Workers provide mental health services to people who are homeless in Ottawa
Ottawa (17 Jan. 2006) - Canada is facing a national homelessness crisis, a disgrace to our reputation as a wealthy country. The National Union of Public and General Employees (NUPGE) and its Component unions across the country see the fallout from this crisis every day.
In the following article, James Huff, an Occupational Therapist with the Psychiatric Outreach Team at the Royal Ottawa Health Group, offers his insight into the problem from the perspective of those workers who provide services to the homeless.
|James Huff, O.T. Reg. (Ont.)
Psychiatric Outreach Team
Royal Ottawa Health Care Group
Homelessness is a growing problem in Canada. As successive governments have reduced social service spending throughout the country, more and more Canadians have found themselves on the streets. There are as many reasons for being homeless as there are homeless people, however, mental illness and addictions are certainly two factors. People who are homeless come from all walks of life, both well and uneducated, highly skilled and those who have never worked. The people are the brothers and sisters and parents who become detached from or burn bridges with their family systems and eventually have nowhere left to go except to the street.
In Ottawa, a team of various health professionals is working to help people who have mental illness and who are homeless. The Psychiatric Outreach Team is a service of the Royal Ottawa Health Care Group. The team is comprised of nurses, social workers, doctors, addiction workers and other allied health professionals, union members and non-union members. The team considers itself to have two types of clients. First, team members work directly with people who have mental illness and are homeless or at risk of becoming homeless. The team sees people with all types of mental illness, including psychotic disorders like schizophrenia, mood disorders, anxiety disorders like obsessive compulsive disorder and personality disorders. People often have co-existing substance use disorders to drugs and alcohol so, for example, the team works to address both the addiction and the schizophrenia at the same time. Clients must be served by one of over 50 “partnered agencies”, agencies in the city which serve this group (e.g. shelters, drop-ins, rooming houses, etc). The team’s involvement can include assessment, referral and direct intervention as required. For example, someone working with the Occupational Therapist might be learning the skills needed to maintain their housing by learning how to clean, cook and keep a budget. Second, the team works with the staff of these partnered agencies. They teach and guide the agency staff about issues related to mental illness and homelessness, such as medication side effects, health risks, and how best to work with this unique group of people. There are no waiting lists to see clients, and the services are publicly funded and available to any person who is served by one of the partnered agencies.
So who in Canada is homeless? How could this happen in a country which is so wealthy and resourceful? In Ottawa, there are about 1000 people staying in shelter beds each night, and this does not include the people who are sleeping outside or “couch surfing” by sleeping at someone’s place for a few weeks and then moving on. There are many reasons for homelessness and they are different for each person. Mental illness is only one reason. In a recent survey completed by Susan Farrell (the team’s psychologist and an OPSEU member) and her colleagues, 60% of adult men reported mental health problems based on a self report screening tool (Farrell et al., 2000). In this same study, substance use was also a problem. Forty-eight percent of the men reported problems with current or past alcohol use, and 42% reported past or present problems with drug use. Another part of the homelessness picture is that homelessness is a vicious cycle; for various reasons, people experience homelessness over and over again. In the study by Farrell et al. (2000), the average number of different times adult men experienced homelessness was 6, and there was a similar trend for the other individuals interviewed (e.g. adult women, male and female youth).
However, the most striking point about homelessness is the misconception that people “choose” to be homeless. This is heard all the time; people saying that the “street people” make the choice to be homeless. It is something I do not believe. The people we work with didn’t grow up dreaming “Wow, someday, I hope I sleep on a park bench and pan handle each day”. True some people choose to sleep outside versus stay in shelters where they may be at risk of theft or assault. Many people have become very hesitant to accept help; most people have poor experiences with the “system” and find it very difficult to trust others, particularly mental health professionals! However, when you offer these people the opportunity to have their own place, they will take it. They would choose to be housed if the option was there.
There is no question that more affordable housing would go a long way to reduce the number of homeless Canadians each night, but there is more to the solution than housing. A National Housing strategy is something that advocates for the homeless have been demanding for some time. We support this and think it is great. However, will this end the problem? If homelessness is recurring for most people, we could expect that even if they become housed, even in affordable housing, they may not be able to maintain their housing. Perhaps, particularly for people with mental illness, there may be living skills deficits that prevent them from being able to maintain their housing, or they may not be able to maintain their mental health without outside help. For this reason, both housing and ongoing support are needed to combat homelessness. Once people are housed they need workers who can help them learn new skills, help them maintain their mental health by continuing the treatments that work for them and help them return to work, or go back to school, workers that can help them reconnect with lost family or integrate into their communities. These are needed human resources that can go a long way to stop the vicious cycle of homelessness.
In the current election campaign, there has been little attention devoted to this national issue. Canadians can make a difference. Each of us can let our Provincial and Federal representatives know that we think a National Housing program is a priority and that there need to be human resources available to help people who are homeless be able to stay housed. We can support the work of the not-for-profit agencies that help feed and care for the people who are homeless in our communities. Finally, we can acknowledge people who are homeless that we see everyday. We can give them a piece of food, or buy them a coffee to help them get through their day. We would do no less if this person was our brother, sister, mother or father.
Farrell, S., Aubry, T., Klowdawsky, F. and Pettey, D. (2000). Describing the homeless population of Ottawa-Carleton. Unpublished fact-sheets. University of Ottawa. NUPGE