Our homelessness and drug toxicity crisis is deepening. Yet, we do have bright spots among the seemingly insurmountable challenges. The solutions are in plain sight, they just need to be consistently and cohesively applied. Hear (read) me out and consider the following...
In purpose-built, adequately funded and staffed Supportive Housing programs, residents have a community to support them and access to harm reduction and safe supply which results in less fatalities. People are less likely to use alone, staff are trained to respond to overdoses, and residents are also trained on how to respond. The community supports each other.
We record between 2-5 overdoses per month. In December 2022, there were 5 overdoses across our Supportive Housing portfolio. Fortunately, none were fatal due to residents and/or staff who responded in each case. At sites where we are not funded to offer a 24/7 staffing model, we do not always know the extent of overdoses, but often, neighbours are able to respond. This is not always the case, and death is all too often encountered.
In Nanaimo, our Supportive Housing sites (and residents by extension) are connected to a pharmacy that supplies and monitors safe supply. The pharmacy can deliver to the residents here and both have support from site staff. Residents of Supportive Housing are more successful in their transition to safe supply because they can be found easily, and therefore are less likely to miss a dose, unlike when they are homeless. Safe supply requires verification and witnessing of use, and being in Supportive Housing facilitates this.
People without a home, and lacking health-related and basic needs supports, can draw significantly on emergency services for survival. They also tend to interact more frequently with police, fire and paramedic services - those first response agencies dealing with the visible symptoms of homelessness.
At our lowest barrier Supportive Housing site in Nanaimo, residents have access to meals and other basic needs, which immediately reduces police interaction (and charges for theft under $500 which clogs the system) thanks to basic needs being met. At that same site, we also have regular health supports offered by Island Health, whereby physicians and nurses regularly visit the site. The impact is massive.
The impact includes a reduction in emergency room (ER) visits because staff know when health professionals will be on site and able to attend to wound and other care. Our residents rarely have ID when they enter our programs, let alone family doctors. So when physicians do not visit Supportive Housing sites, the ER is the only real alternative. Since medical staff began to visit our lowest barrier Supportive Housing site in Nanaimo in spring 2020, staff estimates ER visits went down by 50%.
Health care visits also help bridge the gap between residents and the health care system. Our clients feel stigmatized in hospitals; care on site makes them feel safe in a space where they are not judged. Residents can rely on staff and their community to help them feel safer, advocate on their behalf and start building more trust in the health care system.
All of the above results in more success in keeping people housed, alive and able to make choices about their future. If anything, the lack of consistency in the availability of the above-noted supports across all Supportive Housing sites and the shortage of purpose built sites are the largest barriers. Even the housing itself is in question, as the site is considered transitional, which means there is no certainty how long people will remain, or where they will go after, as many have been stably housed in place for years.
At Pacifica Housing, we do not create the expectation, but certainly do support those who choose to access recovery. Availability is a challenge. Housing after completing recovery programs is another challenge. Due to the lack of sober-living and other types of affordable housing with suitable supports, we welcome people back to harm-reduction focused Supportive Housing sites, which may not be the best places to support the long-term goals of individuals who wish to live a sober life.
The above combination of supports, the relationships built with and among our residents, and clear expectations around program participation have also proven an effective way to mitigate incidents of violence at our sites. However, when all of the mentioned supports are not present, it is much harder to mitigate the crises triggered by toxic drug supply, violence, criminal activity, brain and other injury due to overdose, and death.
As homelessness grows, we receive more complaints about loitering around our Supportive Housing sites. I want to be clear in stating that we are not creating homelessness; the lack of consistent application of identified solutions and prevention are creating homelessness. People seek shelter anywhere they can, which includes urban centre sidewalks, parks, drop-in centres and outside of Supportive Housing sites as well.
What is actually occurring in and around Supportive Housing sites? People who are homeless either use alone, or try to use with someone who is housed, as they know it is safer. When homeless individuals enter as guests and overdose, it overwhelms staff capacity, which is often already severely stretched, or just enough to meet resident need. This is not a position we seek to be in. We desperately want to help and we must balance that with our capacity to keep a community safe.
Outreach workers provide critical harm reduction support and supplies when they are out in the community, but they are not available 24/7. Overdose Prevention Sites (OPS) are important for the homeless community, but even with their existence, people still use alone or seek a housed person to use with. Safe supply is difficult to provide to the street community, as reaching them at a consistent place/time for witnessing is extremely challenging. Forgoing witnessing is not a viable alternative as the safe supply may be sold to meet other basic needs. Nothing fills the void left by a lack of housing.
The solutions are before us and they require health and social support with housing as the anchor. Housing First, which depends on having supports available, is and has always been the answer. A clear and comprehensive plan that includes all of the following with target numbers and delivery dates is crucial: we need more purpose built Supportive Housing. This requires setting target numbers of units to meet need, with purpose built, fully staffed, properly funded sites that are the most effective size for positive outcomes (40-50 units). These must be available in different neighborhoods of communities across the Province. They must be operated by different organizations with different models to better meet the diversity of the people who need support.
Supports must include 24/7, double-staffed housing support workers, harm reduction practices, services geared to meet basic needs such as food, regular scheduled visits from healthcare professionals, availability of safe supply, the option to access recovery programs, options for affordable housing and where sought – sober living options.
More affordable housing that offers choice, including sober-living options, will support positive transfer across the housing continuum to empower those who can transition to living independently and make space for those who need Supportive Housing. Most people need different things at different stages of their lives.
Government must also invest in a robust program to attract and train professionals in the field. Recognition of the specialized service provided is long overdue. Supportive Housing staff are the first responders to the first responders at our sites. They are the non-emergency line. Through the Pacifica Housing model, staff are trained to walk alongside our residents toward a future of their choice – accepting their right to live at risk, holding them capable and treating them with unconditional positive regard. The supports provided are the glue that allows trust to be built and connections to be made to the world that has consistently failed the people we serve.
Now, supporting people transitioning into independent-living, or moreover, preventing the trauma that causes the mental health and substance use disorder issues that necessitate the existence of Supportive Housing… well… that is another story.
Pacifica Housing Values Handbook
Strategic Plan 2021-2025
2020 Impact Report
Pacifica Connector - Summer 2019
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