Homelessness and Mental Illness

Table of Contents

    Overall Themes

    • Homelessness is a problem in every province and territory in Canada
    • Homelessness appears to be on the rise
    • Homelessness is significantly correlated with diagnoses of mental illness and substance abuse
    • The homeless population is difficult to research because of its transient nature
    • There is a body of research available in large urban centres but less is available is smaller provinces and territories

    Introduction

    Research in the area of homelessness, mental illness and substance abuse offers inconclusive evidence regarding whether mental illness and substance abuse leads to homelessness or if it is the other way around – homelessness leads to mental illness and substance abuse.

    What is clear is that a history of mental illness and/or substance abuse places people at greater risk for homelessness. It is also true that people who are homeless experience stress and anxiety and are a much greater risk of being assaulted, [1] leading to mental health problems and the use of substances as a means of coping.[2]

    The increase in homeless mentally ill in Canada is often attributed to the closing of psychiatric hospitals (deinstitutionalization). However the biggest increase occurred in the 1990s when many provinces lowered welfare rates and limited investment in social housing. At this time, there were also fewer funds for health and social services.[3]

    On any given day, it is estimated that 10,000 people do not have a roof over their head [4] although this number may be low given that figures from British Columbia report 11,750 people absolutely homeless for that province alone.[5]

    Definitions Of Homelessness

    While it may seem obvious what being homeless means, there are gradations that are important to consider. Unsheltered means absolutely homeless, living exclusively on the streets or in parklands. These homeless people can be called the invisible homeless because they typically do not use shelters. Sheltered means living in inadequate circumstances where there is lack of potable water, few washroom facilities, overcrowding, violence and theft, and tenure is day-to-day. Examples are shelters, squats and tent cities. At risk means having some form of accommodation but people are close to losing it because they are unable to keep up with the rent, might lose it altogether if admitted to hospital, or they are “couch-surfing” (living with friends or acquaintances on a temporary basis).[6]

    Federal/National Developments

    Human Resource and Social Development (HRSD) has replaced its homeless initiative with a Homeless Partnering Strategy (2008 – 2009). See: http://www.tbs-sct.gc.ca/rpp/0708/hrsdc-rhdsc/hrsdc-rhdsc07_e.asp

    This strategy includes the Homeless Individuals and Family Information System (HIFIS) which populates a national data base called the Homeless Knowledge Development Program. These data form the basis of various reports. See: http://www.hifis.ca/

    The Mental Health Commission of Canada has received $110 million to research best practices in providing services to people who are mentally ill and homeless. See: http://www.mentalhealthcommission.ca/proj_homelessness-en.php

    Homelessness And Mental Illness Throughout The Country

    While all provinces and territories are concerned with homelessness, not all have research that reports the characteristics of their homeless populations. What research is available paints a fairly clear picture; people with mental illness and/or substance abuse problems are over-represented among the homeless.

    In Canada, there are 823 emergency or transitional shelters with a total of 25,038 beds.[7] There are shelters in every province and territory.

    The following is a brief review of some available findings and/or announcements:

    British Columbia

    British Columbia spends $644 million per year on services for the homeless, which translates to $55,000 per homeless person. The province has 130,000 citizens with substance abuse disorders or mental illness and of those, 26,500 are inadequately housed and supported. It is estimated that substance abuse disorders and mental illness affects 60 – 100% of the homeless population. Addiction is the most prevalent mental health problem, followed by dual diagnosis (often called concurrent disorders, meaning both mental illness and substance abuse) and finally, mental illness alone. There are only 7,741 supported housing units in British Columbia for people with these problems.[8]

    The regional BC Steering Committee on Homelessness published its latest figures in April 2008. They showed that homelessness in BC doubled from 2002 – 2005 and has increased 19% from 2005 – 2008. British Columbia is seeing a rise in homeless families, abused women and their children, and immigrants and refugees. Fully 23% of Aboriginal people in that province are homeless with 41% of Aboriginal peoples being at risk of homelessness. Eleven percent of people who are homeless have a diagnosis is schizophrenia.[9]

    Alberta

    Alberta’s booming economy has led to an unwanted rise in homelessness. Alberta does not keep province-wide statistics, however, municipalities do track homelessness. Calgary began counting the homeless in 1992 and found 447. In 2006, that number rose to 3,436. Edmonton started counting in 1999 (836). In 2006, there was 2,200 homeless people in Edmonton.[10] As study of Edmonton homeless revealed that 20% had migrated there from Saskatchewan and Manitoba, mainly due to severe conditions on reserves including violence and alcohol abuse.[11] The government struck an Alberta Affordable Housing Task Force in February 2007 with a mandate that included looking at the province’s homeless problem. Recently, the Alberta Secretariat for Action on Homelessness was established in January 2008 accompanied by an announcement of $285 million in new funding.[12]

    Saskatchewan

    A study of urban First Nations people who were homeless revealed no uniform patter with some being elderly and some being children. Some were educated while others were not. Eighteen percent reported being employed. Some were seriously drug involved while others abstained completely.[13] In 2005, the federal government committed $3.2 million to help address homelessness in Saskatchewan.[14]

    Manitoba

    Studies of homeless youth in Winnipeg showed a disturbing pattern of early abuse with 50% experiencing abuse before the age of eight and 25% of the girls having been sexually abused before age nine. Fifty percent of homeless youth were at high risk of suicide and fully two thirds had symptoms of a lifetime psychiatric disorder. Most used drugs as a way of escaping their bleak lives.[15]

    Ontario

    In Toronto, 30,000 people use shelters annually with many 1000’s more sleeping on the streets or in parks and ravines. There are 70,000 households on social housing wait lists. An additional 150,000 households are at risk of becoming homeless (defined as paying more than ½ of income for rent).[16]

    In a much quoted study,[17] it was found that approximately 66% of homeless people on Toronto’s streets had a lifetime diagnosis of mental illness, roughly 2 – 3 times the rate of the general population. Sixty-six percent had a substance abuse problem with many having both. In total, 86% had either a mental illness or an addiction. To counteract the perception that closing psychiatric hospitals led directly to a rise in the mentally ill homeless, it was found that only 6% had been in an institution in the year immediately prior to becoming homeless, whereas 30% had been in trouble with the law. In a more recent study, [18] a survey of homeless people found that 1/3 became homeless because they couldn’t afford rent and another 1/3 stated that their physical or mental illnesses prevented them from obtaining and keeping housing. The study revealed high levels of physical illness among the homeless with the group being:

    • 29 times more likely to have hepatitis C
    • 20 times more likely to have epilepsy
    • 5 time more likely to have heart disease
    • 4 times more likely to have cancer
    • 3 ½ times more likely to have asthma
    • 3 times more likely to have arthritis or rheumatism and,
    • Twice more likely to have diabetes

    The research also showed that in the past year:

    • 50% had experienced severe depression
    • 1 in 10 had attempted suicide
    • 1 in 3 had been physically assaulted
    • 1 in 8 had been assaulted by police
    • 1 in 5 women had been raped or sexually assaulted

    This report’s findings on homeless women (21% who were Aboriginal) highlighted the extreme danger of the streets.[19] It found that:

    • Homeless women were 10 times more likely to be sexually assaulted
    • 37% had been physically assaulted in the past year
    • 21% had been sexually assaulted or raped one or more times in the past year
    • Homeless women were two times as likely to have been diagnosed with a mental disorder – 50% of those surveyed had a psychiatric diagnosis – the most common diagnosis was depression and anxiety
    • 12% had tried to commit suicide in the last year

    In Ottawa, a regularly published report card on homelessness revealed that, in 2007, the average length of stay in emergency shelters was up 13.9%, the number of families was up 6.4% with 1,237 children in shelters, and the number of times shelter beds were used had increased to 18,540, indicating that Ottawa’s struggle to meet the needs of the homeless is far from over.[20]

    New Brunswick

    It is estimated that there are more than 200 homeless people in Saint John.[21] Most are thought to be sleeping in their cars or utilizing the city’s 151 shelter beds. The report acknowledges that many have mental illnesses and substance abuse problems but does not report percentages.[22]

    Human Resource and Social Development (HRSD) has announced an investment of $1.5 for New Brunswick to help the homeless.[23]

    Nova Scotia

    The Halifax Regional Municipality conducted a 2006 study of the costs of homelessness. Authors found that homeless people are high users of shelter, health (hospital and emergency departments), mental health, substance abuse and correctional services. Their findings have been backed up by the Canadian Institute for Health Information which, utilizing hospital data from Vancouver, Calgary and Toronto, found that mental disorders account for 52% of hospitalizations among the homeless. Thirty-five percent have visited an Emergency Department (for mental health and behavioural disorders) as opposed to 3% of the general population – because they have no family physician. Fifty-two percent of these visits were for substance abuse (defined as a mental disorder).[24]

    The Halifax researchers estimated that investment in supportive housing would save 41% of these costs per person per year.[25]

    Newfoundland

    Human Resource and Social Development (HRSD) has announced an investment of $300,000 for Newfoundland and Labrador aimed at homeless youth.[26]

    Information regarding homelessness and mental illness is limited for Prince Edward Island, Northwest Territories, Nunavut and the Yukon. HIFIS reports the following basic information:

    • Prince Edward Island has 6 shelters and a total of 53 beds.
    • Nunavut has 2 shelters and a total of 30 beds
    • Yukon has 3 shelters and a total of 29 beds
    • Northwest Territories (Yellowknife) has 8 shelters and 25 beds.

    Selected Resources

    Growing home: Housing and homelessness in Canada. 2nd national conference on homelessness. To be held in Calgary on Feb 18 – 20, 2009. See: http://www.nhc2009.ca/index.html

    For a listing of emergency and transitional shelters throughout Canada and other national data collected through the Homeless Individuals and Families Information System (an Human Resources and Social Development public/private sector program that provides software, computers and IT support to shelter to collect data and create a national data base on homelessness), see Shelter Capacity Statistics June 2008 at: http://www.hifis.ca/resources/hifis/index_e.asp

    Street Health Report (2007). Available here.

    Canadian Institute for Health Information (August 30th, 2007). Improving mental health for Canadians: Mental health and homelessness. Available at: http://www.cihi.ca/cihiweb/dispPage.jsp?cw_page=media_30aug2007_e


    [1] Street Health Report (2007). Available here.

    [2] CBC news, July 31st 2006. Winnipeg’s homeless youth struggle with drugs, mental illness study says. The article quotes a study from the Addictions Foundation of Manitoba. Available at: http://www.cbc.ca/canada/manitoba/story/2006/07/31/street-youth-study.html

    [3] Riordan, T. (2004). Exploring the circle: Mental illness, homelessness and the criminal justice system in Canada. Available at: http://www.parl.gc.ca/information/library/PRBpubs/prb0402-e.htm

    [4] Canadian Institute for Health Information (August 30th, 2007). Improving mental health for Canadians: Mental health and homelessness. Available at: http://www.cihi.ca/cihiweb/dispPage.jsp?cw_page=media_30aug2007_e

    [5] Patterson, M. Sommers, J. McIntosh, K. Sheill, A. & Frankish, C. J. (2008. Housing and supports for adults with severe addictions and/or mental illness in British Columbia. Available at: http://www.carmha.ca/publications/index.cfm?contentID=29

    [6] Edmonton homeless study (2004). Available here

    [7] These figures are reported by the Homeless Individuals and Families Information System (HIFIS) and are available at: http://www.hifis.ca/resources/hifis/index_e.asp

    [8] Patterson, M. Sommers, J. McIntosh, K. Sheill, A. & Frankish, C. J. (2008. Housing and supports for adults with severe addictions and/or mental illness in British Columbia. Available at: http://www.carmha.ca/publications/index.cfm?contentID=29

    [9] Patterson. M. (2007). The faces of homelessness across BC. Available at: http://www.heretohelp.bc.ca/publications/visions/housing-homelessness/bck/4

    [10] Harding, K. & Walton, D. (October 7th, 2009. There’s no place like homeless. The Globe and Mail. Available here.

    [11] Edmonton homeless study (2004). Available here.

    [12] Press release available here.

    [13] Saskatchewan Indian Institute of Technologies (2000). Urban First Nations People without homes in Saskatchewan. Available here.

    [14] News release is available at: http://www1.servicecanada.gc.ca/en/sk/newsroom/2005/nr01205.shtml

    [15] CBC news, July 31st 2006. Winnipeg’s homeless youth struggle with drugs, mental illness study says. The article quotes a study from the Addictions Foundation of Manitoba. Available at: http://www.cbc.ca/canada/manitoba/story/2006/07/31/street-youth-study.html

    [16] Wellesley Institute (2006). Blueprint to end homelessness. Available at: http://wellesleyinstitute.com/theblueprint/

    [17] The Pathways to Homelessness study as referenced by Riordan, T. (2004). Exploring the circle: Mental illness, homelessness and the criminal justice system in Canada. Available at: http://www.parl.gc.ca/information/library/PRBpubs/prb0402-e.htm

    [18] Street Health Report (2007). Available here.

    [19] Women and homelessness (2007). The Street Health Report – Research Bulletin #2.

    [20] Alliance to end homelessness Ottawa (April, 2008) Fourth report card. Available at: http://www.endhomelessnessottawa.ca/

    [21] CBC new report referencing a 2008 report called A Portrait of Homelessness in Greater Saint John. Available at: http://www.cbc.ca/canada/new-brunswick/story/2008/03/11/homelessness-sj.html

    [22] A Portrait of Homelessness in Greater Saint John. Available here

    [23] Press release March 17th, 2008. Available at: http://news.gc.ca/web/view/en/index.jsp?articleid=385759

    [24] Canadian Institute for Health Information (August 30th, 2007). Improving mental health for Canadians: Mental health and homelessness. Available at: http://www.cihi.ca/cihiweb/dispPage.jsp?cw_page=media_30aug2007_e

    [25] Palermo, F. Dera, B. & Clyne, D. (June, 2006). The cost of homelessness and the value of investment in housing support services in Halifax Regional Municipality. Available here

    [26] Announcement available at: http://news.gc.ca/web/view/en/index.jsp?articleid=394249