Two years ago, a research team at the Centre for Addiction and Mental Health began a national, mixed-methods study to examine the mental health and wellness of service providers working with people experiencing homelessness in Canada. After asking for your help with recruitment, we heard from hundreds of providers coast-to-coast. In this blog post, I will share some of the key findings from the study.
The quantitative data for this study were collected through an online survey, which was completed by 701 service providers working in the homeless service, supportive housing, and harm reduction sectors during the second wave of the COVID-19 pandemic in Canada. After the survey component of our study was complete, we conducted qualitative interviews with 40 providers to learn more about their work experiences.
Mental Health and Wellness of the Workforce During the COVID-19 Pandemic
- Of the 701 service providers who completed the online survey, 79.5% reported a decline in their mental health during the pandemic. This finding is almost identical to other research on the mental health impacts of the pandemic on healthcare workers in Canada.
- Younger service providers and those who spent all or almost all of their time in direct contact with service users were at the greatest risk of mental health problems.
- The pandemic caused financial problems for 51.4% of service providers.
- Due to the pandemic, service providers were under increased stress for the following reasons:
- New work roles and responsibilities
- New challenges with how to serve clients most effectively
- Less organizational support
- A silver lining of the pandemic was the increased awareness of workplace mental health within organizations.
Workplace Stressors and Critical Events
- 89.0% of service providers had direct exposure to one or more critical events in the workplace during their careers. In this case, the term “direct exposure” means that workers had experienced the critical event themselves, witnessed it, or responded to it in the workplace. The most common types of critical events that providers had been exposed in the workplace were:
- Overdose (58.2%)
- Physical assault without injury (52.1%)
- Threat of death/serious injury (46.1%)
- Suicide or near-fatal attempt (27.8%)
- Chronic stressors, including verbal abuse, were also very common. For example, 18.7% of service providers experienced verbal abuse at work on a weekly or more frequent basis involving racism.
- Working in homeless services with single adults was significantly associated with greater exposure to chronic stressors and critical events.
- Greater exposure to frequent chronic stressors was significantly associated with more posttraumatic stress symptoms and psychological distress.
The Role of Structures and Systems in Workplace Mental Health
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The affordable housing and overdose crises, underfunding of the homeless and housing sectors, and insufficient or inaccessible mental health services created work challenges for providers that increased their risk of distress.
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Service providers working with people experiencing homelessness can encounter social stigma by association. In other words, service providers are sometimes “painted with the same brush” as people experiencing homelessness. This can lead providers to feel misunderstood and experience discrimination in their communities, making it harder for them to reach out for support.
- Moral distress is a common response to challenging work experiences, especially being unable to do more for clients who have many unmet needs, including housing.
- The way that structural and systemic factors exacerbate the difficulty of service providers’ work and put service providers at-risk of work-related mental health distress was labeled as “systems trauma”.
Conclusions and Paths Forward
Our research, as well as other studies from Canada, the U.S., and the U.K., demonstrate that service providers working with people experiencing homelessness have been substantially impacted by the pandemic. However, it is also clear is that many of the challenges affecting work in the homeless service, supportive housing, and harm reduction sectors existed prior to the pandemic and will continue to exist moving forward. Many of these issues are the downstream effects of the same structural and systemic problems that negatively affect people experiencing homelessness just to a lesser extent. Without adequate support, service providers may be at-risk of a range of work-related mental health problems, including burnout, post-traumatic and secondary traumatic stress, moral distress, and helplessness. So, what can be done about it?
Our research has proposed various approaches and recommendations for improving the workplace mental health of service providers working with people experiencing homelessness, including:
- Establishing a national initiative or network to advocate for the needs of service providers working with people experiencing homelessness. The work could include:
- Raising the public profile of this essential workforce
- Creating a workforce development strategy that outlines sectoral capacities; roles, skills, and competency-based training requirements of service providers; and employee retention strategies
- Allocating funds within governmental budgets and investments for ending homelessness towards workforce development and support.
- Expanding access to mental health supports for service providers working with people experiencing homelessness, including:
- Employment-based benefits for psychotherapy, as well as other innovative mental health-social service system collaboration opportunities (e.g., frontline wellness programs). The employee assistance programs currently available were perceived by many service providers to be inadequate and not ideally positioned for addressing the mental health needs of this workforce.
- Strengthening capacity for community agencies to provide supervision to direct service workers that includes emotional support, discussion of work-related issues with service users, and career growth opportunities. Supervision can also be an outlet for recognizing and validating the impacts that structural and systematic problems have on providers.
- Using task rotation strategies to provide service providers with opportunities for respite from the emotional demands of direct service delivery.
- Developing “for staff, by staff” interventions for coping with grief and loss. It is key that service providers involved in establishing and coordinating these initiatives are provided with protected time to engage in this work (i.e., it cannot be an additional responsibility on top of all their other work tasks).
- Using trauma-informed practices to create an organizational environment that minimizes the risk of re-traumatization for people experiencing homelessness and reduces the secondary traumatization of service providers.
- Scaling-up investments in best practice housing interventions to reduce service providers’ experiences of helplessness and moral distress. The benefits for providers are expected to occur indirectly as a result of reducing the barriers that they encounter when helping people experiencing homelessness to find needed housing and supports.
- Using a Quadruple Aim framework to evaluate outcomes of housing interventions and systems, so that wellness of service providers is recognized as a key indicator of service performance.
Collaborators and Acknowledgments
The core research team was comprised of Nick Kerman, Sean Kidd, John Ecker, and Emmy Tiderington. Additional collaborators included Jordan Goodwin, Vicky Stergiopoulos, Stephen Gaetz, and Amanda Aykanian. Funding for this research was provided by the Canadian Institutes of Health Research and the Centre for Addiction and Mental Health Discovery Fund. The Mental Health Commission of Canada and Centre for Addiction and Mental Health also collaborated on knowledge translation and dissemination of this research.
Thank you to the many organizations and networks across Canada that supported this research during data collection, including the Canadian Alliance to End Homelessness and Canadian Observatory on Homelessness, as well as the many service providers who participated in the study.
For more information about the study and its findings, please contact Nick Kerman at Nick.Kerman@camh.ca.