What Happened to the Safe Havens?

Those who provide services to people experiencing homelessness know that the Safe Haven drop-in centres have closed this year (although the Men’s Mission maintains a parallel drop-in service at their same site).  This, as with any service change, has not been very well received in the community.  At a time when resources were stretched, the loss of any service (particularly one that was accessed 113,700 times per this report, pg 331) hits hard.

So, why were they closed?  Well, there were a number of reasons that they might not have been optimal, but the primary reason would be that the funding is being reallocated.  This funding is now being utilized for re-housing services provided by street level workers.  The concept is spending less money on managing homelessness, and more on ending it.  This is a large part of what the current community plan is looking at, and is an intelligent direction.  However, the change is still uncomfortable.

The other important piece to note is that there are indeed places for people to go during the times that the Safe Havens operated.  Now, that they were so well utilized means that they fit a purpose, but there are still other places to go.  That said, it is still worthwhile for London to consider low-barrier, after hours drop in spaces for people, particularly those using substances.

Regarding Needle Disposal Bins

‘Twas a week of letter writing apparently, below is my submission to City Council on the issue of the installation of more needle collection bins in London. You can see the London Free Press article on the issue here.

To the Community Services Committee and London City Council,

I would like to make comment on the issue of recently installed additional needle collection bins. As a professor whose research covers homelessness and health, I have followed with great interest the activities around London CAReS since the original report in December of 2007. I believe that it reflects very well on Council to have been proactive in addressing issues around addictions and homelessness in our community, rather than putting off the concerns to other orders of government. Needle bins are indeed an important component of a comprehensive response to addiction, while also having the added benefit of community safety. Although ‘harm reduction’ is not popular terminology in some circles, it does not take complex science to understand that in order to treat addictions, step one is keeping the addict alive.

I trust that the memory of Council is longer than that of the general public, and you will recall the concerns of needles found in public spaces and spaces utilized by children. Needle bins, although described by a few as ‘unsightly’, are both part of best practices in responding to addictions, and are a significantly better alternative to our former state of haphazard disposal. If you find yourselves requiring further research to assist you with decision-making, I would be happy to serve as a resource to your staff.

Thank you for your time,

Abe Oudshoorn, RN, PhD

My Letter to Councillor Swan

Good afternoon Councillor Swan,

I wanted to send you a brief email in advance of this week’s important budgetary meetings. In finding savings for the budget you had suggested holding payment into the housing reserve fund this year as it was not spent last year due to three projects falling through. As you know, Louise Steven’s plan for building the first 450 units of the Housing Strategies 1200 in years 1-3 has been approved by council. As you also know, the timing of these projects is tricky as it relates to Federal and Provincial funding, as well as private or non-profit partnerships. When the right project comes along, the City needs to be prepared to act, and have sufficient funding to do so, if we hope to come anywhere near the target. As an academic whose focus is on health and homelessness, I would suggest that continued payments into the housing reserve fund are essential as we know that although homelessness isn’t only a housing problem, it is always a housing problem.

Thank you.

Health and Homelessness Report

Through 2011, a partnership of the London Homelessness Outreach Network, the Middlesex London Health Unit, the Regional HIV/AIDS Connection, the London Intercommunity Health Centre, and the City of London reviewed existing health services for people experiencing homelessness. The purpose of this review was to paint of picture of current services, providing a platform for us in 2012 to envision how these could be enhanced and refined. To view the report, click on the image below:

Mental Health Care: Filling in the Gaps

Building all the social housing in the world won’t be enough to end homelessness if we don’t also provide supports in the community for those who need them.  In the context of homelessness, this has much to do with people experiencing an addiction and/or a mental illness.  Knowing that there are serious gaps and deficiencies in mental health services, in Ontario we have been reorienting services is a concerted way since 1998.

The latest step in the reorientation of mental health services in London is a report from the South West LHIN entitled “The Time is Now: A Plan for Enhancing Community-based Mental Health and Addiction Services in the South West LHIN“.  This plan follows other work that focused on acute care services, and focuses on supporting people living in the community.  What is striking about this report is rather than focusing solely on the better organization of care, many clear recommendations are made for increasing services, to fill in the gaps.  This means we need to make serious investments in mental health care in London, including:

  1. 1.0 FTE for community withdrawal services.
  2. 1 new ACT team, at 8.0 FTEs.
  3. 4 new FTEs for case managers.
  4. A mobile crisis support team at 8 FTEs.
  5. 20 new units of supportive housing per year over 5 years.
  6. 2 new FTEs of mental health counsellors.
It’s a lot of coin, but doesn’t begin to compare with the current costs of not adequately treating addictions and mental illness in the community.

The Risks of Knowing Too Much

In refining our health and social services for people who are experiencing homelessness, we have been talking a lot about better information sharing.  Individuals who access services are forced to complete the same forms and answer the same questions from one agency to another, to another.  This leads to what Jodi Pfarr calls ‘agency time’, the time people in poverty devote to just being a part of the system.  It would seem far more efficient if all agencies were linked through common databasing, so that a housing worker at the shelter would, for example, know if an application was already submitted for an individual by a housing worker at Ontario Works.

However, with any system refinement, we have to think of the unintended consequences.  In this case, I’m wondering about the unintended consequences of limiting access to services.  So, for example, much of what service users access where they are getting the same thing in multiple places in considered redundancy.  However, it might also equate to people getting what they need.

Let’s take food for an example.  I just learned the other day that the London Unemployment Help Centre has a food cupboard.  This finalizes it, every service in town has an emergency food cupboard.  So let’s take an individual, we’ll call her Jane Doe, and look at how she acquires food.  She might go to the Hospitality Centre for breakfast, access the food cupboard at InterCommunity Health for lunch, and go to the daily bread program for dinner.  The next day she might do the shelter for breakfast, a church for lunch, and Mobilizing Hope van for dinner.  If every agency charted her access of their food cupboard, her multiple uses might be seen as a redundancy.

So, the big risk of sharing information, is how is it used?  People experiencing homelessness have developed ‘work arounds’ so that they can meet their immediate needs.  Will information sharing close the door to these work arounds without also ensuring that needs are met?