In this newsletter:
1. A rising sense of depression
Health care expenditure opportunities for affordable housing
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1. A rising sense of
I raise this topic with tentativeness, but it's important that we talk about
it openly. I have noticed how depressed, both physically and
psychologically, organizations working for the homeless have become. This is
not the fault of any one of us, but it is now a fact of life.
Many organizations serving the homeless started in the last two decades.
They assumed they would be doing good work for a season or two and then the
crisis would be resolved. As we know, what has happened instead is that the
problem has intensified and many organizations - ranging from Out of the
Cold to more
formal social agencies - are serving two or three times the number of people
that they started with.
These agencies often got underway in whatever space they were easily able to
find, such as churches or other space that no one else was using.
The facilities were old to begin with and often in poor condition, and they
have only gotten worse.
The applications that are now being made to improve
these facilities with limited grants from the federal government (through
the Supporting Community Partners Initiative, SCPI, or “Skippy” as it is
called) are for changes like installing better toilets, improving floors, making the
heating function and so forth. The result is that space which was in the
first place only second rate, is being patched together.
This can be seen in every kind of agency helping the homeless. Daytime
drop-in centres, for instance, are overflowing. Not only are more people
using the services provided but they have higher service needs. Often these
agencies find they do not have enough staff resources or physical resources
on a day by day basis. For example, many agencies are not able to provide
enough food, both because of limited food budgets and because of the huge
demand. The crisis which includes crowding and scarce resources results in
trauma of various kinds –frustration, frayed tempers, and increased
violence. It feels desperate.
Added to these burdens on agencies is the fact that certain aspects of the
community create pressure (aka NIMBYism) around these facilities to try and
contain their activities. It is as though the organizations that are trying
to help the homeless get the blame for the existence of the problem rather
than being lauded for trying to respond to it. It feels insecure.
These conditions lead to vicarious trauma, not only for homeless people
using the services but also for staff. Many staff who have been working in
homeless facilities have been doing so for much too long and understandably,
the burnout rate is growing. Because of the increased workloads and day to
day crises, workers are less likely to be allowed to engage in
community-wide activities or actions which would help press decision makers
for change. Their political voice is minimized. This means that the kind of
mutual support and solidarity that develops among staff and organizations at
community mobilizing events is harder to create. Worse, the organizations
that serve the homeless perceive that they are no longer able to participate
in certain types of advocacy because it may be seen as a risk to their
funding, to their non-profit status, to their reputation.
It feels like we’re
These are difficult long term problems which we never thought would exist,
but which we have seen grow as the disaster intensifies. The homeless have
become a sizeable underclass in our cities and towns, a group of individuals
who have no sense of privilege and whose sense of hope is disappearing. No
there's such a growing sense of depression. It is depressing.
Depression in many cases actually impairs cognitive abilities – it becomes
much more difficult to think clearly and coherently. Choices seem more
limited. There is a rising sense of desperation. Sometimes it can prompt
individuals or groups to lash out inappropriately or unwisely. Depression
and vicarious trauma impede our collective struggle for solutions.
Many people with experience believe that the best “cure” for depression is,
when possible, to get engaged and become involved. Taking concrete action,
even on a small scale, can be the best medicine. While depression often
prompts individuals or groups to become disengaged, the simple truth is that
the best response for this type of systemic depression is to get active.
Therefore, even small, local initiatives can be very therapeutic in that
they may help people to move beyond the depression to action and solutions.
We’ve faced difficult times in the past and engaged in terrific solutions
that mobilized Canadians and led to major funding initiatives – the Rupert
Hotel Coalition, the Toronto Coalition against Homelessness’ cry for an
inquest into freezing deaths, the 1998 declaration by groups across the
country that homelessness qualified as a national disaster. There are many
Please send me your comments about the conditions in your local communities
and organizations and local strategies that may have been adopted to address
what I call “systemic depression”. Local success stories are always welcome
and can be very useful to share with others.
future newsletters, I will try to discuss with you some of these ideas that
will help us move forward.
Some clear trends are developing in a number of communities.
First, there is more crowding in shelters and in drop-in centres. Second,
there is an increase in the number of women living on the street and there
are not enough shelter beds for women. Third, there are more aboriginals
who are part of the homeless population, although it is unclear to me
whether they have recently come from reserves or whether they have lived in
cities for some time but are recently dropping off the economic
ladder. Clearly though, first nations people figure high in the death rate
among the homeless. Fourth, there are increasing difficulties for the
homeless in receiving health care. It is now evident that even the most
creative health care programs for the homeless become just a band aid if
housing is not part of the “care plan”.
It is not difficult to conceive of the public responses needed to reverse
these trends, yet it is fascinating that federal and provincial governments
are not doing the things that are necessary to reduce the population of
homeless, or treating the homeless as real Canadians who deserve good
services. It's as though homelessness is operating in a vacuum entirely
apart from the political realm.
the months to come I hope to visit more communities to see first hand what
they are experiencing.
3. Health care expenditure
opportunities for affordable housing.
Here's a truism: housing is a determinant of health. Poor housing leads
to poor health, just as better housing can lead to better health. Those who
are homeless incur very significant medical expenses. In Canada, where
health care costs are mostly bore by the public, it makes sense to ensure
there is good housing in order to minimize health care costs.
We are currently in the midst of a massive political debate about health
care costs, and there's a summit of provincial and federal leaders scheduled
for mid-September. The provincial premiers talk about the need for more
money to be devoted to health care, and the federal leaders seem to agree,
although they are sure to differ on the amounts and/or the conditions.
If more affordable social housing is made available, health care costs are
be reduced, so it makes sense to link these two matters. Governments should
agree that more money should be available for affordable housing if there's
agreement to spend money on health care. I'm not sure what the actual
ratio should be, but I'd venture this idea: for every extra four dollars
spent on health, we should be spending one more dollar on affordable
housing, at least for the next ten years.
This would mean that if an extra $4 billion is spent on health care each
year, then $1 billion should be spent on affordable housing. If $8 billion
extra is agreed to be the amount spent on health each year, then $2 billion
should be spent annually on affordable housing (The 1% Solution!). What's
amazing about this kind of formula is that spending money on housing will
actually dampen the demand for health expenditures from those who are better
housed, so the bang for the extra health dollars will be big.
One of my colleagues has suggested how this can be put in government
language, and that's by saying that expenditures for health and housing have
to come from the same ‘envelope’, so that what happens in one sphere of the
envelope affects another sphere.
This is an issue I'm hoping to take up during the next few months and I hope
others will embrace it as well. Health care can't be talked about in a
vacuum, and there's no better context to put it in than affordable housing.
Maybe our attention to health care will lead to a way out of homelessness.
After all, that's the history of public health initiatives in Canada, and
it's what has helped drive me as a nurse to focus so much on the public
health tragedy known as homelessness.
Thinking about health and affordable housing in the same envelope of
expenditure is the opportunity that's before us right now. I hope we seize
it. If we address the homeless questions directly by providing truly
housing for the homeless then the substantial health dollars we now spend on
the homeless would decline considerably.
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