I am feeling rather infuriated by a news story shared in this post by a blog I follow called The 13th Juror. In a nutshell, the city of Ashland, Oregon is considering what to do about the people experiencing homelessness who spend time in the downtown and have dozens or even hundreds of unpaid tickets around ‘public nuisance’ citations. Their proposed solution? To create an exclusion zone where people with unpaid tickets could not enter or face being arrested for criminal trespassing. The police chief justifies this by saying that this multiple tickets are contributing to long-term homelessness as they are a barrier to employment.
So, guess what the punishment is for criminal trespassing? Short jail time and a $2,000 fine. Am I the only one who sees this as incredibly backward? If we see that ticketing is an impediment to escaping homelessness, then why keep ticketing? It’s not that people want to be ticketed. If there were public washrooms downtown they would not urinate outdoors. If they weren’t addicted they would not be drunk in public on a weekday afternoon. Enhancing the punishment does absolutely nothing to rectify the situation, it is extremely short-sighted.
However, unfortunately this is too often the rationale of police services that focus on punitive measures and an ‘illegitimate public’, rather than being connected to the broader solutions of social services. I hope such a measure would never be considered here in London, but I’m nervous about what downtown renewal may be conceptualized as.
Close to a year ago, there was talk of another methadone maintenance therapy (MMT) clinic being opened in London, to assist people living with narcotic addictions. The community that this was to be located close to (SOHO, or South of Horton) has a strong neighbourhood association, that very vocally oppossed this. They highlighted some of the concerns with existing clinics, and were adamant that they didn’t want the same in their community (although it should be noted that the proposed site was actually quite outside the residential area of this neighbourhood, and in a very hidden light industrial area).
In response, the City of London implmented a 1 year moratorium on the opening of new clinics, and tasked planners to do a study of the benefits and concerns around MMT. The report has been released, and is available here. There is a public meeting this Thursday to discuss the report, and unfortunately I am unable to attend. Instead, I have forwarded comments to the planner, which I post here for your perusal:
1. Thank you for this thorough and balanced review of methadone maintenance therapy in London and the resulting concerns. I was struck by the statistics on the growth of narcotic addictions in our community and others, and it was clear that methadone maintenance therapy is one effective way of addressing this. In my opinion, it was clear from the report that rather than delaying further openings of methadone clinics, we need to attract more health care providers licensed in this area. It was clear from the report that having more clinics would reduce the primary concern of the community, which is having large amounts of people congregating in front of Clinic 528, which is currently over-stretched by the number of people it must treat. Decreasing this congestion would alleviate much of the concern.
2. Secondly, I am struck by the value to the community of having this type of treatment available. If the 1400 Londoners who access MMT did not have this available and were supporting $100-$200/day addictions, the resulting crime would be devastating to London. Ensuring that every Londoner experiencing a narcotic addiction has easy access to MMT will only make our city a safer and healthier place.
As a follow up to my meeting with the Mayor, I had a chance to participate in a housing round table, where members of the community presented reflections on social housing to MP John McCallum. This follows a blog post by MP McCallum demonstrating that social housing is an area of interest to the federal Liberals, whereas the Conservatives do not believe there should be federal involvement in housing (which is clear from policies and lack of funding over the last 5 years). Here is the gist of my comments, I was one of the last to speak:
“I want to bring to the table a group of people who have not been mentioned yet. I am very happy to see the energy behind affordable housing. However, there is a group of people for whom affordable housing will never be enough. Many of us here who have worked in agencies directly serving persons experiencing homelessness know folks who have been evicted from social housing, some multiple times. These are often people experiencing addictions and/or mental health challenges. For these individuals, housing at 80% the market rate, 70%, or 10% will never be enough. The problem is that they need supports to live in their own accommodations.
We have lessons to learn from the past 5 years of rapid development in social housing, that saw most proposed supportive housing developments simply revert to affordable housing without supports. In our upcoming London Community Housing Strategy we have targeted 1000 new units, with 300 of those being supportive housing. Maybe I’m cynical, but I believe those 300 units will be the last to be built, if they are built at all. That’s because we still have not figured out a good model to make supportive housing work for developers, in the same way we have for affordable housing. No one owns it, and no one is going to invest in it.
Minister McCallum, I know this doesn’t answer your purpose of being in London today, because it only complicates matters. But you started by saying that the Liberal party wants to take care of Canadians who are in need, and those who are chronically homeless are some of the most in need.”
The majority of drug overdoses leading to death occur with other people present. People are not calling 911 to respond to the situation. The problem? Others present at the time of overdose are concerned that they will be arrested for drug use or on prior convictions. And, unfortunately, this is a well founded concern. A community member recently told me of an experience of overdosing, and when his friend called 911, police and ambulance responded and the friend was arrested on a curfew violation.
One response that has been explored is to better equip peers to respond to overdoses, particularly narcotic overdoses. We have explored making Naloxone (Narcan) widely available, but there are many barriers. Firstly, it is prohibitively expensive with Narcan costing $180/dose and the generic costing $400 for 10 doses. These also have a relatively short expiry date. Secondly, there is risk in administering it as it only comes in an injectable form currenlty, with a nasal spray just now being trialed in Vancouver. Thirdly, a prescription is required, and there are legalities around delivering someone else’s medication to them while they are unconscious, even if they have a prescription.
A second response, which seems more promising, is to address police attendance to 911 calls for overdose. In Vancouver, they have a policy where police only respond in cases of concern for safety of the public, and if they do respond, it is solely to support the urgent medical need. The initial announcement of this drug overdose policy can be found here, with the policy itself available here. If such a change was made in London, and community members could be educated of this, it would likely lead to the calling of 911 and prevention of many overdose deaths.
As mentioned in this post, I had the opportunity to participate with the Mayor on a panel looking at poverty in Canada. Although I don’t agree with all of his policy directions, I have long thought of him as a potential resource in the city due to his background as the former national Minister of Housing. So, when at the event he said he would like to hear more about my work, I took the opportunity and followed-up by arranging a meeting.
There were three things that I wanted to focus on in the meeting: the lack of rent-geared-to-income (RGI) housing mentioned in the community plan on housing, the challenges facing supportive housing, and the possibility for him to take a lead on intergovernmental work on housing in Canada. Overall, I was very impressed with the perspective that Mayor Fontana brought to housing. He was well aware of the idea of ‘housing first’ being an internationally recognized solution to homelessness. He also recognized the importance of spreading social housing throughout the community rather than just creating large social housing developments. Here is how he addressed the three issues:
- RGI units: Mayor Fontana agreed that the RGI model is more affordable housing, and that it has worked well in the past. He also sees this as a means to spreading social housing through the community. However, we both recognized that the current incentive system is for affordable housing (ie. 80% of market rates) versus RGI.
- Similarly, Mayor Fontana agreed that supportive housing (ie. housing with supports) is much more difficult than affordable housing. This is where he said that intergovernmental work had the most promise, that breaking down the silos of housing and health might make space for funding case workers or health professionals to be a part of housing developments. However, this point seemed the farthest from being connected to meaningful solutions.
- Mayor Fontana seemed to relate to the idea of London becoming a leader in social housing through his unique experiences. It seemed evident that he was already being tapped by politicians at other levels to work on housing platforms. Most importantly, he is convening a housing roundtable this week, and I feel privileged to be invited. I will keep you appraised as to where this is heading.
Overall, it was a very good meeting, and hopefully a sign of better things to come for our community. An 8-9 year waiting list is not acceptable, and we have a lot of ground to make up since the cancelling of the national housing program in the early 90′s. Also, there are a group of people for whom affordable housing is not sufficient, and they become the chronically homeless. It seems to me that this demonstrates an urgent gap in the system that the Mayor can be a part of plugging.
I wanted to let you know that our next meeting will be happening on Thursday, April 21st, at 6:30pm, at the Victoria Tavern (466 South St).
At this meeting we will be hearing updates from the Creative Arts Sub-Committee, the Mental Health Sub-Committee, the Faith Community Engagement sub-committee, as well as updates on projects including street-level health care and World Homeless Day (October 10th).
I would like to note in particular the work of the Creative Arts Sub-Committee, and let you know that we are working to partner on a magazine that will feature the writing, art, and photography of people who are experiencing homelessness in London. A very exciting initiative! Much thanks to Kelly McConnell of Grit Uplifted, of the London InterCommunity Health Centre (http:grituplifted.tumblr.com).
Also, just a heads-up that ‘Soup ‘N Bread’ lunch, an event that happens a couple times each year to raise awareness in London around homelessness, is happening next on Friday April 15th, at the Covent Garden Market Square, 11am-1pm. Leave your lunch at home, and bring a couple co-workers down for soup and bread.
One of the ideas we have had from the outset of the London Homelessness Outreach Network (www.londonhon.ca) is to connect the different groups in town who are doing creative arts. This includes but is not limited to fine arts at the London Coffee House, the Ark Aid Street Mission, and at WOTCH, and writing groups at My Sister’s Place and InterCommunity Health Centre. This initiative is being spearheaded by Kelly, who for the past 2 years has been running a creative writing group called Grit Uplifted (check out their amazing work at grituplifted.tumblr.com).
Kelly, for a long time, has had a dream of a regular publication that features the work of these groups. This is in part inspired by a book that was put out by Youth Opportunities Unlimited, called Flying a Sign, a portion of which can be seen here. The idea is to capture the text and the images in their unedited, pure form. This whole concept fits well with our idea of engaging with public perceptions around homelessness, particularly in profiling the skills and creativity of people who are experiencing homelessness.
The good news? The project is a go. We have enough submissions to begin with already, and are thinking about an early June opening that would include a reading of some of the work, and perhaps a display of the fine arts, would have a release of the first magazine, and would profile the next Grit Uplifted group that starts on June 18th at the Central Library. Having a great network of enthusiastic people is what is making this possible.
Ask me five or six years ago what I thought of data collection to demonstrate outcomes while I was working full-time as a street nurse, and I would have told you it sounds like a complete waste of time. With some more time behind me, experience in academia, and greater connection with management level of many service providers, my perspective has changed.
I met with the Executive Director of United Way of London and Middlesex the other day, and he told me that United Way has been focusing more energy on funding projects that demonstrate outcomes, rather than those that just sound good. In order to assist agencies with this, they have provided outcome measurement tools and assisted agencies with implementing them. They have also been linking those agencies that are stretched to thin to do this with academics who might be able to help. To many who do street-level care, this may sound like added layers of bureaucracy and time taken away from ‘real’ care. However, in the long-run if it means doing the best we can with the people we work with, then the upfront work is worth it.
I think this links well to the problems we have currently with the whole system of addressing homelessness where most of the money goes to management versus prevention and rapid rehousing. Data is now showing that we are not getting the best ‘bang for our buck’ this way, and it’s time to reconfigure. I believe that we have a lot to learn from thining about impact and outcomes, and it leads to a better system over all. Evidence? The United Way is now funding the Unity Project, a traditionally under-funded shelter in London the provides low-barrier services, and therefore reaches the most vulnerable in our community. That’s what I call ‘bang for our buck’.