Living on the margins:
The connection between mental illness and homelessness
goh iromoto graphic/the ubyssey
Friday, November 21st, 2008
Montréal (CUP) — “Now, they don’t put people in a hospital, which is a good thing, but sometimes it’s so intense. Now there’s a [schizophrenic man] by himself on the street with nowhere to sleep, eat, taking drugs more than they used to, doing prostitution—but I don’t think he even realizes he’s doing it,” Kim Heynemand said of a homeless man she met on the job.
Heynemand works as a peer helper with the Centre local de services communautaires (CLSC) des Faubourgs Équipe Itinérance (homeless division).
While she might see some of the more extreme cases, the fact remains that many of the 30,000 homeless in Montréal—and thousands more in Québec—suffer from mental health disorders.
In a study of 230 homeless individuals surveyed in Ottawa and Gatineau by the Canadian Institute for Health Information, two-thirds of adult males, three-quarters of adult females, 56 per cent of male youths, and two-thirds of female youth self-reported mental health problems.
The percentages of suicidal thoughts and suicide attempts were also higher than in the general population.
But the way the system is set up right now, shelters and community organizations are fighting a losing battle to help some of Montréal’s most vulnerable citizens.
There are only 2865 emergency beds and 1592 transitional beds in Montréal shelters, according to the Centre for the Study of Living Standards. At 3094 beds, that serves only a tenth of the city’s homeless population.
What most people don’t realize, however, is that a lack of programs and resources doesn’t just affect individuals with pre-existing mental health disorders. Living on the streets creates its own stress, and if someone is there long enough, it can lead to serious problems.
Alain Spitzer, director of the St. James Centre in Montréal, notes that while many Montréalers find themselves homeless at some point, he estimates that someone has about three months to get off the street before it starts to really affect them.
Resources are limited for those living on the street. There are shelters and community centres, but many, like the St. James Drop-In Centre, have restricted membership due to budget and resource constraints. While many homeless people do have access to clinics, the drop-in system creates barriers to those people requiring consistent, recurring care.
Dispensing medication might seem like a quick fix: the person takes the drug, feels better, and suddenly has the mental capacity to look for a job and apartment. But while medication does solve some important immediate problems, any good psychiatrist will tell you that even for non-homeless individuals, medication is not enough to treat a psychiatric condition.
CLSC primarily dispenses lithium to patients, Heynemand says, because it only needs to be injected once a week. Lithium, though, is a difficult drug to take—it is linked to acne, weight gain, and a feeling of mind-numbing. It’s not surprising that some of CLSC’s patients choose not to take it.
Other clinics sometimes hand out hard narcotics in original packaging, which some patients choose to sell, Spitzer says.
Heynemand, however, says that even medication can take a backseat to more immediate daily needs.
“It’s hard to make them realize they need to take their medication…but at the same time, taking medication can be hard,” she said. “For a guy doing prostitution, taking drugs for five days in a row with a mental disorder, what’s important is finding him a place to stay.”
Fielding the desire to self-medicate is also a difficult task for people like Heynemand, who work on the street level.
“Sometimes they don’t realize their meds work—they stop taking them and do [illegal] drugs as self-medication. If you hear voices and alcohol makes it stop, then you drink more,” she said.
The individuals interviewed for this story had various coping mechanisms, such as dogs, boyfriends, pot, cigarettes or alcohol.
One man, Martin, a self-labelled alcoholic, spends his days sitting on Sherbrooke Street, panhandling and slowly sipping beer, because “it helps with the pain in [his] muscles.”
Each demographic of homeless people faces their own challenges of how to deal with mental health disorders. Homeless youth—who often use illegal drugs for self-medication—are at a particular risk of resorting to prostitution to get money.
“Working in sex, for a lot of people who take drugs, it’s a big part of it. After some point, if you don’t find money, you’ve got to think of it,” Heynemand said. “Some do it only sometimes, some as a job. For a lot of people who have borderline [personality disorder] it’s a way to find love. Some people just don’t care.”
But once youth hit their mid-20s, many assistance programs end. And if they’re male, even fewer options become available—something Spitzer attributes to society’s notion of “women and children first” and the expectation that men can fend for themselves.
Spitzer also links it to the fact that problems like chronic depression have only recently been diagnosed en masse, so there’s a whole generation of 40 to 55 year olds who did not receive treatment at key points in their 20s when many mental illnesses develop.
Matthew Pearce, director general of the Old Brewery Mission (the largest men’s shelter in Québec) blames the provincial government for the resource strain felt by Montréal shelters and community programs.
“It’s important for [people] to understand that the provincial government funds less than 20 per cent. It’s the public that supports us. The provincial government does not meet its social or moral obligations,” Pearce said. “Shelters in Toronto are 100 per cent provincially funded. We receive $12 per bed, per night, and in Toronto they receive $61 per bed, per night.”
This problem also stems from the process of de-institutionalization that occurred during the 60s and 70s. While many view this as a human rights achievement, others say the government has not held up its end of the bargain.
When many mental health institutions were either closed or reduced in size, government funds were supposed to be channelled to community-based or outpatient health programs and other alternative services like subsidized housing or shelters, says Paul Whitehead, a professor in the department of sociology at the University of Western Ontario.
While Whitehead found that money had, in fact, been moved toward the community programs, he admits the absence of a live-in arrangement for patients resulted in more mentally ill homeless individuals.
Should an individual be lucky enough to find adequate mental health treatment and somehow get a leg up—because starting at $560 a month, welfare will hardly cover rent—statistics remain equally dismal.
There is a 10,000 person waiting list for 24,700 slots of public housing on the island. The city also seems set on razing neighbourhoods with more affordable housing to install condos and luxury housing.
The homeless, particularly the mentally ill, are locked into a vicious cycle of limited treatment and self-medication, with access to equally limited, though well-intentioned, community services trying to compensate for a lack of government responsibility.