Research Matters Blog

By Melanie Redman, Executive Director, A Way Home Canada and Dr. Stephen Gaetz, Director, Canadian Observatory on Homelessness and Professor at York University

In the midst of so much happening at federal, provincial/territorial and municipal levels concerning housing and homelessness, it’s important that we don’t lose sight of some of the most vulnerable people in Canada: youth experiencing homelessness. 

Yesterday, along with MP Adam Vaughan, A Way Home Canada announced the launch of the “Making the Shift: Reimagining the Response to Youth Homelessness Through Social Innovation” project at an event hosted by York University. With this federal investment, we are going to ensure we have a strong proof of concept and evidence base on models of prevention and Housing First for Youth. We will then take these models to scale, in order to ensure better outcomes for more than 1,300 young people and their families over the next two years during phase one.

The Making the Shift project will provide prevention and Housing First for Youth interventions to young people who are homeless or at risk of homelessness in 10 communities in two provinces -- Alberta and Ontario-- where there are existing or emerging provincial strategies to end youth homelessness. 

The main purpose of this project is to support communities and all levels of government to make the shift away from a reliance on emergency response, to a more strategic investment in the prevention and ending of youth homelessness. This means developing a comprehensive knowledge base on prevention and support programs that result in lasting positive changes for homeless youth or youth at risk of homelessness. We’ve chosen to focus on models of family reunification (Family First), Youth Reconnect and Housing First for Youth because there is an existing knowledge base that we can build upon, through a series of demonstration projects that lay the groundwork for scaling these models nationally. (Note: We will be supporting the efforts of Coalition founding member Raising the Roof concerning the scale of a shelter diversion model known as Host Homes.) 

When young people become homeless, they typically become part of the “Not Engaged in Education or Training” population, a group that hasn’t had an education and employment focus placed on them. The proposed interventions in Making the Shift will ensure that these young people achieve housing stability and have natural supports, such as family, that are essential as they receive support to stay in school or access training and employment. And by serving these young people, we will also build an evidence base to inform sound public policy and investment. This will, in turn, stabilize and increase their employment and education participation and success. 

The Making the Shift project is a partnership of A Way Home Canada, the Canadian Observatory on Homelessness, MaRS Centre for Impact Investing, two provinces, and dozens of community partners. Supporting the work of the “Making the Shift” demonstration projects will be the Youth Homelessness Social Innovation Lab (YHSIL) led by the Canadian Observatory on Homelessness. Its role is to identify and imagine policy and practice innovations that have a high potential of contributing to effective solutions. The YHSIL will also be responsible for the research and evaluation necessary to establish “proof of concept”, as well as the knowledge development components necessary to enable taking such intervention models to scale. 

The value of the research and evaluation component of our demonstration projects cannot be overstressed. We know that the successful “At Home/Chez Soi” project has been highly influential in shaping government policy in Canada. The evidence base for youth homelessness interventions, including Housing First for Youth, is currently not as strong. These demonstration projects, if successful, are poised to provide a key evidence base for all levels of government interested in prioritizing youth homelessness.  

We will be taking prevention models with an evidence base elsewhere in the world, as well as the key innovation of Housing First for Youth (co-developed by the Canadian Observatory on Homelessness, youth with lived experience, the Hamilton Street Youth Planning Collaborative and the National Learning Community on Youth Homelessness), and providing proof of concept and ‘facts on the ground’ in Canada. All of the knowledge developed through evaluation will contribute to knowledge development and dissemination, including toolkit development. And through our evaluation work and research, we will focus on developing clear outcomes measures that demonstrate positive impacts on young people, including housing stability, health and wellness, educational engagement and achievement, and labour force participation. We want more for young Canadians than just housing stability -- we want them to have access to what any of us want for our own children.

Beyond the life of the Making the Shift project, the YHSIL will continue to identify, demonstrate, evaluate, disseminate, mobilize and scale innovations in policy and practice across the full spectrum – this will prevent young people from becoming homeless, and if they do, preventing them from ever becoming homeless again.

A Way Home was launched as a coalition in order to have maximum impact on the issue and the time has come for us to ramp up our collective efforts to ensure the job is done. 

The time for innovation is now, because we can truly end youth homelessness, if we want to.

We gratefully acknowledge the support of the Government of Canada. The project is funded through Employment and Social Development Canada and Skills Link.

Over two hundred years ago, Benjamin Franklin said, “An ounce of prevention is worth a pound of cure”. Since that time, most people have come to understand the importance of prevention in dealing with major social, economic, and health problems.  For instance, it is better to prevent cancer, measles, the flu, or other illnesses than have to deal with the consequences. This kind of thinking has influenced how we approach crime, road safety, and many other problems.

So how about homelessness?  For decades we have relied on emergency services to help those experiencing homelessness. Emergency shelters, soup kitchens, and day programs, meant to be short-term supports, have become the main response to manage homelessness. While we will always need emergency services to help those in crisis, it’s past time we move in a new direction and look for ways we can support people to avoid homelessness. Housing First points the way to helping people permanently exit homelessness. But what is and what should the role of homelessness prevention be?

Eighty-nine percent agreed that it is possible to prevent homelessness in Canada
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In March of this year, the Canadian Observatory on Homelessness conducted a nation-wide survey to capture people’s views on homelessness prevention. A total of 633 Canadians answered the survey. The largest percentage of respondents identified themselves as service providers (40%) and 11% of respondents were people with lived experience of homelessness.

The results were compelling. Eighty-nine percent agreed that it is possible to prevent homelessness in Canada; however, only 29% believed their communities have a good understanding of what homelessness prevention involves. Respondents noted that in their communities prevention was a much lower priority (31%) than housing and supports (61%) and even more so than emergency services (71%).

98% agree that homelessness prevention should be a bigger priority for government.
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More significantly, the survey indicated strong support for making homelessness prevention more important priority for government. Over 98% made this point (92% strongly agreed). As the Government of Canada embarks on a process of reviewing its homelessness strategy and investment (HPS expires in 2019), over 97% of survey respondents said the prevention of homelessness should become a major priority. This is important because until now, beyond words and rhetoric, prevention has not really figured into how we respond to homelessness in Canada.

All of this begs the question, what do we mean by the prevention of homelessness?  Today, the Canadian Observatory on Homelessness launches A New Direction: A Framework for Homelessness Prevention with the intention of beginning a national conversation about how we can prioritize homelessness prevention. The survey informed our thinking on the framework and on making the prevention of homelessness a policy and practice priority. The framework provides the language and clarity to begin that conversation. It includes a definition of the prevention of homelessness and a typology that outlines the legislation, policies, collaborative practices, and interventions that will reduce the risk of homelessness.

The international context 

Although Canada hasn’t made homelessness prevention a priority, other countries have been making headway. It is important to note that there are some great local homelessness prevention programs across Canada, but none have been taken up systematically. Alternatively, Australia’s Reconnect program provides outreach and support to youth at risk of homelessness in schools. Finland developed an action plan for cross-sectoral collaboration on prevention. The US has focused on preventing veteran homelessness. Germany and the UK saw a reduction in homelessness when they began running homelessness prevention interventions.

Homelessness prevention legislation is at the center of a lot of the international success because it sets out the government’s prevention goals, lays out different government departments’ responsibilities and how they must work together, and provides the policy and funding for local communities. Wales, Ireland, and Britain have all passed legislation setting out a duty to provide information and assistance to those who are at risk of homelessness. This legislation is rooted in a human rights approach that believes everyone should have access to safe and adequate housing. Over 96% of our survey respondents agreed that housing is a human right.

Defining homelessness prevention

The COH framework creates a definition of homelessness prevention so that we can be clear on what we’re talking about. In our survey, 93% of respondents agreed with our proposed definition.

Definition of the Prevention of Homelessness

Homelessness prevention refers to policies, practices, and interventions that reduce the likelihood that someone will experience homelessness. It also means providing those who have been homeless with the necessary resources and supports to stabilize their housing, enhance integration and social inclusion, and ultimately reduce the risk of the recurrence of homelessness.

The causes of homelessness include individual and relational factors, broader population-based structural factors, and the failure of many public institutions to protect people from homelessness. This suggests that homelessness prevention must not only include interventions targeted at individuals, but broader structural reforms directed at addressing the drivers of homelessness. That not only communities but all orders of government, and most departments within have a responsibility to contribute to the prevention of homelessness is in keeping with a human rights perspective.

The definition sets out the nature and scope of homelessness prevention. Emergency services and the supports they provide, while important, are not homelessness prevention unless they are offered in the context where people have immediate access to housing. In the prevention survey, 94% of respondents, many of whom are service providers in the homelessness sector, agreed that more resources should go to homelessness prevention even if it means in the long run there will be less need for existing services and supports. 

The public health model

The framework is guided by the public health model of prevention, which has been used for decades to prevent disease and more recently in crime prevention and to prevent school dropout. The public health model is broken down into three categories: 

  1. Primary prevention – These are prevention efforts that work at the structural level to help everyone. Primary prevention can be unpacked further:
    1. Universal prevention – Applies to the population as a whole, such as poverty reduction strategies and having an adequate supply of affordable housing.
    2. Selected prevention – Interventions aimed at a particular group, such as school-based programs and anti-oppression strategies for those facing discrimination.
    3. Indicated prevention – Prevention strategies for individuals at greatest risk of homelessness, such as support for families experiencing violence and for individuals with mental health and/or addictions challenges.
  2. Secondary prevention – Programs and practices to help those at immediate risk of homelessness or who have recently become homeless. Examples include evictions prevention and family mediation.
  3. Tertiary prevention – Making sure those who have experienced homelessness never do again. The most common example is the Housing First model.

Most of the homelessness prevention programs currently running fall into secondary prevention. While these interventions are key, they will not prevent homelessness on their own. We need to focus as well on the structural and systemic causes of homelessness if we want to truly prevent homelessness.

The typology of homelessness prevention

The typology of homelessness prevention
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The five elements of this typology each contain elements of primary, secondary, and tertiary prevention show the continuum of prevention models needed to prevent homelessness in Canada. Local prevention programs are supported by prevention legislation, policy, and funding. This will take coordination between multiple sectors. Prevention can’t be the responsibility of the homelessness sector alone. It needs all levels of government on board and collaboration across sectors, including: housing, employment, child protection, health care, criminal justice, and education. The typology is as follows:

  1. Structural prevention – Use legislation, policy, and investment to build up the protective factors that prevent homelessness. Some examples are ensuring an adequate supply of affordable housing and poverty reduction strategies, such as Ontario’s basic income pilot.
  2. Systems prevention – Fixing restrictive policies that limit access to benefits and supports and addressing barriers to using services, such as mobility or transportation issues, difficulty navigating the systems, cultural barriers, and citizenship status. It also highlights the need for reintegration supports for people leaving public systems, such as hospitals, correctional facilities, and child protection.
  3. Early intervention – Acting quickly for those at imminent risk of, or who have recently become, homeless. These include a range of supports, from client-centered case management to shelter diversion, such as Host Homes.
  4. Evictions prevention – Strategies to reduce the likelihood that someone will lose their housing. There are lots of different kinds of evictions prevention, such as strengthening landlord/tenant laws, emergency financial assistance, and rent supplements.
  5. Housing stability – Supports to help people access and maintain their housing. This is especially important for those who have previously experienced homelessness. The Housing First model is a best practice in providing housing and supports.

Given the scope of the typology, it’s clear that homelessness prevention calls for a systems integration approach. We need people across sectors at the table, ready to do their part to prevent homelessness. A key finding from the prevention survey is that we are ready to make homelessness prevention a priority. The framework is a starting place to have a conversation about prevention. Let’s start talking. 

You can join us for a webinar on A New Direction: A Framework for Homelessness Prevention on May 25th at 1:00pm (ET) or post your thoughts on the framework on the Workspace!

York University; Canadian Observatory on Homelessness
April 18, 2017
Categories: Topics

Access to health care is a human right. In Canada, we enjoy a system of universal health insurance and yet, many Canadians are left without services other Canadians can access with relative ease. For individuals experiencing homelessness, the ability to maintain one's health can be compromised by the impact of deteriorating health and obstacles, which often prevent them from getting the critical help they need.

Health & Poverty

In Canada, our publicly funded health care service is a cornerstone of our society -- it is central to the health and well-being of the general population. According to Statistics Canada, 85.1% of Canadians have a family doctor and 59% cite their health as very good or excellent. On the other hand, for individuals experiencing extreme forms of poverty and marginalization, including homelessness, maintaining a healthy life and accessing health care services is a considerable challenge. This is a major problem as these marginalized individuals face the largest likelihood of illness.

Canada Without Poverty provides us with a helpful snapshot by demonstrating the link between poverty and health:

  • 1 in 7 Canadians live in poverty.

  • The World Health Organization finds that poverty is the single largest determinant of health.

  • Poverty is correlated with illness and in turn, illness increases one’s likelihood of poverty.

  • A lack of income can entail inadequate access to nutritious food as well as safe and stable shelter - all working to negatively impact health. On the flip side, illness leads to poverty by reducing household savings, overall productivity, and quality of life for individuals and families.

  • Poverty causes serious health problems such as significantly increasing one's chance of developing diabetes and complications such as blindness and cardiovascular disease.

  • The increase in illness that derives from poverty bears a significant economic burden, where the cost of poverty on the Canadian health care system is approximately $7.6 billion.

Health & Homelessness

Considering the points provided above, it is obvious that poverty is strongly correlated with poor health and increased health care costs overall. What sort of impact, then, would extreme forms of poverty such as homelessness have on the health of this population? The COH defines homelessness as an extreme form of poverty characterized by the instability of housing and the inadequacy of income, health care supports and social supports. These instabilities that characterize homelessness has a profound impact on one's health that include:

  • Common health problems among this population include hypertension, arthritis and other musculoskeletal disorders, obstructive lung disease, tuberculosis, respiratory tract infections, human immunodeficiency virus, hepatitis, peripheral vascular disease, digestive tract disease, poor dental health, visual impairment, exposure-related skin diseases, as well as malnutrition and traumatic injuries.

  • For youth experiencing homelessness, malnutrition is found to exacerbate underlying medical conditions common among this population such as tuberculosis, hepatitis B infection, HIV and other STIs.  

  • Approximately 30% of those experiencing homelessness suffer from at least 2 medical conditions. This likelihood doubles in individuals aged 50 and over.   

  • Women who are pregnant and experiencing homelessness often are at great risk of poor health due to a lack of access to prenatal care, poor nutrition, and exposure to violence.

  • One study found that women experiencing homelessness in general often face sexual victimization and may engage in sex work to earn an income, putting them at risk of contracting HIV/AIDS and other sexually transmitted diseases.

  • Indigenous populations disproportionately experience homelessness. One study found precarious accommodations on reserve are commonly overcrowded implying that houses will have poor ventilation, poor sanitation/waste management and unsafe water supplies - all resulting in poorer health for this population.

Hospital Emergency Care & Homelessness

The information provided above makes it clear that there is a strong link between homelessness and the exacerbation of poor health. And yet, this population faces considerable gaps in getting the help that they need. Considering a lack of access to transportation to attend healthcare appointments, missing health cards, an inability to afford prescriptions and due to the 24-hour accessibility, emergency rooms are often the primary source of care for individuals experiencing homelessness. In fact, nearly 50% of individuals experiencing homelessness do not have a family doctor

hospital

Even in accessing emergency rooms, however, homelessness significantly impacts the ability for individuals to get the care they need. This is due to prejudice, stigma and discrimination on the part of health care providers against individuals experiencing homelessness (particularly those with addictions, who are racialized and/or LGBTQ2S), long wait times and overall negative experiences that result in an interruption of treatment plans.

Coupled with this, use of hospital emergency care is a costly expense. One study found that out of 1,190 homeless individuals surveyed between 2004 to 2005, 77.3% had utilized an emergency department with a rate of 2.1 visits per person, where each person costs $1,462. Moreover, the average monthly cost associated with housing an individual while they are homeless in a hospital bed is $10,900. Ultimately, addressing homelessness via an emergency response framework, which includes emergency room over utilization, has cost Canadians over $7 billion per year.

Considerations

To curb the costly expense of emergency room utilization as the primary source of health care for individuals experiencing homelessness, a variety of innovative initiatives are making great strides in breaking down barriers, making healthcare more accessible to those who need it desperately.

For instance, there are “street medicine teams” that work to bring health care directly to the visibly homeless, rather than waiting for them to visit emergency rooms. This is a great method considering that postponing treatment is a common occurrence among this population.

In Toronto, Street Health is a non-profit agency operating around the intersection of Dundas St. and Sherbourne St., the largest concentration of homeless shelters and drop-in centres in Canada. Street Health works to remove barriers to treatment and provide client-centered, flexible and responsive care. Through this crucially needed initiative, Street Health states that on an average day, 115 clients come through their doors and they are able to assist 40,000 individuals a year.

In addition to the street health initiatives, approaching homelessness via preventative framework is the most effective way to reduce the unnecessary illnesses experienced by this population. It also cuts down the massive costs associated with poverty.

There is strong evidence demonstrating Housing First can reduce illnesses associated with homelessness through providing housing without being contingent upon “readiness” or sobriety. One study following a cohort of previously unhoused individuals placed in stable accommodations found a reduced rate of emergency room utilization, in addition to increased overall health. These findings are consistent across multiple studies, including a Toronto-based study that provided individuals with stable housing, resulting in previously homeless individuals finally able to pursue treatment, attend appointments and fully implement treatment plans. Additionally, according to 7 Cities in Alberta, from 2008 to 2012 their Housing First clients reported 64% fewer days in hospital, 60% fewer interactions with Emergency Medical Services and 60% fewer emergency room visits.

As a fundamental human right, individuals experiencing homelessness are entitled to the universal health care the general population of Canada is able to obtain. And considering the health and monetary benefits associated with Housing First, a preventative approach to ending homelessness just makes sense.  

Homeless Hub
April 07, 2017
Tags: elections
Categories: Ask the Hub

We have an insightful thread on the Community Workspace on Homelessness on voting participation among people experiencing homelessness. The Community Workspace is an interactive space for communities and by communities. It is an opportunity for leaders, service providers and policymakers to share information, seek input and guidance from others, as well as have discussions around homelessness.

We asked you to share your thoughts on the consequences of low voting turn out among the homeless population, their barriers to voting, programs available to facilitate their vote and what stakeholders can do in order to promote voting while eliminating some of the challenges. In this blog entry, I’ll go over what was shared on the Community Workspace. I also encourage you to check the discussion and contribute your thoughts.

During the 2015 federal elections, we posted a blog entry going over the ways that people experiencing homelessness can vote, and touched on the issues of providing identification and not having a fixed address. We also released the Housing and Homelessness Election Guide 2015 which highlighted some recommendations geared towards the federal government from the State of Homelessness 2014. It also included comparison among the main party platforms with a number of resources in order to support voters make informed decisions on who they vote for.

While toolkits such as the Housing and Homelessness Election Guide 2015 are important resources for voters including people experiencing homelessness, there also needs to be mechanisms in place to facilitate the voting process for the homeless population while also reducing the barriers. Below is what we’ve heard from you.

Ideas & thoughts from the Community Workspace

An issue discussed is the discrimination experienced by the homeless population, leaving many to retract or feel uncomfortable in public spaces. As one of the users put it: “Who wants to go vote when you have your stomach in knots?”

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Voting locations are just not welcoming to people experiencing homelessness and this is an accessibility barrier. An idea to address this would be to have mobile polling stations traveling between service providers such as drop-in centers and shelters similar to what is currently available for voters living in long-term care facilities and hospitals. Mobile polling stations could visit the same service provider on multiple occasions until no more votes are casted. This would avoid the anxiety that comes from having to disclose their circumstances to polling officers in front of other voters and running the risk of being turned away in front of others. Mobile polling stations would also make it easier for service providers to vouch for anyone that does not have sufficient I.D.

Having a polling on-site made a big difference for the Lookout Society in BC when the organization licensed its shelter as a “care facility”. One of their staff reported on the thread that having a polling station on-site combined with education made voting participation “extremely high”.  In addition, Lookout Society supported their clients with obtaining I.D., staff were available to confirm identification of voters, posted information and engaged candidates by asking them to fill out a questionnaire made available to the residents. 

While working at YWCA Agvvik Nunavut, we facilitated a series on workshops to discuss the territorial election as requested by a resident. We reached out to candidates to drop off materials, talked to the election officers in advance about what could be done for those without I.D. and they assigned us an election officer that would support voters at the polling station and made herself available to answer any questions ahead of election day. Transportation was provided to and from the polling station and a staff was present at the polling station if needed. While this was a successful initiative, on-site polling stations or mobile polling stations are the better ways to go.

This was proven in the 2015 federal elections when The Calgary Homeless Foundation held a mock election at four shelters including The Alex, Alpha House, YWCA Mary Dover House and the Calgary Drop-In & Rehab Centre. Roughly 500 people participated in this initiative. People had the opportunity to learn about the voting process as well as share their primary concerns. 60% identified affordable housing as their most important issue. In addition, Elections Canada and the Foundation set up a voter registration booth at the Drop-In & Rehab Centre and a mobile polling station on election day. In the first hour and a half of opening, at least 60 people had casted their ballots. However, two people were turned away due to having insufficient I.D. The requirements of identification continue to be a barrier and mentioned in the Community Workspace thread.

Any support available for voters experiencing homelessness may make the difference on whether they vote or not. One person with lived-experience made this clear on the Community Workspace: “The barriers to voting may seem small but to the one on the street it’s almost insurmountable.” We must not assume that because voter turn out is low that people are not interested. Rather, we must look at the systems in place that deter people from casting a ballot and what could be done to facilitate the process.

Below are some questions to consider:

  1. What are the consequences of low voting participation among people experiencing homelessness?
  2. What are the barriers to voting that people without housing face?
  3. How can policy-makers, organizations and advocates reduce those barriers?
  4. Are there programs and initiatives that have had demonstrable success in this area?

We would like to feature your thoughts on this topic. We encourage you to share your feedback with us on FacebookTwitter or the Community Workspace on Homelessness, an online forum to discuss homelessness 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.

Photo credit: CBC News Calgary, “Calgary Drop-In Centre tests mobile station for election day” 

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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    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.

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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.