From homelessness to Recovery

The final Grand Rounds session for 2014 presented an eye opening look at homelessness in Toronto and its environs, as well as the health needs of that population.

To set the tone, Dr. Christopher Tam, Psychiatrist at Ontario Shores began by defining homelessness for the Canadian context.  “Homelessness is an individual or family without stable, permanent, appropriate housing or the immediate prospect, means and ability of acquiring it.  It is important to note that persons who are on the verge of losing permanent housing are considered homeless,’ says Dr. Tam.

Homelessness is usually not a situation that is chosen and is perceived as negative, unpleasant and stressful.

Dr. Tam indicated that there are four types of homelessness in Canada:  unsheltered - where persons are living or sleeping outdoors; emergency sheltered – where persons are given temporary housing, usually at formal shelters; provisionally accommodated – these are the couch surfers and those who may be accommodated temporarily with family or friends or at paid lodging; and those at risk of homelessness - those persons that are on the brink of losing their stable housing.  

“This is a fluid situation and people often move between the four types of homelessness, for example from sleeping outdoors to shelters to couch surfing,” explained Dr. Tam.

In order to ensure housing stability, persons should have a fixed address and should have the relevant income and supports.
Based on a survey conducted in Toronto, the number of homeless people was 5,253 on April 17, 2013.  In addition, the survey shows that there are over 5,000 persons that are considered homeless on an average night in Toronto with nine percent of those sleeping outdoors.  The average length of homelessness is three years; with men represent 67 percent of the homeless population in Toronto.

While 16 percent of all homeless people self-identify as aboriginal, there are 21 percent who self-identify as a member of the LGBTQ community. In addition, trends show that the number of people sleeping outdoors has increased within the last couple of years and the number of seniors has doubled.

“Economic reasons (low income and high cost of housing) are being identified by 52 percent of people as the cause of their homelessness”, adds Dr. Tam.  An unsafe or poor living condition was the reason given by 31 percent of those studied and 25 percent identified eviction as their main reason for homelessness.

Chronic health conditions are common for the homeless in Toronto, and with 52 percent indicating a past diagnosis of a mental disorder.   “One in six homeless individual in Toronto have unmet needs for health care within the past year,” says Dr. Tam. “Interestingly, the average life span of a homeless individual is seven to ten years shorter than the general Canadian population,” adds Dr. Tam.

The barriers to accessing healthcare when you are homeless include being able to balance competing priorities, lack of transportation, a general mistrust of healthcare providers, no health insurance and a general difficulty in accessing medical care. 
“We have to address these barriers if we want to see an increase in housing stability,” says Dr. Tam

Research suggests that getting housing becomes the catalyst for other life changes and creates a sense of hope.  “A positive health encounter can be the first step to a person exiting homelessness and also become the catalyst for recovery for those living with a mental disorder.”