York University; Canadian Observatory on Homelessness/Homeless Hub
January 28, 2015

Today is Bell’s Let’s Talk day. Bell’s campaign focuses on creating awareness, and engaging Canadians in public conversations about mental health issues. There continues to be a great deal of stigma surrounding mental illness. The below infographic, published by the Mental Health Commission of Canada as part of their Informing the Future: Mental Health Indicators of Canada report, addresses some of the unmet needs for mental health care among individuals.

11.5% of people aged 15 and over in 2013 readmitted to hospital within 30 days of hospital discharge for a stay related to a mental illness.

Just over 10% of people discharged from hospital after a stay related to a mental illness are readmitted within 30 days.

Over one tenth of individuals admitted for poor mental health were readmitted within 30 days of their release. This indicates that a sizeable portion of individuals either received inadequate treatment, or were released into a system that is not equipped with adequate resources to prevent readmission. The term discharge planning is used to refer to the procedures in place designed to ensure that patients, when leaving a phase of care, are provided with the necessary supports and care for continued well-being. Aspects of discharge planning include everything from making sure that patients have the necessary medical equipment, medications, and access to care following their release.

Individuals are often discharged from the hospital straight into critical housing situations, or even homelessness. Stress associated with being homeless can cause, and even exacerbate, existing problems for those with poor mental health. Many emergency shelters are not sufficiently equipped to treat individuals suffering from mental illness. There needs to be more services available for homeless individuals suffering from mental illness, and the nature of care provided to these individuals needs to be more comprehensive.

Research has shown that releasing people with poor mental health into communities that have the necessary supports and interventions results in a drop in readmission rates. Unfortunately, few communities have the kinds of supports and interventions in place that can lead to a drop in readmissions. Targeted supports, even those brief in duration, can have a lasting impact on individuals suffering from mental health problems. These supports act as a preventative measure against both homelessness and hospital readmission. Having these supports in place is more cost-efficient and effective than keeping individuals in a continuous cycle of hospital readmission and release.  

People who have a severe mental illness are overrepresented among homeless populations partially because of poor discharge planning and the absence of supports. Rather than designing programs from the top-down, it would be highly beneficial to consider how the lived experiences of homeless individuals living with poor mental health can be used to inform existing practices and programs. This can allow for the development and expansion of policies and procedures that are effective in addressing the mental health needs of homeless Canadians.

While public knowledge and awareness has improved in recent years, there remain barriers to accessing and receiving adequate mental health treatment across Canada. It’s critical that we continue to move beyond conversation to action on issues surrounding mental health.

January 26, 2015
Categories: Topics

Concurrent Disorders (also described as dual diagnosis orco-morbitity) describes a condition in which a person has both a mental illness and a substance use problem. This term is a general one that refers to a wide range of mental illnesses and addictions. For example, someone with schizophrenia who is addicted to crack has a concurrent disorder, as does an individual who suffers from chronic depression and who is also an alcoholic. Treatment approaches for each case could be quite different. 

""People diagnosed with a concurrent disorder generally have shorter life expectancies, are more likely to be homeless, have more frequent acute psychiatric admissions, and spend less time in hospital per admission than those without (e.g. either substance use or mental health problems, not co-occurring). Research also suggests that the prognosis of schizophrenia in individuals with a concurrent disorder is considerably more severe than in individuals who have schizophrenia only. 

People with concurrent disorders are frequently misdiagnosed, as one disorder can mimic another. Relapse rates for substance use are higher for people with a concurrent mental disorder, as are the chances that symptoms of mental illness will return for those with a concurrent substance use problem. 

Mental illnesses and substance use is more prevalent among homeless and incarcerated populations than in the general population. Those with concurrent disorders need help and services from several sectors – mental health, addiction, health care, education, and social services. Improving access to the services and supports these individuals need requires a targeted, holistic, multi-disciplinary approach of complementary mental health and addictions services designed to work specifically with concurrent disorders. 

Common program elements include comprehensive assessment, intensive case management, supported housing, peer groups for support and therapy, training in independent living skills, and mental health and substance use treatment. Program philosophies typically include acceptance and tolerance of relapses, an emphasis on structured approaches, clear expectations within residential programs, and a commitment to long-term care.

Canadian Observatory on Homelessness/Homeless Hub: York University
January 23, 2015
Categories: Ask the Hub

When we have so many social services in a city like Hamilton, ON, how is it possible that homelessness is still so prominent?

We received this question from Kathleen M., who passed it on from a student.

Many Canadian cities have agencies and programs that try to meet the needs of people experiencing homelessness, yet homelessness continues to be a problem. The vast majority of such services fall in the emergency services category, which do little to prevent people from becoming homeless in the first place. In the words of the Homeless Hub’s State of Homelessness in Canada 2014 report: “For years we have been investing in a response to homelessness that, while meeting the immediate needs of people in crisis, has arguably had no impact in reducing the scale and scope of the problem.” 

Strategy framework for ending homelessness

This isn’t to say we haven’t been making progress, because we certainly have. The At Home/Chez Soi project showed that with the right interventions (housing people quickly with appropriate supports), people who are chronically homeless can be and remain housed. As more municipalities adopt housing first models we will see improvements, but not complete eradication, of homelessness. The reasons why are numerous and complicated, but the two most pressing are as follows:

Reductions in housing funding in CanadaLack of affordable housing

Over the past few decades, federal funding for affordable housing has slowed. In 1982 20,450 new affordable units were built; in 1995 less than 1,000; and in 2006, 4,393. The increase in 2006 was due the efforts of Jack Layton and the NDP, who secured $4.6 billion for affordable housing and mass transit. (This is considered one of Layton's biggest triumphs.)

All in all, over 100,000 units were not built due to funding cuts and cancellations.

This has left Canadians overwhelmingly dependent on skyrocketing private rental markets. According to the latest annual housing affordability survey, Vancouver, is the second most unaffordable city in the world, with Toronto, Victoria, Kelowna, and the Fraser River Valley areas also deemed unaffordable.

As a result, many cities have hundreds of thousands on waiting lists for subsidized housing. An estimated 18% of Canadians spend more than half of their income on housing, which places them at risk for homelessness.

Poverty  

In Canada, minimum wage has not kept up with the rate of inflation, nor have social assistance rates. This, combined with decreasing numbers of long-term, well-paying jobs with benefits, has left people less financially secure. As Vineeth wrote back in November, Canada now ranks 24th out of 35 countries when it comes to child and family poverty. And the income gap between the rich and poor is widening, with the wealthiest 10% of Canadians seeing a median net worth increase of 42% since 2005.

The real solution to homelessness

It isn’t just more shelters, beds, or emergency services—it’s a real commitment to building affordable housing as soon as we can.

Recommendations for ending homelessness in Canada

To learn more about what we can do to end homelessness, read our State of Homelessness in Canada 2014 report.

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.

York University; Canadian Observatory on Homelessness/Homeless Hub
January 21, 2015

Youth represent the fastest growing segment of Canada's homeless population, and a large proportion of these homeless youth are newcomers. Data from a recent survey conducted with homeless youth in Toronto shows that 22.3% of those surveyed had been born outside of Canada. The below infographic, created by the Centre for Addiction and Mental Health (CAMH) and the Children’s Aid Society of Toronto for their report on homeless newcomer youth in Toronto, looks into the experiences newcomer youth have with homelessness and provides recommendations to change the status quo. When I looked at the snapshot of survey participants, two things jumped out at me.

In the study, over one third of participants identified as LGBTTIQ. LGBTTIQ youth, because of their gender identity, are far more likely than straight youth to be the victim of further discrimination and physical violence within the shelter system. This highlights the urgent need for specialized services for LGBTTIQ youth in major urban centres like Toronto. To date, there are zero specialized initiatives directed at the needs of LGBTTIQ homeless youth in Canada.

The infographic also states over half of youth participants had a level of education of grade 12 or higher. It says youth who have credentials that do not match Canadian school systems may be told that they have to repeat high school in Canada. As well, work experience that youth may have is often discredited as being 'not up to Canadian standards.' Rather than being told that they need to start over from scratch, the presence of bridging programs and supports that would help link these youth up with other educational supports could do a great deal to help these youth.

Despite the high proportion of homelessness youth who are also newcomers, data about the needs and experiences of these youth is hard to come by. Engaging these youth in decision-making processes about how services are structured and designed will go a long way towards creating informed changes to how we provide supports to this group. This means including youth in the design of targeted action plans, identifying which tailored supports are most needed and developing safe spaces in which these youth can voice their ideas and concerns. Advocating for, and supporting, specialized programs that demonstrate commitment to newcomer youth living in critical housing situations is one way to bridge the gaps present in their social safety net.

A Research Study on Homeless Newcomer Youth in Toronto increases our understanding of newcomer youth and those born outside of Canada who have experienced homelessness.

One-fifth of participants who had previously been in the care of Children’s Aid Society reported they have moved to a shelter once they transitioned out of the care system.

There is a mismatch between the support services that are needed, and those that newcomer youth are receiving.

Access the PDF version of the above infographic.

York University - The Homeless Hub/KMb
January 20, 2015

A few weeks ago I tweeted about three things I learned while working on the Leaving Home report on Youth Homelessness in York Region. Oxana from the Homeless Hub promptly messaged me – and planted the idea that ‘this would be a good blog post’.  I have taken some time to expand on what I learned, though they aren’t to be mistaken with the ‘key findings’ of the report:

York Region sign

  1. Youth are resilient – but they need support.

    This was particularly clear when you listen to the details of the stories that youth told during interviews. For example. Chris, who is 20 reported the following:

    My dad had prostate cancer and my mom had diabetes so it was up to me and my sister…we had to take care of them most of the time. Then we kinda got depressed and started taking pills for that.

    While this might not seem immediately connected to the concept of resiliency – it’s this kind of narrative and story that demonstrates some of the struggles that youth go through – and adapt to.

    Before I started teaching my course on Homelessness, I spoke with a friend who had been street involved when he was younger. I asked him if there was anything that I should make sure to tell to my students – he said:

    Humans will adapt to anything, just put someone in an environment – and they’ll do what they have to do to survive.

    The question that becomes more important is – how do we get better at helping people thrive, not just survive. I feel strongly that the answer is to move towards a more coordinated system that draws, and strengthens, the resources that we already have in communities like York Region. This includes providing more funding to service agencies, as well as using schools, community centers and public libraries as partners to facilitate better access to services.

  2. Youth are likely to blame themselves for their experiences of homelessness- even if the situation has to do with physical or emotional abuse.

    Just over 20% of youth reported leaving home because of abuse, another 70% left home because of conflict with their parents.  Not all conflict is emotional abuse (I remember being a teenager, sorry mom) – but I would hazard a guess that some of that is, and may not be identified as such. 

    We know that victimization is much higher for youth experiencing homelessness. There is also a major need for addressing trauma for those who have experienced victimization while still at home.  This applies to the youth homeless sector in general – and not just York Region. Unfortunately – the way the sector is now, there are not enough resources to address trauma related to life experiences.

  3. Service providers are working very hard to help youth access services - but they need more resources.

    We know that integration is important. We often talk about the importance of having a system of care – or an integrated homelessness service system.  I think it’s important to keep in mind that service providers are working very hard within a system that isn’t integrated – maybe even harder than they should be for their own self-care and well-being. It’s hard not to when you’re so committed to helping the youth that access services with you.  This commitment showed in many different ways, but two stood out:

    - There was common sentiment from the executive director level that there was very low employee turnover in their agencies. This might be suprising to some, considering the amount of emotional energy it takes to provide services.

    - Workers had many examples of going out of their way to help youth access the services that they needed. One worker drove a youth to Hamilton to access a detox program that wasn’t available in York Region because the youth had come to say that they were interested in enrolling. We know with substance use, it’s terrible to turn someone away if they’re interested in working towards recovery.

    Speaking with service providers, and people involved in services, throughout York Region was inspiring.  There are solid groups of people that are working hard towards the goal of ending youth homelessness in York Region.  The service sector in York Region has, what I find to be, an unparalleled commitment to connecting, sharing resources and focusing on solutions to common problems that has allowed them to make great strides without having access to population proportionate funding. Imagine what could be done with sufficient funding.

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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.