In Canada, between 35,000–40,000 young people experience homelessness each year – that’s approximately 6,000-7,000 youth on any given night. Public systems (e.g., healthcare, child welfare, criminal justice) contribute to whether a young person experiences homelessness, and whether they remain on the streets or not. Among these systems, the healthcare system plays a critical role in youth’s trajectories into, and out of, homelessness.
Drawing on findings from a national consultation with youth experiencing homelessness, What Would it Take? Youth Across Canada Speak Out on Youth Homelessness Prevention, this blog explores how young people view the connection between the healthcare system and housing precarity in their lives. We outline youth-generated insights into how the healthcare system can help prevent homelessness, highlighting youth’s recommendations for change.
Youth Homelessness & the Healthcare System
When young people experience extreme forms of poverty and marginalization, such as homelessness, maintaining mental and physical health is a considerable challenge. Homelessness, while already a fundamental human rights violation, exposes young people to some of the most severe health harms, including: premature death, suicide, physical and/or sexual violence, deteriorating physical health and mental health, substance dependence, and traumatization. The Without a Home study (2016) found that:
- “The adversity of life on the streets means that young people are exposed to a number of factors that lead to poor health, including inadequate nutrition, poor hygiene, lack of proper rest, high levels of stress, increased risk of injury, increased sexual activity with more partners, increased exposure to STIs, and greater exposure to a range of communicable diseases.” (p.61)
- “An overwhelming 85.4% of youth experiencing homelessness report facing high symptoms of distress. Nearly half (42%) of participants reported at least one suicide attempt, and 35.2% reported having at least one drug overdose requiring hospitalization.” (p.11)
- “Suicide is a leading cause of death for youth experiencing homelessness – where exposure to street sexual and physical violence also made youth over 3x as likely to experience high mental health risks.” (p.11)
Research demonstrates that these health outcomes are not just individualized challenges that young people face, but are the result of structural and public system failures.
Systems Failures in the Healthcare System
Across the country, young people experiencing homelessness explained how health challenges become pathways into homelessness when systems failures occur. Systems failures refer to situations where inadequate policy and service delivery contributes to the likelihood that someone will become homeless, or extends or worsens that experience of homelessness. For example, lack of access to healthcare services while on the streets may contribute to the deterioration of a young person’s mental and physical health, which in turn may make it more difficult to transition into housing.
Young people experiencing homelessness identify numerous challenges to accessing quality care within the healthcare system, including:
- Lack of familiarity with how to access healthcare resources
- Limited access to transportation needed to get to healthcare services
- Lack of respect or cultural sensitivity in interactions with healthcare providers
- Restrictive rules and regulations for accessing services
- Lack of supported transitions between services
- Long waitlists
- Cost (e.g., for prescriptions)
- Discrimination by healthcare providers (e.g., transphobia)
- Lack of healthcare facilities within their neighbourhood/community (e.g., in rural and remote communities)
- Language barriers
These experiences make it difficult for young people to access the healthcare services they need and deserve, and can contribute to a distrust of healthcare providers. Young people may also avoid healthcare services for fear of coming to the attention of social services, or fear of legal intervention. For instance, some studies have found that those experiencing homelessness who are pregnant are often hesitant to pursue prenatal care out of fear of having their child(ren) removed by child welfare services. Such practices create a barrier to service utilization for some expectant mothers, putting them at risk of miscarriage, abortion, barriers to a nutritious diet, and quality prenatal care. These barriers not only put the mother’s health at risk, but may detrimentally impact the child - suggesting a potential intergenerational impact on overall health and well-being.
Indigenous youth face unique challenges within the healthcare system. Those who live in remote communities (e.g., Northern Indigenous communities, on reserves) face incredibly limited access to healthcare services, where facilities are essentially non-existent. In urban centres, despite an abundance of services available, Indigenous youth often face cultural barriers and anti-Indigenous racism when trying to access these services, and thus are less likely to seek help. What’s more, Indigenous youth in Canada have a mortality rate that is 3 times higher than the national average, and have disproportionately higher rates of preventable chronic and infectious diseases than non-Indigenous youth. Such statistics demonstrate the ways in which structural inequities are manifested in and through the healthcare system.
In What Would it Take?, youth raised four key areas of concern with respect to the healthcare system:
- Availability: Youth indicated that in some cases, healthcare services weren’t available in their community, or youth didn’t know about them. Youth particularly struggled to access mental health supports once homeless, with one young person in St. John’s explaining that they had been on the waitlist to see a psychiatrist for three years.
- Accessibility & Appropriateness: Some youth couldn’t access supports because of age restrictions or because caregivers refused to grant them permission. The appropriateness of available healthcare was also an issue, with several youth commenting that supports or services were rarely targeted to young people, including young women, and thus did not feel safe or welcoming.
- Affordability: The cost of mental health services was prohibitive for many, as was the cost of prescriptions (for example, one Yellowknife youth explained that obtaining Plan Bs was very difficult).
- Discrimination: An additional issue raised by many youth was the discrimination and stigma they experienced both within and outside of the healthcare system. For example, LGBTQ2S+ identifying youth experience barriers to accessing healthcare services due to a lack of LGBTQ2S+ culturally competent staff, and homophobic and transphobic discrimination.
Building a Better Healthcare System
Young people experiencing homelessness across Canada have brilliant ideas about how to improve the healthcare system, which are outlined in the What Would It Take report. By implementing these recommendations, we have the opportunity to build a more effective and equitable healthcare system that serves the needs of youth experiencing homelessness.
Youth’s Recommendations:
Policy & Systems Change
- Run public awareness campaigns that de-stigmatize mental health issues
- Improve coordination and communication between healthcare services and other systems
- Run public awareness campaigns for youth about available mental health and addiction services
- Co-locate mental health and addiction services with other supports for youth at risk of homelessness
- Enable youth under 16 to access services for mental health and addictions without parental signatures
- Reduce the age at which youth can act as an advocate for themselves in the healthcare system
- Reduce waitlists for mental health supports, including in-patient care
Investments
- Establish highly accessible emergency funds for families experiencing a health crisis
- Fund and expand affordable, accessible mental health and addiction supports in all communities, including Indigenous and rural communities
- Build and expand rehab centres for youth, including centres for female-identified youth specifically
- Increase social assistance rates for people with disabilities and chronic health issues
- Increase funding for community-based mental health supports for youth and their families
Professional Conduct & Training
- Train medical staff to identify and report abuse when they see it
- Provide all healthcare professionals training on culturally-sensitive healthcare provision, empathy, and trauma-informed care
Interventions
- Provide concrete, hands-on supports to assist youth to access mental health, health, and addiction services (e.g., accompany youth to appointments)
- Provide free access to dental care for youth and their families
- Offer free programs and supports to families whose child is experiencing mental health or addiction issues
- Ensure all mental health interventions are adjusted to each youth’s unique needs