“Now they don’t put people in a hospital which is a good thing – but sometimes it’s so intense. Now there’s a [schizophrenic man] by himself on the street with nowhere to sleep, eat, taking drugs more than they used to, doing prostitution – but I don’t think he even realizes he’s doing it,” says Kim Heynemand, of a homeless man she met on the job.
Heynemand works as a peer helper with the Centre local de services communautaires (CLSC) des Faubourgs Équipe Itinérance (homeless division). While she might see some of the more extreme cases, the fact remains that many of the 30,000 homeless in Montreal – and thousands more in Quebec – suffer from mental health disorders. In a study of 230 homeless individuals surveyed in Ottawa and Gatineau by the Canadian Institute for Health Information, 60 per cent of adult males, 74 per cent of adult females, 56 per cent of male youths, and 61 per cent of female youth self-reported mental health problems. The percentage for suicidal thoughts and suicide attempts were also more common than in the general population.
But the way the system is set up right now, shelters and community organizations are fighting a losing battle to help some of Montreal’s most vulnerable citizens. There are only 2,865 emergency beds and 1,592 transitional beds in Montreal shelters, according to the Centre for the Study of Living Standards. At 3,094 beds, that serves only a tenth of the homeless population.
What most people don’t realize, however, is that a lack of programs and resources doesn’t just affect individuals with pre-existing mental health disorders. Living on the street creates its own stress, and if someone is there long enough, it can lead to serious problems.
“Being on the street so long you lose self esteem. It’s like you’re so broken you develop mental problems being around that shit all day. It gives you mental problems. You need some self esteem. You become paranoid, want to avoid people,” says a friend who spent several years of his twenties on and off the street while he was addicted to heroine.
Alain Spitzer, director of the St. James Centre, notes that while many Montrealers find themselves homeless at some point, he estimates that someone has about three months to get off the street before it starts to really affect them.
One of the problems is that resources are limited for those living on the street. There are shelters and community centres, but many, like the St. James Drop-in Centre, have restricted membership due to budget and resource restraints. While many homeless people do have access to clinics, the drop-in system creates barriers to those people requiring consistent, recurring care. Dispensing medication might seem like a quick fix: the person takes the drug, feels better, and suddenly has a job and an apartment. But while medication does solve some important immediate problems, any good psychiatrist will tell you that even for non-homeless individuals, medication is not enough to treat a psychiatric condition.
CLSC primarily dispenses lithium to patients, according to Heynemand, because it only needs to be injected once a week. Lithium, though, is a difficult drug to take – it is linked to acne, weight gain, and a mind-numbing side effect. It’s not surprising then that some of CLSC’s patients choose not to take it. Other clinics sometimes hand out hard narcotics in original packaging, which some individuals choose to sell, according to Spitzer.
Heynemand, however, says that even dispensing medication can take a back seat to more immediate daily needs. “It’s hard to make them realize they need to take their medication…but at the same time taking medication can be hard,” she says. “For a guy doing prostitution, taking drugs for five days in a row with a mental disorder, what’s important is finding him a place to stay.”
Fielding the desire to self-medicate is also a difficult task for people like Heynemand, who work on the street level. “Sometimes they don’t realize their meds work – they stop taking them and do [illegal] drugs as self-medication. If you hear voices and alcohol makes it stop, then you drink more,” she said.
Of the individuals I met during interviews, each had their own coping mechanism, ranging from a dog, to a boyfriend, to a regular supply of pot, cigarettes, or alcohol. One man, Martin, a self- labeled alcoholic, spends his days sitting on Sherbrooke, panhandling and slowly sipping beer, because “it helps with the pain in [his] muscles.”
There was also loose camaraderie between individuals – whether sharing cigarettes, or momentarily stopping to chat. Often when I was in the middle of an interview, someone would come up and start to ask questions, even if they didn’t know the interviewee.
Each demographic of homeless people faces their own challenges of how to deal with mental health disorders. Homeless youth – who often use illegal drugs for self-medication – are at a particular risk of resorting to prostitution to get money.
“Working in sex, for a lot of people who take drugs, it’s a big part of it. After some point if you don’t find money, you’ve got to think of it,” Heynemand says. “Some do it only sometimes, some as a job. For a lot of people who have borderline [personality disorder] it’s a way to find love. Some people just don’t care.”
But once youth hit their mid-twenties many programs end. And if they’re male, even fewer options become available – something Spitzer attributes to society’s notion of “women and children first” and the expectation that men can fend for themselves. Spitzer also links it to the fact that problems like chronic depression have only recently been diagnosed en masse, so there’s a whole generation – particularly from ages 40 to 55 – that did not receive treatment at key points in their twenties when many mental illnesses develop.
Pearce blames the provincial government for the resource strain felt by Montreal shelters and community programs. “It’s important for [people] to understand that the provincial government funds less than 20 per cent– it’s the public that supports us. The provincial government does not meet its social or moral obligations – shelters in Toronto are 100 per cent provincially funded. We receive $12 per bed per night, and in Toronto they receive $61 per bed per night,” says Pearce.
The source of this problem can also be traced back to the process of deinstitutionalization that occurred during the sixties and seventies. While it is viewed by many as a human rights achievement, the government has not held up its end of the bargain. When many mental health institutions were either closed or reduced in size, government funds were supposed to be channelled to community-based or outpatient health programs, and other alternative services like subsidized housing or shelters, according to Dr. Paul Whitehead, a professor in the Department of Sociology at the University of Western Ontario. While Whitehead found that money had in fact been moved toward the community programs, he admits that the absence of a live-in arrangement for patients resulted in more mentally ill homeless individuals.
Clearly, Montreal and the provincial government aren’t keeping up with their promises for alternative rehabilitative services. Should an individual be lucky enough to find adequate mental health treatment and somehow get a leg up – because starting at $560 a month, welfare will hardly cover rent – statistics remain equally dismal: there is a 10,000-person waiting list for 24,700 slots of public housing on the island. The city also seems dead-set on razing neighbourhoods with more affordable housing, like Griffintown, to install condos and luxury housing.
The reality is that the homeless, particularly the mentally ill, are locked into a viscous cycle of limited treatment and self-medication, with access to equally limited – though well-intentioned – community services trying to compensate for a lack of government responsibility. But nothing will change until we start to engage with a part of the population that is marginalized again and again.