This is the fourth instalment in a five-part series looking at what Ontario can do now to address systemic issues that the COVID-19 pandemic has brought into sharp relief. Read Part 3 here. Watch for Part 5 on Friday.
Last month, here at TVO.org, I interviewed a series of experts on big, system-wide challenges the province will be facing as it exits the pandemic. But there was so much more that could have been covered, so we’re doing it again: five more articles about specific challenges the province faces today — this time, with a greater emphasis on what can be done now. It will take many years to build new hospitals and train thousands of new nurses, but what can be done in weeks, months, or even just a few short years?
Today, TVO.org speaks with Stephen Hwang, a physician and research scientist at St. Michael’s Hospital in Toronto who focuses on homelessness, housing, and health.
Matt Gurney: Stephen, thanks so much for doing this. Before we start, it’s worth noting that a lot of this is going to relate to Toronto specifically, but wherever possible we’ll highlight provincewide stuff. So we’ll start with the same question everyone else got first: What was the homelessness situation like before COVID-19 hit?
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Stephen Hwang: I would have described homelessness in Ontario cities as being a persistent and relatively stable problem that was not being adequately addressed — and that was perhaps not at the forefront of people’s minds.
Gurney: Huh. That’s interesting. I know that anecdotes only tell you so much, but I live in Toronto, and I would have said it’s been getting worse — at least visibly.
Hwang: Over the course of the pandemic, I think there has been an increase in the number of people experiencing homelessness. But, in particular, there’s been a dramatic increase in the number of people who are visibly homeless because they’re on the street or in encampments. And I think that’s undoubtedly why people are more aware of the issue.
Gurney: And was that already something we saw before COVID, or is this linked directly to the pandemic?
Hwang: I think it’s a direct link. The number of people who were using shelters and not on the street was relatively stable prior to the pandemic, and I don’t believe the numbers have increased dramatically over the course of the pandemic. So I think what we’ve seen is really a shift in visibility.
Gurney: There are a lot of stereotypical images that surround our concept of homelessness, and particularly, of the homeless. When you look at the info you have about the homeless, as a population, do you see any major commonalities? Can we point to a demographic profile of “a homeless person in Ontario,” or is the population just too diverse?
Hwang: It’s too diverse. It’s much more diverse than people realize. The public has a lot of inaccurate preconceptions about who is experiencing homelessness. The population of people experiencing homelessness includes a large number of teenagers and young adults. It includes many women. It includes many parents with young children. And it includes men who range in age from young adult up through adulthood to the elderly. I think our perception is driven more by who we see on the street, which would typically be a middle-aged man or sometimes a woman. But what we don’t realize is the diversity of people who are experiencing homelessness or the size of the problem — because there are many, many people who are experiencing homelessness, and they’re managing by sleeping in their car or staying with a friend and couch-surfing.
Gurney: That’s interesting. I know better than to peddle stereotypes, but if you say to me, “Think of a homeless person,” I don’t think of someone experience housing insecurity or someone caught in a motel while trying to find a new apartment. I think immediately of a guy with a long beard and a torn-up trench coat and a tattered baseball cap. And I know better, but that’s still what comes to mind first. This is another tricky question for you, but when we look at the homeless people who live in motels or in a car for a time, or who stay with a friend or end up on a street or in an encampment — and we’ll talk about those in a few minutes — are there reliable predictors for who’ll end up in what kind of homelessness?
Hwang: In general, it’s fairly predictable. Rather than seeing it as a progression, where you start in the shelter and then end up on the street, there are different groups of people who are much more likely to end up sleeping on the street. Those are, in particular, people who have severe addiction or substance-use problems. It often is people who have severe mental-health problems. And also it is disproportionately people who identify as Indigenous. It is not a random selection of people experiencing homelessness that are staying in encampments or sleeping on the sidewalk. For example, it would be unheard of for a mother with her two kids to be sleeping on the street. But we have hundreds of mothers with kids staying in homeless shelters in Toronto. And it’s completely invisible unless you work in one of those facilities.
Gurney: And this is what skews our conception of what homelessness is and looks like: some of it is out in the open; some of it is tucked neatly away out of sight. You’ve told me a bit about the group most likely to end up on the street. Can we flip that around and say with any accuracy what group is most likely to avoid that outcome and end up in a shelter or staying at a friend’s?
Hwang: No. We don’t really know that for sure. We don’t really have good information on the people who are the hidden homeless, because, by definition, it’s really hard to identify and talk to them, because they’re hidden. They’re not staying at a public institution, like a shelter or on the street. So we really don’t know, but the sense is that those individuals are often people who, first of all, are homeless for shorter periods of time. So they’re not people who’ve been homeless for years, but they’re people who are homeless for a few months, perhaps. They’re probably more likely to have lower levels of health problems and therefore have a greater chance of finding accommodation and exiting homelessness after a relatively short period of time. So we do know that those individuals are significantly different from the people that are homeless for long periods of time.
Gurney: You told me a bit about the general characteristics of those who end up on the street: often Indigenous, often with severe mental-health or substance-abuse issues. Is there a unifying general characteristic — demographic, economic, whatever — that would link those who are homeless but don’t end up on the street? I know you’ve said you don’t have great data. I’m just wondering what you do know about those people.
Hwang: It’s the lack of affordable housing across our community, our city, and our communities. So anyone who’s tried to get housing — particularly in Toronto, but certainly in many cities across Canada — knows that it’s tough to find a place that is decent that you can afford. The problem is that, in that kind of a situation, it doesn’t take much to go wrong for you to end up not having a place to stay. You can just lose your job, or you could have some plan fall through, and you don’t have a place to stay. At a certain level of systemic failure to create affordable housing, it doesn’t take much to go wrong and for someone to end up homeless. Therefore, it’s not about who the person is; it’s about the housing environment.
Gurney: With all this in mind, what happened to the homeless population when COVID-19 hit?
Hwang: The pandemic really laid bare a couple of things. The first is that people experiencing homelessness were living in crowded situations, typically in shelters or other places where disease transmission — and particularly COVID transmission — occurs really quickly, really easily. We realized very quickly that, suddenly, we had a crisis on our hands. The situation had not changed, in terms of who was living in shelters. But what we realized was that if we didn’t do something urgently, we were going to have a massive outbreak among people living in shelters.
And so we had to act quickly and move people out of shelters and into different kinds of accommodation. We opened up community centres as shelters; we rented and leased hotels and used them as shelters and are still using them as shelters. And this has come at tremendous expense, right? Because we had to essentially do something or else we would have faced catastrophic outbreaks in the shelter system. So the pandemic forced us to confront the cost of doing things. That was really the key impetus to people realizing that this was a big problem. And we’d had it all along. But now we had to deal with it.
And I think the other factor was the realization that, as long as anyone is at risk for COVID, we’re all at risk for COVID, right? We can’t close our doors and hide behind walls and think that, you know, these other people will get it, but we won’t. So we realized that we were essentially in it together in a good way and in a bad way, actually, and that we really needed to do something.
And then, lastly, what happened was, of course, people experiencing homelessness made a fairly rational choice. They looked at shelters, and they said, “If I stay here, I’m gonna get COVID, and I might die. No thanks. I’m going to sleep outside in a tent.” And, frankly, like I said, that’s a rational decision they made in the interests of self-preservation.
Gurney: And this brings us to the encampments, then. I live quite close to the Bayview Extension, in Toronto. When you drove downtown and looked off toward Rosedale Valley Road, you’d see the odd tent. This is before COVID. If you knew where to look, you’d see tents. And then, suddenly, but observably, there were more. And then still more. And then they were under the Gardiner Expressway. And in parks. And I began seeing homeless people in parts of the city I hadn’t seen them in before the pandemic.
And then recently, obviously, we’ve seen the homeless encampments in some parks being dispersed in large police operations. We don’t have to dwell on that, because that’s obviously a very complex issue all its own, but what we can obviously say is that this what happens when thousands of people with nowhere to go … had to go somewhere. And where else are they going to go? If they go to private property, the police will evict them immediately. So they end up in public spaces. Where else but parks? As you said above, this is entirely rational. Not optimal, but rational.
Hwang: The issue of people staying in encampments is a really vexing problem. The fundamental first principle is that we should realize that we have to make them unnecessary, rather than illegal. We cannot solve this problem with an enforcement effort, because all that will do is move people around and actually make the problem harder to solve in the long term. That’s the first principle.
The second principle we need to realize is that, when people are making rational choices that we would like to see shifted, when we’d like to see them change the decision they’re making, we need to make it possible for them to make those other rational choices and better decisions — decisions that we hope are better for them and better for everyone. Trying to figure out ways to create accommodations and housing situations for people that they will accept, rather than enforcing it. Encampment clearances are not the right answer.
And the other point I would make is that it is actually a relatively small problem in the grand scheme of things. The number of people that are sleeping in encampments, although it’s much greater than it used to be, is quite limited. We should really keep in mind that it is a solvable issue, and it’s not going to be solved by enforcement alone.
Gurney: So, it was reported at the time that, when the encampments were cleared, some of those people went into shelters. But not all. Do we know, in an aggregate sense, where the rest went?
Hwang: I don’t know. You would need to ask community-based organizations that had relationships with those individuals, and who those people trust, and they are still keeping in contact with some of them. I would suggest contacting Anishnawbe Health Toronto. They might know that.
You’re highlighting the key issue, though, which is that these individuals have not left the city of Toronto; they’re still here. And they are now even more wary of any efforts to work with them, to house them, and to help provide them with the supports they need.
[Note from the author: I indeed contacted Anishnawbe Health Toronto and received this reply, from executive director Joe Hester: “We too often don’t know specific locations, as they don’t have destinations in mind. Too often it is removed further from supports the homeless need.” Anishnawbe Health also provided me with a copy of a letter it sent to officials at the City of Toronto in which it specifically noted that encampment dispersals remove homeless citizens from physical proximity to supports, such as medical and pharmaceutical care, that they depend on.]
Gurney: So one thing we’ve done to add housing, as you’ve said, is basically dragoon motels and hotels into service on an emergency basis. We’ve also been adding some modular supportive-housing units in parts of the city, but, thus far, at a fairly small scale. Is the solution here to just do those things, but more?
Hwang: There’s a separate answer for those two things. In terms of building modular housing or additional affordable supportive housing, we definitely need to do that. And we need to do that on an ongoing basis because we have a huge deficit in terms of available units. In terms of the hotel shelters, that’s a situation where we absolutely need to maintain many of them just to prevent the situation from getting even worse than it is currently. If we were to go back to the way we were before the pandemic and close those shelter hotels, we would instantly have an enormous, even more visible problem with homelessness in our city. When you’re in a hole, the first thing you should do is stop digging, right? Not closing those shelter hotels is really critical. Work with the people who are staying at them to try to ensure that they have the wellness and the supports that they need to ultimately move out of them into housing and not back into shelters or to the streets.
Gurney: This is probably oversimplified, but in an ideal scenario, would the idea be to phase out the hotels and motels — which, as you noted earlier, are expensive — as more units of purpose-built housing comes online?
Hwang: That would be ideal. Another possibility that I think is on the table is potentially purchasing some of the hotels and turning them into affordable housing. The challenge with that is that, based on our experience, based on both long experience and research, a hotel is not a good model for creating affordable housing, because you essentially recreate the SRO or “single-room occupancy” hotel model that exists in Vancouver, where you have literally 200 people living in one building, each one with one little room that was never meant to be individual housing. It’s a hotel room! It’s a housing form that is not conducive to wellness, either for the individuals or for the community.
Gurney: We’re having this conversation against the backdrop now of a federal-election campaign, and housing is going to be a big issue. I don’t want to derail the talk into federal matters or politics, but I did note with interest that the Conservatives — the federal Tories, I mean — have put a massive expansion of housing front and centre in their platform. And at enormous scale: they’ve pledged a million new homes in three years. Even if they can’t do that, that at least is the kind of number we need to be talking about. And we’ve talked a bit about the modular housing units, and they’re opening, you know, like 100 here and 80 there. Dozens or hundreds at a time. That’s great! But it won’t be enough. So do you have a sense of the scale of what we’d need here, of how many homeless people we’d need to house?
Hwang: I’m probably not the person to give you the most precise estimate. I can say that we have a desperate need for hundreds of thousands of units of affordable housing, which would not be aimed at people experiencing homelessness. It would be aimed at the people who keep our city running. These are the people who make our food and deliver our food and take care of our children. They keep the city running, but they can’t afford to live in our city anymore. So we have a need for hundreds of thousands of those units. For people experiencing homelessness who need supportive housing, we probably have a deficit in the range of thousands. That’s a deficit that has accumulated over the last 30 years of neglecting our need for housing.
Gurney: Yeah. You just drew an important distinction there. Affordable housing, among all kinds of other benefits, would prevent some people from falling into the economic crisis that results in them becoming homeless. But we need different solutions for some of the population that is homeless, and, as you’ve noted, some of those people have very complicated situations.
It seems to be me that we could probably actually handle the emergency side of this faster. We could grab a government property, a military facility or old school, and, poof, it’s emergency housing. Or we could do as you say and outright buy some of these hotels. And we could do that reasonably fast — Canadian public policy never moves fast, but, in an emergency, we can move somewhat faster. But the big part of this … the hundreds of thousands of new affordable homes. Gosh. That’s harder to see happening. What could we do immediately to make things better in, say, the next 12 months?
Hwang: I think that it is possible, given the disruption caused by the pandemic, to look at opportunities that have been created to rapidly create new supportive-housing units. It’s particularly hard in large cities like Toronto, but in smaller cities and other communities where the housing market is not as insanely inflated as it is in the GTA, it is actually possible to create that kind of housing in the community at a reasonable cost and significantly reduce the number of people who are chronically homeless in the community permanently. That’s something that could be done quite quickly. It’s not a substitute for a long-term housing strategy. We can address several thousand people in a city that are chronically homeless much easier than we can address the bigger problem of housing affordability. It’s not an either/or proposition. We have to really look at both the short-term and the long-term approaches.
Gurney: Just speaking hypothetically: Let’s say we did these things — we addressed affordable housing, at least enough to keep a lot of people living on the edge from falling into homelessness. And we also built out the supply of supportive housing for those with complicated issues and who are already homeless. Most of what we’ve talked about today is the bricks and mortar part, the actual physical infrastructure. My last interview was with Deepy Sur, who spoke with me about social workers. So if we built the housing for the complex cases, would we have the staff to support them once they were housed?
Hwang: That’s a critical issue you’ve put your finger on. We’re doing research and evaluation on this right now at our research centre. The challenge is that, some people — not the majority of people experiencing homelessness, but some people — really need intensive supports and services that can help them succeed and achieve wellness and stable housing. There is a shortage of those kinds of services. So what we’re doing now, in collaboration with community agencies, is a project called Beyond Housing, which is really recognizing the fact that you just identified: for some people, it’s not just about the housing, the roof over their heads. That’s not the only need, and we need to address those other needs. Their health and support needs need to be addressed both before and after they move into housing. And there is really a critical shortage of the intensive services that are needed for those cases that are the most complex.
Gurney: This is maybe a tough question to answer. And I know the pandemic has obviously scrambled things. But are we making progress? You’ve spent years on this issue. Is there cause for optimism? Do you see any signs that we’re getting on top of this?
Hwang: I think it’s too early to say. We’ve made progress. Things have changed dramatically over the course of the pandemic. And we’re now at a tipping point, because we’re in a new situation that can’t just be sustained as the new status quo. We’re going to either go forward and solve some of these problems permanently pr we’re going to just go back to the way things were, and it’ll be even worse than it was before. I think it’s really impossible to imagine that we will go back. Before, we could imagine that homelessness would just kind of grumble along the same way it always had, and nothing would change, except around the edges. Now I think that things have changed, and the system has been destabilized in a way that means we will either make substantial progress toward addressing the problem or things will get even worse. That’s my take on it.
Gurney: Uh, oh. Stephen, I have a rule that when we’re betting on the direction of Canadian public policy, I always take the downside.
Hwang: [laughs] Well, yeah. But I’m hopeful, I’m hopeful that we can achieve some progress given that we have the opportunity to really make progress. And I hope that people have seen the issues broadly across our society, the deep inequities that exist, and have realized that we can’t just go back to business as usual.
Gurney: Anything else as a final thought?
Hwang: Yeah. That we didn’t talk enough about how to prevent homelessness. But we’ll save that for another time.
This interview has been condensed and edited for length and clarity.