Homelessness Questions & Answers

Answers to many of the questions surrounding homelessness and poverty issues.

1) What is homelessness?
Homelessness is an extreme form of poverty characterized by the instability of housing and the inadequacy of income, health care supports and social supports. This definition includes people who are absolutely homeless (those living on the streets, sometimes referred to as "rough sleepers"); shelter dwellers (people staying temporarily in emergency shelters or hostels); the "hidden homeless" (people staying temporarily with friends or family), and others who are described as under housed or "at risk" of homelessness.

When people lose their housing, they often move in temporarily with friends or family, a practice known as "couch surfing". If the option of moving in with friends and/or family is not (or is no longer) available because of weak social capital or a lack of steady income, many people will stay in temporary emergency shelters, or end up absolutely homeless. Emergency shelters exist in medium- and large-sized urban centres, but are not generally available in rural areas and small towns.

If they are able to generate money, people who experience homelessness may rent motel rooms, move into rooming houses, or with friends, temporarily. Others will sleep "rough" in parks, along alleyways, on rooftops, or under bridges. Most people who are homeless move through a variety of temporary and unstable living situations, which makes generating income, maintaining health, keeping safe, nurturing healthy relationships and obtaining permanent housing extremely challenging.

Homelessness, then, is not defined strictly by an absolute lack of shelter (though this is the most obvious manifestation of it), but rather by the intersection of a range of social exclusionary factors that exacerbate poverty, limit opportunities and create barriers to full participation in Canadian society. Real political solutions to homelessness rest not only in addressing the inadequate supply of affordable housing in Canada, but also in improving income security, equitable access to health care supports (including mental health and addictions) and justice, for example.

2) Different types of homelessness
Homeless or "houseless people" fall into three very clear categories: the absolute homeless, the concealed homeless and those at risk of becoming homeless.

Absolute Homelessness
Homeless persons are defined as people "sleeping rough" or using public or private shelters. People sleeping rough, which means in the street, in public places are those forming the core population of the "homeless". Those sleeping in shelters provided by welfare or other institutions are considered part of this population. Persons or households living under these circumstances will furthermore be defined as "homeless".

Concealed Homelessness
People who are homeless, but temporarily housed with friends or family form another category of the "homeless" - referred to as "concealed homelessness."
Another, not obvious side of the problem is "concealed homelessness." Under this category falls all people living with family members or friends because they cannot afford shelter themselves. Without this privately offered housing opportunity, they would be living in the street or be sheltered by an institution of the welfare system. The extent of this phenomenon is extremely difficult to calculate.

At risk of Homelessness
In addition to absolute and concealed homelessness, some people are at risk of losing their housing and can be categorized as people at "risk of homelessness."

Another group living under the threat of "homelessness" are those facing the risk of losing their shelter either by eviction or lease expiry, with no other possibility of shelter in view. Prisoners or people living in other institutions facing their release and having no place to go to, are considered part of this population.

Finally, we need to recognize that there are many Canadians who are inadequately housed. While being inadequately housed is not the same as being homeless, it can lead to being at risk of homelessness. Most of the people who become homeless started off being inadequately housed.

Before becoming homeless, many people have been living in "substandard housing" situations. Households with feeble and perhaps insecure income are likely to live in substandard housing units and might also experience homelessness because of economic difficulties. Their situation is somehow comparable with those without shelter, as they are all deprived of the human right of a housing situation without health hazards, allowing the full development of the individuals' capacities. Therefore, the population living in substandard houses should be included in the study of homelessness.
From www.raisingtheroof.org

3) Why does homelessness generate so much debate and confusion?
While there should be no difficulty in understanding the nature of the problem, there is indeed a great deal of confusion and debate. Service providers, policy makers, researchers, citizens and politicians tend to use the term in many different ways. The confusion is due to conceptual imprecision, fuzzy boundaries, the influence of political agendas, the heterogeneity of the homeless population, and the assumptions and attitudes of the housed population.

This confusion is caused by two factors- one political and one practical.
Defining homelessness for policy and program purposes (i.e., taking action) requires compromises between concerns for social injustice, economic realities and political expediency. It requires some authority or combination of authorities - levels of government, in partnership with agencies and charities - to take responsibility. Taking responsibility means allocating resources and imposing regulations and changes in those institutions and practices which are producing homelessness, and which stand in the way of addressing existing and preventing further homelessness.

The confusion and inaction is also attributable to the fact that homelessness is the outcome of a very complex set of social processes. These processes include:
• Global economic restructuring (including deindustrialization and labour market changes);
• Restructuring of the welfare state (national, provincial and local welfare and income maintenance policy and programs);
• Demographic change (more single person and single parent households);
• Change in social attitudes and lifestyles;
• A housing system in crisis (gentrification, conversions, low vacancy rates, cuts in social housing supply and general housing assistance, etc.); and
• An inadequate system of supports for vulnerable groups, including people who require assistance with mental illness and substance abuse problems.

These major contextual issues are not only relevant and crucial to understanding the problem, but are difficult to grasp and sort out.
From www.raisingtheroof.org

4) Isn’t homelessness a mental health and substance use problem?
Substance Use

The relationship between substance use and homelessness is complex. While rates of substance use are disproportionately high among the homeless population, homelessness cannot be explained by substance use alone. The use of substances alone does not necessarily signal addiction, nor a harmful or problematic lifestyle. In addition, many people who are addicted to substances never become homeless, but an individual that is experiencing housing instability, often due to low income, has an increased risk of losing their housing if they use substances. Once on the streets, an individual with substance use issues has little chance of getting housing as they face insurmountable barriers to obtaining health care, including substance use treatment services and recovery supports.

The term "substance use" refers to all types of drug and alcohol use. It is used in place of the traditional label of "drug abuse" which perpetuates social stigma and judgement and can marginalize and alienate people from the supports they need. The term "use" signals a push to reduce the harms for all users - from the person who uses drugs or alcohol occasionally, to someone who has a serious addiction. The term "substance", rather than drugs, better reflects the full range of psychoactive substances including alcohol, cigarettes, illegal drugs, prescription drugs, solvents, and inhalants that are habit-forming.

The potential harms associated with the use of substances are many. This includes pharmacological effects of the substance itself that may impair a person’s ability to safely and competently make decisions and carry out tasks that they engage in. Problematic substance use may lead to deteriorating health; accidental death; and increased chances of risky sexual behaviours. Other harms that may result from problematic use of substances include: the inability to work or stay in school, ruptured relations with family, friends and community members, and problems with the law.

Responses to substance use are varied. They include: prevention (which may emphasize abstinence, at one extreme, or harm reduction), treatment (for those whose substance use is considered problematic), harm reduction (programs that seek to reduce the risk of substance use) and enforcement. The latter point is important. In Canada, as elsewhere, the use of substances is highly politicized, meaning that some potentially harmful substances are legal (cigarettes and alcohol, prescription drugs), while others are not. As a result, a potential "harm" of substance use is getting arrested.

People who live on the streets and engage in substance use face many risks, one of which is difficulty obtaining and maintaining employment and housing. The frequency of such problems suggests the potential viability of harm reduction programs that provide a safe environment for stabilization to clients who are unable to maintain abstinence. As well, stable supportive housing is needed to give people an environment in which they are better able to deal with their substance use problems.

Transitional housing is frequently recognized as an approach to addressing substance use problems, and is often provided through emergency shelters and supportive recovery facilities. Often though, these housing options require abstinence in order to accept clients. The result is that many people fail to qualify, and remain on the streets or in environments that are not conducive to addressing their substance use problems. And even if they do complete treatment, because of a lack of supported housing options, once they are discharged from hospital or treatment center, many people with substance use issues have no place to live, a situation which puts their recovery in jeopardy.

Mental Health
People with poor mental health are more susceptible to the three main factors that can lead to homelessness: poverty, disaffiliation, and personal vulnerability. Because they often lack the capacity to sustain employment, they have little income. Delusional thinking may lead them to withdraw from friends, family and other people. This loss of support leaves them fewer coping resources in times of trouble. Mental illness can also impair a person’s ability to be resilient and resourceful; it can cloud thinking and impair judgment. For all these reasons, people with mental illness are at greater risk of becoming homeless.

Homelessness, in turn, amplifies poor mental health. The stress of being homeless may exacerbate previous mental illness and encourage anxiety, fear, depression, sleeplessness and substance use. The needs of homeless people with mental illnesses are similar to those without mental illnesses: physical safety; education; transportation; affordable housing; and, affordable medical/dental treatment. When providing care to people who are homeless, it is essential to create a non-threatening and supportive atmosphere, address basic needs (e.g. food and shelter), and provide accessible care.

People with mental illness remain homeless for longer periods of time and have less contact with family and friends. 30-35 percent of homeless people, in general, and up to 75 percent of homeless women specifically, have a mental illness. 20-25 percent of homeless people suffer from concurrent disorders (severe mental illness and addictions). People who have a severe mental illness are over-represented in the homeless population, as they are often released from hospitals and jails without proper community supports in place.

Community-based mental health services play an important role. Homelessness could be drastically reduced if people with severe mental illness were able to access supportive housing, as well as other necessary community supports. They encounter more barriers to employment and tend to be in poorer health than other homeless people. Housing outreach services that provide a safe place to live are a vital component of stabilizing the illness and helping individuals on their journey to recovery.

5) Who are people who are homeless?
No one is safe from experiencing homelessness. No one chooses to be homeless and it can happen to anyone. In most cases, it is the intersection of structural factors, personal histories and individual characteristics that lead to homelessness. Structural factors include: the growing gap between the rich and the poor, the decrease in affordable housing supply; the decrease in services, supports and social assistance; and, discrimination and racism. Personal histories and individual characteristics include: catastrophic events; loss of employment; family break up; onset of mental and/or other debilitating illnesses; substance use by oneself or family members; a history of physical, sexual or emotional abuse; and, involvement in the child welfare system. Every community in Canada has homeless people, even if you don't see them on the street. Most homeless people don't live on the street.

Working poor and single-parent families with children often live in crowded housing. They are unable to afford a decent place to live while feeding and clothing their children. About one-in-seven users of shelters across Canada is a child. Women are vulnerable to becoming homeless as they are often victims of family violence and generally earn less than men. Newcomers to the rental housing market - especially young people, immigrants and refugees - are required to rent housing that they cannot afford and are one cheque away from eviction. Many seniors face eviction and homelessness due to fixed incomes, increased rents and taxes and a decline in physical and mental health. Many homeless youth, particularly gay, lesbian, bisexual or transgender youth, are living in shelters or with friends as they are fleeing abusive situations. Visible minorities are often at risk of homelessness due to racial prejudice and employment disparities. Aboriginal people experience many of these contributing factors as well as migration; third world housing conditions (on-reserve); loss of cultural identity; and, the residential school system.

Understanding the factors that lead to homelessness is not easy considering the heterogeneity of the population, and the fact that there are many pathways to homelessness. More and more, researchers are recognizing that any analysis of homelessness must take account of the distinct challenges that specific sub-populations face. More and more community organizations are beginning to recognize the value of good demographic data for rationalizing their local service programs for homeless people. By using such tools as a database to track demographics and characteristics of their clients, they can better focus on specific approaches and services that match the people they are serving. While collecting data cannot resolve all of their priorities or make all of their decisions it helps to provide clarity and a starting point for planning appropriate programs and services.

6) Does welfare prevent people from becoming homeless?
Government benefits can in some cases be preventative of and responsive to causes and impacts of homelessness. Federally, such government benefits include: Employment Insurance and Regular Benefits; a Skills Development Program; Self-Employment Benefits; Maternity, Parental or Sickness Benefits; An Opportunities Fund for Persons with Disabilities; Canada Pension Plan, Old Age Security, and rent allowances. Additionally, there are provincial government benefits that differ from province to province. They may offer all or some of the following: income support/social assistance, employment supplements; programs for persons with barriers to employment; or vocational rehabilitation programs.

Contrary to popular opinion, very few homeless people receive government benefits. Because of this, they need to generate income in other ways, such as through panhandling, squeegeeing and the sex trade. In many cases, homeless people are entitled to various government benefits - including social assistance, disability and pension benefits – but experience barriers (e.g. administrative processes, timeline constraints, a lack of ID or personal address) to accessing them.

Social assistance (commonly called welfare) is the income program of last resort in Canada. It provides money to individuals and families whose resources are inadequate to meet their needs. Although people talk about welfare as a single entity, there are 13 welfare systems in Canada: one in each province and territory.

Most people living on social assistance were poorer (in inflation-adjusted terms) in the 1990s than the people living on welfare in the 1980s, according to the National Council of Welfare, a federal government appointed advisory and research group reporting to the Minister of Human Resources. People on welfare are invariably poor, but the depth of poverty is getting worse, according to the National Council. Single employable people on welfare fare the worst, with incomes as low as one-fifth of the poverty line. The incomes of all welfare households in all provinces were well below the poverty line, as measured by Statistics Canada's low-income cut-offs.

The Ontario government's 21.6 percent cut in social assistance payments in October 1995 was one of the more dramatic decreases in assistance to the very poor. This, together with other social assistance cuts, resulted in a net decrease of nearly 24 percent between 1994 and 1996 for Ontario's social assistance recipients. How many low- or even moderate-income households can sustain a loss of about a quarter of their cash income without facing serious difficulties?

The federal government also cut its transfer payments to the provinces for social assistance during the mid-1990s. From 1966 until March 1996, the federal government paid a share of the cost of welfare and social services under the terms of the Canada Assistance Plan (CAP). On April 1, 1996, the federal government replaced CAP with the Canada Health and Social Transfer (CHST). The CHST is a "block fund" covering Medicare and post-secondary education as well as welfare and social services. Ottawa's support for these important programs decreased by 16 percent between 1996 and 1998 - a cut in transfer payments to provinces that some provinces simply passed on to low-income households. Thus, both senior levels of government have contributed to the problem of low-income households lacking enough money to pay for adequate food and housing.

The housing portion of social assistance payments was never enough to cover the actual rent payment. The gap is much larger now. Benefits have decreased across the country, yet rents do not decrease.
From www.raisingtheroof.org

7) What is the health status of people who do not have housing?
The health of populations - individuals, their families and communities - is determined by the complex interaction of many factors - social, political, economic, legal, cultural, historical and biomedical. Of these determinants of health, income has long been recognized as one of the most important. People with higher incomes and higher socio-economic statuses tend to live longer, have lower rates of illness and injury, and are more likely to report that they have good or excellent health. People living in poverty have a lower life expectancy and higher rates of illness across a wide spectrum of diseases. Poor health predisposes individuals and families to homelessness and homelessness exposes individuals and families to particular health problems.

Homeless people live in conditions that adversely affect their overall short- and long-term health and contribute to an increased mortality rate. Although deaths among the homeless are occasionally due to freezing, they are mainly the result of injury, and the rigors of street life. Climatic conditions, psychological strain and exposure to communicable disease create and lead to a range of chronic and acute health problems, including injury from cold, tuberculosis, skin diseases, cardio-respiratory disease, nutritional deficiencies, sleep deprivation, musculoskeletal pain and dental trouble.

Being homeless makes it difficult, and in some cases impossible, to access general health care services. The homeless are unable to: obtain medical treatment without a health card (applicants require an address); pay for items not covered by provincial medical or drug insurance plans; receive adequate treatment in cases where their personal appearance alarms health providers; make a health appointment (lack of an address and telephone); and receive coordinated care when comprehensive medical records are not kept in one location with one provider.

Following treatment or hospitalization, a homeless person experiences problems with acquiring adequate follow-up healthcare. People who are homeless have no place to recuperate and no consistent caregiver. As a result, health care delivery to homeless individuals is concentrated in emergency departments, in the core of large urban centers and in the institutions set up to address their lack of shelter and social supports. There is a need to respond to the acute and chronic health problems of this population and to redirect attention to preventive health.

Whether as a cause or a consequence of ill health, homelessness has emerged as a fundamental health issue for Canadians. Homelessness affects a significant number of Canadians of all ages and is associated with a high burden of illness, yet the health care system may not adequately meet the needs of homeless people. The main barriers to good health, among the homeless, include a lack of adequate, safe, accessible and affordable housing that is linked to employability, community support, personal health care and access to health services.

8) Don't some people choose to be homeless?
The overwhelming majority of homeless people want to get off the street and into stable adequate housing. A homeless existence is characterized by demeaning environments, numerous threats to survival, and the most abject poverty affecting every aspect of daily existence.

Some people who find themselves without housing do choose to avoid using some or all of the emergency shelters because of the rules, the potential for violence, theft and so on. When the range of choices is limited to an emergency shelter or making do elsewhere, it is difficult to call this "choosing to be on the streets."

Among the general population, many people make bad choices at some time in their lives. For those on the economic margin, a bad choice can result in becoming unhoused. The alienation and deprivations that accompany life on the streets do not help people learn new and better choices. Sometimes, the effect is just the opposite.

Most people will never know what it is like to try to survive without housing. Homeless persons and the people who assist them list the following as just some of the realities:
• the constant search for temporary shelter;
• inadequate food and nutrition;
• shortage of appropriate clothing;
• sexual victimization; harassment and physical assault
• inadequate medial services;
• negative or low self-esteem;
• social isolation;
• development of mental health and/or substance abuse problems; and
• poor prospects for employment and appropriate permanent housing.
From www.raisingtheroof.org

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