The following information is intended to be complementary to the more detailed cost-benefit discussion on housing and supports in the final report.
ESTIMATING HOMELESSNESS AND INADEQUATE HOUSING
While the intention of our work is to focus broadly on people living with mental health problems and the variety of housing situations they live in, the reality is that many people who are homeless are experiencing significant mental health issues – this is the most basic reality of our findings and countless national and international reports: people living with mental health problems are at greater risk of becoming homeless through the complex interactions of the social determinants of health, including income, and homelessness is the most visible evidence of inadequate housing and supports’ systems. Moreover, residing in inadequate housing is a risk factor for homelessness - most of the people who become homeless started off being inadequately housed49.
In some ways, it is easier to capture the extent of inadequate housing compared to capturing the extent of homelessness because of the existing definition of core housing need by CMHC, together with the broader measure of affordability of spending 30% or less of gross income on shelter. What is more complicated is measuring the costs of inadequate housing.
INADEQUATE HOUSING
Further discussion follows on the various definitions relating to homelessness – of which the Kirby report estimates that 30-40% of people have serious mental health issues. Here, we briefly discuss individuals at risk of homelessness (sometimes referred to as inadequately housed) which refers to families and individuals with formal shelter but in precarious circumstances (Pomeroy, 2001; Policy Research Initative, 2005). Risk factors relate to the trajectory of homelessness which is complex and usually the result of a variety of factors (i.e., personal levels of human and social capital, mental health, macro-economic trends, the accessibility of community-level supports, and government policies).
Individuals at risk of homelessness (sometimes referred to as inadequately housed) refers to families and individuals with formal shelter but in
precarious circumstances (Pomeroy, 2001; Policy Research Imitative, 2005).
Risk factors relate to the trajectory of homelessness which is complex and usually the result of a variety of factors (i.e., personal levels of human and social capital, mental health, macro-economic trends, the accessibility of community-level supports, and government policies).
The affordability of housing is of fundamental importance to the
‘trajectory’ of being inadequately housed or homeless. In 2001, 590,100 households were paying 50% or more of their income on shelter – average shelter cost to income ratios was 67% (Policy Research Imitative, 2005).
Practically speaking, the stress of this level of household expenditures may
create a vulnerability for people to develop mental health issues, or exacerbate existing mental health issues.
The City of Calgary, through its review of the literature in developing its 10-year plan, identifies a range of “root causes”
that contribute to homelessness and marginalization (2007, pp. 29-30):
49 J. David Hulchanski, Question and Answer, Homelessness in Canada: www.raisingtheroof.org/lrn-home-QandA-index.cfm - Note that definitions are consistent with those of the federal government’s 2004 National Homelessness Initiative.
“Without a physical place to call ‘home’
in the social, psychological and emotional sense, the hour-to-hour struggle for physical survival replaces all other possible activities. This social
Poverty;
Mental illness, addictions, and concurrent disorders (mental illness and addiction);
People fleeing violence;
Relocating to find employment;
Population group (visible minorities tend to be under-represented among the absolutely homeless, whereas Aboriginal persons are generally overrepresented);
Federal and provincial withdrawal from non-market (social or subsidized) housing initiatives starting in the mid-1980s;
Provincial deinstitutionalization of psychiatric patients who were housed in specialized facilities up until the early 1990s, without the transfer of comparable funding levels to community-based mental health service providers;
Low-income due to: low earned income (minimum wage versus living wage); scaled-back and clawed-back federal and provincial social support benefits; or lack of income for those leaving the foster care or child welfare systems and those exiting prison; and
The high cost of housing (owned and rented) compounded by low vacancy rates.
Municipalities often use “homeless counts” (“point in time” snapshots) to try to determine the number of people who are absolutely homeless – the 2008 Saskatchewan Housing Forum summarized issues relating to these counts including:
Homeless counts traditionally underestimate the numbers due to an inability to reach this entire target group;
Results are a snap shot in time only, and do not capture cyclical/long-term data;
These counts do not include people at-risk of being homeless, categorized as individuals or families currently living in inadequate, overpriced, unsafe, and/or overcrowded housing; and
These counts do not include people who are considered part of the concealed homeless.
Similarly, the United Way of Calgary and Area, provides a thoughtful analysis of homeless counts and learning from U.S.
cities (2007) that was reported in the City of Calgary’s Background Research for the 10-year Plan to End Homelessness in Calgary (p.44): for example, despite some data that suggests that homelessness in New York is on the decrease,
homelessness actually remains at record highs – there are increases in family homelessness and general shelter use despite the appearance of reduction in usage. The report also discusses the widely circulated cost-savings argument that the chronically homeless make up 10% of the homeless but are using 90% of services:
Most recently, the Health and Housing in Transition (HHiT) study by the Research Alliance for Canadian Homelessness (REACH) has produced some initial findings from its longitudinal, multi-city study of people who are homeless or vulnerably housed in Canada. Approximately 1,200 vulnerably housed and homeless single adults are being followed in three cities: Vancouver, Toronto, and Ottawa. The definition for people who were considered “homeless” encompassed
“This statistic is based on a 1997 study that only included data for single adults who used publicly funded shelters in two major metropolitan areas. It did not examine resource use by families with children, unaccompanied youth, or rural or suburban homeless populations. Moreover, the study did
not measure the use of any “service” other than publicly-funded, centrally-administered emergency shelter days. Based on this very limited study, which cannot be generalized to the entire homeless
population, many cities are making significant planning decisions for their 10-year plans. One consequence of the diversion of resources to the single male population is an upsurge in the number
of homeless families and children in the United States.”
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of homelessness). Researchers have since found that the distinction between these two groups is artificial as people who are considered vulnerably housed had spent almost as much time homeless in the previous year as the homeless group:
“Instead of two distinct groups, this is one large, severely disadvantaged group that transitions between the two housing states” (Research Alliance for Canadian Homelessness, Housing, and Health, 2010).
The key finding in the initial phase of this study (which runs to 2012), is that people who are vulnerably housed
experience the same risk of serious problems as people who are homeless including serious physical and mental health problems, problems in accessing health care services, hospitalization, assault and going hungry. There are an estimated 400,000 people who are vulnerably housed – using the definition provided by Hwang et al. – note that the Wellesley Institute identifies a range of 450,000 – 900,000 for people who are precariously housed and part of the “hidden homeless”. Findings to date of the study group that relate both to people who are homeless or vulnerably housed:
More than half (52%) reported a past diagnosis of a mental health problem – most commonly, depression (31%), anxiety (14%), bipolar disorder (13%), schizophrenia (6%), and post-traumatic stress disorder.
Close to two-thirds (61%) have had a traumatic brain injury at some point in their lives.
One in 3 reported having trouble getting enough to eat – being able to get good quality and nutritious foods was also commonly reported as an issue. Of the 36% of people who have been advised to follow special diets, only 2 in 5 (38%) do.
About 1 in 5 (23%) reported having had unmet mental health care needs, - a similar proportion (19%) reported that they didn’t know where to go to get the mental health care they needed.
Two in 5 unmet health care needs in the past year.
Over half (55%) had visited the emergency department at least once in the past year.
One quarter had been hospitalized overnight at least once in the past year (excluding nights spent in the emergency department).
Consistent with other recent research, high rates of chronic disease and physical health needs were found among the study group, including diabetes, asthma, and cardiovascular disorders. Over one quarter of the study group also identified having mobility issues.
The Centre for Applied Research in Mental Health and Addictions at Simon Fraser University estimates that roughly 20%
to 40% of people with serious addictions and/or mental illness are inadequately housed. Of this group, they further estimate that 70% of individuals are also inadequately supported.
WAITING LISTS
While there isn’t a standardized process for measuring waiting lists for affordable housing in Canada, there is a central waiting list process for most types of affordable housing in Ontario. The Ontario Non-Profit Housing Association (ONPHA) 2011 Annual Wait List Report identified that 152,077 households were on the municipal waiting lists. The number of households looking for housing across Ontario grew by 10,442 over the previous year (7.4% increase) and by 22,824 since 2009 (17.7% increase). The Wellesley Institute’s (2010) Precarious Housing report suggest extrapolating this to a national level as a crude measure of need, equating to roughly 3.4 million households.
ESTIMATING HOMELESSNESS
The Mental Health Commission estimates that 30-40% of people who are homeless experience serious mental health issues.
One of the problems in capturing the costs of homelessness is the challenges in trying to capture the extent of homelessness and, thus, the strategies needed to address homelessness. In the 2007 mission to Canada by the UN
Special Rapporteur on the right to adequate housing, Kothari notes that Canada has yet to come to national consensus on the definition of homelessness. Consistent with past UN reviews, it was recommended that this warranted immediate attention: without appropriate definitions of homelessness, and the factors that put people at risk of homelessness, official national data can grossly underestimate the level of need (Kothari, 2009).
The types of homelessness (or “houselessness”) experienced by people can be “absolute” or “concealed”50:
Absolute homelessness: Houseless persons are defined as people “sleeping rough” or using public or private shelters.
People sleeping rough, which means in the street, in public places or in any other place not meant for human habitation are those forming the core population of the “homeless”. This approach is consistent with the United Nations’ definition for absolute homelessness - meaning people who are living in the street with no physical shelter of their own, including those who spend their nights in shelters.
Concealed (also referred to as relative or hidden) homelessness: Under this category fall all people living with family members or friends because they cannot afford any shelter for themselves. Without this privately offered housing opportunity, they would be living in the street or be sheltered by an institution of the welfare system. This phenomenon is extremely difficult to enumerate.
The nature of homelessness can be chronic, cyclical or temporary in nature (Policy Research Initiative, 2005 pp. 4-5):
Chronic homelessness: faced by people who live on the periphery of society, often with problems of drug or alcohol abuse, or mental illness. Many different definitions have been used to try and capture “chronicity” of homelessness.
For the purposes of this report, and consistent with the federal government’s National Homelessness Initiative’s 2004 definitions, a person or family is considered chronically homeless if they have either been continuously homeless for six months or more, or have had a least two episodes of homelessness in the last two years. In order to be considered chronically homeless, a person must have been sleeping in a place not meant for human habitation (e.g., living on the streets) and/or in an emergency homeless shelter. It is estimated that roughly 20-30% of the homeless population is chronically homeless.
Cyclical homelessness: affects those who have lost their dwelling as a result of some change in their situation, such as loss of a job, a move, a prison term or hospital stay.
Temporary homelessness: captures those who are homeless as a result of a disaster or significant change of personal situation, such as a separation.
Municipalities often use “homeless counts” (“point in time” snapshots) to try to determine the number of people who are absolutely homeless – the 2008 Saskatchewan Housing Forum summarized issues relating to these counts including:
Homeless counts traditionally underestimate the numbers due to an inability to reach this entire target group;
Results are a snap shot in time only, and do not capture cyclical/long-term data;
These counts do not include people at-risk of being homeless, categorized as individuals or families currently living in inadequate, overpriced, unsafe, and/or overcrowded housing; and
These counts do not include people who are considered part of the concealed homeles