Housing - not health care - may be best medicine

ANDRÉ PICARD
PUBLIC HEALTH REPORTER
The Globe and Mail
August 31, 2007

People with severe mental illness often end up on the streets. Conversely, people who end up homeless - usually for financial reasons - are at high risk of being afflicted with mental health problems.

Regardless of their starting point, the homeless mentally ill make far more use of health services such as hospital care and emergency room treatment. This double-barrelled message comes from a new report of the Canadian Institute for Health Information that examines the complex relationship between mental health and homelessness.

Far less complex is the solution, activists and academics say.

"The most obvious solution to homelessness is housing," said Tim Aubry of the Centre for Research on Educational and Community Services and a professor at the University of Ottawa.

He said while this may seem flippant or self-evident, the "housing first" philosophy is just beginning to take root in Canada.

"In this country we invest so much in health care that we often think it's the solution to everything," Dr. Aubry said. "But the best medicine for mental illness is probably housing."

Mary Martha Hale, chairwoman of the Alliance to End Homelessness, agrees. She said people who suffer from mental health problems need stable living conditions in which they can receive support, not the stress and risks of living on the street or in shelters.

Similarly, those who become homeless for economic reasons such as losing their jobs need stability so they can get training, find a new job and avoid a downward spiral of their physical and mental health.

"The answer is housing," Ms. Hale said. "And you know there are social and financial costs to having people living in shelters or on the street that are likely greater than subsidized housing."

The CIHI report, for example, shows that the homeless are big users of health-care services, in particular for treatment of mental health problems.

Specifically, mental disorders (including substance abuse) account for 52 per cent of hospital stays among the homeless, compared to only 5 per cent among the general population.

Similarly, 35 per cent of emergency room visits by the homeless were for treatment of mental disorders, compared to 3 per cent among the general population.

The homeless - and street youth in particular - also have much higher rates of attempted suicide.

"This heavy use of ERs and hospitals reflects just how isolated and marginal homeless people are in their communities," Dr. Aubry said.

Elizabeth Votta, program lead at the Canadian Population Health Initiative of CIHI and one of the report's main authors, said it is important to stress that "not all the homeless are mentally ill and not everyone mentally ill is homeless."

In fact, identifying how many of the homeless suffer from mental illness is difficult. One small study found that almost two-thirds of shelter residents in Toronto had suffered mental health problems in their lifetime. But an Ottawa study found that one-quarter of the homeless were suffering mental health problems.

Even estimating homelessness is difficult, Ms. Votta said. The new report says there are at least 10,000 people living in shelters nightly in Canada, but concedes that that underestimates the true number of homeless people.

Michelle Gold, senior director of policy and programs at the Canadian Mental Health Association, said the report "should serve as a wake-up call around a couple of issues: one, we need to tackle the high rate of poverty among people with serious mental illness and two, we need more affordable, supportive housing."

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