Where does it hurt?

I turn around and go back, setting down my bike.

“Hey guys, I’m a nurse, is everyone ok?”

(She’s not ok, they’re not ok. At a glance I see poverty, my nose senses alcohol.)

“No man, she’s bleeding good and out of it.”

Blood out her nose and mouth, unconscious. I get a pulse on her wrist and never let go of it the whole time. Breathing is shallow but regular.

“Did anyone see what happened?”

“She said someone smashed her.”

(Is this an assault? Is it an accident? Does anyone here or out there care?)

“I think she just fell.”

“Yep, I saw her fall, just blam.” He claps his hands sharply.

“Mam, can you hear me?”

I rub her shoulder, turn her to the recovery position.

“oww oh oh”

“Where does it hurt?”

(Your body? Your heart? Your mind? Your spirit?)

Her hand drifts around, settles on her back and nose, drops back to the ground.

“You guys already called an ambulance?”

“Yep, I think I can hear it now.”

“If you can hear me, can you tell me your name?’


Bless you Tanya. I hope that some day soon you stop hurting.

12 Things to Know About Homelessness in London

The City of London recently released two important reports which give a lot of valuable insight into homelessness in our community. These are annual reports, so include an assessment of trends over time. The first is a review of London’s emergency shelters, and the second is results of interviews with 400 people experiencing homelessness in London. I have selected 10 things that I think are important to note from these two reports.

1. Indigenous people are vastly over-represented amongst those experiencing homelessness

This comes as no surprise to those who work within the sector and have met folks at street-level, but the degree of the disproportion between general population and those experiencing homelessness is vast. Where 2016 Stats Can data has Indigenous people as 2.5% of the London poplulation, 29% of those interviewed identified as Indigenous or of Indigenous ancestry.

2. London serves as a hub for those in crisis

Those who lose housing, flee violence, require health services, or seek broader employment options from across Southwestern Ontario are drawn to London both as a service hub and as a city of broader opportunities. 22% of those interviewed identified as being new to London in the past year. I think it is a good thing that people are drawn to our community, for work, for school, or for housing support, and it also means we need to be adequately resourced as the service hub that we are.

3. Veterans are still becoming homeless in London

To be honest, this one surprised me the most. With a dedicated system of identifying and wrapping housing-based supports around veterans, I had presumed that all were being moved rapidly and effectively into permanent housing with appropriate supports. An important wake-up call that even after targeted investment, this population still requires intensive support.

4. Emergency shelters are only one space in which people experiencing homelessness spend their nights

Only 56% of those interviewed identified shelter as their primary sleeping location. The Canadian Definition of Homelessness highlights that other sites include rough sleeping, couch surfing, being in hospital or jail, or other forms of precarious and temporary shelter. Many also move in and out of housing. This helps us remember the hidden nature of many experiences of homelessness, and that the scale of this experience is always higher than we can easily count.

5. Trauma/abuse and/or relationship breakdown are incredibly common pathways into homelessness

In interviews, trauma/abuse and relationship breakdown, measured separately, both vastly eclipsed substance use as identified causes of homelessness.This confronts widely held perceptions of why people become homeless. However, if you think about it, most people who experience mental health challenges or addictions do not become homeless. Therefore, these issues are only a part of the picture in terms of pathways in, and clearly not the priority issues as identified by those interviewed experiencing homelessness.

6. Housing is the solution for homelessness

(With adequate supports.) In particular, either income that meets the reality of rent, or rents that meet the reality of income, were identified by those interviewed as what they needed to exit homelessness. This is why the recently proposed reforms to social assistance, including significant increases, are so crucial to the sector. Poverty and homelessness are almost completely correlated.

7. Shelter-based data on homelessness under-represents the experiences of women

An important prelude to the shelter report notes that women staying in violence against women (VAW) shelters are not included in the data. Where the shelter report notes 24% women, those interviewed in the survey were 35% women, which is closer to what you would get if you combined VAW shelter data with emergency shelter data (although this would include overlap of individuals who stay in both). All that to say, estimates of gender breakdown in the experience of homelessness are often at risk of underestimating the proportion of women.

8. The trend of less unique individuals accessing shelter on a year-over-year basis has halted

While total numbers are still down significantly from when shelter reports started, this is the first year where the number of unique individuals entering shelter has increased versus decreasing. This solidifies the call by the Homeless Hub to ensure we are focusing enough of our energy and resources on homelessness prevention in addition to rehousing those already homeless.

9. A far greater proportion of those experiencing homelessness are youth

In 2011, 21% of those accessing shelter were under 24, in 2016 that number was up to 26%. This highlights the value of the City’s recent investment to develop a new housing first shelter for youth.

10. Occupancy rates in shelter have spiked

From 87% in 2011, these have increased to 98% in 2016. This means that shelters are running, on average, full.

11. Because length of stay has increased

Occupancy rates aren’t due to a significant spike in new experiences of homelessness, but rather due to the fact that those who are in shelter are occupying a bed for a longer time. Average length of stay has increased from 34 nights in 2011 to 41 nights in 2016. There is significant need for emergency shelters to look comprehensively on what it would mean to adapt a Housing First philosophy to guide their service delivery model. This also adds urgency to new supports such as the housing allowance that will assist Housing First based programs in expanding available housing options to those who they support.

12. Older adults are staying the longest

Perhaps this reflects those who are most adapted to using shelters are a long-term solution. However, this stat also boggles the mind due to the increased access to income supports that comes in older adulthood. Essentially, if people are receiving the income to which they are entitled, there should be no barrier to affording rent. This indicates that for older adults, the barrier to housing stability is the need for housing supports.

Why We Gather

The Canadian Alliance to End Homelessness (CAEH) recently held their annual conference in Winnipeg, Manitoba. Subsequent to the conference, this article by Susan Huebert was published by the CBC. As it contains many of the tropes commonly encountered by those who work in health and social services, I thought it worth the time to correct some misconceptions. So, here are 10 things to consider about why and how people gather for a conference on homelessness:

1. Knowledge Exchange is Crucial

The very title of the article, “More than talk needed”, displays a common prejudice we encounter in social services, that somehow gathering to share how to enhance the work is inferior to or takes away from doing the work itself. This is based on the false assumptions that information exchange and direct action are not complimentary, and that doing the work without exchanging knowledge is a better use of time. However, we know that in all sectors people gather for conferences, colloquiums, workshops, and all other forms of knowledge exchange. This is because, in spite of technological advances, there is still immense value in gathering together to talk, learn, listen, debate, and commiserate. Indeed, this type of knowledge exchange pays off several-fold in all of us working better to end homelessness. Conversely, working independently in our communities to end homelessness without any knowledge of best practices would be the true waste of time and money.

2. Fusion policy problems need complex and multi-sector solutions

The author suggests that perhaps money could be saved on the event if less speakers were involved. The first thing to note is that the vast majority of speakers present were not paid, but rather paying to participate, so having less of these speakers would actually increase the cost of such an event. Secondly, decreasing the speakers is counter to the first point regarding the value of knowledge exchange. Limiting the discussion to just a few speakers would limit the breadth and depth of what was learned. Importantly, we know that homelessness is a fusion policy issue, meaning that policies across many sectors contribute to people becoming homeless and struggling to exit homelessness. Therefore, we need many, many people involved in coordinating solutions that are upstream, policy-based, and targeted to root, systemic causes.

3. Voices of lived experience are present and clear

The author alludes to the presence of individuals with lived experience at the conference, but then suggests that participants should listen to them, as if these voices were not present and clear at the conference. This suggestion leads me to wonder just how much of the conference the author attended, as the voice of lived experience was the predominant voice, whether from keynote presentations, from the entire program stream focused on lived experiences, or from the lived experience integrated in other population-specific program streams. If you were at the conference and didn’t hear these voices, then you certainly weren’t listening. There is also naievity in focusing on just the 50 individuals who participated through lived experience sponsorships, as so many others at the conference, at all levels of service delivery, policy-making, and research, bring their own lived experiences as the root of their passion for this sector.

4. Space is made for diverse voices of lived experience

Not only does the author down-play the strong engagement of persons with lived experiences, they make no mention of the breadth of diversity of lived experience present and represented at the conference. CAEH has been incredibly responsive for calls to include diversity of experiences based on social locations, such as youth, women, those identifying as LGBTQ2S, Indigenous peoples, and others. To be honest, these calls have often been blunt and confrontational, yet CAEH has always responded graciously by creating space for all voices. This includes seats on the board, advisory committees, program streams, and other ways that ingrain diversity into the conversation in real versus tokenistic ways. CAEH needs to be commended for this work.

5. The voice of lived experience is more than just story-telling

While the author is perhaps calling for what she believes is a better way to meet the needs of those experiencing homelessness, her conceptualizations actually do a disservice to these individuals. In considering the role of persons with lived experience in the conference, she states that they are “enhancing the participants’ learning with first-hand experience of living without a home of their own.” This regretfully downplays the true role of individuals with lived experiences in the conference who did far more than story-telling (although they did that as well), but were integrated in service planning, policy debates, best practice considerations, and so much more in terms of strategic discussions to end homelessness. Thinking of lived experience as only being useful as anecdotes is disturbingly pejorative.

6. Participants’ needs must be met

Critiquing the event itself, the author provides a decidedly unhelpful suggestion of simpler meals. It should be noted that meals were far from extravagant, but mostly your regular meat/potatoes/vegtable fare with coffee and water. Paring this down would mean that you would have 1,050 conference delegates receiving less than satisfactory nutrition. This would have the adverse effect of less delegates attending in future years (see point #2), and the time-wasting effect of delegates leaving the venue to make a purchase to complete their meal (see point #1). More importantly, those with lived experience, for whom the author purports to advocate, would be the most negatively impacted by providing incomplete nutrition for a 3-day event. As meal costs are factored into the conference registration fees, the scale of participation is a good indicator that CAEH has struck the correct balance between keeping costs down while meeting participants’ basic needs sufficiently.

7. There are a lot of participants, and there needs to be

In addition to less food, the author recommends a less formal venue. While this sounds good in theory, a simple question to the organizers would have provided the very simple answer: Almost all cities in Canada have only a single venue that can accommodate a conference of 1000+ delegates. Building on points #1 and #2, it is important that we have broad representation at such conferences, and this means that the choice of venue is incredibly limited.

8. Of course we feel the contrast between our lives and the lives of those we serve

One of the most infuriating claims made by the author is that in paring things down, “some of the attendees might have become aware of the contrast between the comfortable conditions and good food at the venue and the needy community that was just outside the doors of the convention centre.” This is clearly an author who does not work in the sector. If she did, she knows that daily, in every way, every person who works front-line or beyond feels deep in their soul the contrast between their own life and the lives of those they serve. This disparity haunts us. This disparity causes us to grieve. This disparity motivates us. This disparity leads us to gather together to exchange knowledge on how we can permanently end this human rights abuse of lack of shelter. How dare she suggest that we don’t feel the sorrow of inequities.

9. This struggle was thoroughly recognized

To add insult to injury she states: “Some formal recognition of the struggling people nearby would have given an added sense of purpose to the gathering.” She wasn’t listening. This very recognition grounded the gathering, from the opening, to the perpetual fire, to the sleep out, to the memorial event for lives lost, to the voices of lived experience, to the calls to action. No conference is more centred on the urgency of the need, the reality of the struggle, and the desperation of our purpose than the CAEH conference.

10. People are paying for the conference, not direct services

I leave this point to last because it’s more of a technical one and less important I think than the philosophical ones preceding it, but worth mentioning none-the-less. One of her conclusions is that in paring down the conference, money could instead go to front-line services. This, however, is not how conferences work. Rather, they are budgeted to meet the needs of the conference, so if you pare it down then you need to decrease the cost, or no one will attend. The revenue side of a conference is not pre-set, but rather it reflects the number of participants who register. Should a conference create a surplus, this money supports the mission of the host organization. If the mission is strategy/training/planning/advocacy versus front-line service, and an individual would prefer to support front-line service, then they can choose to do so themselves. Suggesting that all money in the sector should only ever be spent on front-line services brings us right back full-circle to point #1.

What do we do about Sunny?

The recent furore regarding Sunny James and the removal of his belongings from public property reminded me that the London Homeless Coalition needs a position statement on how to address people experiencing homelessness engaging in private behaviours in public spaces. This issue actually harkens back to the lock down of the Victoria Park bandshell in 2014, and before that the increased ticketing of people experiencing homelessness around the World Figure Skating Championships in 2013.

This is by no means a local issue, as municipalities around the world frequently turn to ticketing as a response to managing behaviours in public spaces, here’s one today from the UK: Homeless people in Oxford threatened with £2,500 fines

So, I’ve taken a crack at it and would be interested in feedback on the wording and the approach. Please note, this is just a DRAFT and in no way reflects policy of the London Homeless Coalition.

BACKGROUND: People experiencing homelessness often spend a significant amount of time in public places. Within these public places they may engage in activities normally done in private. This can include sitting/laying/sleeping, storing of personal effects, consumption of substances, intimate relationships, or attending to one’s personal needs. The root factor for engaging in these activities in public is the lack of personal, private space. Many of these activities are offences under municipal by-laws or the criminal code. This position statement is pertinent to City staff, business owners, by-law officers, London Police Services, and the general public. Preventing and ending homelessness would alleviate these issues, however, until such time, the following is our position:

POSITION 1: The following principles should guide any interactions with people experiencing homelessness who are engaging in private activities in public spaces:

  1. Compassion – In considering the appropriate response, all persons should come from a position of compassion, acknowledging that engaging in private behaviours publicly is not deliberate, but is rather of function of lacking personal, private space to do so.
  2. Relationship – If approaching individuals experiencing homelessness regarding behaviours in a public space, all persons should first seek to come to know and understand the individual and their circumstances.
  3. Least Punitive Response – Although ticketing or temporary incarceration may address the immediate issue, neither have been proven to be effective long-term in ending homelessness and the consequent public activities. In fact, ticketing has been shown to be an additional barrier to permanently exiting homelessness. Therefore, if coming from a position of compassion and relationship, behaviours must be addressed, this should be done by seeking mutually agreeable alternatives to punishment.
  4. Advocacy – Any person engaged in confronting public behaviours of people experiencing homelessness can be of assistance to systemic change. By bringing their experiences of dealing with such issues to tables such as the London Homeless Coalition, they can help us and our partners find more effective long-term solutions.

Position 2: Major events can place a particular strain on these issues. Increased policing and security around such events can lead to increased punitive interactions based on private activities done in public spaces. Therefore, in addition to the above principles, we would add the following regarding major events:

  1. Discretion – All individuals in public spaces should be generally left alone unless they are of harm to themselves or others. For example, there is no reason to engage with people who are legally panhandling within the guidelines of the Safe Streets Act. Threats of ticketing or arrest should not be used as a means to move people out of sight of those attending the major event.
  2. Human rights – All individuals have a right to be present in public spaces, this includes individuals displaying symptoms of an active mental health challenge. Activities perceived as abnormal, if legal and of no harm to self and others, are not justification for confronting an individual in a public space.
  3. Collaboration – Increased policing and security may unintentionally lead to the observation of behaviours that are illegal under municipal by-laws or the criminal code. Persons addressing these behaviours are encouraged to work collaboratively with street outreach or mental health crisis services in considering their response to these behaviours.

Photo courtesy of https://www.flickr.com/photos/12567713@N00/ under creative commons license.

The Stories we tell Ourselves about Youth Homelessness

The other morning at the end of a swim practice I was chatting with some fellow swimmers about a new grant we had received to explore policy and poverty. An older gentleman I hadn’t talked with before was sitting nearby and overheard our conversation. He piped up:

“My wife and I used to run drop-in for homeless youth on weekends. Just before Christmas I was surprised when no one showed up. We went out to the streets and no one was there either. They had all gone home for Christmas. Makes you wonder…”

The clear allusion being made was that street-involved youth aren’t in fact homeless, but rather choose not to be at home. I highlighted to him research that shows that regardless of where choice to exit home lies (ie. kicked out or fleeing), over 70% of homeless youth identify abuse in the family home as the cause of their homelessness.

His response: “Is the abuse real or imagined? I worked in social services for over 40 years.”

It struck me that this anecdote was a story that he had at the tip of his tongue, and was happy to intrude on a stranger’s conversation to share. It obviously meant a lot to him to have this narrative that homeless youth are just run-aways, ne’er-do-wells, and not so much in need of housing as we might presume. I suspect that we weren’t the first with whom he had shared this anecdote, and it wasn’t the first time he used his “expertise” from in the sector to add clout to the premise.

In a broader sense, this narrative of homeless youth as “bad kids” is a popular and a common one. It serves to relieve a sense of guilt we feel when youth, who seem more vulnerable (innocent? fragile?), are part of the experience of homelessness. This story I’m sure gets perpetuated in middle-class households across our communities. Yet, this narrative of “street punks” goes directly against research that shows that most are grappling with a difficult home life, and few, for example, grapple with substance use prior to their experience of homelessness. Of course youth who have left an abusive home environment might choose to go home for Christmas. Or maybe because it was Chritsmas, a lot of other places had activities that youth were choosing to go to instead.

Or maybe they just didn’t want to hang out with this asshole anymore on weekends.

Shelter Use in Canada

Although the vision in London and across Canada is to end homelessness, emergency shelters continue to play a key role within the system as it stands. They serve as a ‘sure thing’, a landing spot for people as they encounter crisis, or a short (or unfortunately longish) term solution for those with more complex challenges. When options run out, people are able to access shelter on short notice and be assured of having their basic needs met for at least a brief period of time. In fact, the future ideal state still includes emergency shelters as part of a comprehensive system. This is because people will still encounter crises and will need a place to go to connect with the system and be supported into new permanent housing. However, what will change will be the length of stay in shelters and the services received, with very short stays and intensive services to ensure quick exit to appropriate housing.

(Side note: Because new people will continue to be de-housed for a variety of reasons, the terminology within the sector for ending homelessness is ‘functional zero’. This is a state when everyone who is de-housed is continually re-housed. More information on functional zero can be found at: http://homelesshub.ca/blog/infographic-what-functional-zero.)

So, what is happening in emergency shelters is important information to understand how we are doing on ending homelessness. To this end, the Government of Canada has recently released their updated national shelter stats (covering up to 2014), and I believe there are a few important points worth mentioning:

1. Fewer people are accessing emergency shelters in Canada

Number of shelter usersThis is obviously good news. This means that to some degree we are doing a better job at preventing homelessness in the first place, or keeping people housed once they have been re-housed. The majority of these shelter users stay one night, meaning that we are also doing a good job in helping people find permanent housing options.

2. However, those who are staying in shelter are staying longer

Shelter length of stayThis means that counter to the efforts of Housing First, meaning rapid rehousing of those who use shelter the most, chronicity is increasing. I would be curious to see whether there are regional trends to these numbers and if communities with extremely low or negative vacancy rates (such as Toronto and Vancouver) are skewing the numbers. However, this speaks clearly to a greater need for affordable housing options to support people in exiting shelter.

3. Leading to pressures on shelter capactiy

Shelter occupany rates

This creates a challenge for government: Do you build more shelters to respond to occupancy demands at the same time that you are trying to provide more permanent housing options to reduce shelter use? Interestingly the same parallel exists in housing for frail seniors, where there is demand for more long-term care facilities while the ideal is that more people are supported to age at home. Do you respond to the immediate need if it may counter the long-term ideal state? My response would be to specify the focus and look community-to-community and population-to-population. For example, a community may have overall sufficient shelter capacity by the stats, but insufficient for a particular population such as LGBTQ or single women. Or, a whole province might average sufficient capacity yet one urban area might have a significant need. Therefore, I think we hold the vision of reducing emergency shelters in general, while perhaps increasing capacity in specific areas for specific populations.

In conclusion, I see both good news and bad news in the stats. However, I think the message is clear that we still need more affordable, permanent, and safe housing options to move people from shelter to home, and the rights supports to make this successful.

A Call For Compassion

Poor LawEnglish poor laws, dating back centuries, were termed as a form of “relief” for the poor. However, in reality they were simply a means to remove poverty from sight. Children were arrested and put into workhouses, men were put in stocks or returned to their city of birth, sex workers and those with major mental illnesses were jailed. These poor laws, lasting into the early 1900s in Canada, were rooted in moral and class assumptions that poverty was a personal failing, and to see poverty was an affront to the non-poor. The solution clearly was to remove poverty from sight, to see people experiencing poverty as delinquent, a scourge, a blight on society.

Yesterday an interaction between a store owner and two individuals allegedly injecting drugs gained significant attention. As can be seen in the video linked in the London Free Press story, the store owner crosses the street, yells and threatens the individuals with a bat, until they stand up and move along. As highlighted in the article responses to the incident have been very mixed, with the majority of Twitter and Facebook comments applauding the act as a means of cleaning up the core, while a minority of others suggest that the threat was both illegal and ineffective in addressing addiction.

What is most interesting and worrisome to me is the underlying narrative when I press individuals who support the actions of the store owner. I highlight that threatening someone with a weapon is actually an illegal act and the response is that the visible and public use of illegal drugs is itself a threat. There is an implicit and often explicit sentiment that someone who uses drugs publicly deserves to be assaulted because they themselves were first to commit an affront to others who had to observe them. Therefore, the premise is that to see someone experiencing addiction engage in their addiction is a harm to the observer.

This brings us back to the poor laws of preceding centuries. The same classist and inhumane assumptions that seek to hide poverty out of sight drive the desire to hide addiction out of sight. Not only is this completely ineffective in actually addressing addiction, it is a sign of a society that is willing to see some as less human because of their health condition.

Let’s keep some perspective: The person who suffers most from the public use of drugs is not the person who observes it, it’s the person caught in the grips of addiction.

8 ways that Ontario’s Affordable Housing Update will help end Homelessness

Housing VissionOntario’s Long-Term Affordable Housing Strategy Update was announced today. Here are 8 ways that this update will help end homelessness in Ontario communities:

  1. Increasing CHPI Funding – CHPI stands for Community Homelessness Prevention Initiative. This is the provincial contribution to municipal level services for people experiencing homelessness. It is worth noting that in many communities, such as London, CHPI funds provide the vast bulk of government funding. At about 80% of the homelessness funding from governments in London, any adjustment has significant implications. So the announced $45M increase over 3 years (from $294M) is a good example of ‘putting your money where your mouth is’.
  2. Providing operating support for Supportive Housing – Housing First is a proven model and it involves rapid rehousing with supports. That last bit, with supports, can prove to be the biggest challenge in a stretched system. $100M in operating funding for supportive housing based on best practices will have a real impact in helping people find home, and most importantly, remain housed. This is homelessness prevention.
  3. Switching the affordable housing framework to focus on portability – We know that demand for affordable housing out-strips supply, yet we also know that there are vacant apartments throughout our community. A limitation of the current model of affordable housing is that the subsidy is attached to units rather than being attached to the individual who requires housing. Portable housing benefits that follow the individual will greatly assist our ability to help people move quickly from homeless to housed.
  4. Helping women leave violence without becoming homeless – When we consider pathways to homelessness for women, violence and trauma are over-arching concerns. Unfortunately, for many women leaving a violent relationship has equated to becoming homeless. So, considering portability mentioned above, a new portable benefit is being provided to help 3,000 survivors of domestic violence move to a new and safe home rather than becoming chronically homeless.
  5. Getting serious about Indigenous homelessness – Women aren’t the only population with unique needs around homelessness, and we have known for a very long time that Indigenous persons are vastly over-represented among the homeless. We are finally getting serious about the issue and collaborating on an Indigenous Housing Strategy.
  6. Innovating to increase the number of units – All the ways mentioned so far are about program specific supports with an impact on homelessness, but we do also simply need more supply of affordable units. Yes, we need new construction (see #8), but this is costly and slow. If we can integrate affordability into new construction already being done within the private sector we can increase supply more expediently. Inclusionary zoning is a model that allows municipal governments to put affordability requirements into agreements with private developers. Formerly impossible due to provincial legislation, the promise is for tools to make this doable.
  7. Getting our social housing act together – Existing social housing, provided as rent-geared-to-income, is an excellent model to provide housing to those on meager Ontario Works rates, yet a terrible model in terms of the financial impact on municipalities. The per unit revenue is simply insufficient to meet the capital costs and social support requirements for this type of housing. Thus, social housing has become stigmatized and into dis-repair. A strategy to reform, renew, and refinance social housing can greatly improve the quality of housing that is often the first home for people who have been chronically homeless.
  8. New supportive units – As mentioned above, we also simply need more units. Particularly, units that have support for particular populations. I would like to see managed alcohol as an example of new supportive units, but we shall see. 1,500 new units is a good starting target.

Are you sure you’re ready to talk about mental health?

Vicous-cycle-of-mental-illness-and-povertyLet me preface what I’m about to say with acknowledging my support and thanks for #BellLetsTalk. I believe that any effort to de-stigmatize mental illness is a valuable one whether it comes from corporations, academia, or activists. However, as a nurse and educator who works in mental health, I question how ready we actually are to have the tough conversations required to address mental health long-term? We can tweet and text our support for the cause, but can we really talk about the issues involved? If so, here are some of the conversations we need to have:

Mental illness isn’t primarily a middle-class issue.

Everyone’s mental well-being is important, and every person matters. However, stories told of mental illness and recovery are often as much reflective of personal privilege and opportunity as they are of personal strength. In fact, my own story of recovery from depression depends on access to resources, supports, employment benefits, and opportunity that are far from available to all. The hard truth is that people experiencing poverty are nearly twice as likely to have a mental health challenge than those who are middle-class, and over 7 times as likely as those who are wealthy. Comments like “mental illness affects us all” serve to effectively de-stigmatize mental health, while simultaneously masking the significant variances in who is impacted most by mental illness. So if we truly want to talk about mental health, we need to talk about why it’s much more of an issue for those experiencing poverty than an issue of the middle-class.

Meeting the basic needs of people experiencing mental health challenges means bigger government.

As demonstrated by the thorough and powerful reporting by Jennifer O’Brien into the substandard housing conditions faced by many with mental health challenges in London, basic needs of food and housing prove out of reach to many. With many individuals who are in the midst of a mental illness living on Ontario Works at $676/month and inadequately supported in the community, affordable housing wait lists of years, and food prices rising, mental illness is equating to hunger and homelessness. Altering this reality means a significant raise to two tax-supported government systems: affordable housing and social assistance. If we are willing to talk about mental health, then we need to also talk about an expanded social safety net and what it will cost.

The first step is to stop causing mental illness.

The root causes of mental illness are complex, interactive, and quite individual. The role of genetics is often highlighted as the idea that “mental illness is an illness like any other” is effectively de-stigmatizing. However, the role of genetics is often over-stated, with Dr. Gabor Mate teaching us that environmental factors and determinants of health play a much greater role, and even genetic predisposition is itself effected by the environment. A greater explanatory factor than genetic predisposition is the experience of trauma. Physical abuse, sexual abuse, cultural abuse, emotional abuse are primary root causes of mental illness and are perpetuated by us. In fact, half of the women reading this post will have experienced physical or sexual violence, the majority perpetuated by a male intimate partner. Therefore, if we are willing to talk about mental health, we should also be willing to stop our own acts of violence and stop perpetuating trauma. Are we ready to talk about mental health but avoiding talking about our violence against women?

(Note: If you are a woman experiencing violence in London support is available at Women’s Community House.)

Some people who commit crimes have mental health challenges.

Compassion is easy when we are not personally effected, can we maintain it when we are? It’s possible that you have or will be victim of a crime, whether it’s something minor like having change taken from your car, or major like being assaulted. It’s possible that the person who commits this crime has a mental health challenge. If this occurs, will your response to this be tempered by your compassion around mental illness, or will it be driven by the evolutionary desire for vengeance? With those facing mental health challenges incarcerated en masse, I would suggest that neither individuals nor the justice system are particularly good at considering the impact of illness on behaviours, and how we might better assist people to be well. The out-cry surrounding Vince Li getting day passes, even though not criminally responsible, shows that vengeance reigns over compassion. We avoid talking about mental illness and crime because thinking of those with mental health challenges as criminals has been a horrendous part of the stigmatization process. However, if we are willing to talk about mental health, we need to be willing to talk about how we can reform our justice system to stop having jail serve as the new asylum.

Many of us discard our own mentally ill children.

I left this one to last as it is the most personal and most painful for many, including myself (my brother’s experience of homelessness started when he was kicked out of our family home). Visiting any youth shelter, you will find a group of youth who have been driven out, kicked out, and frequently simply discarded by families. Where many have the misconception of homeless youth as “bad kids who run away”, I highlight that the lead cause of youth homelessness is the experience of violence in the home. And, the overwhelming majority of youth experiencing homelessness face a mental health challenge. Therefore, when confronted most closely with mental health challenges within our family, many of us respond poorly and reject rather than support them. If we are going to talk about mental health, then we need to talk about how we respond to those in our own family who struggle.

(Note: I want to acknowledge that so many, many of you do the very opposite. You are the rocks, the amazing supports for you loved ones through their difficult times. You are their pathway to recovery and I want to thank you…it’s not you who I’m talking about here.)

So yes, let’s talk about mental health.

For sure, we need to. Mental health is a catastrophe and a crisis. However, if the primary narrative is the cost of mental illness on our economy, and the solution is driven by workplace wellness, then I think we are missing a lot of the conversation. The issues go beyond middle-class concerns, and get to fundamental questions of how we structure our society, how we share our resources, and how we live together. Let’s have those conversations too.