London Homelessness Outreach Network

In spreading the word around town about homelessness and the surrounding issues, I found myself constantly approached by people who were interested in taking some kind of action. This happened often enough that I started taking names and email addresses, and in the spring a group of 12 of us got together to talk about what we could do. This led to some community consultations through the summer, which further increased interest. Now at over 35 members, we have decided to formally create the London Homelessness Outreach Network. I’m putting together a website right now, and it will detail some of our current projects as well as future plans. So stay tuned, this is a very exciting time for me and for others in town who are seeking positive change.

Statistics Update

I have come across a number of new statistics on homelessness in Canada that may be of interest.

There are over 19,000 shelter beds in Canada (Library of Parliament), which means my estimate of 30-50,000 persons is probably pretty close.

Homeless women in Canada aged 18-44 are 10x more likely to die than women of the general population (Cheung & Hwang, 2004), and only have a 60% chance of living to age 75 (Hwang, et al., 2009).

Somewhere in the range of 10% of people experiencing homelessness in Canada are older adults (aged 50, 55, or 65+ depending on the study; McDonald, Dergal, & Cleghorn, 2007).

Over 70% of homeless youth in Toronto have experienced some form of abuse in the home (Youth Without Shelter).

One study found that 1 in every 5 incarcerated people in Toronto were homeless prior to being jailed (John Howard Society).

In London, Ontario, $9.2M is allocated annually to addressing homelessness in our city (London Community Plan on Homelessness).

A Limitation of Research

Reviewing the research on power within client-provider relationships in health care with people who have experienced homelessness has served to remind me yet again that your research results will only be as broad as your own lens.  That is, you can only ever see what you have been prejudiced to see.

Take for example the article “The Lived Experience of Homeless Men” by Lafuente and Lane (1995).  In this study, the authors interviewed homeless men in a shelter to try to learn more about social disaffiliation.  The concern being addressed is that social disaffiliation may be serving as a major barrier to homeless men receiving formal health services.

The authors start by outlining their conceptualization of social dissaffiliation, and it catches my eye that one path in their theory is ‘Voluntary withdrawal from the community’, and the example given is drug addiction.  So, I am immediately struck that drug addiction has been set-up as a choice in the conceptualization that is driving the study.  I also note that there is a question that asks the men how they feel about being socially disaffiliated.  This takes for granted that all the men are socially disaffiliated because of their ‘homeless’ status.

The authors conclude that most of the men were socially disaffiliated due to life changes and personal choice to withdraw from community.  Because the authors bring a lens to the project that is devoid of concepts of power relations at the interpersonal level, and power in social structures, the findings are devoid of reflections on power and both the cause and the solution to homelessness is seen to lie with the men themselves.  So, their novel suggestion to health care professionals is that they create a ‘buddy’ system to connect homeless men formally with each other.

Unfortunately, I fear that research that focuses solely on personal agency, actually has the potential to further disempower people who are experiencing homelessness.  I would suggest that all studies need to reflect on systems and structures of power that form our individual actions in the world, and need to work to address these as much as help the individual.  However, I conclude by wondering in this, my own lens, what I am missing, and what conclusions I will never reach.  Because, I can only see what I have been prejudiced to see.

It Can Happen to Anyone…sort of

If you are not familiar with TED Talks, they are basically an opportunity for anyone who has something interesting to say, to share it with the world.  The following talk is from last year:

There are a lot of things going on in this video that are worth reflecting on, but most importantly, I thought that it’s a good lead off to talk about the idea that homelessness can happen to anyone.  This is a conceptualization that I hear often, and the idea is that it enhances empathy in public perceptions if we can see that we are all at risk of experiencing life circumstances that would cause us to be homeless.

I believe that this is a helpful idea, and with my students I do share some stories that illustrate how even the wealthiest and most popular can lose it all.  However, I also believe that this can’t be our only narrative, as it hides the larger story.  For most people who experience homelessness, it is simply a step onto a lower stair of a life of poverty.  If you were to chart of curve of highest lifetime income and homelessness, there would be exponentially more people who have experienced homelessness on the lowest levels of lifetime income.  And, this isn’t just for the individual themself, but often reflects family histories of poverty, experienced as a cycle.

Becky’s story is meaningful, to show the limitations of our ‘social safety net’, but her former skills were a means to assist her rapidly out of homelessness.  Few who are homeless have access to the same resources.  So, the ‘it can happen to anyone’ narrative is helpful for creating empathy, but we can’t stop there.  We also need to confront poverty head-on of we are to confront homelessness.

How to Solve Homelessness: A Hypothesis

I have been mulling over a conceptualization of how to solve homelessness.  I must start by saying that I have always found the terminology ‘solving homelessness’ to be rather trite, as if it is a simple problem that just needs a solution from expert enough experts.  However, I would suggest that our ultimate end must be the elimination of homelessness entirely, and that requires a solution.

So here it is: I believe that we must solve homelessness on three levels, the political, the perceptual, and the personal.  The political means reforming and creating healthy public policies that meet the needs of all people.  This includes such things as affordable housing, early prevention and rapid re-housing programs, comprehensive mental health services, low-barrier addiction services, increased social assistance, etc.  I believe that this will require reform from within (ie. policy makers), but also pressure from outside the system (ie. protestors).

The perceptual means confronting public perceptions around homelessness.  As long as homelessness is perceived as an appropriate outcome for poor personal decisions, there won’t be the public will necessary to create political change.  And, as long as people who are experiencing homelessness are considered the undesireable other, they will continue to be traumatized by experiencing discrimination.  Novel forms of media need to be utilized to engage the narratives we tell about poverty, and the injustices that are perpetuated.

The personal has two components.  Firstly, we must continue the restribution of wealth to services that are delivered by individuals through a caring connection.  What does that mean?  That means tax-funded services such as shelters, food banks, health centres, etc. must continue to be enhanced until everyone’s basic necessities are being met.  And, each one of these myriad service providers must focus on providing relational care that creates a space where people can empower themselves.  Secondly, personal means each one of us being critically reflective about power relations and social hierarchies and our place within these.  We must each improve ourselves and the way we live to break down these barriers, and be part of communities that see no economic divides.

This, perhaps, is how homelessness can be solved.

Homelessness and Health: Chicken or the Egg?

In my previous article, I outlined the many health challenges and barriers to care that people who are experiencing homelessness face.  In particular, as mentioned in my video, approximately 58% of homeless people will have a lifetime diagnosis of mental illness, and about 38% will have experience an addiction in the lifetime.  However, an interesting issue with this is what came first, the mental illness/addiction, or homelessness?  This obviously has implications for how we understand the causes of homelessness.

Fortunately, a report titled “Homelessness in Melbourne: Confronting the Challenge” has included an exploration of this.  Although their numbers for mental illness (30%) and addictions (43%) were different than the ones mentioned above, reflecting looking at current issues versus lifetime prevalence, I believe the stats on when the mental illness/addiction was identified are very relevant.

So, what are they?  This report found that 66% developed their addiction after becoming homeless, and 53% developed their mental illness after becoming homeless.  These are important figures, as they point to the toll that living homeless has on people, and highlight the importance of rapid re-housing programs.  It’s also interesting to note the high percentage of people who develop an addiction after becoming homeless, showing how substance use can be a protective mechanism against the physical and emotional pains of street life, while at the same time making it harder for people to escape the streets.

The Us/Them Dichotomy

I have been confronted in the last week by several incidences of the us/them dichotomy.  That is, homeless people are ‘them’, the undersirable other, that which we are afraid of, and that which must be eradicated.  We are ‘us’, the upright citizens, those who are employed and spend money in retail stores, those who must be catered to.

Here are a few examples.  Downtown London is working on creating a master plan for the core, to make it a desireable place to work, live, and seek entertainment.  Part of this process has been a discussion board on a Facebook group.  Two of the commenters noted the following: “Also, make panhandling illegal… The people not just sitting on the street with a hat, but actively walking in front of you and asking for money seems to have increased lately, and this makes me feel less safe downtown.”  And, “The first thing I would do, is get rid of the loiterers and panhandlers. I would have a more visible police presence to deter these harassers.”  At the same time, an article came out today expressing that city council is looking at strict rules as to where methadone clinics can be located, with a quote from re-elected councillor Steve Orser “(The addicts) are the ones who decided to go on the stuff in the first place. The rest of us shouldn’t suffer from it.”

I won’t go into the specifics of how these commenters are misinformed or simply unaware of such things as the Safe Streets Act, London Police Department foot patrol, and the nature of addiction.  What is more important here is the two part narrative of there being people who are unwanted in our city, and how to change that.  It’s amazing how quickly we forget that these panhandlers and loiterers are people first, people who are experiencing some of the greatest suffering that humans can experience.  These are people who have meaning, who are beautiful in their own way.  Yet, we just see the circumstances, and how they impact negatively upon us (one commenter on the Free Press article referred to people in poverty as ‘ocular trauma’).

And, it’s very short-sighted to see the solutions to this as driving people away, through by-laws, ticketing, policing, and harrassment.  If we truly want a desirable city, and want to have a city where poverty is not evident, then we need to confront the root causes of poverty.  People don’t panhandle because it is their desired profession, they panhandle out of need.  Let’s address the need, so panhandling is never necessary.

Moral Hazard: A Hazardous Term

At the “Rethinking Homelessness” conference in Montreal, Dennis Culhane spoke about the successes in the US around housing first models, and rapid prevention.  One thing that he mentioned in prevention programs is that we have to be careful of ‘moral hazard’.  The way he used the term, was around individuals utilizing resources to assist the homeless who didn’t truly qualify.  Or, the idea that programs that are too accessible will be taken advantage of (moral hazard is more frequenlty conceptualized in this context as people not taking as much personal initiative to prevent challenges if they have a safety net).

In a nutshell, he was expressing that we need to have strict boundaries around a programs so that they are not misused or over-used.  This is an idea that was tossed around in my work as a nurse at a drop-in health centre for homeless persons, that we need to be careful to screen out people from using our services who don’t qualify.  So, for example, if we give out emergency food, we need to be sure that people aren’t just walking in off the street and asking for food, even though they are housed.

I believe that this term is problematic, and reflective of a certain ideology that I am not comfortable with.  The idea here is that there are a bunch of free-loading people around just waiting to take advantage of social services.  However, it has been our experience that those who access our services that are not officially homeless clients of the health centre are still those who are at risk of homelessness.  Therefore, we don’t mind if they use our services, as it is actually a form of prevention.  Perhaps this food, or socks, or shower, or whatever, is a piece that will help them never officially qualify for our programs.

That said, with limited budgets for programs tartgeted at specific populations (ie. people who are experiencing homelessness), we do need to be intelligent about how we use our resources.  But I believe that this actually reflects another discussion around how awkward it is to define programs around housing status, which is such a fluid thing.

Perpetuating Prejudice in the News

The media has a large role in forming public perceptions of social issues, such as homelessness.  This is not inherently good or bad, it’s simply the way it is.  However, it becomes unfortunate when the media chooses to perpetuate negative perceptions or false information, rather than educating the public.

Take for example this article published yesterday.  Reports on jobs for homeless persons always catch my eye as there is a popular misconception that people simply need jobs to end homelessness, not realizing that for most at this point in their life, jobs are a number of steps up the hierarchy of needs; hence the focus on housing first, rather than employment first, medication first, or any other such model.  So what were three things that made me cringe in reading this article?

  1. A shelter that defines its mission as “to rehabilitate the homeless”.  There is so much in the language of that phrase that is pejorative.  The definition of ‘rehabilitate’ fits in terms of it being good if people could have their former privileges and health back, but ‘to rehabilitate’ is something that is done to people.  It’s as if ‘we’ can somehow fix ‘them’.  And of course, I have talked previously about my beef with the term ‘the homeless’.
  2. They quote a man saying, “It’s not really a choice for all of us who are on the streets.”  This implies that homelessness is actually a choice for many who are on the street, which perpetuates a common stereotype.  However, research on preferences for housing has found that either 0% or less than 1% (depending on the location of the study) of homeless people choose homelessness.  He should instead have said, “It’s not a choice for any of us to be on the the street.”
  3. The article is reporting on an event that promotes jobs first, rather than housing first.  All the research from the past 10 years has demonstrated that for long-term success (ie. not returning to homelessness) people need stable living accommodations first.  Setting people up with employment who do not have stable housing is often setting them up for failure, which may be reflected in the 50% success rate the article mentions.

It seems that before we can use the media to educate the public, we first have to educate the media.