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Published on January 28th, 2015 | from CAMH

Ending Homelessness in Ontario: Addressing the Mental Health and Functional Needs of the Most Vulnerable Amongst Us

HomelessnessBy Dr. Sylvain Roy, Neuropsychologist and the Lead Clinician at the CAMH’s Psychosocial Rehabilitation Assessment Service.

Today is #BellLetsTalk – a day where thousands of Canadians speak up in support of mental health and come together to address the issues associated with stigma. It’s a day when, as a society, we say no one should feel guilty or shameful when asking for help. It’s a day to imagine an Ontario in which mental healthcare is readily available to everyone when needed. We are not there yet. We are still living in a reality in which the most vulnerable amongst us, arguably the homeless, are not able to access timely mental health services, sometimes with tragic consequences.

Earlier this week the Ontario Government, under the leadership of Deputy Premier Deb Matthews and Minister Ted McMeekin, created an Expert Advisory Panel whose mandate is to end long-term homelessness. This panel comes at a time when several Toronto homeless men have died in the cold and our newly elected Mayor, Mr. John Tory called the city’s lack of mental health supports a “scandal.”

Key to addressing homelessness is healthy collaboration amongst professionals. Interprofessional collaboration is crucial in addressing the bio-psycho-social factors interfering with persons’ ability to function independently in the community. Homelessness is complex and many factors in addition to poverty and unaffordable housing must be considered. The individuals I serve struggle with even the smallest things we tend to take for granted. This includes walking up a few steps, bathing, getting dressed, preparing meals and paying bills on time.

In the following piece, I share my ideas for effective solutions to address the complex mental health and functional needs of homeless individuals.  Intervention must begin with a comprehensive bio-psycho-social assessment that takes into account brain-behaviour relationships as well as functional skills. In the article, I explain why increasing access to psychologists in Ontario makes sense, and why having the right care at the right place is critical in helping everyone reach their full potential.

I wish the Panel well in their deliberations and applaud the strong leadership of Deputy Premier Deb Matthews, Ministers McMeekin and Hoskins and Mayor John Tory.

A link to my article can be found here: psych.on.ca/OPA/media/Public/News%20briefs/January-NewsBrief-Ending-Homelessness.docx

Follow Dr. Roy on Twitter @DrSylvainRoy

Dr. Sylvain Roy is a registered neuropsychologist and the lead clinician at the CAMH’s Psychosocial Rehabilitation Assessment Service. He does work with the homeless at Inner City Family Health Team and he is also the Co-Chair of the Ontario Psychological Association’s Primary Health Committee. Dr. Roy’s clinical practice is focused on the assessment and rehabilitation of patients with severe and persistent mental illness and brain dysfunction.

Image courtesy of Andy Burgess on Flickr

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8 Responses to Ending Homelessness in Ontario: Addressing the Mental Health and Functional Needs of the Most Vulnerable Amongst Us

  1. Ending homeless does not just start with a home, which is one of the programs being offered in some cities. People with serious and persistent mental illnesses often do not appreciate that they are ill and rail against medication. Hardly surprising , would any of us take meds if we did not know or believe that we were ill?

    Many are placed in a home, but they often cannot keep it because of the cognitive problems that interfere with managing illnesses are obvious Without very realistic and needed support along with medical treatment failure looms. Sad to say few of the street people are even on medical treatment on a consistent basis. Over the years I have observed that many with the severest illnesses do better if the support is on the front end i.e. after the first medical intervention. In addition inpatient time with proper support and education appears to improve outcomes. Beds are required and trained professionals are required. Proper follow up and not fly by night stuff. The Select Bipartisan Report ,AUG 2010, certainly identified problems that cause the mess. But unless the system is rebuilt from the ground up it likely will not meet with much success. It is time to get realistic. Prison is not the place for the mentally ill. Patricia Forsdyke.

  2. With respect I do not know of any replicable research on benefits of cognitive therapy with actual numbers of randomly selected research subjects who became more efficient in their decision making following this treatment

    Too often our system accepts this kind of advice even when there is no evidence that it made any improvements in most subjects–unless it was accompanied with massive supports during the research bolstering their individual services.

    Unfortunately many families are so desperate for help that they accept every new theory with out question.

    Nor have I seen research using randomly chosen subjects for early psychosis treatments which have been touted as also a way of “fixing/improving” the lives of seriously mentally ill citizens.

    • I agree with Kathleen here. I know many families who have the physical and emotional ability to care for their mentally ill offspring in their homes. Many of them are doing this now and others would do so with the right kind of help.

      If these families were given the appropriate and timely financial and social help to manage this, we should identify them and give them all necessary help they need

      I agree that would be one way to reduce some homelessness.

  3. Kathleen Mochnacki says:

    I read this report and found it interesting. I was disappointed to observe that there was no focus on a pro-active approach to reducing homelessness of people with serious mental illness. For example, there is no mention of supporting families who struggle every day supporting a relative with these severe cognitive deficits plus other severe symptoms of serious mental illness. Families after years of struggle finally break apart and homelessness can happen.
    While, the author brings our attention to what the profession of psychology can bring to the situation, families persevere without support or acknowledgement. Often we observe iwith anguish the negative outcomes that could, in some way, have been prevented if professionals had been motivated to listen. I believe a multi-professional approach can only be successful when there is a welcoming approach to invite families into their midst. And to listen with an open mind to what families have to contribute.

    • I would agree with Kathleen . Families usually know quite a lot about their relative and why they are floundering. Unfortunately families are still to this day mistrusted by some professionals and hide behind the confidentiality legislation as well as the current Mental Health Act. Alas, some professionals use common sense and hear the families. The families are the ones that are still trying to stay connected through thick and thin when all the professionals have abandoned their loved one. The hardest to serve are left high and dry whilst easier to serve move up the list needing help. Families often wage the most heroic battles to the bitter end. Pat

    • e and says:

      I agree, I am one of those families, who has been totally destroyed by mental illness, with absolutely no help in site as long as I, the parent am alive,
      everyone has different problems, but when you have two in the same home, it is worse, and I am caught in the middle,

      • e and says:

        all while the mental health workers sit behind a desk telling you to join up to another program, like that will work , same as the other ten programs,
        you go there for help, join their group, their answer is to turn your back on your child or in my cases sons, who have mental health issues, have nothing to do with them, all while they write in their brochures that family is the most important thing to men or women with mental health issues, so how the hell does that work,

  4. I I think that many families manage to house their relatives who have persistent mental illness. I agree with June that if they want to they should receive support services and financial help, but I am always wary of the failed system pushing unrealistic burdens, responsibilities and expectations on families.

    Policy makers and professional health care workers, in my opinion,should listen to families and respect their wisdom. These illnesses are lifelong and families age on the job. Proper housing with in house support such as Pilot Place offer some kind of solution. I imagine Home on the Hill is a very good idea. Families should be part of the circle of care, but they also must have a life to remain healthy. Then they can offer very real support. Many families worry about what will happen to their relative after they are gone.

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