Dealing with addiction and mental illness alone will not solve the homeless problem, say some experts. Michael Swan

Homeless: Search for solution grows more urgent than ever

  • February 10, 2023

As Canada’s largest city panics over a series of random stranger attacks, there is sudden media and political attention on Toronto’s exploding homeless population, especially the homeless who appear to be addicted or mentally ill.

“I have no doubt that these incidents have been taking place, but I think they are being over-reported,” Common Table volunteer Paul Pynchoski told The Catholic Register. “Certain aspects of them are repeated over and over again.”

The Common Table at Redeemer Anglican Church in downtown Toronto functions as a kind of community centre for Toronto’s homeless, providing meals, nursing, a book club, art and craft activities and a warm place to sit and talk.

Whether or not the attackers in nine headline-grabbing instances of stranger violence since Dec. 8 are homeless, or mentally ill, or addicted is mostly unknown. In one of the highest-profile cases, a homeless man, Ken Lee, was killed in an alleged swarming attack by eight teenaged girls between the ages of 13 and 16.

Media focus on the homeless, mentally ill and addicted has been everywhere.

“Are Toronto’s attacks linked to homelessness? Not necessarily,” Toronto Star columnist Bruce Arthur wrote in his Jan. 29 take on the situation. “But we know Toronto closed three of its 23 shelter hotels late in 2022 and plans to close five more in 2023; the pandemic increase in funding that accounts for 30 per cent of shelter beds has dried up.”

On Jan. 28, Toronto Sun columnist Warren Kinsella called Toronto “a scene out of Stanley Kubrick’s dystopian Clockwork Orange” and blamed the deinstitutionalization of the mentally ill.

“We have jettisoned the moral duty we owe those fellow citizens who desperately need psychiatric help. People who were protected, and helped, in psychiatric hospitals,” Kinsell wrote. “We’ve dropped them into the back alleys.”

A dangerous increase in the toxicity of street drugs gets the blame in a Jan. 27 Globe and Mail column by Gary Mason, headlined “Random acts of violence? Better get used to it.”

Toronto Mayor John Tory has dispatched 80 more police officers to patrol the transit system. He has called for a national conference on the issue and told CP24 Breakfast he’s “not timid” about drawing connections between mental health and violence in public places. 

Tory’s plan also adds security guards and “Community Safety Ambassadors” working in the TTC system who are directed to deal with the city’s homeless population.

The mayor is pushing to add $48.3 million to Toronto’s police budget to cover about 200 more officers and programs addressing youth violence. The actual link between mental illness, homelessness and violence may not be so straightforward, pointed out psychiatrist Jack Haggarty. People suffering psychosis are at times a risk to others, he said.

“But they actually die from other causes 15 years earlier than the average person, and they have a higher risk of actually being victimized by others,” Haggarty told The Catholic Register.

Their treatment at the hands of others, their vulnerability to physical ailments and the risk of suicide make the mentally ill on the street vulnerable. A media picture of the homeless as a threat to the rest of us bothers Pynchoski, who leads a book club for the homeless.

“I don’t think the media is intentionally doing this, but I think we’re being pushed toward, ‘Oh God, we have to get tough on crime,’” he said. “It’s not a response of ‘What are the needs that are not being met here?’ We want to deal with the symptoms but we never want to deal with the problem.”

Just before the drumbeat of violent incidents grabbed the spotlight, Toronto’s Catholic hospital system put out a note to the city about how they’re dealing with the problem of Toronto’s 8,000 to 10,000 homeless people.

“We are seeing an increasing number of people with cold-related injuries. Routinely, we care for people who are homeless and suffering direct complications of cold weather: hypothermia, frostbite, swelling and infections, and exacerbation of pre-existing conditions,” said the Jan. 17 note on the Unity Health website. “We also see patients who require medical assistance because of the strategies used to survive outside in unpredictable weather. These include injuries from sleeping in unsafe areas or overdoses from substance use. We are also seeing many unhoused patients coming into our emergency departments simply looking for a space to shelter.”

Hospitals can’t solve Toronto’s homelessness problem, said St. Michael’s Hospital research scientist Dr. Stephen Hwang, an internationally renowned expert on health and homelessness.

“There’s no sense in which the health care system, or hospitals, can solve homelessness,” he told The Catholic Register. 

“What we’re seeing is that the failures and gaps in our system are causing people to end up on the doorstep of our hospitals. Hospitals are simply the place of last resort for many people.”

Looking at a problem that has spread and deepened decade after decade since the 1980s, Hwang does not believe Toronto or Canada should just resign itself to the inevitability of tent cities, people in sleeping bags on city streets, open drug use on the subway and thousands in the shelter system with no way out.

“This is a problem that is definitely solvable. We didn’t get into this situation in months, or just 15 years,” said Hwang. “It’s been a problem that’s been building for a long time. It’s going to take us a while to turn this ship around, but it is possible to do so.”

Hwang’s prescription for a solution begins with an honest look at the problem. Even if many homeless people are obviously mentally ill or addicted or both, homelessness is not primarily a mental health issue, he said.

“If we want to address homelessness, we really have to address the housing and poverty issues that are driving it,” he said. “It’s true that we do need to address, to help people with conditions such as mental illness and substance use if we want them to be more well once they’re housed. But it’s definitely a false belief that simply addressing substance use and mental illness will reduce homelessness.”

In January, 2023 CMHC reported that as of October 2022 the average Toronto bachelor apartment rents for $1,169 per month. One-bedroom units go for $1,347. But that’s for existing rents in existing units. When an apartment changes hands from one leaseholder to the next it is temporarily released from rent control. The average increase to the new leaseholder is 29 per cent.

In a rich city, it’s hard to be poor.

“The fundamental reason that we see so many people who are experiencing homelessness, and more than before, is that we have a system that doesn’t create enough affordable housing and a system that creates a lot of people living in poverty,” Hwang said.

The economics of having an apartment just doesn’t work for the poorest people in the city, said Good Shepherd executive director Aklilu Wendaferew.

“A person who is on ODSP (Ontario Disability Support Program), they take in about $1,200 per month,” Wendaferew said in an interview. “That’s food and rent. If they have to pay the entire ODSP amount plus (for rent) I don’t know where they can get the rest. … That contributes heavily to people becoming homeless.”

Wendaferew doesn’t deny there are mental health and addiction troubles widespread in the homeless population. 

“The question is, are people becoming mentally ill because of homelessness — once they become homeless — or are they becoming homeless because of their mental health issues? That’s not very clear. I suspect it’s because of both,” Wendaferew said.

Hwang’s groundbreaking research has firmly established the “Housing First” principle in caring for the homeless. Careful, methodical, scientific research has established that it doesn’t matter whether people are homeless because of their mental health or mentally ill because of homelessness. Either way, their health issues can’t be addressed without stable, secure and safe housing. Nobody gets better living in a lean-to under the Gardiner Expressway.

“There’s no one whose health problems can be solved while they’re homeless,” Hwang said.

Housing that people can afford is the key.

“We could treat those conditions and still, if there’s not enough affordable housing, there would still be a growing number of people who are homeless,” said Hwang.

Hwang’s scientifically informed common sense underpins the City of Toronto’s policy.

“Substance use issues or mental illness should not be barriers to accessing housing and can be better addressed once the need for housing is satisfied,” City of Toronto spokesperson Anthony Toderian said in an e-mail to The Catholic Register.

The city’s 24-month “Housing Recovery and Resilience Plan” aims to create 4,000 new affordable and supportive housing spaces by the end of 2024. Through the decade from 2020 to 2030, Toronto’s HousingTO plan has set itself the goal of moving over 13,000 homeless people into permanent housing. Through this winter the city will add 400 new permanent affordable rental units to its stock.

If the situation on downtown streets looks worse, a lot of that has to do with the lack of treatment beds for people trying to get clean and sober. Through the pandemic years, treatment programs had to reduce the number of beds to meet physical distancing requirements imposed by the virus. The Good Shepherd has a waiting list to get into its pre-treatment program DARE (Drug and Alcohol Recovery Enrichment).

Wendaferew is pleading for resources that will allow the Good Shepherd to get addicts safely off the street and supported on their way to sobriety.

“Something has to be done. We are more than willing to expand our program,” he said.

But in the meal line at the Good Shepherd not everybody is an addict. There are immigrants and refugees, people living in rented rooms with no cooking facilities, the lonely.

“Overall, it’s poverty, it’s mental health, it’s lack of affordable housing, it’s addiction, the lack of support for mental health and addiction,” Wendaferew said. “For the homeless people, that’s really contributing to homelessness in Toronto.”

At The Common Table, Pynchoski urges citizens and ordinary Christians to solve homelessness with small, everyday acts of charity.

“Our best solutions don’t come from above,” he said. “They come from getting close to the people who are in the midst of the problem. People need to get to know homeless people, get to know Indigenous people, get to know people from other religions. You can’t do that in the newspaper. You can’t do that in conferences. You have to be willing to do it with your boots on the ground, at street level. You have to be willing to walk by and say, ‘How’s your day going?’ 

“Somehow we create the opportunity for ourselves, or we volunteer somewhere that has that opportunity. Or we work with our local parishes and congregations to be able to create those opportunities — find opportunities for people to be together.”

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