I Know How to Fix the Homelessness Crisis in Canada
All I need is a whole bunch of money
Recently the City of Montreal announced that it was going to begin holding public consultations on ‘social cohabitation’ with homeless people. “Residents, parents, families and business owners are concerned about the way resources are planned in their sector and we must do better at predicting the increasing needs,” said the mayor, Valerie Plante. This came on the heels of complaints about a new supervised drug-use site in St-Henri, including from the Centre for Research-Action on Race Relations, which accused the City of not consulting with other marginalized groups when setting up its new initiatives. All of this is occurring in the midst of a very visible spike in homelessness in Montreal. Miniature tent cities have sprouted up all over the city, including in the small park a block from my house where I play fetch with my dog.
I worked in homeless shelters and as a street outreach worker for around five years. I care deeply about the needs of this population and tend to side with them, within reason, against the interests of business owners and so on because their position is so utterly precarious and their needs are so great. I think that homeless people are far and away the most thoroughly dehumanized and degraded subset of the population, so much so that when I was working in that field, it sometimes became legitimately difficult for me to take seriously the claims of marginalization coming from other groups. I’ve revived homeless people from overdoses, I’ve dressed their wounds and washed their bodies, I’ve let them cry on my shoulder. My own uncle was homeless for most of my adult life. And I’ll tell you right now that I don’t want to ‘cohabitate’ with homeless people.
It’s not because I think they’re dangerous and disgusting and unworthy of my respect. It’s because homeless people are not, as me and my partner Clementine joke and as liberals seem to believe, ‘a special kind of trans person’, who we just need to learn to understand and accept. Homelessness is not an identity, it’s a condition that people are, generally, forced into in one way or another, and here’s the thing: it’s an unacceptable one. There simply should not be any such thing as someone living in a tent in the park in a country as wealthy as Canada. And no amount of public consultations and ‘social cohabitation’ workshops is going to end this sickening failure of Canadian society.
I believe that almost anyone who has worked in the homelessness sector for five years could probably more or less immediately solve the homelessness crisis if you put them in charge of policy. The problem is not that we don’t know the solutions. The problem is that governments are unwilling to spend the amount of money up front that it would take. Instead we add one more bandaid to the gunshot wound every election cycle, ultimately prolonging the problem, making it harder and harder to eventually fix, and in the meantime spending far more on it over the decades than we would if we just dealt with it. This is a classic symptom of liberal politics, where the goal is always to spend just enough money on a problem to make it seem like you’re doing something, but never enough to address any underlying realities; and of conservative politics, where the idea is to just throw cops at a problem until it goes away.
Clearly, these approaches have not been working. It might be time for a different method — one that actually works. So without further ado, here’s how we can solve this crisis.
1. General housing
Unfortunately, it’s not as simple as the common leftie mantra of ‘housing first’. More on that later. But it’s a fact that whenever housing prices spike, the craziest and least functional half a percent of the housed population simply falls out of the bottom of the housing market. People who were basically getting by, on some combination of disability checks, odd jobs and general scheming, get priced out and end up on the street. At the same time, the number of people who become homeless as a result of three or four bad luck disasters in a row also increases (the type of story where someone loses their job, experiences some kind of severe personal tragedy like the death of a spouse, runs into trouble with the bank, gets evicted and can’t find another place to live). This influx of people into the homelessness resource ecosystem puts extreme stress on shelters and other organizations, who are unable to cope with the need, resulting in more people visibly living outside and, generally, becoming crazier and crazier as the traumatic experiences of homelessness pile up. In turn there is even less of a chance of any homeless people eventually finding a place to live, already a near-impossible task for all but the most functional.
Therefore general housing needs to be made more accessible, by any means necessary. Absent the possibility of abolishing landlordism altogether, rents need to be frozen. Landlords need to be fined for keeping units vacant unnecessarily. AirBNB should be banned entirely in large cities. Landlords found guilty of repeatedly violating rental law should have their units confiscated and converted into social housing or housing co-operatives. Governments at municipal, provincial and federal levels need to coordinate to rapidly build large numbers of low-cost rental units to be owned by the city or by not-for-profit cooperatives. It would also not be unwise to peg immigration targets to the number of actually existing available units in the country.
2. Specialized housing
Homeless people can be roughly subdivided into two main groups. The first are people who are transiently homeless or ‘housing-insecure’. These are people who are reasonably well-functioning and are experiencing more or less temporary setbacks related to poverty or personal disaster. They often have some support networks they can make use of, often are able to sleep on friends’ couches for some period, typically can hold down a job if they get one, and sometimes have assets they can sell or cars they can live in. For people like this, the mainstream shelter system often works reasonably well; it’s a place where they can sleep and store some belongings while they get back on their feet, and following the usual rules, such as curfews or bans on intoxication, isn’t much of a problem for them. These are also the people for whom ‘housing first’ works very well; if you just hand them the keys to an apartment, no questions asked, their most pressing problem disappears and they are usually able to find work and regain stability.
The second are people who are chronically homeless. In my experience virtually 100% of such people have backgrounds including very severe trauma and experience the complex and often debilitating mental health problems that that’s associated with. The kind of trauma I’m talking about includes things like repeated episodes of brutal sexual violence; long-term severe child abuse; repeated neglect and abandonment in the foster-care system; long-term incarceration; or, often, some combination of the above.1 The kind of PTSD that such experiences produce is distinct from the kind of PTSD experienced by soldiers or survivors of random violence, which usually leaves the individual struggling, and susceptible to flashbacks set off by specific triggers related to the traumatizing event, but otherwise fairly functional in core areas of their life, and with established treatment protocols. By contrast, people with PTSD related to severe, repeated and prolonged trauma from which there is little chance of escape, such as survivors of long-term child abuse, often develop what’s called Complex PTSD, which is characterized by serious personality shifts and crippling, ongoing feelings of terror, helplessness, worthlessness, and distortions in thinking and self-image. Treatment is extremely difficult and requires long-term specialized therapy. People with Complex PTSD typically have great difficulty in functioning and are at extremely high risk of addiction and further abuse, which further exacerbate the problem. Not everyone with Complex PTSD ends up homeless, to be sure, but I would say that of the chronically homeless people I worked with, the vast majority exhibited symptoms of Complex PTSD.
For many such people, especially those who have been homeless for years experiencing compound interest on their original trauma, giving them a job and keys to a regular apartment simply won’t work. They aren’t capable of maintaining these things by themselves. To paint with broad strokes, their most pressing problem doesn’t disappear because their most pressing problem is internal. They require long-term access to specialized services. They’re not going to get what they need in prison or locked in a psych ward, either – in fact these ‘solutions’ often make the problem much, much worse. What they require is specialized housing. And the model already exists – it just isn’t nearly as widespread as it needs to be.
What you do is you build or acquire apartment buildings and staff them with full-time nurses, intervention workers, social workers and cleaning staff. You give people the keys to these apartments. They are not temporary accommodations; people can live there as long as they want, though if they want to move out they can get help finding a regular apartment. They can bring their kids and pets. They have access to services which help them maintain their apartments, services which are in the same building and consist of familiar faces, rather than a visit from a random city social worker every month. They can access classes and workshops on basic life skills they may be lacking. Their neighbours in the building are people who have been through the same kinds of things and often are their actual community, people who they know from the street – one common failure of housing-first is that you set someone up with an apartment in some far-off part of the city and people simply get so lonely that they abandon it. You create tiers, where some buildings are much more service-intensive and others are for people who require less help. You ensure that there is a realistic pathway to independent living for anyone who wants it. You ensure that there are buildings only for women and their kids, buildings only for Inuit with staff who understand Inuktitut2, buildings for First Nations individuals with a high proportion of First Nations staff, units for people living with chronic longterm alcoholism (more on this later) and so on.
Once you have systems like this set up on a very large scale, what you do is every time the authorities or intervention workers interact with a homeless person, that person is offered a spot at one of these facilities3. Over a short period of time, the number of people living on the street will shrink to a tiny number of very extreme cases or the kind of punk kids who are just travelling through town having an adventure. Almost everyone else will be extremely happy to be offered a spot and stop living in a tent under an overpass.
3. Same-day detox and rehab
For many years there has been a heavy emphasis on a safe supply of street drugs to combat the overdose crisis, with some advocates going so far as to suggest that the government should supply users with chemically pure narcotics. In my opinion, something along these lines is desperately needed, but -- and this is the really really important part -- CANNOT be the only measure in place. It absolutely needs to be paired with massively increased access to addiction health services.
Addiction is an extremely cruel disease which stems largely from alienation on a social level and trauma on an individual level. People who study addiction note that almost all chronic, extremely high risk users, the types who end up on the street, have severe PTSD of some kind or another, and as noted above, this is my experience working with homeless people as well. Drugs being difficult to access and cut with dangerous chemicals does not deter these people, and leads directly to a lot of the more dangerous behaviours we see such as survival sex work and petty crimes for cash. It also leads directly to the ongoing overdose crisis which, if you work on the street, means you are watching people die on a regular basis. The criminalization of drugs also of course leads to gang control over the supply and the associated violence.
However, safe supply doesn't solve the problem of addiction, and this is where I diverge from some of the more gung-ho safe supply advocates. I know that criminalization isn’t effective, but I also know from personal and professional experience that addiction is real, and crushing, and robs people of control over their one sacred life. I don't want addicts to just have government dope. I want them to have access to recovery. When I was working doing street outreach I would have the experience on a regular basis of someone having a moment of clarity and begging me to help them get clean. Remember that withdrawal is unimaginably painful for dope and often literally lethal for alcohol; for most chronic users it absolutely needs to be medically supervised.
Think about our healthcare system and imagine how easy it would be for a dirty, belligerent, penniless Inuit woman, who is homeless, and does street level sex work to survive, and lost all her ID years ago, to get access to medically supervised detox. Someone in that abject state usually has a near-zero capacity to show up to an appointment in three weeks for an initial evaluation at the hospital and then show up in another three weeks to begin detox then, once out, to organize rehab for herself and get herself there. Maybe a street worker like me could find her in three weeks and drive her to the hospital; maybe her moment of clarity has lasted that long but almost certainly not; maybe she's still willing to actually do detox in another few weeks after the first appointment but most likely she's despaired and is back in the mix; if everything goes well maybe the shelter can scrape together money and transport for the rehab. But those are an awful lot of maybes for a process that is already extraordinarily difficult for a chronic user to pursue and follow through with.
Addiction as a phenomenon will probably never be solved completely because alienation and trauma are unlikely to ever be solved completely. But I know, and other people who work on the street know, that same-day detox and free rehabs with no wait lists are absolutely crucial to any policy that seriously wants to make a dent in the problem. It needs to be made almost absurdly easy for someone to get access to these services, even if they have no ID and no money and no car and no friends and nowhere to live, even if they’re crazy and sketchy and dirty and rude, even if they don’t speak French in Quebec, even if they’ve been in and out a bunch of times, even if, even if. At the end of the day, giving people all the safe government dope in the world is just evil if it’s not accompanied by the possibility of recovery.
4. Managed alcohol programs
It might surprise some people, but in my experience alcohol is one of the most dangerous and destructive drugs used by chronically homeless people. First of all, harm reduction for drinkers is very difficult; for dope and crack you can give people clean needles and pipes and testing kits and Naloxone and so on, but some of the major dangers associated with drinking aren’t hepatitis or fentanyl overdose, but instead are drunken fights or freezing to death; and there’s no instantly-administered reversal drug for an alcohol overdose that you can carry in your pocket like there is for fentanyl. Secondly, very heavy drinkers are often among the most low-functioning of the chronically homeless population because it’s simply so difficult to accomplish anything with very high levels of alcohol in your system. Very heavy drinkers also often struggle immensely to comply with basic rules at shelters and service centres, and thus can become totally isolated from services, because alcohol reduces your ability to control yourself and often makes people aggressive. It’s also very easy to access and, notoriously, very very difficult to quit, with withdrawal symptoms that can literally kill you. There are drinkers who, to put it simply, are never going to stop, and for whom there is relatively little that street outreach workers can do to make them safer.
Pilot projects have sprung up over the past little while called managed alcohol programs (MAPs). In particular I’m interested in MAPs which are also permanent living arrangements. This is another type of (very) specialized housing, where a smallish number of people can live and their needs met while being given to a prescribed dose of alcohol at regular intervals, something like one beer an hour. If they choose, they can ask to have their dose gradually reduced, but they don’t have to. In some ways, MAPs like this can be thought of as a type of hospice care for people who realistically are almost certainly going to die of alcohol-related complications and aren’t functional enough to access other services. I think that facilities like these are incredibly important and should be adopted universally. Many drinkers I worked with were very interested in getting into the pilot project in Montreal, but there was never space; introducing these facilities en masse would get a lot of the old-timers off the streets, the types who live curled up in the doorways of abandoned buildings, soaked in body fluids, never able to hang on to any belongings, cut off from almost everyone. I want these people to be able to have some dignity and frankly so should we all.
5. A fourth emergency service
During the years I worked doing street outreach, I often fantasized about what it would look like if we had even a fraction of the resources that the cops do. Dispatch centres, radio cars, full-time 24/7 staff, college programs dedicated to training us, some legal powers, that kind of thing. The thing is, street workers who’ve been working for a couple years usually end up knowing almost everyone who’s chronically homeless in a given area, and we develop relationships with many of them. If someone describes a person – there’s a woman wearing giant Hello Kitty slippers standing in the middle of the intersection at Parc and Milton yelling at cars – there’s a really good chance we know exactly who it is and will be able to do something about it. They know us, too. They’ll confide in us, ask us for help, and, often, listen to us in a way they’re unlikely to listen to anyone else.
We don’t just end up knowing the really destitute people either. We end up getting know people in the whole street ecosystem – dealers, squeegee kids, assorted sketchy hangers-on. And often we can ‘deal with them’ in a way that cops can’t or won’t, again because of the personal relationships and because we’re so self-evidently there to help. It doesn’t always work but it’s often relatively straightforward for us to get some dealers to move to a different spot or to ask a group of people to stop using in the doorway of a particular business or whatever, and they do it because they have some respect for us, not because they’re just trying to avoid the cops.
All this has led me to believe that something that would help profoundly is a fourth 911 service made up of unarmed civil mediators dedicated to addressing mental health issues, substance use issues, ‘public nuisances’, atypical healthcare needs, and similar. The teams could be made up of a street nurse and an intervention worker, for example, equipped with radios and a vehicle, operating in collaboration with local outreach services, and served by a dedicated dispatch centre. 911 calls not requiring an ambulance, firetruck or police presence would be triaged to this fourth emergency service, freeing up the resources of these three traditional 911 services and allowing professionals who are actually trained for this work to do it. Because frankly, having witnessed hundreds of interactions between cops and paramedics and the homeless population, it’s very clear that they typically have absolutely no idea how to handle a public mental health crisis, have few tools with which to do so, and anyway don’t care because they have other things to be doing which they see as much more important. Ambulances will often take hours to respond if they understand that the subject is a homeless person, and will often simply leave without taking the subject if the individual is being belligerent. Cops in Montreal usually just resort to yelling ‘calm down’ in French and then pulling out weapons or handcuffs when that doesn’t work. Their understanding of trauma and how it works is usually verging on non-existent. In other words, the existing public response institutions are totally unsuited to dealing with this kind of situation, which is a major reason why they don’t.
6. Therapy
I am, obviously, not a psychiatrist. But I can say this: though medication can be useful for some people for some things, most of the chronically homeless people I’ve worked with have shit haunting them that pills can’t fix. The constant torment being generated by their own brains isn’t the result of a mysterious ‘chemical imbalance’. It’s a direct response to series of severely traumatic events, events which would fill any person with feelings of terror, rage and hopelessness. Modern research on this type of Complex PTSD indicate that psychiatric interventions like antidepressants and anxiety medication are next to useless in treating the underlying issues and not very effective in treating the symptoms. Further, such medication is usually contraindicated for people struggling with alcohol and street drugs because of the potential for harmful drug interaction, and many people in this population have precarious relationships with alcohol or street drugs. What people need is therapy.
Mental health services need to be rolled into the public healthcare system entirely and be offered for free. At the very least, well-staffed public options for long-term mental health therapy need to exist, with a program offering priority access for people coming off the street. People currently on the street might benefit to some degree too but in my experience, for many people it’s practically impossible to gain mental stability before gaining material security. In collaboration with the specialized housing system and the fourth emergency service, non-coercive therapy with short wait times and no end date needs to be offered to those who are exiting the street, since, as noted, many of these people are among the most thoroughly traumatized people in society and need very extensive follow-up over very long periods in order to get their lives back.
Indigenous Canadians are hugely overrepresented in the chronically homeless population, and I could write another whole article about specialized services and policy interventions which would work well to address this fact. But for now, I’ll just say that I’ve seen Indigenous-led mental health options including traditional healing practices like sweat lodges and so on work very well for some people, and programs offering these services should be well-funded. On a broader long-term basis, huge efforts should be made to be able to offer mainstream professional therapy options in Indigenous languages with comparatively large numbers of native speakers, such as Inuktitut. Because of the very small total number of speakers of these languages and the small pool of speakers with professional credentials, this will be a difficult and lengthy undertaking, but I believe that Canada has both the resources and the responsibility to provide services like these in Indigenous languages. This is important not only for reasons of justice and dignity for Indigenous peoples (though justice and dignity are in themselves positive for mental health outcomes) but also because expressing oneself in one’s first language is usually going to be more effective in a therapeutic setting.
And that’s my six part plan for dealing with the homelessness crisis. It looks insanely expensive until you realize how much our current giant patchwork of ineffective revolving-door nonsense is costing us. Fuck ‘cohabitation’; let’s eradicate the phenomenon to the best of our ability. There is no good reason for it to exist. Time to finally deal with this horrific stain on our collective conscience once and for all.
Another form of trauma common among this category of people is physical trauma to the brain from a head injury, which can result in personality changes and loss of function which can be difficult or impossible to treat.
As a result of different histories of colonization, Inuit, unlike many First Nations, often speak their language, Inuktitut, as a first language. Many speak English or French with reduced fluency, which in my experience can result in serious miscommunications, difficulty establishing rapport, and difficulty communicating important information. Rather than treating this as a problem with Inuktitut-speakers, a focus should be on intensively training workers in social services to speak Inuktitut and training Inuktitut-speakers to work in the social services.
Telling people to just move along, without giving them somewhere to actually go, is just evil. Telling people to move along while offering them a nice spot with decent services is far more ethically defensible (and effective). Ideally, you have a situation where most of the time you don’t have to have cops telling people to move along, but this is the real world and cops probably aren’t going anywhere anytime soon.