Managing the Streets

“You do not manage a social wrong. You should be ending it.”
Philip Mangano
Executive Director
US Interagency Council on Homelessness

By Elizabeth Haggarty

In February 2006 I was admitted to the Emergency Ward of St Michael’s Hospital. Sitting on the bed of my curtained cubicle I saw the nurse walking past let out a tired sigh as she approached the homeless man in the secure room across from me. Now stripped of his stained winter coat and salt crusted shoes his arms and legs were bound to the gurney, the result of an attempted escape. The nurses had relented and left the door open on the promise that he would keep quiet. His silence lasted 5 minutes. ‘Help!” he screamed as the security guards on either side of him exchanged bemused looks. “Are you going to be quiet?” The nurse asked holding up a syringe. His answer was clear “Help! They’re trying to kill me!” As the nurse approached he continued to yell “My Name is Nathan Ross,” he repeated again and again as the needle slipped into his arm “Nathan Ross,” he said his voice now weak and his head slumping forward “and they’re trying to kill me…”

At the National Film Board of Canada's Street Health Stories display at the Church of the Holy Trinity I was reminded of Ross. Tucked in a corner and guarded by the smiling face of the red vacuum abandoned beside them, eight blown up photos of the exhibits homeless subjects stared out from their lit wooden boxes. Under each were headphones where you could listen to interview exerts about their lives on the street. They spoke of inadequate housing, of depression and friends, but as I moved from the face of Phil to Joe to Susan one phrase repeated itself “I don’t want to be admitted to Emergency.” Why? I thought. Joe of all people should want to go to Emergency he had been stabbed with scissors, surely he wanted to be helped?

I can only guess why Phil and the others shared a fear of the Emergency Ward, but between their stories at Holy Trinity and the Street Health Report it seemed clear. They wanted help, but on entering Emergency were immersed in a system where each stage was designed to look after them temporarily, before leaving them to the street. Joe’s wounds were stitched and he was released with nowhere to go. Back on the street his wounds became severely infected; the cycle had begun.

The temporary nature of care for the homeless is not limited to hospitals but epidemic in the system that deals with them. Shelters, support systems and medical care are all in place to manage an immediate problem and when the person is released from the program they maybe well or rested or fed, but they are back on the street.

The frustration for both the homeless and the caregiver must be enormous. Constantly being offered care that is undone when you are sent back to the street would make you not want to be helped at all; and who could not be tired out by caring for someone only to see them return again and again because of circumstances neither of you can control.

Nathan Ross may have been screaming in paranoia against a syringe-bearing nurse, but as I stood in front of the street health exhibition it seemed he was screaming against a system where people would manage his immediate needs as best they could before expelling him to restart the process of decline.

Three quarters of Toronto’s homeless have at least one chronic or ongoing physical health condition. But, contrary to popular belief it is often not mental or physical illness that leads to homelessness, but they are bred from homelessness.

“People need adequate, affordable housing in order to stabilize their lives and be healthy,” states the Street Health Report. The statement is given as prescriptive and preventative. One third of the homeless became so because they couldn’t afford rent says the report that also estimates 1.7 million Canadian households are at risk of homelessness because social assistance benefits and minimum wage are too low to support the most basic housing needs. “You can’t rent anything worthwhile” says the recording of Phil at the exhibit “they’re all drug infected, prostitute infected, crack infected, needle infected – it’s degrading.”

In a study in the 1990’s a Boston College Graduate Student Dennis Culhane compiled a database keeping track of everyone who was entering and leaving homeless shelters in New York. He found that 80% came and left very quickly over one or two days. Another 10% would come for three weeks and then leave returning periodically. The remaining 10% were the ‘chronically’ homeless who would spend their lives on the street. This ten percent alone cost the city $65 million.

According to the Street Health report the number of chronic homeless is higher in Canada; one third of the people they interviewed had been homeless for 5 years or longer. The cost of keeping one of these people in a homeless shelter is estimated to be between $30,000 and $40,000 per year. In contrast, the combined costs of service and housing for housed individuals ranged from $22,000 to $28,000 per person per year.

Homeless people also tend to suffer from more chronic health problems that are more difficult and expensive to treat. The average health care costs of a homeless person are $4,714 a year. The average Canadian citizen uses $2,633 per year in public health care services.

Providing more subsidized housing could be the permanent block that is needed to start solving the problem of homelessness instead of managing it. Something needs to change because in too many cases today, as the Street Health Stories show, homelessness is not temporary.


Listen to Dennis Culhane giving a lecture on his original study and propose solutions to the problem of homelessness:
http://frontrow.bc.edu/program/culhane/

Breakdown of the cost of the homeless in Canada:
http://www.cbc.ca/fifth/main_nowayhome_cost.html

Article by Malcolm Gladwell on tackling homelessness in the US:
http://www.gladwell.com/2006/2006_02_13_a_murray.html