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Day One
Illustrations by Nikki Ernst

When Western nursing professor Abe Oudshoorn, BScN’04, PhD’11, started working with people experiencing homelessness nearly 20 years ago, he’d often have to convince Londoners the problem existed. Today, that’s no longer the case.

Increased visibility has brought the issue to the forefront, with the number of people experiencing homelessness rising in urban and rural areas across the country. Yet, individuals living rough remain largely unseen when it comes to housing options.

“If we want to address homelessness in Canada, we need to change our systems,” Oudshoorn says. He points to the National Housing Strategy, currently under review.

“It identifies homelessness as a priority, but it primarily supports the development of more rental — units at market rates, not genuinely affordable housing that provides support for those most at risk of chronic homelessness — a group deeply and perpetually excluded from the housing market.”

Oudshoorn’s ongoing research shows permanent supportive housing — affordable units with on-site supports to meet individual needs — has been transformational for those who have spent years or decades experiencing homelessness or in mental health-care facilities.

Delivering these supports on a continual basis, however, is beyond the budgets of the non-profit organizations providing these services, with no straightforward ways to access public funding.

Western experts say Canada’s homelessness crisis demands a national response, with support from provincial governments to cross broader systems — housing, criminal justice, child welfare, health care and education — and municipal action to implement programs best suited to their communities.

A willingness of London to loosen zoning restrictions, along with an ambitious plan to address the housing crisis, led the federal government to recently choose the city as the first municipality in Canada to access a $4-billion federal housing fund, with an investment of $74 million earmarked to build more than 2,000 housing units.

“This is a step in the right direction in increasing the overall supply of housing,” Oudshoorn says. “I hope that affordability criteria will be attached to all uses of these new federal dollars.”

Cheryl Forchuk, a Distinguished University Professor in the Arthur Labatt Family School of Nursing, says the answer to the homelessness crisis is actually “quite simple,” using a metaphor to drive her point home.

“If you understand the game of musical chairs, you understand homelessness. The chairs represent the affordable housing available and the people circling are experiencing poverty. The more people circling the dwindling chairs, the greater the number of people experiencing homelessness.

“We need strategies to increase the number of chairs and to decrease the discrepancies between them, as well as the number of people circling. We also have to pay attention when the music stops abruptly during periods of transition — leaving foster care, hospitals or incarceration — when people are most vulnerable. If we don’t, we’ll continue to have a homelessness problem.”

It’s important to first know the true scope of homelessness, to shape policy and identify success.

The federal government reports approximately 230,000 people experience homelessness across Canada in a given year. But relying on shelter data alone leaves the number seriously underestimated — and many uncounted, including rural, Indigenous and young people.

I’ve visited shelters and encampments under bridges and in the woods, and I can tell you, after decades in this field, homelessness has become worse everywhere

To get a more accurate picture to effectively deliver and measure services, Forchuk and nursing professor Richard Booth, MScN’07, PhD’14, are integrating provincial health data to get a better grasp on the numbers. Early indicators show they’re three times the current estimate.

Forchuk and her team have also travelled across the country, talking to more than 400 homeless individuals, to understand the specific needs of individuals living in different regions.

“I’ve visited shelters and encampments under bridges and in the woods, and I can tell you, after decades in this field, homelessness has become worse everywhere,” Forchuk says. “Sixteen per cent of the people we interviewed first experienced homelessness during the pandemic.”

People living on low incomes are most at risk of homelessness, regardless of whether they’ve been unhoused before.

Most are living on social assistance, with disabilities, mental illness or substance abuse challenges.

“We need to reevaluate our social assistance programs and implement policies that increase the incomes of these individuals, so we aren’t leaving them in a constant state of lack,” says Carrie Anne Marshall, a professor in Western’s School of Occupational Therapy and director of the Social Justice in Mental Health Research Lab.

For those living on support from Ontario Works or Ontario Disability Support Program (ODSP) funding, at approximately $700 or $1,200 a month, respectively, Marshall says safe and dignified housing is often out of reach.

“Often the only housing available to individuals leaving homelessness has bed bugs, vermin and cockroaches — or it’s poorly maintained. Or they feel unsafe there. But it’s all they can afford.”

On an extremely limited budget, food is also less available than when they were unhoused and could access it through shelters.

“People leaving homelessness are not ‘lazy,’ but rather excluded from employment opportunities due to a range of factors, including their health,” Marshall stresses. “They’ve faced a lot of disadvantages in their lives. If they’re on ODSP, they’ve been identified as unable to work by a medical professional. Now they’re in a situation where they’re constantly trying to manage their own survival following homelessness. And survival takes all day long.”

In addition to secure tenancy and daily, affordable living, a recent study led by Marshall showed there’s a need to support individuals to attain more than just survival following homelessness. Community integration and engaging in meaningful activity are key to helping them thrive.

“Human beings are social animals. We need to interact with other people and feel included in social groups. That’s where services can help people who’ve only known people in the shelter or on the street find connections with their broader community.”

Marshall and her team are currently working on a Peer to Community (P2C) model, co-designed with persons with lived experiences of homelessness, service providers and policy makers.

The model includes an occupational therapist and peer support specialist collaborating to help a person identify and participate in meaningful activities and build relationships in their community following homelessness.

Citing her observation of a group run by a peer support specialist who organized an outing at a driving range, Marshall says, “it was heartwarming seeing people who’ve just been housed and faced multiple barriers to social inclusion being welcomed. One person had been all over the world golfing prior to losing his housing. To return to that activity, and be seen for his strengths, rather than his deficits, was incredibly meaningful for him.”

Integral to the success of the P2C model is including people from the broader community. Not only does it help restore dignity and citizenship to individuals who experience homelessness, but “it helps shift society’s lens,” Marshall says, “and we start to really see people with histories of homelessness as individual human beings with strengths and challenges like the rest of us.”