Research Matters Blog

April 27, 2015
Categories: Topics

While Canada has universal health care, there are still many barriers preventing homeless individuals and families from accessing health services. The lack of identification – particularly their health ID card – is often cited as the biggest barrier to obtaining health care for people experiencing homelessness. Another significant barrier is following up on prescriptions (due to lack of insurance benefits or inability to pay the co-payment) or ongoing medical “home treatment” (such as sitz baths, bedrest or wound care).

Other barriers to adequate health care faced by people experiencing homelessness include the daily struggle for the essentials of life. A reliance on drop-ins and shelters for meals does not provide a nutritionally balanced or adequate diet. Living situations (i.e. sleeping outside, squats or crowded shelter) often result in increased disease transmittal. Many shelters require people to leave during the day preventing someone from obtaining needed rest. 

Homeless women and men do not  have ‘different’ illnesses than the  general population.  However, their  living circumstances and poverty affect their ability to cope with health problems.Homeless people as a group die younger than housed people and many suffer from more frequent severe illnesses and at an earlier age. For example, the 2011 Winnipeg Street Health report found that compared to the general population, homeless people in their survey were:

  • 20 times as likely to have hepatitis C
  • 8 times as likely to have epilepsy 
  • 3 times as likely to have had a heart attack
  • 6 times as likely to have angina
  • 2 times as likely to have asthma
  • 2 times as likely to have arthritis or rheumatism 
  • 3 times as likely to have diabetes
  • 10 times as likely to have FAS/FAE 
  • 5 times as likely to have migraine headaches 

These numbers echo an earlier report from Toronto’s Street Health which in 2007 found that the homeless people they interviewed were:

  • 29 times as likely to have hepatitis C
  • 20 times as likely to have epilepsy
  • 5 times as likely to have heart disease
  • 4 times as likely to have cancer 
  • 3 1⁄2 times as likely to have asthma
  • 3 times as likely to have arthritis or rheumatism
  • Twice as likely to have diabetes 

In terms of public mental heath care in Canada, there are three different types of care. Primary mental health care (first-line services) includes simple diagnostic procedures, basic treatment and referral to more specialized services as needed. Secondary care consists of specialized care that provides more extensive and complicated procedures and treatment. It may be provided within hospitals, clinics or office-based practices, on an inpatient or outpatient basis. Tertiary care is a set of specialized interventions delivered by highly trained professionals to help individuals with problems that are particularly complex and difficult to treat in primary or secondary settings. 

Canadian Observatory on Homelessness/Homeless Hub: York University
April 24, 2015
Categories: Ask the Hub

“I’m looking for resources to help put together an effective communications plan to manage NIMBY if we were to move our housing services into a new neighbourhood. I was wondering if the Homeless Hub had any resources that might be helpful to look at with this objective in mind?” 

This question came from Misha via email.

There is an unfortunate lack of guidance in creating specific communications plans, as evidenced by you needing to ask this question! NIMBY is something that many housing and homelessness organizations have found they need to overcome, so there are some resources available. I’ll first describe what NIMBY is for all our readers. Then I’ll discuss some responses to it and how they can be applied to communications.

Construction zone signWhat is NIMBY?

NIMBY is short for “Not in my backyard,” which describes a phenomenon in which residents of a neighbourhood consider a new development (like affordable/supportive housing, a group home, or a shelter) or tenant changes within an existing building as unwanted or ill suited to the area.

NIMBYism has been especially common in the last few decades. Its arguments are typically rooted in anxiety and fear of change, and as such, do not highlight the benefits of shelters and affordable/supportive housing. They are also influenced by negative stereotypes and sometimes, outright discrimination of people living in poverty; people experiencing homelessness, mental health issues, and/or drug abuse. The ideas lead to concerns that that crime will increase, property values will go down, etc. if a new development serving these groups enters a community.

This can be difficult, but not impossible to overcome. The first step in creating successful communications for a shelter or affordable/supportive housing project is being able to speak to NIMBY-based concerns. The Greater Victoria Homelessness Coalition has created an excellent series of fact sheets about NIMBY; and the Ontario Human Rights Commission has an entire section debunking myths about shelters and affordable/supportive housing. Both contain references to studies that have found that the common NIMBY-based concerns are not true. (Crime doesn’t go up! And property values do not decrease!)

There’s also this study, which reviewed literature on the subject and found that subsidized housing developments do not negatively impact communities.

Potential supporters for shelters and housingTips for effective communication

Once you know how to respond to NIMBY, it’s time to create your communications strategy. In her analysis of 14 case studies in 7 Canadian cities and across 5 provinces, Jeannie Wynne-Edwards writes: “While bias and prejudice may not yield to facts, education and awareness through the presentation of facts is important. This fear can only be addressed through education, awareness and change.” She also describes the entire NIMBY cycle and makes specific recommendations around what language to use based on what kind of opposition (ie. prejudice-based).

The Fair Housing Alliance of Pennsylvania made a great toolkit for developing fair housing. In its 4th section, they emphasize the importance of building community support. Here I’ve adapted some of their points on how to launch a successful community campaign:

  1. Research everything you can about the community. What it is like? Who lives there? What has happened to similar proposals in the past? Who are the neighbourhood leaders and political representatives? What are the zoning laws and bylaws of the area? 

  2. Find potential allies and seek their endorsement. Partner with nearby social service agencies. Find out how they’ve been involved with housing issues in the past, and if they have influence with any relevant decision makers. The writers of the toolkit make some specific suggestions about which kinds of groups to approach (pictured right).

  3. Make sure the messaging is specific. As the writers state: “Early in the process it is important to develop a set of talking points about why THIS development is the right project for THIS neighborhood and THIS community at THIS point in history.” People are much more likely to support a project they feel matters and they are invested in—it won’t be enough to quote general statistics about homelessness or the importance of affordable housing, though those can come in handy too.

  4. Prepare a media strategy. If your project is likely to meet opposition, reach out to media first to make the case for its development. This involves telling the story of why this project matters to this community, now. Be sure to also prepare short, fact-based responses to anticipated claims from opponents, as those will inevitably arise when media coverage comes around. (A legal strategy may also be necessary if opponents bring up zoning issues.)

  5. Get creative to reach different audiences. Putting up a few posters isn’t going to reach everyone you want to anymore. Embrace multimedia and social media, and factor each of those into your communications plan. Create different audiences (Potential Opponent, Youth, Person Experiencing Homelessness, City Councillor) and tailor materials to them, what they care about, and what their concerns might be. In the toolkit, the authors mention a particularly creative example where developers arranged public tours of existing affordable housing buildings to help residents see what the new development would actually be like.

My colleague Tanya also made a great suggestion in a previous Ask the Hub post, in which she highlights the potentially high impact of including personal stories from people with lived experience in communications. As she wrote:

The Dream Team, a group of mental health survivors who advocate for supportive housing, have used videos, post card campaigns and lawsuits to challenge both NIMBYism and to call for more supportive housing. By telling their stories — see Philip and Linda sharing their stories — they help educate the public and government alike about the importance of supportive housing and how it helped get them off the streets.”

A few other resources make similar points and are also worth reading:

- Jaimie Ross’s fact sheet on NIMBYism and overcoming community opposition

- The Canada Mortgage and Housing Corporation’s case study research on affordable housing projects

- Matthew McNeil’s step-by-step guide to overcoming NIMBYism

Additional resources

While none of this makes a complete communications plan, it hopefully provides a foundation and understanding of NIMBYism that can help you move forward in creating your own specific plan. Here are a few more resources you might want to check out: 

A guide to overcoming NIMBY for municipal officials (Canada)

Creating inclusive communities in Florida (United States)

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: Elliott Brown on Flickr

York University; Canadian Observatory on Homelessness/Homeless Hub
April 22, 2015

The below infographic, published by the Ontario Non-profit Housing Association, acts as a handy guide to the number of housing options that exist in the province. This post will focus on three of these housing options mentioned: (1) emergency housing, (2) co-op housing, and (3) transitional housing.

Types of affordable housing infographic from the Ontario Non-Profit Housing Association.

1. Emergency Housing

In many cities, shelters are the primary response that communities have to homelessness. The role of these shelters extends far beyond providing temporary housing, they also provide clients access to a network of a wide variety of resources. These resources can include everything from access to food and basic healthcare, to informal counselling and employment services.

Specialized shelter services exist for certain subgroups of the homeless population, and other individuals who use shelters (e.g. shelters designed for women fleeing abuse). In major cities like Toronto, there is an urgent need for specialized shelter initiatives for LGBTQ2 youth, who are overrepresented in Canada's homeless population. A recent Toronto survey estimates that 25-40% of all homeless youth in the city are LGBTQ2. Many of these youth, who left home because of the discrimination they faced, often end up facing homophobic and transphobic violence in the shelter system. To date there are zero specialized housing initiatives in Canada that address their needs. However, Toronto City Council recently approved 54 new shelter beds  specifically for LGBTQ2 youth as part of its 2015 budget. An official announcement of these new shelter spaces is expected in the coming months.

2. Co-op Housing

Co-operative housing provides housing for individuals with low to moderate incomes. Co-ops include subsidized units and units that cost market rent. Funding for subsidies varies across municipalities and provinces; for example, in Ontario the provincial government no longer funds housing co-ops, while subsidies are available in Toronto for the vast majority of co-ops, due to federal funding.

This kind of housing is “rooted in the principle that members [of a housing complex] should be empowered to make decisions about their housing”. Since ownership of co-ops is collective, decisions in co-op housing tend to be governed by a democratic process. Applications of this kind of housing solution have often been applauded because they present individuals with greater autonomy over their housing. A recent study of Aboriginal housing cooperatives in Canada found that co-op housing encouraged self-determination and feelings of community among members.

3. Transitional Housing

Transitional housing is defined as "an intermediate step between emergency crisis shelter and permanent housing". These programs are designed to provide clients with a safe and secure environment where they can begin to rebuild their lives. While transitional housing services are more long-term than emergency shelters, time limits are still enforced in most programs. Depending on the focus and the resources of a transitional housing service, the maximum duration for a stay can vary from a few months to a few years.

In order to be effective, transitional housing services require the availability of affordable, permanent housing for individuals who are moving on. The rising costs of housing jeopardizes the continuity of such programs and the progress that participants have made. In the absence of affordable housing, there needs to be adequate supports to help these individuals. If these supports do not exist, participants risk re-entry into a cycle of poverty and homelessness.

We also need to consider what happens to individuals who do not see significant improvements over the course of their stay in transitional housing. Since this housing option is often time-limited, where would these individuals go? This is one of the problems inherent with transitional housing, and presents us with the need for alternate non-profit housing options.

April 20, 2015
Categories: Topics

Legal and Justices Issues for People Experiencing HomelessnessThe research on legal and justice issues focuses on factors that may contribute to homelessness, including criminal victimization (physical, sexual and emotional abuse of children, women and seniors), discrimination (based on race, class, sexual orientation, and gender, for instance), poverty, justice system involvement, and/or criminal or delinquent behaviour (illegal substance use, involvement in crime). Research also explores how experiences of homelessness produce a range of legal and justice issues

People who become homeless are more likely to be victims of crime and discrimination, may become involved in illegal or quasi-legal activities for survival reasons, and have a much greater likelihood of being involved in the justice system. A dominant response to the homelessness crisis has been to criminalize the behaviours and activities of people who become homeless but legal and justice issues that impact people experiencing housing instability and homelessness can also be non-criminal in nature. 

Poverty and homelessness has potentially catastrophic effects on civil liberties, including the right to vote, the right to secure government benefits or essential services, the right to security of the person, and the right to participate in the democratic life of the community. As well, homelessness is directly linked to the criminal justice system – many discharged inmates end up homeless and, conversely, many homeless people wind up in prison. 

Non-criminal legal problems that impact civil liberties include: claims for government benefits such as social assistance or disability benefits; housing and homelessness issues such as evictions, tenant/landlord disputes, and housing discrimination; family law, including divorces, child custody, and domestic violence; consumer issues; employee rights; elder law, such as rights of nursing home residents; mental health and disability issues, especially where benefits are denied; immigration law; and, any other non-criminal legal problems. Service providers and outreach teams often work with individuals, that are at risk of or experiencing homelessness, in an attempt to mediate these difficult challenges.

Canadian Observatory on Homelessness/Homeless Hub: York University
April 17, 2015
Categories: Ask the Hub

How does homelessness impact the recidivism rates for youth involved with the justice system?

This question came from Marlene N. via our latest website survey.

As a 2006 Toronto report points out, most research suggests that the relationship between homelessness and incarceration is bidirectional: “That is, just as homeless people are at high risk of becoming incarcerated, prisoners are at high risk for becoming homeless.” Unfortunately, the criminal justice system in Canada is inextricably linked with homelessness.

This is also true for youth involved with the criminal justice system, which is a highly vulnerable population. Specific data about youth offenders in Canada is difficult to obtain, but we know that many of these youth come from backgrounds of poverty, health issues, conflict and/or violence, and general instability. As a result, many do not have a stable, positive place to stay once they’ve been released; or families, friends and other social systems simply are not able to cope with caring for those who have been recently discharged. In the words of Jane Glover and Naomi Clewett (from their report, No Fixed Abode): “…periods of unsettlement in the transition periods just prior to release and immediately following release from custody can be triggers for disengagement from services, risky behaviour and re-offending.” The authors presented several case studies and outlined their paths to homelessness and back into custody (if that occurred). Below is one example of how they conceptualize the system failures that can lead youth back into custody.

Amy's route back into custody

In England, fewer youth are committing crimes but recidivism rates are very high at 74%. Glover and Clewett’s report highlights previous research from the English government that estimated youth recidivism rates could be reduced by 20% if stable housing was provided; and notes: “A Home Office evaluation concluded that 69 per cent of offenders with an accommodation need re-offended within two years, compared to 40 per cent who were in suitable accommodation.”  

Similar rates have been found in a number of American studies. A 2013 study from the Washington state department found that 26% of youth released from juvenile detention facilities are homeless within 12 months of being released; and that recidivism rates were higher for these youth than those who had stable housing. Furthermore, the youth who experienced homelessness were found to have “a high rate of substance abuse, serious mental illness, rates of chronic illness, and higher mortality rate than youth released with no identified housing need.”

Potential solutions

A lack of stable housing and effective discharge planning also affects adult offenders, as research by Gaetz and O’Grady explores. Studies have also been done on the complex relationship between homelessness, trauma, poverty, and mental health—all of which makes people more likely to be incarcerated. 

Other research supports solutions that go beyond limiting recidivism and improving people’s lives. A study about the cycle of homelessness and incarceration among Aboriginal women in Canada—among the participants, 56% reported a lack of housing contributed to recommitting crimes—concluded that “…there is a need for prevention and intervention supports for women living in poverty." The writers also argued that we "...need to address the systemic and institutional racism and sexism that continue to deny women the right to a living income, safe and affordable housing, and human dignity.”

As NextCity reported last July, taking a Housing First approach with people (and youth) leaving incarceration can dramatically reduce homelessness and recidivism amongst this population.

Glover and Clewett recommend that youth first be given the opportunity to stay with family whenever possible upon release, with additional support services to ease the transition. If this is not possible, the writers state that youth be provided with safe, supportive accommodation (with quality standards defined by the government) as they have seen success with this approach through their work at Barnardo’s. The writers also advocate for a cross-government strategy to support not only youth, but their families in order to move towards preventing homelessness.    

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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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.