Research Matters Blog

May 25, 2015
Categories: Topics

Community-based mental health care encompasses a wide variety of programs and services designed to meet local needs. These programs are delivered primarily by community agencies and sometimes through hospitals or health clinics. The majority of programs provided by community-based agencies are designed to serve the most vulnerable and most severely mentally ill

Often, people that receive community mental health services have a diagnosis of schizophrenia, chronic depression, bipolar disorder or borderline personality disorder. Most have been ill for a lengthy period of time. And have suffered from a series of complex life problems such as poverty, homelessness, involvement in violent relationships, a history of child abuse, incidents of victimization through sexual or physical assault in adulthood, multiple periods of institutionalization, physical illness, and, sometimes, trouble with the law. 

To meet the needs of homeless people that experience mental health problems a number of community mental health services are required: 

Housing services:

Different housing options are needed for different people.Different types of subsidized and supported housing such as group homes, shared accommodation and apartments. Housing workers visit sites regularly offering counseling and holding tenants' meetings. Some agencies work with individuals to find appropriate housing in the private sector. Some agencies provide 'safe houses,' which provide short-term accommodation for people in crisis, designed to prevent hospitalization. 

Case management:

Case managers work one-on-one with individuals, often several times a week, in the setting of the client's choice (apartment, coffee shop). They help people find the services they need, access medical care, acquire new skills, find jobs and make friends. Certain case managers also provide counseling or help in overcoming addictions and work to prevent hospitalization. 

Treatment:

Psychiatric treatment for mental illness may be offered in hospitals and includes assessment, diagnosis, the prescription and monitoring of medication, electro-convulsive therapy and interpersonal or cognitive therapy (individual, group or family). In the community, multi-disciplinary teams that include psychiatrists, social workers, nurses and case managers provide treatment to clients in their homes and in their communities so that hospitalization can be prevented. 

Peer support and self-help programs:

These groups bring together people with similar circumstances or illnesses to share experiences, challenges and coping strategies. Family members also have their own support groups. 

Crisis services:

Community mental health agencies respond to people who are in a crisis situation by assessing their immediate circumstances, providing short-term counseling, getting prescriptions for medication or assisting with hospitalization if it is required. 

Mobile crisis services:

These services operate 24 hours a day and provide immediate care where and when they are needed. 

Court diversion programs:

People with a mental illness who have committed a minor offense need not go to jail. Instead, court diversion programs work to get them the help that they need outside of the judicial system. Court division programs reduce court costs and meet people's mental health needs in a more effective manner than the corrections system. 

Clubhouses:

These programs provide a place for people to go to five days a week. Members participate in the running of the club but they also can receive training for work and support while in job placements. 

Employment services:

Agencies partner with local businesses to find jobs for people with a mental illness. Staff may also provide skills teaching and job coaching. 

Other programs:

Community mental health services are developed with the particular needs of the community in mind. Some agencies provide warming rooms for the homeless in the winter where people can take a shower, eat and have a good night's sleep. Other examples of programs include support groups for the newly bereaved, or people who are divorcing, clothing or food banks, and education programs on mental illness for high school students.

Canadian Observatory on Homelessness/Homeless Hub: York University
May 22, 2015
Tags: LGBTQ2
Categories: Ask the Hub

This question came from Matias C.L. via our latest website survey.

Queer and trans youth – who I will refer to as LGBTQ2 youth – are overrepresented among people experiencing homelessness.

Research from Ottawa, Ontario in 2000 found that anywhere between 25 and 40% of all youth experiencing homelessness identify as LGBTQ2. More recently, the 2012 Toronto Street Needs assessment asked participants staying in youth shelters about their LGBTQ2 identity for the first time and found that 1 in 5 youth experiencing homelessness identify as LGBTGQ2. Given these numbers, it’s crucial that we make shelters and transitional, supportive and affordable housing accessible for this population.

While youth in general have a variety of needs when it comes to housing, there must be extra considerations for those who identify as LGBTQ2. Many leave home due to lack of family/guardian acceptance, and find the same lack of support elsewhere. As Dr. I. Alex Ambramovich wrote in No Safe Place to Go:

“The threat of violence and harassment on the streets is exacerbated for LGBTQ youth due to frequent encounters with homophobia and transphobia. These threats make it especially hard for youth who were forced to leave home due to homophobia or transphobia because it makes coming out and trusting people more challenging. There are also countless situations where youth are victimized, ridiculed, and beaten up on the streets and in the shelter system simply for their gender and/or sexual identity. Regardless of their gender or sexual identity, homeless youth most often come from family situations of conflict, abuse, and neglect.”

While overt discrimination due to trans- and homophobia is a large issue for many LGBTS2 youth, there are also situations in which it is subtlety present or systemic, as in shelter systems. In the same report, Abramavich highlighted this as well: “Most shelters are segregated by birth sex, which increases the risk for gender discrimination and gender violence to occur within shelters. Shelter staff members tend to have minimal training around transgender-related issues, needs, and terminology.” It is estimated that 1 in 3 transgender youth, who experience more violence than any other group, are turned away from shelters based on their gender expression/identity.

Recommendations

Sprott HouseAbramavich recommended that homelessness support services (such as shelters) increase training re: LGBTQ2 issues, adopt harm reduction approaches to substance use, revise complaint systems to improve shelters, implement strict anti-homophobic and anti-transphobic language policies, and openly identify as a LGBTQ2 positive space. At the government level, Abroamavich recommends developing a specific strategy to address the homelessness of this group. Indeed, the city of Toronto Street Needs Assessment came to similar conclusions – with 54 beds specifically for LGBTQ2 youth included in the city’s 2015 budget. These beds will come in the form of Sprott House, pictured right – which will be the first specifically LGBTQ2 youth housing program in Canada. 

None of this, however, directly addresses how to make low-income or social housing more accessible. Unfortunately, as I wrote a few weeks ago, there has been little research on LGBTQ2 youth outside of their experiences within urban shelter systems. That said, I think many of the recommendations made by Abramavich and other researchers/advocates/community members can be applied to low income and social housing.

  • Training: Ensure that everyone involved (caseworkers, property managers, superintendents, etc.) receive explicitly anti homophobia and anti transphobia training; and learn about LGBTQ2 issues, experiences and terminology.

  • Community involvement: Give LGBTQ2 youth experiencing homelessness opportunities to share what would make housing more accessible and safer for them in your specific building, complex, or community. Encouraging involvement and meaningful participation (not just tokenism) can make services more effectively inclusive.

  • Reformed processes: Trans youth may have identification, documentation, and/or references that correspond with a different name, sex, and/or gender than what they currently identify as. Creating processes that are flexible and understanding of these changes is key to making any kind of housing more accessible. 

  • Integrated supports: Depending on age, circumstances and experience, LGBTQ2 youth will need a variety of supports (casework, financial assistance, education, life skills, counselling, family reunification, etc.) to help them secure and stay within housing. What is important here, as pointed out by Gaetz and others, is availability and choice - some LGBTQ2 youth will want completely independent living while others will want housing that is more deeply supportive.

Ultimately, as Gaetz et al. wrote in Youth Homelessness in Canada, moving to a homelessness prevention model is key to ending youth homelessness. In the meantime, however, we must make existing services more safe and accessible – especially for vulnerable groups like LGBTQ2 youth.

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: Erica Lenti on Torontoist

York University; Canadian Observatory on Homelessness/Homeless Hub
May 20, 2015

This week’s infographic is from a Mother Jones article that looked at the success that the Housing First philosophy has been having in Utah. Housing First is an example of an alternative to status quo approaches to homelessness, combining immediate access to permanent housing with wrap-around supports. The presence of built-in supports, including health care and counseling services, as well as employment and education supports, are essential for the Housing First approach. There are several causes of homelessness and in order to become solutions, it makes sense that approaches towards solving homelessness also need to be multifaceted.

Osceola County, Florida, tracked 37 homeless people arrested 1,250 times over 10 years for 61,896 total days of incarceration.

Recent years have seen the increased criminalization of homelessness in the United States. The infographic states that 37 homeless people living in Osceola County, Florida, were arrested over 1,000 times over a ten year span, spending a cumulative 61,896 days in jail. It is estimated that the costs associated with arresting these individuals, charging them, and providing them with care in jail was well over six million dollars. Compared to the cost of providing support services to individuals living in homelessness, arresting and putting them into jail is prohibitively expensive.

However, we need not look all the way to the US for examples of laws that target individuals living in homelessness and waste financial resources. In 2000, the Ontario Safe Streets Act (SSA) came into effect. While the act was meant to address aggressive forms of solicitation, the way the law has been applied in real life is considerably different. A review of SSA tickets handed out by Toronto Police indicates that four out of five tickets were handed out for non-aggressive acts. This places increasing financial stress on individuals who, as it stands, have difficulty affording basic needs. Involvement with the criminal law system effectively acts as a barrier for many individuals seeking access to supports and services that can help them move out of homelessness. This includes educational supports, training opportunities for employment, housing subsidies, and food assistance. Fifteen years in, it's clear that the Act is an unproductive and discriminatory means of dealing with the province's growing homelessness problem.

The SSA provides a great example of how ineffective laws targeting homeless people are, compared to policies addressing affordable housing and other measures that actually address homelessness head-on. Criminality is not a synonym for the word homeless; we need to be doing a better job of supporting and enacting research-informed practices and policies. Strategies that look to address homelessness need to have a long-term focus and be informed by the experiences of people living in homelessness, rather than myths about homelessness. Spreading awareness has a vital role to play in informing the general public about real solutions to homelessness.

The SSA is a misinformed, inefficient, discriminatory piece of legislation that contributes to the criminalization of homelessness. It has no place in a province that possesses a social conscience and an interest in promoting the well-being of all of its citizens. I invite you to join the coalition to repeal the SSA. Criminalizing homelessness targets individuals living in homelessness, rather than homelessness itself.

Canadian Observatory on Homelessness/Homeless Hub: York University
May 15, 2015
Categories: Ask the Hub

This question came from Ashley L. via our latest website survey.

According to our latest report, of the over 235,000 Canadians who experience homelessness in a year, about 5000 people are unsheltered (living on the streets). It is reasonable to wonder, what with so many services available, why some unsheltered people would “choose” to remain so.

The reasons why people become homeless are multiple and complicated. Between individual/relational factors, structural factors, and systems failures, homelessness itself is generally not a choice – despite a pervasive myth that it always is. When thinking about homelessness as a choice it’s important to recognize what other options are available to people, and what their experiences have been. If homelessness is an option, and not something that happens out of necessity, what are the other options available?

James from Money Changes YouIt is important to recognize that for some people, being housed feels less safe than being homeless. Some may have experienced violence and/or sexual assault in their homes, and grew to feel trapped. Some lose jobs or live in poverty for a long time – without a strong social support system or an abundance of affordable housing, a person can become homeless during just one bout of unemployment. Some are currently experiencing violence and conflict and have nowhere else to go. For other people, being homeless gives them a sense of freedom. As James (pictured right), a participant experiencing homelessness in the film Money Changes You, said: 

“I’d rather be back on the street because I understand the street better than living indoors. Living outdoors you’re completely free. You’re independent and life is as you make it day by day by yourself and it’s more honest and honourable. Because once you’re indoors you start having all the syndromes of modern industrial society. Living indoors you go soft right away.”

Another factor is the shoddy state of some shelters, the primary response to homelessness in North America. Many are often overcrowded and understaffed. As Lauren Gostick, a frontline social worker, told NOW in January:

"The shelter systems in general are broken and they're old. You're thrown in with a large group of people who are all in an immediate, acute crisis situation. One person may have extreme mental health issues, another is dealing with substance abuse and somebody else is smoking crack in the bed across from you. It's survival of the fittest."

In other words, for people experiencing mental health issues and/or substance abuse, shelters can be even worse environments for them than the streets. Shelters often lack the services and skills needed to accommodate older adults, people with disabilities, and other marginalized people. For example, LGTBTQ2 youth are overrepresented in the homeless population, many of which are fleeing families where they are not accepted. When seeking shelter services, it’s estimated that 1 in 3 trans youth will be turned away.

Regardless of what other “options” people experiencing homelessness have, remaining unhoused is not an ideal choice – it is one people feel they have to make because it is the best option for them at the time. In the words of Christine Schanes: ”…one choice from two or more options is only a true choice when the consequences of the choices are equal or nearly equal. The choice between living in a home or living on the streets is an unequal choice because of their unequal consequences."

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: Still from Money Changes You

York University; Canadian Observatory on Homelessness/Homeless Hub
May 13, 2015

The below infographic, published by the Greater Victoria Coalition to End Homelessness as part of their recent report, takes a look at pathways in and out of youth homelessness.

Pathways In & Out of Youth Homelessness in Greater Victoria

Pathways Into Youth Homelessness

The pathways into homelessness for youth are varied. A major push factor (mentioned in this infographic) is the violence and discrimination youth may be facing at home. A high number of LGBQT2 youth leave home for just this reason. Many of these youth relocate to major urban centers like Toronto in the hopes that they will be able to find the services and supports they need. Unfortunately, specialized services for homeless LGBQT2 youth, even in large cities like Toronto are few and far between.

Trauma is also a common experience for many youth before and after becoming homeless. If they find themselves living on the streets, youth are at increased risk of experiencing further trauma. Living on the streets is directly linked to increased risk of witnessing and being victims of physical and sexual violence. The longer a youth is homeless, the greater the likelihood of further physical and emotional harm. As a result, many youth turn to substance use (and abuse) as a coping mechanism to deal with stressors associated with living on the streets. Homelessnesss is an independent predictor of injection drug use among street-involved youth.

Finally, some youth may find themselves living in homelessness because of the high cost of rental housing. The cost of housing has spiked in recent years, and this rise in the cost of rent has not been accompanied by a similar growth in affordable housing.

Pathways Out of Youth Homelessness

Factors involved in the pathway to youth homelessness tend to be based on the unique circumstances faced by different individuals. Accordingly, we are unlikely to find one quick-stop solution, or support, that can put an end to youth homelessness, as this infographic indicates. When we consider the scope of the problem, it can be difficult to know where to start.

Fortunately, there has already been a great deal of research documenting what steps can be taken to help youth living in homelessness. For starters, it should be understood that youth living in homelessness have similar needs and goals as youth not living in homelessness. Accordingly, there should be a visible difference in how services and supports are designed and delivered for youth living in homelessness compared to adults living in homelessness. Providing specialized supports, tailored to the needs of youth, is a step in the right direction.

Preventing Youth Homelessness

Early interventions – not directly outlined in this infographic – should be considered when discussing pathways in and out of homelessness for youth. It can be understood as a preventative measure against chronic homelessness, and as a means to protect youth entering homeless from the serious dangers that come with living on the streets, before they get there. The current lack of early intervention programs for youth just entering homelessness has harmful implications for the long-term health and well being of these youth.

Factors like trauma and family breakdown have been identified as precursors to homelessness, but it is not necessary for these youth to become homeless in order for their needs to be addressed in these situations. Preventive approaches to youth homelessness have been undertaken in the United Kingdom and Australia to great effect. In some situations, these programs have looked to prevent breakdown in familial relationships. In others, where a youth may experience abuse and trauma in the home, these programs have looked to help transition young people into living situations that have built-in supports.

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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.