Addressing homelessness does not end with securing tenancy. For many, the struggle continues beyond just having roofs over their heads.
Western researcher Carrie Anne Marshall says finding housing is only a partial fix to a larger problem. She recently led a community-based participatory research project aimed to identify the strengths and challenges of the system currently offered to individuals leaving homelessness in London, and to inform new strategies and/or build on existing supports.
“Once a person secures tenancy, it’s often assumed their situation has improved,” said Marshall, professor in the Faculty of Health Sciences School of Occupational Therapy. “But for many individuals leaving homelessness, especially those living with mental illness and substance use difficulties, they continue to live in a state of survival and often struggle to sustain their housing.”
An estimated 235,000 Canadians experience homelessness each year. It’s a growing challenge faced by cities across the country, including the City of London. A 2018 point-in-time count showed 406 people in the ‘Forest City’ experiencing homelessness on any given night, with 62 per cent of those individuals experiencing chronic homelessness.
Unmet psychosocial needs after leaving homelessness include ongoing poverty, low levels of community integration, high levels of substance misuse, symptoms of mental illness, low levels of engagement in meaningful activity, housing instability and food insecurity.
Along with her co-investigators, Abe Oudshoorn (associate professor, nursing) and Debbie Rudman (professor, occupational therapy), Marshall sought the perspectives of individuals with lived experiences of homelessness, to drive ongoing and future discussions on how the community can help individuals secure not only housing, but the services and supports needed to thrive following homelessness.
A team of peer partners at Queen’s University conducted a parallel study in the City of Kingston. The end goal is to develop a model for use across Canada.
Marshall’s team worked with a community advisory board for the design and delivery of all project activities. In addition to service providers and leaders of organizations that serve individuals who experience homelessness, the board consisted of individuals with lived experience of homelessness.
“We’re really proud that right from the beginning we had individuals with lived experience on the research teams at both sites [in London and Kingston],” Marshall said.
Between July and December 2020, Marshall’s team interviewed 56 stakeholders from three groups: those with lived experience of homelessness living with mental illness and/or substance difficulties; service providers working in organizations that support individuals as they are leaving homelessness; and leaders in these organizations.
Participants described the strengths and challenges of London’s current system of support and what they thought individuals living with mental illness and/or substance use need to thrive following homelessness.
The researchers expected a divergence in opinions from the different stakeholders, but the data proved otherwise.
“Remarkably, our findings are quite similar across all groups, with the individuals experiencing homelessness sharing the same views as the service providers,” Marshall said. “This was the case in London and in Kingston, which tells us we’re seeing the same kinds of patterns across communities.”
Community integration key to thriving
Participants reported that finding a home is an ongoing journey, with those experiencing homelessness stuck in a system that prevents thriving.
“One person captured the essence of our research findings, telling us, they don’t just need a place to survive, but a space; a healthy environment that supports an individual and enables thriving.”
They also identified a need for conditions that nurture and maintain a supportive community, and responsive substance-use support aligned to individual needs.
“We heard from all three groups that once people are housed, services fall off the radar,” Marshall said, noting huge caseloads and long waiting lists, with social services siloed, competing for the same pool of funding.
“Imagine being a person who has psychiatric condition, as well as a substance-use difficulty, being told there’s no help available for nine months and having to navigate an entire system on their own.”
The realities of the system make it tough for service providers drawn to a profession based on a desire to help.
“One of the service providers said it was a miracle they hadn’t burned out,” Marshall said. “They said it was hard for them to go home at the end of the day when they wanted to ‘do more but couldn’t because you’re embedded within a system that doesn’t allow you to do what is the right thing to do.’”
Policy and practice recommendations
Results of the interviews are now being shared with the broader community advisory board, with recommendations to create strategies to building on existing supports.
Recommendations include creating opportunities for “genuine belonging.”
“People talked about a certain service in the city that allows people to come together in an emotionally safe space, where they can just be themselves,” Marshall said. “We heard loud and clear through our interviews about the importance of community integration and how that’s not always happening.”
Sometimes people may feel a greater sense of belonging within shelters and encampments, and will sometimes forgo their housing to maintain that, Marshall said.
However, the idea of community integration can fall by the wayside when a service provider’s priority is ensuring a client has shelter or food. Thus, the recommendation is to also promote the idea of affordable daily living.
“If we want to end homelessness in Canada, that’s the biggest thing we need to address,” Marshall said.
Further recommendations call for an increase in permanent social housing needs and timely, recovery-oriented and appropriately funded mental health supports.
Developing a model approach
Working with their colleagues at Queen’s, Marshall’s team hopes to next collaborate with key stakeholders, drawing on the voices of those with lived experiences of homelessness to co-design a model that effectively meets the needs of persons with mental illness following homelessness.
“Person-centered care needs to be more widely adopted in services across London,” Marshall said.
They want to build on existing supports and engage the broader community to identify solutions that are feasible, relevant and effectively target crucial outcomes that have historically challenged communities.
“Homelessness can happen to anyone,” she said. “There was a time in my career where I worked in a shelter, and I saw people walk through that door who I’d never imagine I’d see. Lightning can strike a person three or four times in a row and they quickly find themselves without a home. I think it’s a responsibility of the broader community to make sure that we care for others.”