When Bill stopped speaking to support workers, his illness quickly got worse. Anxiety kept him housebound. Rubbish piled up, barricading his doorway. He couldn’t stand still or walk in a straight line. Paranoia set in, and delusions of armed intruders left him jumpy and frightened.
Despite Bill’s diagnosis of schizophrenia, his mental health team disconnected. Overburdened by other requests for help, and unaware of Bill’s deteriorating health, team members didn’t have time for someone who wouldn’t return their calls.
Unfortunately, this is far too common.
Bill lives in Australia, but Canada’s no better off. Under pressure and still reeling from COVID-19, case workers rarely have enough time to adequately support people with acute psychiatric conditions. Canada is in the midst of a mental health crisis, and we need to have an urgent conversation about how to support some of our country’s most vulnerable people.
Clinical intervention alone isn’t enough
Medicine has come a long way, but medication therapy, while essential, is not enough in isolation. For many, what’s missing is the stability of a safe place to live and the consistent relationships necessary for managing daily life, feeling connected and supporting good mental health.
Housing affords security, peace of mind and the fulfillment of basic needs. Relationships support proactive treatment, and a companion to notice when things start to go awry. Without the right combination of medication, housing and community, patients can receive treatment only to find themselves lonely, disconnected, homeless, incarcerated or back in hospital again.
Learning from Australia: Leveraging the strength of community housing
Had he been living on his own, this might have been the outcome of Bill’s story. He doesn’t have any family to take care of him, pay bills or help maintain his tenancy. His health was deteriorating fast, and he would have likely continued to decline.
However, by virtue of living in a unique rooming house run by the Australian non-profit, Servants Community Housing, Bill was able to get the support he needed. Even as case workers disconnected, live-in house managers (a core element of Servants’ model) leveraged their ongoing relationship with Bill to understand what was going wrong. They advocated for him within the healthcare system, and ensured he received adequate care.
When residents face a mental health crisis, instead of this decline leading to homelessness, house managers engage health support services to connect them with the care they need.
Servants is unique. Its model focuses on community relationships and supports residents who have experiences of homelessness, acute mental illness, family violence, incarceration and trauma. House managers live on-site, build genuine relationships, ensure the property remains safe, respond to emergencies and facilitate proactive referrals to health and community supports. If a resident’s behaviour changes, house managers typically notice much faster than a case worker who might only have the time to visit when there’s an emergency. When residents face a mental health crisis, instead of this decline leading to homelessness, house managers engage health support services to connect them with the care they need. With the right clinical support and the strength of community, residents have a higher chance of maintaining their tenancy and regaining their health.
Amanda Donohoe, Servants’ CEO, says this housing is a long-term investment in the lives of vulnerable people.
“At the end of the day, although health-care workers can do a lot, it’s the network of real relationships in someone’s life that enables them to thrive,” says Donohoe. “The benefit of our community housing model is that tenants know someone’s there who cares for them. The house becomes its own community, and a collection of people, often with mental illness, and who often arrive isolated, with no friends and no family, suddenly get to experience one of the best examples of community Melbourne has to offer.”
Perhaps Servants has something to teach us. Although there are supportive housing programs across Canada, for the most vulnerable we need models that address psychosocial needs through genuine, long-term relationships.
And they can be affordable, too. Servants’ residents pay up to a maximum of 25 per cent of their income to live there, with an additional fixed fee covering services like utilities, cooked dinners and a linen service. It’s more efficient to run than other housing models because it supports residents in a manner that allows them to maximize their agency. Unlike supported residential services, for example, residents are encouraged to actively contribute to their home, cook and gain new skills to overcome barriers to employment.
At the end of the day, everyone needs people around them who care. So, when it comes to addressing mental illness, we can’t afford to forget that it takes more than a clinical approach to ensure some of our society’s most marginalized, including those who are homeless and experience mental illness, can thrive.