What Is The Issue?
The largest city in Canada, Toronto’s population is more than 2.7 million people—47 per cent of whom belong to racialized groups, including Aboriginal people and those who were previously referred to as “ethnoracial or people of colour.” While diversity is vital to the city’s culture, it also makes dealing with issues of mental health and homelessness particularly challenging.
Given its size, it isn’t surprising that Toronto also has the country’s largest homeless population. As many as 6,500 people are homeless on any given night and 32,000 people use the city’s shelters each year. Immigrants make up a third of the homeless population; at the same time, more than 30 per cent of the city’s homeless come from diverse racialized communities. On top of the challenges of accessing adequate and appropriate housing and mental health services, these people face racism and discrimination that can cause them to further disconnect from the health care system.
What Are We Doing?
A primary focus of the Toronto At Home/Chez Soi project was to study the effectiveness of the Housing First approach among immigrants and people with mental health problems from racialized communities. More than 500 took part in the study; a targeted approach to recruitment resulted in 46 per cent of participants being born outside of Canada and 53 per cent coming from various racialized communities. This provided an excellent opportunity to see how the Housing First model could be adapted to meet their needs.
Working closely with the City of Toronto through its Shelter, Support and Housing Administration Division, project staff partnered with 53 private landlords to provide apartments to program participants. Staff worked with participants to give them the power to choose where they wanted to live and to provide individualized clinical and housing support to make sure they remain in stable housing over the long term.
Meeting the needs of Toronto’s diverse population
To ensure its service delivery model met participants’ needs, the Toronto project was based on the anti-racism/anti-oppression service framework of Across Boundaries, one of the two Intensive Case Management (ICM) teams. This framework integrates mental, physical, social, economic, cultural, spiritual and linguistic supports to combat the impact of racism and inequality on mental health. The Across Boundaries team focused solely on assisting immigrants and people from racialized groups, with Toronto North Support Services fulfilling other ICM needs, and Assertive Community Treatment (ACT) provided by COTA Health.
To gain a better understanding of the challenges faced by these individuals, the research team from St. Michael’s Hospital (CRICH) added a qualitative component to the recruitment process, asking participants how racism and discrimination affected their access to mental health services.
To better reflect Toronto’s diversity, staff from diverse racialized communities made up at least 30 per cent of the full staffing component across all project teams.
Empowering people through peer support
To ensure a strong voice for people with lived experience in all aspects of the project—including governance, service delivery, research and communications—the Toronto At Home/Chez Soi team established a “consumer caucus” in June 2009.
In addition, two peer support workers led a Wellness Recovery Action Plan (WRAP) program for participants. Encouraging personal responsibility for one’s own recovery, the eight-week WRAP course included the development of crisis plans to help participants define their interactions with the primary care and mental health systems. Working in a group setting, WRAP cultivates problem-solving and decision-making skills, ultimately giving participants greater confidence in and control over their daily lives.
What We've Learned
The Toronto At Home/Chez Soi study has shown it is possible to provide stable housing for people who have experienced chronic homelessness, even those with mental health problems. Final results of the Toronto study have proven that the Housing First approach is compatible with anti-racism/anti-oppression frameworks and easily adaptable to the needs of people from racialized communities experiencing homelessness. It has also been found to be a cost-effective intervention, reducing the time participants spend in emergency rooms, shelters, and jails.
On February 12, 2013, Ontario’s Minister of Health and Long-Term Care announced $4 million in annual funding to support participants after the conclusion of the MHCC study. This ongoing, funding sustains the three Toronto service teams (COTA Health, Toronto North Support Services and Across Boundaries) and ensures that the people helped by the At Home/Chez Soi program will continue to get the support they need to stay in their apartments.