How widespread are the homeless/mental health/addiction issues in your city/province?

[acottawa]

Originally Posted by Acajack

These are all excellent points, though I do think they probably play a fairly minor role in the issues we are discussing here. For example, not sure how it's done but homeless people don't seem to have a problem getting access to the money from their monthly welfare payments, right?

Still, it's a growing societal issue, I'd agree.

I had an aunt who was a high functioning addict. She was always broke due to her addiction and modest income (opioids), but was able to navigate various government programs, tax credits, rolling over introductory rates on credit cards, etc. I think navigating bureaucracy, interpersonal relationships and other systems is a significant dividing line between those who have significant problems in their lives and those who have significant problems in their lives and are also homeless.

[SignalHillHiker]

I think the crack era was worse, even here, as society as a whole was in decline and the distribution network for illegal drugs relied more on organized crime.

There is one way, however, that the opioid crisis is worse: whether they’re deep in addiction, or just someone chancing a one-off high night, people are being murdered by those cutting the drugs with fentanyl, unknown to the users. Whether they’re a heavy user who knows how much they can usually take, or a teenager trying a small dose to test the waters, mixing in a bit of fentanyl is usually enough to kill them.

[Nashe]

A growing problem here, it's never been worse.

Moncton spending $1M to double community officers in response to safety fears

[Hali87]

Currently in downtown Edmonton. Way more bleak than I realized. Staying in the Quarters district at a relatively nice, relatively new hotel. Nearly every window on the ground floor is smashed out. There is a nicely landscaped but completely (like, 100%) deserted pedestrianized street adjacent to the hotel, however, there are tents in every alleyway and random nook, out-of-it people sitting on the ground screaming at each other, people wandering around unaware of their surroundings and unable to walk in a straight line, with others dancing exuberantly around them, hopped up on stimulants, equally unaware of/indifferent to their surroundings. A guy passing us on the sidewalk randomly started taking his pants off. All of this was in broad daylight on a weekday in what is ostensibly a "vibrant" neighbourhood. Halifax's encampments look like a hippie utopia in comparison. This place reminds me of an angrier version of the DTES.

[OldDartmouthMark]

Originally Posted by MonctonRad

I think the one unifying reason for the homelessness crisis is that some people have great difficulties in coping with the complexities of modern life.

I keep asking myself what has become so broken in society that we have arrived at this situation, and I have to believe that this is a large part of it.

I also have to think that there have been other massive societal swings that have made living much less satisfying and enjoyable than it was some 40 - 50 years ago (for those of us old enough to remember what it was like). Nostalgia aside, the transition to digital living seems to have brought about a change in expectations for what a "good life" should be, combined with increased scrutiny by our peers, a reduction in the quality of personal interactions, loss of privacy, etc etc. What were societal norms like mutual respect and politeness seem to have gone by the wayside as well. Maybe it's just my naivete showing through, but generally people seemed happier back then.

Using drugs in an attempt to escape the realities of life has been around forever, but what is happening now is at a whole other level. Soft drugs were very prevalent in the 1970s and 80s, and they created huge problems of their own, but that's hard to reconcile with the proliferation of hard drugs that have a large chance of killing you (i.e. cut with god-knows-what), and people accepting that the risk of this is a better choice than dealing with the world around them.

I know I am oversimplifying things, but I'm feeling genuine grief for the world around me and how quality of life has degraded for so many people, so quickly. Nothing more to add than that.

[Nashe]

I suspect the change in what "institutionalized" mental health looks is a factor, as well. 50 years ago you could have someone "committed" for being slightly eccentric (and even then, what you got as "treatment" really... wasn't.). Now it's pretty much 72-hour "holds" and then release to avoid stressing the system. The sad thing is that 72 hours likely makes a person think that someone at least cares a tiny bit for them, when in reality they've fallen through the cracks, many times.

[MonctonRad]

Originally Posted by Vorkuta

I suspect the change in what "institutionalized" mental health looks is a factor, as well. 50 years ago you could have someone "committed" for being slightly eccentric (and even then, what you got as "treatment" really... wasn't.). Now it's pretty much 72-hour "holds" and then release to avoid stressing the system.

People back then were institutionalized much more easily. Treatment was nonexistent or ineffectual, but at least the inmates were warm, well fed and off the streets.

[acottawa]

Originally Posted by Vorkuta

I suspect the change in what "institutionalized" mental health looks is a factor, as well. 50 years ago you could have someone "committed" for being slightly eccentric (and even then, what you got as "treatment" really... wasn't.). Now it's pretty much 72-hour "holds" and then release to avoid stressing the system. The sad thing is that 72 hours likely makes a person think that someone at least cares a tiny bit for them, when in reality they've fallen through the cracks, many times.

That’s true, but that transition happened in the 70s and 80s.

[Acajack]

Originally Posted by acottawa

That’s true, but that transition happened in the 70s and 80s.

Or at least it began. Public perceptions were driven at least in part by stuff like One Flew Over the Cuckoo's Nest and The Logical Song...

I think the impacts of de-institutionalization have been building like a wave for a couple of decades now.

It could just be that we've reached a critical point right now, with contemporary factors bringing everything to a head at this precise moment.

I am fuzzy on the details and numbers, but I recently read a shocking factoid which was that Montreal around 1980 had something like 20,000 psychological hospital beds or "spots", and that today the total was something like 800.

[acottawa]

Originally Posted by Acajack

Or at least it began. Public perceptions were driven at least in part by stuff like One Flew Over the Cuckoo's Nest and The Logical Song...

I think the impacts of de-institutionalization have been building like a wave for a couple of decades now.

It could just be that we've reached a critical point right now, with contemporary factors bringing everything to a head at this precise moment.

I am fuzzy on the details and numbers, but I recently read a shocking factoid which was that Montreal around 1980 had something like 20,000 psychological hospital beds or "spots", and that today the total was something like 800.

Has that number changed in the last 20 years? I take your point, but if people are saying that the situation has gotten worse over the last decade and most psychiatric hospitals closed 30-40 years ago then it is hard to see it as a proximate cause.

[MonctonRad]

Originally Posted by acottawa

Has that number changed in the last 20 years? I take your point, but if people are saying that the situation has gotten worse over the last decade and most psychiatric hospitals closed 30-40 years ago then it is hard to see it as a proximate cause.

Deinstitutionalization spilled a vulnerable population back into the community. These people have poor coping skills. They are susceptible to decompensation in an increasingly complex world with many stressors. They tend to have poor family support and marginal income earning potential, hence are at high risk of homelessness. Once deposited on the streets, they don't have many options and are easy pickings to pushers, taking drugs to ease their pain and anxiety. This leads to panhandling, petty crime and vandalism.

It is a cascade of events. These inciting causes feed off one another. This allows government agencies to absolve themselves of responsibility because they can blame a cause not under their immediate jurisdiction. Meanwhile these victims fall between the cracks and things get worse and worse.

Sometimes I wonder if the answer isn't reinstitutionalization to deal with the immediate crisis, followed by slow methodical reintroduction into society under heavy supervision for those who have sufficient motivation.

Some people however may require lifelong institutionalization. As I said before, at least they would be clean, warm and well fed.

Note that I am talking about institutionalization, not incarceration.

[Nashe]

Originally Posted by acottawa

Has that number changed in the last 20 years? I take your point, but if people are saying that the situation has gotten worse over the last decade and most psychiatric hospitals closed 30-40 years ago then it is hard to see it as a proximate cause.

It was still changing, as of 2004. A report:

Forty Years of Deinstitutionalization of Psychiatric
Services in Canada: An Empirical Assessment

Conclusions
The data support the hypothesis that deinstitutionalization of psychiatric services has spanned at least 40 years for most of the provinces. Deinstitutionalization of psychiatric services is a fact in Canada. Transinstitutionalization did occur throughout the 1980s, but total days of care in PHs and psychiatric units in GHs decreased during the 1990s. This indicates that transinstitutionalization is a major component in the transition from institutionalization to deinstitutionalization.

Per capita expenditures on community-based psychiatric services also increased throughout these time periods. These data support the contentions of the Clarke Institute of Psychiatry (29); of Goering, Wasylenki, and MacNaughton (30); of Health and Welfare Canada (6); and of the annual reports and policy documents of the provincial Ministries of Health (24,25,31–37) that identify the progress of PH deinstitutionalizing and the subsequent reallocation of resources to the community.

Ample evidence supports the contention of Bachrach (1,2), Mechanic (4) and Mechanic and Rochefort (5) that the policy of deinstitutionalization has not been implemented consistently across geographical areas. This finding has major implications for future policy implementation and for research evaluating the impact of deinstitutionalizing psychiatric services.

First, if research is being conducted between regions, the stage in the process of deinstitutionalization must be considered as having a potential impact on the results.

Second, these data suggest that it is possible to compare provinces that have clearly implemented the process of deinstitutionalization earlier with provinces that have implemented the policy later to determine whether there are differences in population-based outcomes, such as levels of psychological distress and access to psychiatric services.

Third, it is apparent that deinstitutionalization is still occurring, even if we cannot identify the precise circumstances under which it would be completed. There is no criterion to determine when the level of community-based services is high enough and should not be expanded further. No one suggests that inpatient psychiatric services be eliminated.

My Q on this (something it doesn't address) is:

"If deinstitutionalization has lead to shorter "stays" (as I read it), where did these people go? From the looks of things, a mix of community-based care (see above costs shifted there) and probably... nowhere." That last bit, is the concerning part.

[Acajack]

Originally Posted by MonctonRad

Deinstitutionalization spilled a vulnerable population back into the community. These people have for coping skills. They are susceptible to decompensation in an increasingly complex world with many stressors. They tend to have poor family support and marginal income earning potential, hence are at high risk of homelessness. Once deposited on the streets, they don't have many options and are easy pickings to pushers, taking drugs to ease their pain and anxiety. This leads to panhandling, petty crime and vandalism.

It is a cascade of events. These inciting causes feed off one another. This allows government agencies to absolve themselves of responsibility because they can blame a cause not under their immediate jurisdiction. Meanwhile these victims fall between the cracks and things get worse and worse.

Sometimes I wonder if the answer isn't reinstitutionalization to deal with the immediate crisis, followed by slow methodical reintroduction into society under heavy supervision for those who have sufficient motivation.

Some people however may require lifelong institutionalization. As I said before, at least they would be clean, warm and well fed.

Note that I am talking about institutionalization, not incarceration.

The problem outlined in the OP is also multi-faceted.

I mean, just one example: if you've seen interviews with the people who tend to set up and live in those "tent cities", they're not generally people who would be, should be or would agree to be institutionalized in a psychiatric facility.

[Nashe]

Originally Posted by Acajack

I mean, just one example: if you've seen interviews with the people who tend to set up and live in those "tent cities", they're not generally people who would be, should be or would agree to be institutionalized in a psychiatric facility.

That's a fair point, though the "interviews" I've seen tend to be with the uh... more coherent and "present". There definitely is a vibe of "i'm not hurting anyone, just doin my thing" for some folks, and they tend to be the least... dangerous? Though I admit I am straying into anecdotal territory, here. There is a pretty varied mix of folks out and about.

[Acajack]

I mean, if they're able to get their hands on a tent, set it up, organize their stuff and in some cases even a very basic "society" with others, that's quite different from people who are zonked out in the middle of the street who have lost track of what year it is and what city they're in.

I'd wager most tent dwellers aren't that different from a lot of people who live in the cheapest, most run-down apartments of our cities.

In some cases it's more the "alt" off the grid lifestyle and the freedom it brings that appeals to them.

[niwell]

It's a generalization for sure, but from my experience I'd say a decent percentage (most?) of encampment dwellers in Toronto are the types of people who previously would have been living in cheap rooming houses. Problem is, the number of those rooming houses is dwindling, the ones that remain aren't even that cheap anymore and it's virtually impossibly to legally build new ones.

I knew a few people living in those types of places a decade or so ago and while they weren't great it beat living in a tent. While it would have even been tough at the time, you could at least pay for the space with ODSP (disability) or other social assistance. Doubt that would even be possible now.

[JHikka]

Originally Posted by JHikka

Seems like the solution to a lot of what people are talking about in this thread is simply more housing.

[MonctonRad]

Originally Posted by niwell

It's a generalization for sure, but from my experience I'd say a decent percentage (most?) of encampment dwellers in Toronto are the types of people who previously would have been living in cheap rooming houses. Problem is, the number of those rooming houses is dwindling, the ones that remain aren't even that cheap anymore and it's virtually impossibly to legally build new ones.

I've made this point myself, and it bears repeating.

There have always been vagrants and panhandlers in Moncton, but the proximate reason for the current crisis is that about five years ago, the city fire marshall ordered the demolition of a significant number of dilapidated buildings in the downtown west end of the city. Some of these were rooming houses, others were abandoned SFHs, which had been broken into and turned into unofficial encampments. All were fire hazards, hence the demolition order.

The net result was that in a short period of time, a couple of hundred people found themselves homeless in the city with no real options. Some of these people have so much difficulty coping that I think they should be institutionalized for their own protection. Others however are salvageable, and for these people, a concerted effort by the city to provide low rent micro apartments or even rooms in a rooming house should be undertaken.

Even a rooming house is a much better option than a shelter bed. Everyone needs a space to call their own. They need more than a bunk bed in a dormitory. This should be a basic human right.

These people need a fixed address (somewhere government cheques can be sent). They need a phone and internet access (for potential employment). They need assistance (if necessary) to fill out forms on line and to conduct basic banking. Basic health and social services to deal with addiction issues should also be available.

This isn't rocket science.

[MolsonExport]

I fear that re-institutionalization is part of the solution for those that are clearly suffering from severe mental health issues. We also need to spend big on social housing (in a sense, recreating the rooming houses of the past, and perhaps with basic meals: '3 hots and a cot', sort of thing), drug and alcohol addiction counseling, sexual abuse counseling (so many currently living on the street were sexually abused as children), basic job training and apprenticeships, and 'make work' projects (even if menial tasks like street cleaning, etc., just to keep people busy).

And we need to develop a government-run, nonprofit banking system for the unbanked (~5% of people are unable to get a bank account, and they are ripped off horribly by the payday loan vultures).

We need to remember that societies are judged in part by how they take care of its least fortunate members.

[giallo]

Originally Posted by MolsonExport

I fear that re-institutionalization is part of the solution for those that are clearly suffering from severe mental health issues. We also need to spend big on social housing (in a sense, recreating the rooming houses of the past, and perhaps with basic meals: '3 hots and a cot', sort of thing), drug and alcohol addiction counseling, sexual abuse counseling (so many currently living on the street were sexually abused as children), basic job training and apprenticeships, and 'make work' projects (even if menial tasks like street cleaning, etc., just to keep people busy).

And we need to develop a government-run, nonprofit banking system for the unbanked (~5% of people are unable to get a bank account, and they are ripped off horribly by the payday loan vultures).

We need to remember that societies are judged in part by how they take care of its least fortunate members.

The underfunding of mental healthcare facilities has cause so much suffering. We, in North America, really let it slip over the past three decades, so it's no coincidence that it's both Canada and the US are feeling the effects of it.