Transcript: Paula Goering, Michael Shapcott on Social Inequality | Jun 19, 2004

Paula Goering addresses an audience in a dimly lit auditorium, behind a podium with a sign that reads “University of Toronto. Munk Centre for International Studies.
Paula is in her sixties, with chin-length curly salt and pepper hair. She’s wearing a cream blazer.

A caption appears on screen. It reads "Paula Goering. University of Toronto. Poverty, discrimination, and mental health. The shared citizenship lecture series. March 25, 2004."

Paula says I HAD A
CHANCE TO HAVE LUNCH WITH MY
ADULT SON A FEW WEEKS AGO.
WE WERE AT SHOPSY'S AND --
GOING TO A
PLAY, AND UM, I TOLD HIM THAT I
WAS FEELING A LITTLE BIT
ANXIOUS AND EXCITED ABOUT
GIVING THIS TALK.
AND HE ASKED ME WHAT I WAS
TALKING ABOUT AND I SAID --
DISCRIMINATION, POVERTY, AND
MENTAL HEALTH.
WHAT TO THINK?
WHAT TO DO?
AND HE SAID TO ME YOU HAVE THE
ANSWERS TO THAT?

[Audience laughing]

Paula continues IT WAS, IT
WAS A BIT HUMBLING.

She laughs and continues
I DON'T HAVE THE ANSWERS.
UM, YOU'RE GONNA FIND THAT I
TEND TO FOCUS MORE ON POVERTY
IN THIS TALK THAN STIGMA AND
DISCRIMINATION, PARTLY CAUSE I
DON'T HAVE SPACE TO DO THEM
BOTH JUSTICE.
BUT I'M ALSO, WHAT I'M PLANNING
TO DO IS NOT GIVE YOU ANSWERS,
BUT HOPEFULLY GIVE YOU SOME
IDEAS.
SOME WAYS OF THINKING ABOUT
BOTH WHAT COULD BE THE CAUSES
AND WHAT SOME OF THE SOLUTIONS
ARE TO THE PROBLEM.
NOW WHEN YOU COME TO THE
CAUSATION QUESTION, THE, THE
FIRST ONE IS ALWAYS CHICKEN AND
EGG.
WHAT'S THE DIRECTION OF THE
CAUSATION?
DO PEOPLE END UP ILL BECAUSE
THEY LIVE IN POVERTY, OR DO
THEY LIVE IN POVERTY BECAUSE
THEY'RE ILL?
UM, IT'S A DIFFICULT THING TO
DISENTANGLE, BUT IT IS POSSIBLE
WITH SOME RESEARCH DESIGNS TO
TRY TO, TO DO THAT.
TO FIGURE OUT WHAT CAME FIRST
AND WHAT WAS ACTUALLY CAUSING
THE SUBSEQUENT ONE?
AND WHAT YOU
HAVE HERE IS A SUMMARY FROM A,
A RECENT DOCUMENT AT THE
FEDERAL LEVEL THAT JUST
UNDERLINES THAT WE DO KNOW THAT
SOCIAL CONDITIONS AFFECT HEALTH.

A slide pops up on screen under the title “Impact of poverty on health.”
The slide reads “Regardless of how measures of health status and measures of SES are combined, there is little doubt that poverty leads to ill health. For example, in a recent review of the literature, Benzeval and Judge provide evidence from 16 studies using eight different data sets from four different countries.
In summing up their review, the authors conclude: ‘all of the studies that include measures of income level find that it is significantly related to health outcomes.’”

Paula continues AND THAT --
IT'S A RECIPROCAL RELATIONSHIP BUT IT
INCLUDES THAT LINE.
THAT POVERTY DOES INCREASE THE
LIKELIHOOD THAT PEOPLE ARE GOING
TO BECOME ILL.
IT'S NOT JUST MENTAL ILLNESS.
IT'S ALSO PHYSICAL ILLNESS.
WHAT THIS SLIDE ILLUSTRATES IS...

Another slide pops up showing a table titled “work picture at the beginning.”

Paula continues THE FACT THAT
MANY OF THE INDIVIDUALS WHO ARE
USING THESE SERVICES ARE
UNEMPLOYED.
IN FACT, ONLY ABOUT TEN PERCENT
WHEN THEY ENTERED INTO OUR
STUDY HAD ANY KIND OF PAID, HAD
ANY KIND OF COMPETITIVE WORK
AND FOR MOST OF THEM THAT WAS
PART TIME WORK.
I'M MENTIONING THIS --
BECAUSE OVER
THE YEARS WE'VE BEEN ABLE TO
SHOW THAT PROVIDING COMMUNITY
MENTAL HEALTH PROGRAMS AND
SUPPORT HELPS INDIVIDUALS WITH
SEVERE, MENTAL ILLNESS.
AND BY SEVERE, MENTAL ILLNESS I
MEAN PEOPLE WHO HAVE USUALLY A
PSYCHOTIC DIAGNOSIS, THAT MEANS
SCHIZOPHRENIA, OR BIPOLAR
DISEASE.
UM, AND THEY'RE STRUGGLING TO
DEAL WITH ILLNESSES THAT ARE
DISABLING AND TOO OFTEN ARE
CHRONIC.
AND WHAT WE FIND WHEN WE TRY TO
LOOK AT, TRY TO EVALUATE THE
EFFECTS OF SERVICES AND
TREATMENT IS THAT THEY'RE
HELPFUL.
BUT WHEN YOU STAND BACK AND
LOOK AT THE PICTURE SUCH AS
THIS ONE --

The slide pops up again. The chart shows that only 10.6 percent of people were working at a paid job.

Paula says WHAT YOU
DISCOVER IS THAT THE
CIRCUMSTANCES OF PEOPLE'S LIVES
ARE WHAT TOO OFTEN IS REALLY
RESTRICTING, THEIR ABILITY TO
RECOVER AND TO BE REINTEGRATED.
AND WORK IS
ONE OF THOSE VERY FUNDAMENTAL
ISSUES THAT DEFINES BEING
INTEGRATED INTO OUR SOCIETY.
AND AS YOU CAN SEE IT IS AN
ISSUE.
THIS IS A QUOTE FROM AN
INDIVIDUAL WHO HAD FOUND WORK.

A quote pops up with the following phrase highlighted: “something to do and somewhere to go.”

Paula says UM, AND I
THINK IT SAYS BETTER THAN I CAN
THAT WORK IS NOT JUST ABOUT
INCOME.
WORK IS ALSO ABOUT HAVING
MEANINGFUL ACTIVITY AND HAVING
A ROLE TO PLAY IN OUR SOCIETY.
NOW, YOU MAY THINK THAT FOR
SOMEONE IN THIS GROUP THAT I'VE
DESCRIBED --
HAVING COMPETITIVE WORK MIGHT BE VERY
DIFFICULT OR IMPOSSIBLE, AND
IT'S NOT TRUE.
WE NOW HAVE LOTS OF EVIDENCE
THAT INDIVIDUALS WHO FIT THIS
CHARACTERIZATION OF HAVING
SEVERE MENTAL ILLNESS CAN WORK.
THE ISSUE IS WHETHER WE PROVIDE
THEM WITH SUFFICIENT SUPPORTS
AND ACCOMMODATIONS TO ENABLE
THEM TO DO SO.
ITS NOT JUST WORK THAT OFTEN
TIMES IS MISSING IN PEOPLE'S
LIVES.
THERE ARE ALSO LOTS OF ISSUES
AROUND THE PREDICTABILITY OF
HAVING A DECENT, PERMANENT
PLACE TO LIVE, AND ITS NOWHWERE
MORE STRIKING THAN WHEN YOU
LOOK AT POPULATIONS WHO ARE
LIVING IN OUR SHELTERS.
OVER THE YEARS WE'VE DONE MANY
STUDIES OF PEOPLE WHO ARE
HOMELESS AND WHO ARE LIVING IN
SHELTERS.
UM, THIS SLIDE SHOWS YOU --

A chart pops up under the title “Homeless surveys. Lifetime prevalence of DSM disorders based on structured interviews.”

Paula continues OUR STUDY
THAT WAS CALLED PATHWAYS, AND
THE PREVALENCE OF MALE ILLNESS
IN THE HOMELESS POPULATION.
UM, THERE'S ALSO OTHER STUDIES
THAT HAVE USED SIMILAR
EPIDEMIOLOGICAL SURVEY METHODS
LISTED HERE JUST SO YOU GET A
SENSE OF THE, OF THE
COMPARISON.
IN THE 300 PEOPLE THAT WE
TALKED TO FOUR OUT OF FIVE HAD
IN THEIR LIFETIME HAD A
PSYCHIATRIC DISORDER OR A
SUBSTANCE ABUSE PROBLEM.
NOW, THE PREVALENCE OF
PSYCHOTIC ILLNESS OR
SCHIZOPHRENIA IS LESS.
YOU NOTICE ITS ONLY ABOUT SIX
PERCENT IN THIS SAMPLE, THAN
YOU MIGHT HAVE THOUGHT.
OUR IMAGES OF
THE HOMELESS ARE VERY --
DETERMINED BY
WHO'S ON THE STREET AND WHO'S
MOST FREQUENTLY SEEN IN THE
SHELTERS.
IF YOU STAND BACK AND LOOK AT
THE WHOLE POPULATION --
OF PEOPLE USING THE SHELTERS YOU GET A
SOMEWHAT DIFFERENT PICTURE.
AND AS YOU CAN SEE THE
PREDOMINANT DIAGNOSIS IS
DEPRESSION.
BUT THERE'S A LOT OF --
THERE'S A LOT OF PEOPLE WHO
HAVE DEPRESSION AND HAVE
TROUBLES WITH ALCOHOL, OR HAVE
TROUBLES WITH SUBSTANCE ABUSE.
SO, IF, IF YOU TAKE UM, A
PERSPECTIVE ON THIS THAT SAYS
WELL, CLEARLY MENTAL ILLNESS
AND HOMELESSNESS ARE RELATED,
THESE RATES ARE MUCH HIGHER
THAN WE WOULD FIND IN OUR
NORMAL POPULATION, THEN THE
QUESTION BECOMES, WELL WHAT
DOES THAT MEAN?
UM, AND IF YOU WANT TO
UNDERSTAND WHAT THAT MEANS AND
WHY THAT HAPPENS ONE OF THE
THINGS THAT WE HAVE TO BE ABLE
TO DO IS TAKE A MORE LIFE CYCLE
APPROACH TO THINGS.
AND IN THIS STUDY, WE ASKED
PEOPLE NOT ONLY ABOUT THEIR
CURRENT CIRCUMSTANCES, BUT ALSO
TO GIVE US A SENSE OF THEIR
HISTORY.
AND AGAIN, I THINK YOU CAN SEE
FROM READING THROUGH THIS SLIDE
THAT THE INSTABILITY IN HOUSING
IS NOT NEW.

A slide pops up titled “Childhood factors among homeless adults.”
Bullet points on the slide read: 43.7 percent of the sample had been homeless for a week or more before the age of 18,
18 percent had lived in at least one foster home,
25 percent had been placed in group home or institutional care as children,
37 percent reported at least one indicator of family poverty,
24 percent reported that a family member had been mentally or physically disabled for a month or more,
48 percent reported alcohol and or drug abuse problems among adult family members.

Paula says AND THAT THE
BACKGROUND FACTORS IN TERMS OF
HAVING LIVED IN POVERTY, HAVING
HAD A PARENT WHO WAS SUFFERING
FROM SUBSTANCE ABUSE OR MENTAL
ILLNESS, UM, ARE QUITE STRONG.
NOTICE THAT THE SAME BACKGROUND
FACTORS THAT CONTRIBUTE TO
VULNERABILITY TO MALE ILLNESS
ARE ALSO CONTRIBUTING TO THE
LIKLIHOOD OF BEING IN A SHELTER
OR ON THE STREET.
THESE FINDINGS ARE ECHOED WHEN YOU
LOOK AT CHILDHOOD ABUSE.
HERE, WE DO HAVE COMPARISON
FIGURES FOR THE POPULATION IN ONTARIO.

A slide pops up briefly titled “History of childhood abuse.”

Paula says AND BOTH
SEXUAL, ABUSE ARE MUCH HIGHER
IN THE HOMELESS POPULATION.
ONE OF THE SUBJECTS IN THE
STUDY WHO I'LL CALL JIM --
WHEN WE ASK
HIM HOW HE ENDED UP IN THE
SHELTER ON THE STREET,
DESCRIBED TO US WHAT HE CALLED
A DOWNWARD SPIRAL, WHICH I
THINK IS AN INTERESTING SORT OF
METAPHOR TO USE.
WHERE HE HAD LOST HIS JOB AND
THEN AFTER LOSING HIS JOB HAD
THE DEATH OF HIS MOTHER, WHO
WAS REALLY HIS ONLY SOCIAL
SUPPORT AND SUBSEQUENTLY ENDED
UP BEING EVICTED BECAUSE HE
COULDN'T PAY HIS RENT AND FOUND
HIMSELF IN THE SHELTER.
WHEN HE TALKED ABOUT THIS HE
ALSO TALKED ABOUT THE WAY IN
WHICH HIS LIFE AND BEING IN A
SHELTER REMINDED HIM OF HIS
CHILDHOOD.
HE'D GROWN UP BACK EAST.
THEY HAD MOVED A LOT, BECAUSE
HIS FATHER HAD DIFFICULTY
FINDING WORK.
WHEN HIS FATHER WAS UNEMPLOYED
HE DRANK, AND WHEN HE DRANK HE
WAS SOMETIMES ABUSIVE.
UM, SO THAT'S THE KIND OF
DESCRIPTION THAT, THAT YOU GET.
IT'S NOT JUST THE CURRENT
CONDITIONS, BUT ALSO THE
BACKGROUND CONDITIONS THAT WE
HAVE TO TAKE INTO
CONSIDERATION.
AND I DON'T IMAGINE ANY OF THIS
IS NEW TO YOU.
I MEAN THESE FINDINGS ARE, WE
FIND OVER AND OVER AGAIN.
THAT THERE IS A CONNECTION
BETWEEN HEALTH AND MENTAL
HEALTH AND THE KIND OF SOCIAL
CONDITIONS THAT EITHER PEOPLE
LIVE IN OR THAT THEY'VE COME
FROM.
THE QUESTION IS LIKE WHY IS
THAT, AND WHAT DO WE DO ABOUT
IT?
THE KIND OF FRAMEWORK THAT'S
USED TO TRY TO PUT THIS ALL
TOGETHER COMMONLY, IS SOMETHING
CALLED POPULATION HEALTH.
IT'S A CANADIAN FRAMEWORK IN
MANY WAYS.
WE'VE PROMOTED IT AROUND THE
WORLD, AND IT CAN BE APPLIED TO
MENTAL HEALTH.
UM, AND THAT'S BEEN DONE THE
MOST BY PEOPLE IN AUSTRALIA.
AND REALLY BASICALLY WHAT IT'S
SAYING IS SAYING THAT WE'VE GOT
TO THINK ABOUT BOTH.
WE HAVE TO THINK ABOUT THE
INDIVIDUAL AND THE CAPACITIES
THEY HAVE, AND WE HAVE TO THINK
ABOUT THE ENVIRONMENT, IN WHICH
THEY LIVE.
AND IF WE ONLY THINK ABOUT
INDIVIDUALS WE'LL BE MISSING
OUT ON THE POPULATION FACTORS
THAT REALLY PUT INDIVIDUALS AT
RISK.
SO WE NEED MORE THAN ONE LEVEL
OF LOOKING AT THINGS.
NOT AT THE JUST THE INDIVIDUAL
LEVEL BUT ALSO THINKING ABOUT
WHOLE POPULATIONS AND HOW THEY
FARE.
ACADEMICS LIKE DIAGRAMS SO I
BROUGHT ONE FOR YOU I'VE
ACTUALLY BROUGHT TWO.
BUT AH --

A diagram appears under the title “components of the population health model.”
The diagram shows three main boxes: Social environment, physical environment, and genetic endowment. The three connect to a box named Individual response, behaviour, biology. This box connects to health and function, disease, and health care. Health care connects to prosperity, and prosperity connects to well-being.

Paula continues THIS IS A, A
DESCRIPTION OF THE POPULATION
HEALTH AND YOU CAN SEE WHAT
IT'S DOING.
IT'S PUTTING SOCIAL ENVIRONMENT
WITH PHYSICAL ENVIRONMENT AND
GENETIC ENDOWMENT.
AND SAYING THAT THEY INFLUENCE
THE INDIVIDUAL AND, AND
ULTIMATELY INFLUENCE BOTH
HEALTH AND DISEASE.
THIS IS DIFFERENT THAN THE
USUAL BIOMEDICAL MODEL, WHICH
WOULD FOCUS ON DISEASE AND
PRIMARILY BE INTERESTED IN THE
BIO-BIOLOGY BEHAVIOUR
CONNECTION.
SO WHAT YOU'RE DOING IS KIND OF
EXPANDING THE FOCUS, AND WHAT
HAS HAPPENED IS THAT --
INITIAL STUDIES IN MENTAL HEALTH THAT
WERE LOOKING AT POVERTY AS AN
ASPECT OF THE SOCIAL
ENVIRONMENT, AND NOTICING THAT
PEOPLE AND THIS IS VERY MUCH A,
A GIVEN.
PEOPLE IN THE LOWER, SOCIAL AND
ECONOMIC CLASSES HAVE HIGHER
RATES OF MENTAL ILLNESS.
TRYING TO UNDERSTAND THAT AND,
AND WHY THAT IS, KEEPING IN
MIND THAT IT'S NOT A ONE-TO-ONE
CONNECTION.
THAT A LOT OF PEOPLE WHO LIVE
IN POVERTY DO NOT DEVELOP
MENTAL ILLNESS.
THE, THE, THE
FIELD OF SOCIAL EPIDEMIOLOGY
HAS FOCUSED ON TRYING TO
UNDERSTAND THIS LINK, AND
LOOKING AT THE MECHANISMS THAT
CONNECT THE SOCIAL ENVIRONMENT
TO THE INDIVIDUALS, AND IT'S IN
IT'S, IT'S
CALLED RISK FACTORS, PROTECTIVE
FACTORS.
THE COMMON PARADIGM HERE IS
LIFE EVENTS AND STRESS.
SO IF WE WENT
BACK TO JIM AND THOUGHT ABOUT
HIS STORY, THAT DOWNWARD SPIRAL
WOULD BE LOOKED AT IN TERMS OF
WHAT WERE THE LIFE EVENTS?
AND WHAT KIND OF COPING,
FACTOR, STRATEGIES COULD BE
BROUGHT TO THOSE?
WHAT KIND OF SOCIAL SUPPORT
MIGHT BE AVAILABLE?
WHAT ARE THE ISSUES THAT WOULD
DETERMINE WHETHER OR NOT THE
RESPONSE TO THE LIFE EVENTS
ENDED UP IN A SHELTER OR NOT?
THAT WOULD BE THE KIND OF
DISENTANGLING THAT WOULD BE
DONE IN TERMS OF LOOKING AT
INTERVENING FACTORS.
THERE'S A LOT OF EXCITEMENT
ABOUT THIS.
THERE'S A LOT OF RESEARCH ABOUT
THIS.
UM, BUT IN, IN A RECENT PAPER
BY LINK AND ALL, THEY POINT OUT
THAT IF WE SPEND ALL OF OUR
TIME ON THIS, WE KIND OF FORGET
WHERE WE STARTED.
I MEAN THE REAL ISSUE WITH JIM,
IF, OR ONE VERY IMPORTANT ISSUE
WITH JIM IS THAT BOTH HE AND
HIS FATHER WERE OUT OF WORK.
UM, AND IF WE, IF WE LOSE TRACK
OF THE QUESTION OF WHY ARE THEY
OUT OF WORK, AND WHAT DOES IT
MEAN TO HAVE HIGH RATES OF
UNEMPLOYMENT IN A SOCIETY?
WE'RE GONNA UM, BE VERY SHORT
SIGHTED.
UM, SO THAT LEADS TO THE, THE
THOUGHT THAT THERE ARE
FUNDAMENTAL CAUSES OF DISEASE -

A slide titled “Fundamental causes of disease” pops up briefly.

Paula continues AND THEY'RE
AT THE BROAD LEVEL.
THEY'RE AT THE STRUCTURAL
LEVEL, AND WE NEED TO KEEP OUR
ATTENTION FOCUSED ON THESE
THINGS BECAUSE THEY'RE GONNA
EFFECT HEALTH AND ILLNESS
THROUGH MULTIPLE PATHWAYS.
YOU MIGHT FIX
ONE PATHWAY AND THEN THEY'RE,
THEY'RE, IT'LL BE MANIFEST
THROUGH ANOTHER, AND THEY ALSO
AFFECT MULTIPLE OUTCOMES.
SO IT'S VERY IMPORTANT TO, TO
NOT NEGLECT THE, THE BIG
ISSUES, THE UNEMPLOYMENT,
POVERTY, DISCRIMINATION, WHEN
WE'RE TRYING TO FIGURE OUT
ABOUT THIS CONNECTION.
NOW, THE SOCIOLOGISTS AND THE
POLITICAL SCIENTISTS HAVE ALSO
TAKEN ON THIS POPULATION HEALTH
FRAMEWORK AND CRITICIZED IT.
AND WHAT THEY'RE SUGGESTING IS
THAT EVEN GOING BACK AND
FOCUSING ON THE CONNECTION
BETWEEN FUNDAMENTAL CAUSES AND
INDIVIDUAL BEHAVIOUR IS NOT
ENOUGH.

A complex diagram with illegible text pops up under the title “The class/welfare regime model.”

Paula says UM, THIS IS A
RECENT ARTICLE BY A COLLEAGUE
IN PUBLIC HEALTH SCIENCE, IN
THE UNIVERSITY OF TORONTO, IN
WHICH HE BACKS UP THE
PERSPECTIVE UM, AND LOOKS AT
COMPARISONS BETWEEN NATIONS AND
WHAT GOES ON WITHIN NATIONS.
SO THAT WE'RE ACTUALLY
EXAMINING IS THE UM, THE
STRUCTURE OF THE SAFETY NET AND
THE ECONOMIC MARKETS IN A
COUNTRY AND THEIR EFFECT ON THE
ISSUES THAT WE HAD PREVIOUSLY
THOUGHT WERE FUNDAMENTAL
CAUSES.
NOW, WE'VE GOT MORE FUNDAMENTAL
CAUSES TO THINK ABOUT IN TERMS
OF WHAT EFFECTS SOCIAL COHESION
AND ULTIMATELY HEALTH.
AH, ONE OF OUR PROBLEMS IS THAT
WE DON'T KNOW ENOUGH.
UM, WE DO NEED TO KNOW MORE
ABOUT THOSE PATHWAYS AND MORE
IMPORTANTLY, WE NEED TO KNOW A
LOT MORE ABOUT INTERVENTIONS --
AND WHAT WORKS TO TRY TO CHANGE THINGS.
WHEN YOU LOOK AT THE LITERATURE
ON INTERVENTIONS IT'S DIVIDED
INTO TWO PARTS.
WE HAVE WHAT OUR CALLED
DOWNSTREAM AND UPSTREAM
INTERVENTIONS, AND ACTUALLY
IT'S QUITE ENCOURAGING WHEN YOU
LOOK AT THE DOWNSTREAM
INTERVENTION LITERATURE.
WE DO KNOW A FAIR AMOUNT, IF
WE'RE TARGETING PARTICULAR
POPULATIONS AND LOOKING AT SOME
OF THOSE MORE PROXIMAL, KINDS
OF CAUSES.
I'LL JUST GIVE YOU A COUPLE OF
EXAMPLES.
WE'VE GOT RESEARCH THAT SHOWS
THAT IF YOU GO INTO SCHOOLS AND
IDENTIFY AGGRESSIVE, BOYS AND
YOU WORK TO INTERVENE WITH THEM
WITH THEIR TEACHERS AND THEIR
FAMILIES YOU CAN PREVENT
SUBSEQUENT DELINQUENCY AND
SUBSTANCE ABUSE IN THAT
POPULATION.
ANOTHER EXAMPLE WOULD BE
PROGRAMS FOR THE UNEMPLOYED.
IF YOU SET UP PROGRAMS FOR
PEOPLE WHO ARE RECENTLY
UNEMPLOYED AND ASSIST THEM WITH
COPING AND WITH ACTUALLY
INSTRUMENTAL ASSISTANCE YOU CAN
REDUCE THE RATES OF DEPRESSION
IN THAT POPULATION.
SO THERE ARE THINGS THAT WE CAN
DO AND THAT WE KNOW ABOUT.
WHEN YOU GO BACK TO THE MORE
DISTAL, ITS, IS WHERE WE HAVE
LESS, EVIDENCE.
ALTHOUGH EVEN THERE THERE'S A
RECENT REPORT THAT JUST CAME
OUT FROM THE CANADIAN POPU-
POPULATION HEALTH INITIATIVE,
WHICH DOCUMENTS HOW WE'VE BEEN
ABLE TO REDUCE POVERTY AMONG
SENIORS IN OUR COUNTRY BY
CONCENTRATED ATTEMPTS TO LOOK
AT THE DIFFERENT BENEFITS
AVAILABLE TO THEM, AND SAFETY
NETS THAT, THAT THEY CAN
ACCESS.
NOW, WE HAVEN'T DONE A VERY
GOOD JOB WITH SINGLE PARENTS,
AND WE HAVEN'T DONE A VERY GOOD
JOB WITH OTHER POPULATIONS.
WITH CHILDREN, WE STILL,
CHILDREN LIVING IN POVERTY IN,
IN OUR COUNTRY IS QUITE
DISTRESSING.
BUT UM, THIS IS, THIS IS THE
PLACE WHERE YOU THINK, WELL, DO
WE NEED TO WAIT UNTIL WE HAVE
MORE RESEARCH AND THEN WE'LL
FIGURE OUT WHAT TO DO?
I DON'T THINK SO.
I THINK WE KNOW ENOUGH THAT WE
SHOULD START TO ACT, AND
SIMULTANEOUSLY BE CONTINUING TO
STUDY AND TRY TO UNDERSTAND THE
NATURE OF THESE PROBLEMS.
IT'S ACTUALLY FAIRLY
ENCOURAGING FROM WHERE I SIT
ABOUT DOING MORE RESEARCH IN
THIS AREA.
UM, WE HAVE A WHOLE CANADIAN
INSTITUTE OF HEALTH RESEARCH
DEVOTED TO POPULATION HEALTH.
IN MY OWN DEPARTMENT OF
PSYCHIATRY, WE RECENTLY HAVE
DEVELOPED A STRATEGIC PLAN
AROUND MAKING POPULATION HEALTH
MORE A PART OF OUR ACTIVITY.
IN MY OWN RESEARCH UNIT, I HAVE
VERY KEEN, BRIGHT, YOUNG,
INVESTIGATORS WHO ARE VERY UM,
INVESTED IN TRYING TO
UNDERSTAND THINGS LIKE WHY ARE
SINGLE MOTHERS RATES OF
DEPRESSION TWICE THAT OF THEIR
PEERS?
WHAT'S HAPPENING IN TORONTO
THAT YOUR, ACCESS TO
PSYCHIATRIC SERVICES IS MUCH
LESS IF YOU LIVE IN A SOCIO-
ECONOMIC, A LOWER CLASS, SO
THOSE KINDS OF QUESTIONS.
I THINK THOUGH THAT ALL THIS
RESEARCH IS OF NO VALUE UNLESS
IT'S RELATED TO ACTION.
AND IT'S WHEN YOU LOOK AT THE
ACTION PART OF THINGS THAT WE
TEND TO FALL DOWN.
THESE ARE RECENT, NOT SO
RECENT.
THESE ARE POLICY DOCUMENTS,
OVER THE LAST DECADE OR SO IN
ONTARIO ABOUT MENTAL HEALTH.

A slide pops up under the title “Mental health policy documents that include broad determinants of health.” It lists several documents.

Paula continues IF YOU JUST
SAT DOWN AND READ THROUGH THOSE
AND ASKED HOW WE WERE DOING
WITH THINKING ABOUT POPULATION
HEALTH AND THINKING ABOUT BROAD
DETERMINANTS, YOU'D FEEL REALLY
GOOD.
ALL RIGHT, EVERY, SINGLE, ONE
OF THESE, DOCUMENTS TALKS ABOUT
THE IMPORTANCE OF INCOME, THE
IMPORTANCE OF WORK, THE
IMPORTANCE OF DEALING WITH
STIGMA.
UM, IT, IT
WOULD BE THE SAME IN MY, IN MY
INSTITUTION, THE CENTRE FOR
ADDICTION AND MENTAL HEALTH,
WHICH IS A, A TREATMENT AND
REHABILITATION INSTITUTE, IN
THE NEW, STRATEGIC PLAN,
THERE'S A LOT OF EMPHASIS ON
WORK AND JOBS AND HOUSING,
THOSE ISSUES.
UM, BUT AGAIN, THE PROBLEM HERE
IS NOT SO MUCH THE RHETORIC,
CAUSE WE'RE PRETTY GOOD ABOUT,
ABOUT THAT IN CANADA, EVEN IN
THE PUBLIC RECOGNIZING THESE
THINGS.
WHAT IS THE PROBLEM IS MORE
WHEN YOU TURN TO THE PRACTICE.
THERE'S A VERY, NICE ARTICLE
THAT WAS RECENTLY PUBLISHED BY
A GEOGRAPHER AT MCMASTER.
HE WAS LOOKING AT THE GAP
BETWEEN THE MENTAL HEALTH
POLICIES THAT I'VE JUST TOLD
YOU ABOUT, ALL OF WHICH
EMPHASIZE THE IMPORTANCE OF
INCOME, AND WHAT'S HAPPENED IN
OUR PROVINCE OVER THE LAST
WHILE WITH REGARD TO INCOME.
AND WHILE THOUGH, WE'VE SAID WE
RECOGNIZE ITS IMPORTANCE,
THERE'S BEEN AN INCREASE, I
MEAN A DECREASE OVER ALL IN THE
AMOUNT OF SUPPORT AVAILABLE.
IT'S PARTICULARLY TRUE FOR THIS
GROUP OF INDIVIDUALS WHO LIVE
IN RESIDENTIAL AH, LODGING AND
GET ONLY A PART OF THEIR
DISABILITY --
IS GIVEN TO
THEM AS PERSONAL ALLOWANCE
CHEQUES, 112 A MONTH.
THAT'S FOR EVERYTHING --
THAT THEY
NEED TO BUY AND TO DO, BESIDES
THEIR RENT.
IN THIS STUDY HE ALSO TALKED TO
PEOPLE AND HE TALKED A, A
GENTLEMAN WHO WAS ABOUT 20
YEARS OLD, AND ASK HIM ABOUT
WHETHER HE EVER WENT OUT?
AND HIS RESPONSE, WHICH IS
CAPTURED HERE IN THE QUOTE --

A quote appears on screen, under the title “Self-esteem and social stigma.” The quote reads “No, you got nothing to go out with. Look, if you want to buy a jacket or something like that, a decent jacket could be fifty or a hundred, and it’s wintertime. In the summer you might be able to just go in a shirt but... that’s basically it, but I mean you’ve got to get clothes that match the pants right, and the Salvation Army is kind of a joke. It’s old man’s clothes. YOU LOOK STUPID!”
Quoted from Wilton, 2004.

Paula continues JUST
UNDERLINES HOW IMPORTANT IT IS
TO HAVE SOME RESOURCES IF YOU
WANT TO FEEL A PART OF SOCIETY
AND BE ABLE TO DO THINGS.
SO THAT IT CAN BE STIGMATIZING
TO, TO NOT BE ABLE TO NOT BE
ABLE TO HAVE CLOTHES THAT, THAT
ARE DECENT OR THAT LOOK NICE.
NOW, THERE'S
A GROUP THAT HAVE TRIED TO DO
SOMETHING ABOUT THIS PERSONAL
ALLOWANCE, AND SEE IF THEY
CAN'T ADVOCATE WITH THE
GOVERNMENT TO INCREASE IT.
IT'S AN EXAMPLE I THINK OF THE
KIND OF SOCIAL ADVOCACY THAT'S
NOT THAT IMPOSSIBLE TO IMAGINE
HAPPENING, AND THAT COULD HAVE
A REAL DIFFERENCE IN THAT
DETERMINANT OF PEOPLE'S LIVES,
THAT DOESN'T HAVE ANYTHING TO
DO WITH TREATMENT PER SAY.
UM, I'M NOT SURE THOUGH HOW
SUCCESSFUL THEY WILL BE IN
THEIR EFFORTS TO DO THAT.
WHAT HAPPENS AND I'VE SEEN THIS
THROUGHOUT MY CAREER, IS THAT
IT'S VERY HARD TO BROADEN
BEYOND THE CLINICAL, TREATMENT
FOCUS IN PRACTICE.
UM, AND YOU KNOW, WE'VE
RECENTLY JUST HAD NEW FUNDING
FOR HOSPITALS IN THE SYSTEM.
AND MY OWN ORGANIZATION GOT
INCREASES IN THEIR BUDGET AND
THE COMMUNITY MENTAL HEALTH
AGENCIES ACROSS THE PROVINCE,
WHICH DO A LOT OF THE PSYCHO-
SOCIAL REHAB WORK HAVE NOT HAD
AN INCREASE IN TEN, FIFTEEN
YEARS.
SO THAT IT'S A KIND OF
CONTINUING STRUGGLE TO TRY TO
DO SOMETHING AND IT'S PROBABLY
ABOUT POLITICS, UM, AND IT IS
SOMETHING THAT I THINK IS, WE,
WE JUST HAVE TO CONTINUE TO
STRUGGLE.
WE JUST DID A, A STUDY IN THE
SHELTERS IN TORONTO.
THEY ASK US TO COME IN AND LOOK
AT HOW HEALTH CARE IS BEING
DELIVERED TO PEOPLE IN
SHELTERS, BOTH MEDICAL HEALTH
CARE AND, AND MENTAL HEALTH
CARE.
SO, WE WENT AND WE TALKED TO
PEOPLE WHO WORK IN THE
SHELTERS.
WE TALKED TO SHELTER USERS
THEMSELVES.
WE TALKED TO HEALTH CARE
PROVIDERS WHO COME IN.
IT'S A, UM, IT'S A BIT OF A
MESS.
I MEAN WE DON'T DO A VERY GOOD
JOB OF IT.
THE HEALTH CARE SYSTEM IS KIND
OF GIVEN OVER TO PEOPLE WHO
AREN'T TRAINED IN HEALTH,
RESPONSIBILITY FOR A LOT OF THE
FUNCTIONS.
BUT WHAT WAS INTERESTING TO ME
WAS HOW CONSISTENT THE MESSAGE
WAS, WHEN, WHEN WE HAVE THESE
FOCUS GROUPS, WHEN WE HAVE
THESE INTERVIEWS OF THE PEOPLE
IN THE SYSTEM, THAT WHAT REALLY
MATTERS IS HOUSING.
THAT NOT TO FORGET THAT THIS
ISN'T REALLY ABOUT HEALTH CARE,
CAUSE IF THEY WEREN'T IN THE
SHELTERS THIS WOULDN'T BE AN
ISSUE.
WHAT, WHAT REALLY IS THIS ABOUT
IS ABOUT AFFORDABLE HOUSING.
UM, NOW, IN A FEW MINUTES
YOU'RE GONNA HEAR THAT THINGS
CAN BE DONE ABOUT HOUSING.
YOU'RE GONNA HEAR FROM MICHAEL,
WHO'S A VERY, STRONG AND
EFFECTIVE ADVOCATE ON, ON THAT
BEHALF.
AND I THINK, WHEN WE THINK
ABOUT THESE KINDS OF ISSUES,
UM, EACH, EACH OF US HAS TO
FIND OUR OWN WAY OF BEING
EFFECTIVE AND OF TRYING TO
SPEAK OUT AND, AND HAVING A
VOICE.
UM, BUT WE'RE ALL CITIZENS.
WE ALL VOTE.
WE ALL HAVE A CHANCE TO TRY TO
COUNTERACT THOSE FORCES, WHICH
IN CANADA ARE INCREASING THAT
GAP.
SO THE RICH ARE GETTING RICHER
AND THE POOR ARE GETTING
POORER.
UM, IT'S, IT'S ABOUT TAX CUTS.
IT'S ABOUT MINIMUM WAGE.
IT'S ABOUT, IT'S NOT ROCKET
SCIENCE.
THERE ARE WAYS, IN WHICH WE
MAKE THAT HAPPEN, OR WE PREVENT
IT FROM HAPPENING.
UM, WE ALSO CAN EITHER STAND BY
AND WATCH WHILE THE SAFETY NET
GETS KIND OF CHIPPED AWAY, AS
YOU'VE SEEN IN THE, IN THE
INCOME REDUCTION AS YOU'LL HEAR
ABOUT WITH REGARD TO OUR
HOUSING STOCK.
OR WE CAN TRY TO DO SOMETHING
ABOUT THAT, AND SPEAK UP
AGAINST IT.
IN, IN, IN THOSE KINDS OF
SITUATIONS I THINK THERE'S A
VERY IMPORTANT PLACE FOR
INDIVIDUAL PERSONAL, ACTION.
UM, AND WE HAVE A ROLE MODEL
FOR THAT KIND OF ACTION IN THE
SPONSOR OF THIS SERIES.
THIS IS A QUOTE THAT I'VE TAKEN
FROM “OUT OF MUSKOKA.”

A quote appears on screen that reads “At first I blamed problems of identity and early childhood poverty for creating a personality so fragile that it would collapse in the face of a mugging. I pulled myself together and realized that the racial discrimination and poverty that I experienced were no different from what millions of Canadians endured at that time and continue to experience today. I, however, had been the lucky one.”
J. Bartleman, “Out of Muskoka”, 2003.

Paula continues WHICH IS UM,
THE LIEUTENANT GOVERNOR'S
MEMOIR ABOUT GROWING UP IN PORT
CARLING.
UM, IT'S A VERY, INTERESTING
BOOK TO READ BECAUSE HE,
HIMSELF HAS COME OUT OF AN
ENVIRONMENT NOT THAT DIFFERENT
THAN JIM'S IN SOME WAYS, AND
YET HAS HAD A VERY DIFFERENT
TRAJECTORY IN TERMS OF HIS LIFE.
I WAS IN THE
AUDIENCE LAST, FALL WHEN
HONOURABLE, BARTLEMAN SPOKE TO
THE MAKING GAINS CONGRESS.
IT'S A MENTAL HEALTH CONFERENCE
THAT HAD A LOT OF CONSUMERS,
FAMILIES, PROVIDERS, IN THE
AUDIENCE.
AND HE SPOKE ABOUT HIS OWN
PERSONAL STRUGGLES WITH
DEPRESSION, AND HE DOES THAT.
HE WRITES ABOUT THAT.
THAT HAS A TREMENDOUS EFFECT IN
TERMS OF DEALING WITH STIGMA,
UM, AND HELPING TO CHANGE
THINGS.
AS DOES THINGS LIKE SPONSORING
THIS SERIES AND, AND WORKING
WITH THE, THE, GETTING THE
LIBRARY AND BOOKS UP NORTH.
I MENTION THOSE THINGS BECAUSE
I THINK --
THAT WE ALL
SHOULD BE INSPIRED BY WHAT AN
INDIVIDUAL CAN DO.
AND THAT IF WE LOOK IN, TO
THESE KINDS OF EXAMPLES --
WE'LL ACKNOWLEDGE THAT EVEN THOUGH
POVERTY, DISCRIMINATION AND
MENTAL ILLNESS ARE HUGE ISSUES,
THEY'RE NOT IMPOSSIBLE AND WE
EACH COULD BE THINKING ABOUT
WHAT WE MIGHT DO TO TRY TO
TACKLE AND SOLVE THEM.
THANK YOU.

[Audience applauding]

Now Michael Shapcott addresses the same audience. He’s in his fifties, clean-shaven and balding. He’s wearing a black suit, white shirt, and red tie.

A caption appears on screen. It reads "Michael Shapcott. University of Toronto. A place to call home: Issues and Solutions. The shared citizenship lecture series. March 25, 2004."

Michael says WHAT THE
PATHWAYS STUDY AND MANY OTHERS
DO IS WHAT ACADEMICS SOMETIMES
CALL DEALING WITH THE FRONT END
QUESTIONS.
UM, WHO BECOMES HOMELESS?
WHAT PREDICTS HOMELESSNESS?
WHO ARE THE HOMELESS MAKERS,
AND WHAT ARE THE HOMELESS
MAKING PROCESSES?
AND AGAIN AS YOU'VE SEEN FROM
DR. GOERING'S PRESENTATION,
THERE'S ACTUALLY BEEN QUITE A
LOT OF --
VERY GOOD AND USEFUL ACADEMIC RESEARCH
THAT ATTEMPTS TO BRING US TO A
BETTER UNDERSTANDING OF SOME OF
THESE QUESTIONS.
NOW, I'VE SPENT AS YOU CAN TELL
FROM THE BRIEF INTRODUCTION,
I'VE SPENT MOST OF THE LAST 20
YEARS OF MY LIFE IN A SLIGHTLY
DIFFERENT AREA THAN WHERE I AM
RIGHT AT THE MOMENT, AT THE
UNIVERSITY OF TORONTO.
I'VE, I STARTED IN THE MID 80S
WORKING AS A LAW STUDENT AT
PARKDALE LEGAL SERVICES,
HELPING LOW INCOME TENANTS,
OFTEN PEOPLE WITH PSYCHIATRIC
HISTORY, TO, ACCESS AND
MAINTAIN HOUSING.
TO FIGHT BAD, LANDLORDS AND TO
TRY AND ENGAGE OFTEN IN
DIFFERENT POLITICIANS.
THEN MOVED TO A COMMUNITY
CENTRE IN THE EAST END OF
DOWNTOWN TORONTO, WORKING WITH
HOMELESS ADULTS THERE, AND, AND
AGAIN TRYING TO IN A VERY,
PRACTICAL WAY, GOING OUT AT TWO
IN THE MORNING AND TRYING TO
HELP PEOPLE TO SURVIVE FROM ONE
DAY TO THE NEXT, TO FIND FOOD,
TO FIND BASIC, MEDICAL HELP AND
THEN TO FIND HOUSING.
OVER THE COURSE OF MY 20 YEARS
I'VE HELPED TO BUILD QUITE A
FEW HOUSING PROJECTS, BEEN
INVOLVED IN ADVOCACY.
AND I'VE BEEN INVOLVED
NATIONALLY AND INTERNATIONALLY
IN ATTEMPTS TO TRY AND BRING IN
THE BIG SOLUTIONS THAT ARE
NEEDED.
I PROBABLY DON'T NEED TO TELL
ANYONE IN THIS ROOM THAT CANADA
IS FACED WITH A HOMELESSNESS
DISASTER.
WE HAVE ABOUT A QUARTER OF A
MILLION CANADIANS THAT WILL
EXPERIENCE HOMELESSNESS ON AN
ANNUAL BASIS.
A LOT MORE PEOPLE WHO ARE THE
BRINK OF HOMELESSNESS.
ESTIMATES RANGE UP TO ABOUT 1.7
MILLION HOUSEHOLDS ON THE BRINK
OF HOMELESSNESS ACROSS CANADA.
AND AGAIN I DON'T NEED TO DWELL
TOO LONG ON THIS BUT I DO WANT
TO SAY THAT IF THERE'S ANYONE
THAT DOUBTS THAT HOMELESSNESS
IS SOMETHING MORE THAN AN
UNCOMFORTABLE MOMENT, YOU COULD
COME WITH ME AS I'VE BEEN
SEVERAL TIMES IN THE LAST
COUPLE OF WEEKS TO THE INQUEST,
THE CORONER'S COURTS INQUEST
INTO THE DEATH OF JAMES TEGASSER.
MR. TEGASSER DIED A COUPLE OF
YEARS AGO OF TUBERCULOSIS.
HE WAS A RESIDENT AT A HOMELESS
SHELTER HERE IN TORONTO.
ONE OF THREE MEN WHO DIED IN A
MICRO EPIDEMIC OF TUBERCULOSIS
IN TORONTO'S HOMELESS SHELTERS,
15 ACTIVE CASES, THREE DEATHS,
OUT OF THAT MICRO EPIDEMIC,
WHICH WAS CAUSED QUITE SIMPLY
BY OVER CROWDING IN OUR SHELTER
SYSTEM.
AND INCIDENTALLY IN THE LAST
COUPLE OF MONTHS, TORONTO
PUBLIC HEALTH HAS REPORTED AN
INCREASE AGAIN IN THE NUMBER OF
ACTIVE T.B. CASES IN OUR
HOMELESS SHELTERS.
SO AGAIN, THE QUESTIONS THAT
DR. GOERING AND OTHERS ASK IN
TERMS OF THE LINKS BETWEEN
MENTAL HEALTH, BETWEEN POVERTY,
SOCIAL INEQUALITY AND
HOMELESSNESS, THESE ARE
FUNDAMENTALLY IMPORTANT
QUESTIONS, AND WE NEED TO
CONTINUE TO UNDERSTAND THEM.
THERE'S A CHANGING FACE TO
HOMELESSNESS, AND AS
HOMELESSNESS CHANGES OVER TIME
WE NEED, WE NEED TO CONTINUE TO
DEVELOP BETTER UNDERSTANDING.
WHAT I WANT TO DO HOWEVER IS I
WANT TO LOOK AT THE OTHER SIDE
OF THE, THE QUESTION BECAUSE AS
YOU CAN TELL I'M NOT AN
ACADEMIC.
UM, I'M MORE INTERESTED IN THE
VERY, PRACTICAL QUESTION OF HOW
DO WE GET PEOPLE FROM THE
CONDITIONS OF HOMELESSNESS TO
BEING HOUSED?
SO WHAT SOME ACADEMICS CALL THE
EXITS FROM HOMELESSNESS.
HOW DO PEOPLE STOP BEING
HOMELESS AND HOW DO THEY BECOME
STABLY HOUSED?
AND STRANGELY ENOUGH, ALTHOUGH
I WOULD THINK AS THESE ARE
FUNDAMENTALLY IMPORTANT AND
INTERESTING QUESTIONS, THERE'S
ACTUALLY NOT A LOT OF RESEARCH
THAT'S ACTUALLY BEEN DONE ON
THESE QUESTIONS.
THERE IS HOWEVER UM, AN
ACADEMIC IN NEW YORK CITY, MARY
BETH SHINN, WHO I'M PROUD TO
CALL ONE OF MY FAVOURITE
ACADEMICS.
I'M A GROUPIE OF HERS.
MARY BETH OF NEW YORK
UNIVERSITY HAS ACTUALLY SPENT A
LOT OF TIME DOING SOME VERY,
INTERESTING WORK LOOKING AT
EXITS FROM HOMELESSNESS AND HAS
PUBLISHED A NUMBER OF IMPORTANT
PAPERS.
AND I WANT TO SUMMARIZE ONE OF
HER MOST IMPORTANT PAPERS,
WHICH WAS PUBLISHED IN THE
AMERICAN JOURNAL OF PUBLIC
HEALTH IN NOVEMBER, 1998, UNDER
THE TYPICALLY BORING ACADEMIC
TITLE OF “PREDICTORS OF
HOMELESSNESS AMONG FAMILIES IN
NEW YORK CITY, FROM SHELTER
REQUESTS TO HOUSING STABILITY.”
NEW YORK UNIVERSITY REPUBLISHED
THIS ARTICLE ON A SEPARATE
IMPRINT AND UNDER THE TITLE,
“HOUSING CURES HOMELESSNESS,”
WHICH I THINK IS ACTUALLY A
MUCH BETTER TITLE THAN THE ONES
THAT THE EDITORS OF ACADEMIC
JOURNALS LIKE TO STICK ON
PUBLICATIONS, AND YOU'LL SEE
WHY IN JUST A MOMENT.
WHAT DR. SHINN DID WAS SHE WENT
INTO THE HOSTEL SYSTEM, THE
HOMELESS SHELTER SYSTEM IN NEW
YORK CITY AND INTERVIEWED 568
HOMELESS FAMILIES AND HOUSED
POOR FAMILIES.
SHE DID HER FIRST ROUND OF
INTERVIEWS IN 1988, AND THEN
SHE INTERVIEWED THEM AGAIN
ABOUT FOUR AND A HALF, SLIGHTLY
MORE THAN FOUR AND A HALF YEARS
LATER IN 1993.
AND HER TWO RESEARCH, KEY
RESEARCH QUESTIONS WERE WHO WAS
STABLY HOUSED?
THAT IS TO SAY WHO HAD MANAGED
OVER THAT FOUR AND A HALF YEAR
PERIOD TO MAINTAIN THEIR
HOUSING FOR AT LEAST ONE YEAR.
AND WHY WERE THEY STABLY
HOUSED?
SO WHAT ARE THE FACTORS THAT
ALLOWED PEOPLE WHO WERE
HOMELESS TO BECOME SUCCESSFULLY
HOUSED?
AND SHE DID ALL OF THE USUAL
TYPES OF THINGS THAT ONE WOULD
EXPECT A SOCIAL SCIENTIST TO DO
AND SHE ELIMINATED THROUGH ALL
OF HER ANALYSIS A NUMBER OF
FACTORS, AND IT MAY SURPRISE
YOU, SOME OF THESE, FACTORS.
BUT SHE FOUND THAT THESE
THINGS, THERE WAS NO
CORRELATION BETWEEN ANY OF
THESE FACTORS AND HOUSING
STABILITY.
NO CORRELATION BETWEEN RACE,
AGE, PREGNANCY, PERSISTENT
POVERTY, EDUCATION, WORK
HISTORY, MARRIAGE, TEEN
MOTHERHOOD, CHILD POVERTY,
MENTAL ILLNESS, SUBSTANCE USE,
PHYSICAL HEALTH, INCARCERATION,
NO RELATIONSHIP BETWEEN SOCIAL
TIES, DOMESTIC VIOLENCE OR
CHILDHOOD DISRUPTIONS.
THAT'S A PRETTY COMPREHENSIVE
LIST, AND IF I WERE TO ASK MOST
PEOPLE IN THIS ROOM OR
ELSEWHERE WHAT CAUSES
HOMELESSNESS YOU'D PROBABLY
WANT TO THROW AT LEAST A FEW OF
THOSE FACTORS ONTO THE TABLE
AND SAY THOSE ARE SIGNIFICANT
FACTORS.
AND SHE SAID THAT THOSE FACTORS
HAVE ABSOLUTELY NO BEARING IN
TERMS OF HOUSING STABILITY.
SO THE OTHER END OF THE
EQUATION, YOU HAVE PEOPLE
HOMELESS AND YOU'RE LOOKING AT
HOW THEY CAN BE STABLY HOUSED.
WHAT ARE, WHAT ARE THE KEY
FACTORS?
NONE OF THOSE WERE FACTORS.
SO WHAT WAS HER FINDING?
WELL SHE FOUND FOR INSTANCE,
THAT 80 percent OF THE FAMILIES WHO
WENT INTO SUBSIDIZED HOUSING IN
NEW YORK CITY WERE STABLE.
THEY WERE ABLE TO MAINTAIN
THEIR HOUSING FOR AT LEAST A
YEAR, BUT ONLY 18 percent OF THE
FAMILIES WHO WENT INTO
UNSUBSIDIZED HOUSING.
NOW IN NEW YORK CITY THERE IS
TWO KINDS OF SUBSIDIZED
HOUSING.
THERE IS HOUSING, IN WHICH ITS
BUILT BY NON-PROFIT OR
GOVERNMENT AGENCIES, AND THE
SUBSIDY IS PAID THROUGH THE
ACTUAL HOUSING ITSELF, AND THEN
THERE ARE VARIOUS KINDS OF
VOUCHERS AND HOUSING ALLOWANCE
PROGRAMS.
SO BOTH OF THOSE WERE PUT
TOGETHER.
BUT SHE SAID THAT IF YOU WANT
TO KNOW WHO WAS STABLE YOU JUST
LOOK AND SEE THE ONES THAT GOT
SUBSIDIZED HOUSING, GOT WERE
STABLE.
AND SO SHE CONCLUDED IN HER
STUDY THAT THE ONLY FACTOR THAT
CAN EXPLAIN AFTER, AFTER FOUR
AND A HALF YEARS, WHY SOME
PEOPLE WERE STABLE AND OTHERS
WEREN'T STABLE, IS SUBSIDIZED
HOUSING.
AND IN FACT AS DR. SHINN WRITES
IN HER PAPER, SUBSIDIZED
HOUSING IS BOTH NECESSARY AND
SUFFICIENT A CURE HOMELESSNESS
AMONG FAMILIES.
SHE GOES ON TO SAY FOR THE LAST
SIX YEARS --
GOVERNMENT AND PRIVATE FOUNDATIONS HAVE
WORKED UNDER THE ASSUMPTION
THAT BEHAVIOURAL DISORDERS ARE
THE ROOT CAUSE OF HOMELESSNESS.
AN INDIVIDUAL CANNOT BE STABLY
HOUSED UNTIL THESE DISORDERS
HAVE BEEN ADDRESSED.
OR TO BE IN THE VERNACULAR,
PEOPLE ARE CRAZY, AND YOU'VE
GOT TO DEAL WITH THEIR MENTAL
HEALTH ISSUES --
AND IF YOU
DON'T ADDRESS THOSE ISSUES THAN
NOTHING ELSE WILL WORK.
DR. SHINN SAYS OUR RESEARCH
REFUTES THAT ASSUMPTION.
WE FOUND THAT SUBSIDIZED
HOUSING SUCCEEDS IN CURING
HOMELESSNESS AMONG FAMILIES
REGARDLESS OF BEHAVIOURAL
DISORDERS OR OTHER CONDITIONS.
WHATEVER THEIR PROBLEMS,
SUBSTANCE ABUSE, MENTAL
ILLNESS, PHYSICAL ILLNESS OR A
HISTORY OF INCARCERATION,
NEARLY ALL THE FAMILIES BECAME
STABLY HOUSED WHEN THEY
RECEIVED SUBSIDIZED HOUSING.
AND HER COLLEAGUE, DR. WEITZMAN
FROM NEW YORK UNIVERSITY WENT
ONTO SAY, OUR RESEARCH
INDICATES THAT HOMELESSNESS IS
NOT A PERMANENT CONDITION.
PEOPLE DO GET THEMSELVES OUT OF
THE PROBLEM.
BUT IT ONLY HAPPENS WHEN SOME
INTERVENTION OCCURS THAT
PROVIDES THEM WITH ACCESS TO
THE HOUSING MARKET.
NOW, I WANT TO GO ONTO A, A
SECOND STUDY THAT SHE DID,
WHICH IS A BIT MORE CHALLENGING
STUDY.
BUT I WANT TO STOP JUST FOR A
SECOND AND SAY TO, TO THOSE
THAT ARE ACADEMICS THAT UM, OR
PERHAPS MAYBE I SHOULD SPEAK
MORE DIRECTLY TO THE ONES THAT
AREN'T ACADEMICS, THAT PERHAPS
THE STUDY I'VE JUST SUMMARIZED
SOUNDS KIND OF LIKE BELABOURING
THE OBVIOUS.
WELL OF COURSE IF SOMEBODY IS
HOUSED, THEY'RE NO LONGER
HOMELESS AND THAT IS THE, THE
SOLUTION.
BUT I WANT TO, I WANT YOU TO
HOLD THAT THOUGHT AND REMEMBER
THAT HOUSING CURES HOMELESSNESS
AND THAT'S A TRULY INTERESTING
AND RADICAL DISCOVERY.
NOW DR., SOME, SOME PEOPLE
CRITICIZED DR. SHINN AND DR.
WEITZMAN AND SAID WELL YOU JUST
TOOK YOU KNOW, PEOPLE OUT OF
THE HOMELESS SHELTER, AND SURE
SOME OF THEM HAD MENTAL HEALTH
ISSUES.
SURE, SOME OF THEM WERE
SUBSTANCE USERS, ALCOHOLICS,
DRUG USERS AND SO ON.
SOME OF THEM HAD OTHER ISSUES,
BUT YOU KNOW THAT WAS A PRETTY
TAME POPULATION.
WE CHALLENGE YOU TO GO AND TAKE
SOME PEOPLE THAT SOCIAL WORKERS
CALL HARDEST TO HOUSE, THAT IS
TO SAY PEOPLE WITH SERIOUS,
MENTAL ILLNESS.
SO, LAST YEAR I WAS ACTUALLY
TALKING WITH DR. SHINN AND DR.
WEITZMAN, THEY'RE ABOUT TO
PUBLISH BUT THEY HAVEN'T YET
PUBLISHED A STUDY, SO I'M GONNA
GIVE YOU A SNEAK PEEK OF A
STUDY THAT THEY'RE, THAT
THEY'RE JUST IN THE PROCESS NOW
OF REFINING.
WHERE WHAT THEY DID WAS THEY
TOOK UP THE CHALLENGE AND SAID
OKAY, WE'VE, WE'VE LOOKED AT A
GENERAL HOMELESS POPULATION.
NOW LET'S, LET'S GO AND LOOK AT
THE PEOPLE FROM A PSYCHIATRIC
FACILITY IN NEW YORK CITY.
SO THEY LOOKED AT 225
INDIVIDUALS WHO WERE DISCHARGED
FROM A PSYCHIATRIC FACILITY,
AND ALL 225 PEOPLE HAD THESE
THREE CHARACTERISTICS.
THEY HAD BEEN HOMELESS A
SIGNIFICANT PERIOD OF TIME,
OVER IN THE MOST RECENT SIX
MONTHS, THAT 15 OF THE LAST 30
DAYS THEY HAD BEEN ON THE
STREET AND THEY HAD A SERIOUS,
MENTAL ILLNESS.
THEY HAD A CLINICAL DIAGNOSIS
OF A SERIOUS, MENTAL ILLNESS.
THEY TOOK HALF OF THOSE PEOPLE
AND THEY RANDOMLY ASSIGNED THEM
TO WHAT THE AMERICANS CALL A
CONTINUUM OF CARE MODEL AND
HALF OF THEM WERE ASSIGNED TO
HOUSING FIRST MODELS.
CONTINUUM OF CARE IS WHAT THOSE
OF US IN TORONTO AND OTHER
PLACES MIGHT CALL SUPPORTIVE
HOUSING.
THAT IS TO SAY IT'S HOUSING
WHERE YOU NOT ONLY GET FOUR
WALLS AND A ROOF, BUT YOU MAY
GET HARM REDUCTION PROGRAMS, A
MENTAL HEALTH WORKER, A
PERSONAL NEEDS ASSISTANCE AND
SO ON.
SO YOU GET SOME LEVEL OF NON-
HOUSING SUPPORT IN ADDITION TO
THE, THE BASIC HOUSING.
SO HALF THE PEOPLE WERE STUCK
IN CONTINUUM OF CARE AND THE
OTHER HALF WERE PUT INTO THE
HOUSING FIRST MODEL.
AND OF COURSE THE, THE QUESTION
THAT YOU WANT TO ASK THEN IS
WHAT, WHAT IS GONNA HAPPEN WITH
THESE PEOPLE?
AND DR. SHINN TOLD ME THAT THEY
WENT INTO THIS, THEY'RE
ASSUMPTION GOING IN WAS THAT
PEOPLE WHO WENT INTO THE
SUPPORTIVE HOUSING, WOULD,
WOULD BE MORE STABLY HOUSED.
BECAUSE THEY NOT ONLY HAD THE HOUSING,
BUT THEY HAD THE SUPPORTS TO
ADDRESS THEIR SERIOUS, MENTAL
ILLNESS AND OTHER NON-HOUSING
NEEDS.
AND THE PEOPLE IN THE HOUSING
FIRST, IN OTHER WORDS, JUST
GIVEN FOUR WALLS AND A ROOF AND
TOLD THIS IS, MAKE --
MAKE YOUR OWN WAY AS BEST YOU CAN.
THAT THEY WOULD PROBABLY NOT DO
AS WELL, SO THAT WAS THEIR
ASSUMPTION GOING IN.
WHAT THEY FOUND IN THE FIRST 12
MONTHS AFTER THEY LOOKED AT IT,
THERE WAS NO SIGNIFICANT
DIFFERENCE BETWEEN THE TWO
GROUPS IN TERMS OF HOUSING
STABILITY.
IN OTHER WORDS, THE SAME
NUMBERS OF PEOPLE IN THE
CONTINUUM OF CARE AND THE
HOUSING FIRST WERE STABLY
HOUSED AT THE END OF 12 MONTHS.
AND SO THEIR PRELIMINARY
CONCLUSION, AND THEY HAVEN'T
PUBLISHED THE RESEARCH IS THAT
HOUSING IS A CURE FOR THE
HOMELESSNESS FOR THOSE WITH
MENTAL ILLNESS.
NOW SHE WANTS ME ALWAYS TO ADD
THE CAVEAT, IS THIS TOO GOOD TO
BE TRUE, OR IS THIS AN ARGUMENT
FOR GOVERNMENTS TO CUT
SUPPORTIVE HOUSING?
AND SAY WELL WE DON'T NEED ANY
MORE SUPPORTIVE HOUSING.
LET'S JUST THROW PEOPLE INTO A
ROOMING HOUSE WITH NO SUPPORTS
AND SERVICES.
AND SHE'S SAYING THAT'S NOT OF
COURSE WHAT THIS STUDY IS
ARGUING, OR SHOWING, BUT WHAT
IT IS SHOWING IS THAT HOUSING
IS ONE OF THE MOST FUNDAMENTAL
ISSUES FOR UM, FOR HOMELESS
PEOPLE WHATEVER THEIR OTHER NEEDS.

Watch: Paula Goering, Michael Shapcott on Social Inequality