable and long-term housing, and then providing additional supports as needed.
“There has been some research done of the Housing First model where people are provided with safe housing first, with supports usually built into the program, and that has been shown to have positive outcomes. [These studies show that] housing stability [results] in decreases in violence, fewer accidental overdoses, and overall fewer deaths with those type of supports been built in,” Dr. Moore says.
The John Howard Society often takes a Housing First approach with their clients and has found this approach successful for many of their clients.
Husein shared one example with us:
“Jack* is a true example of the benefits of our Housing First mentality. The client has struggled for over a decade with substance abuse issues and homelessness resulting from those same struggles. When the client reached out to our housing worker at John Howard Society of Toronto, he had been living in an encampment at Trinity Bellwoods with his female partner who was dealing with similar addiction and legal issues as the client in question.
With the help of our Post incarceration Housing Department, the client was found housing and immediately his life began to change for the better. Both in his wardrobe and appearance, the client quickly began presenting himself better physically, as he had access to a laundry room, and place to store his clothing…After being housed the client began to reach out to his housing worker for information on drug treatment programs, and for aid in securing his rent payment moving forward through income support programs.
Jack has since completed an in-treatment addiction program that he says has changed his life. It is also worth mentioning that since being housed the client’s live-in partner, Anna*, has also had the opportunity to successfully complete an in-treatment drug program. Both clients are currently sober for the first time in over a decade, and have sustained housing for six months, which is the longest time they have held housing in over two years. Jack is currently seeking to re-enter the work force, as he has a degree in social work and would like the opportunity to help people in at risk communities like the ones he has inhabited as best he can.”
*Names changed to protect the clients’ privacy
Fighting misconceptions
Mental health and homelessness are complex topics but learning what “some of the challenges and barriers that this population faces just in day to day living” can help with understanding this complexity, as well as the resiliency of this population group, Dr. Moore says.
“I think maybe one misconception is that people don’t want to get better and if they could just do more, or get a job, then they would be able to get housing and get out of the situation,” Dr. Moore says. “But when you see what people have gone through and see the barriers they face every day, you would realize that is just not possible without our system having better supports for this group.”
If you would like to know more about mental health, homelessness, and the justice system, check out these resources by the John Howard Society of Ontario: Broken Record, Closed Quarters, and Poverty Reduction Submission.