Health Providers Against Poverty

HPAP members Dr. Michaela Beder and Dr. Sarah Griffiths delivered deputations to the City of Toronto’s Budget Committee on January 10th, 2018. Both are powerful calls for the city to take meaningful actions to improve living conditions for Toronto’s vulnerably-housed population.

They focus on 6 key recommendations:

1. Increase long term shelter space by 1500 beds to meet Toronto’s 90% shelter occupancy target.
2. All shelter staff should be trained in harm reduction techniques and philosophy (e.g. naloxone administration for people with an opiate overdose)
3. Keep at least 1000 interim shelter beds open throughout the summer until the new shelter beds are open.
4. Increase affordable housing opportunities by increasing rent-geared-to income housing, repairing old TCHC units, creating at least 1,000 new affordable rental housing units a year, and increasing supportive and mental health housing.
5. Increase tax revenue by raising the property tax, instituting a vacant property tax, reducing tax incentives for developers, and reinstituting the vehicle registration tax.
6. Change the definition of “affordable housing” from the average cost of market rent, to the amount someone on social assistance or Old Age Security can afford, ie “deeply affordable.”

In this 2 part blog post, we are posting the manuscripts for both deputations. Part 1 will be Dr. Beder’s deputation (see below) and part 2 will be Dr. Griffiths’.

Dr. Beder’s Deputation to the City of Toronto Budget Committee

Thank you for the opportunity to speak to you this evening. My name is Dr. Michaela Beder, and I am a psychiatrist working in Toronto. I work mostly with people with severe mental illness, the majority of whom experience poverty and homelessness. I am a member of Health Providers Against Poverty, and also the mental health lead for Inner City Health Associates, a group of doctors working with homeless and vulnerably housed people. In all of my work places, I see daily the impact of homelessness.

I have significant concerns about the current budget, especially how the shelter and housing crises will be addressed.

I’d like to start by telling you a composite client story, pulled together from my clinical experiences. I’ll call him Aaron Doukas*, a middle-aged man with schizophrenia, who uses drugs, and who has for many years been homeless. While living on the street, he got frostbite, and even lost 3 toes a few years ago.  Due to paranoia and a well-founded fear of assault, he often feels unsafe in shelters, and instead sleeps in stairwells. On the coldest nights, he sometimes finds relief in an Out of the Cold, but even then, fear often drives him back to the streets. He is on many housing lists, but affordable, supportive, harm reduction mental health housing is just not sufficiently available. In the mornings, he sometimes comes to my office, and a worker tries their best to find Mr. Doukas a detox bed, only to be told that there are none, to please call back later. I lie at home at night, worrying, especially on those bitter cold nights, whether Aaron, and many others like him, will survive until the morning.  

I recently went out with Health Providers Against Poverty to survey staff and clients at the winter respite centres. I was shocked by some of the stories we heard – the older woman who could not get out of the cot on her own to go to the bathroom, as it was too low on the ground; the 81 year old man who had no-where else in the world to go; the pregnant woman who had to spend the night sleeping on a chair.

The shelters are full. The streets are cold. How can we, in a city as wealthy as ours, leave people to live, and at times die, in this situation? We have to do better.

I would like to offer some solutions for the City to consider.

1. Shelter Occupancy: In order to meet the 90% shelter occupancy, we need at least 1,500 new shelter beds to be opened across the city.
2. Harm Reduction: To prevent overdose deaths, the City must train all shelter staff in recognizing and treating drug overdoses and administering naloxone, and create a low barrier, harm reduction friendly culture.
3. Interim All-Season Emergency Measures: In the mean time, until new shelter beds are available, the poor conditions in the Winter Respite Centres have to be addressed. The opening of the armouries and the new respite centres is a positive step forward, but we need at least 1000 interim beds to stay open throughout the summer until the new shelter beds are open. These facilities must adhere to shelter standards, and offer showers, adequate bathrooms, proper sleep surfaces (beds or cots with mattresses), locked storage for personal items and medications and at least 2.5 feet between sleep surfaces.
4. Housing: Toronto Community Housing Corporation (TCHC), Rent-Geared-to-Income Housing, Supportive Housing: In terms of housing, we need more rent-geared-to income housing and for TCHC units to be repaired. The city should aim to exceed its target of 1,000 new affordable rental housing units a year. And the city needs to ensure that 20% of units in all new multifamily residential developments are permanently rent-geared-to income and affordable. We also need more units of supportive and mental health housing.
5. Tax Revenue: In terms of funding, I would urge you to explore the following revenue sources: raising the property tax, instituting a vacant property tax, reducing tax incentives for developers, and reinstituting the vehicle registration tax.
6. Definition of Affordable Housing: In terms of housing, we also ask that you change the definition of “affordable housing” from the average cost of market rent, to the amount someone on social assistance or Old Age Security can afford, ie “deeply affordable.”

When people such as Aaron Doukas get supportive, affordable housing, they are able to focus on recovery, and their physical and mental health improves. Investments in services for vulnerable people will result in a healthier society for everyone.

We must find ways to care for all members of our community. This is the time to act boldly, and I look forward to seeing how this budget will address the shelter and housing crises.

Thank you for your time and consideration.

*A fictional name.