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Housing and Mental Health

December 1, 2012

Housing is a basic human right and requirement for good health. According to the United Nations the right to housing is protected under international law and Canada has endorsed such rights guaranteeing “an adequate standard of living… including adequate food, clothing and housing.”1 Likewise, the Ottawa Charter for Health Promotion identifies shelter as a basic prerequisite for health.

Adequate, suitable and affordable housing contributes to our physical and mental well-being. It leads to increased personal safety and helps decrease stress, leading to improved sleep and diet. All of these factors result in better mental health outcomes. When housing is inadequate or unavailable, personal as well as community well-being can suffer.

The high cost of rental accommodations has created a critical shortage of affordable housing and is a leading contributor to poverty in Ontario. Accommodation is considered affordable if it requires less than 30 percent of a household’s pre-tax income.

Many individuals with mental health conditions are on social assistance and majority do not have access to affordable housing. Our Housing Stats and Facts highlight the dire need for affordable housing in Ontario. Adequate dwellings are defined as those not requiring major repairs, whereas suitable dwellings refer to those that have enough bedrooms for the size of the household.

Affordable housing is an investment in health promotion and illness prevention. When a person has adequate housing they experience fewer health problems and are able to devote more of their income to adequately feed and clothe themselves and their family.

Social Housing

As of 2011, Ontario has

  • 260, 000 public housing units
  • 41, 454 co-operative housing units
  • 223, 885 non-profit housing units
  • 2201 urban native housing units
  • 11, 317 dedicated supportive housing units

At the beginning of 2011, there were 152,077 low income households on active waiting lists for social housing Ontario.

Housing with Supports

(Ministry numbers, personal communication, 2012)

  • Ontario provides housing with supports to 107, 294 Ontarians in need

Of this number:
Ministry of Health and Long-Term Care provides rent supplements to 6,742 individuals with mental health conditions

  • Dedicated mental health supportive housing assistance is available for 3,195 individuals
  • 430 persons with mental health conditions receive supports through room and board arrangements

Housing and Mental Health Conditions

For people with serious mental health conditions, safe and affordable housing can provide a place to
live in dignity and move towards recovery. Individuals with serious mental health conditions frequently
identify income and housing as the most important factors in achieving and maintaining their health.2

However, for many, maintaining safe and affordable housing can be difficult. During periods of illness,
individuals may be unable to work and/or experience a loss of income. Without adequate income, they
may have difficulty paying rent and may eventually lose their home and household contents.
Consequently, many live in substandard housing that is physically inadequate, crowded, noisy and
located in undesirable neighborhoods.3

Many people with mental health conditions live independently; however for those with more serious
mental health conditions, there are a variety of supports available to them. Housing with supports
gives one access to a range of housing options: supportive housing, supported housing, and rent
supplements. Supportive housing provides assistance by staffing housing units with 24 hr supports.
Other individuals may live in the larger community and have supports, such as homecare and
counseling when they need it. This is referred to as supported housing.

Residential care and permanent supported housing approaches appear to yield the greatest reductions
in hospitalizations.4 People living in housing with support have also been found to be less likely to be institutionalized in jails and prisons.5 Individuals in supported housing also report higher quality of life due to their housing, more choice and control over their housing and better quality of housing.6 Other research has shown that improvements in personal coping, relationships and community involvement are greater for individuals with housing supports.7

Rent supplements or rent-geared-to-income housing are two strategies that can provide individuals with the financial resources they need to access desirable housing in their community.


Why Are People Homeless?

Two trends are largely responsible for the rise in homelessness over the past 20 years: a growing shortage of affordable rental housing and a simultaneous increase in poverty.

Homelessness and poverty are linked.8 Poor people are frequently unable to pay for housing, food, child care, health care and education. Difficult choices must be made when limited resources cover only some of these necessities. Being poor means being an illness, an accident or a paycheque away from living on the streets.


What Constitutes Homelessness?

Persons who reside in places that are not intended as, or are unfit for, human habitation, including cars, abandoned buildings, bus or train stations, under bridges, in garbage or recycling dumpsters, parks, or other places lacking basic amenities.

Persons sharing housing at the whim of other persons on an interim or emergency basis. Persons whose primary nighttime place of abode is a supervised publicly or privately operated shelter designed to provide temporary living accommodations, including shelters for victims of domestic violence, welfare hotels, congregate shelters and transitional housing.


Homelessness Is a Frequent Experience of Persons with Mental Illness

It is difficult to state whether homelessness or mental illness occurs first. Each case must be considered individually. Research tends to support both theories. The stress of being homeless may exacerbate previous mental illness. However, the difficulties of being homeless may encourage anxiety or depressive disorders9, 10

The challenge of providing stable housing for persons with serious mental health conditions is reflected in the estimated 67 percent of homeless persons with a lifetime history of mental illness in Toronto.11

People with serious mental health conditions are disproportionately affected by homelessness. The consequences of homelessness tend to be more severe when coupled with a mental health condition. People with mental health conditions remain homeless for longer periods of time and have less contact with family and friends. They encounter more barriers to employment and tend to be in poorer health than other homeless people.12


Housing Makes a Difference

Research indicates that a stable, supported living environment is essential to maintaining the health and well-being of people with serious mental health conditions and is integral to their recovery. Housing with support can generate positive outcomes, including enhanced life skills, improved health status, an increased sense of empowerment and involvement in the community. Research shows that maintaining and improving the housing of individuals with serious mental health conditions can contribute to a reduction in psychiatric symptoms13and therefore decrease the need for emergency and treatment services.14

Community mental health services can assist people to both access and maintain their housing. Some of the key supports that have been identified by people with serious mental health conditions include medical services available in-house or on-call (for crisis management and medication monitoring), homemaking and personal care services, vocational training, life skills training, as well as assistance with income support and housing advocacy. Service providers have also identified the following factors which support successful housing arrangements: rent geared to income, community support services, a strong personal support network, and availability of case management.15


Affordable and Housing with Supports Makes Economic Sense

Affordable housing makes economic sense. Many factors contribute to a city’s economic success, such as the talent of its residents, location, transportation and government investment. Affordable housing is also part of this equation enabling employees to live in a community. As TD Economics states, “…working to find solutions to the problem of affordable housing is also smart economic policy. An inadequate supply of housing can be a major impediment to business investment and growth.”

Likewise, supportive housing is economical. It costs approximately $486 a day ($177,390 per year) to keep a person in a psychiatric hospital, compared to $72 per day ($26,280 per year) to house a person in the community with supports.16

Furthermore, persons who cannot afford to live in decent housing are more likely to experience exposure to violence, communicable diseases and increased chronic conditions.17


Challenges to Affordable Housing

As of July 2012, 41 percent of people receiving ODSP have a primary diagnosis of mental health/psychiatric disorders, according to a recent IPSOS survey. 18 In Ontario, the average market rent for a one-bedroom apartment is $866.19 However, the maximum income for a single person receiving ODSP is $1075.20 For most people it is not feasible to allocate on average 80% of one’s social assistance to housing; and this situation is putting people on ODSP at risk of losing their home.21

The challenges of poverty, stigma and discrimination that persons with mental health conditions face directly impact their ability to access, find and keep housing. Due to stigma, the typical reaction encountered by someone with a mental health condition is fear and rejection. Many living with a mental illness are often denied housing in the private market as a result of their psychiatric illness.

Furthermore, many supportive housing projects also encounter a “not-in-my-backyard” response (NIMBYism) from neighbours, businesses, councillors, etc. This type of behaviour may include discriminating and slandering comments in person, by e-mail, or through flyers and posters which protest a new supportive housing development.

Despite improvements in Ontario’s economy and a modest level of rental development in a number of markets, there continues to be a serious housing affordability issue in Ontario. There are fewer affordable housing units available now than a decade ago. Between 1996 and 2006, after adjusting for inflation, more than 78,000 units were lost in the moderately affordable rent ranges ($400 to $800) in Ontario.22

Recent policy reports addressing housing have included Ontario’s affordable housing strategy launched in 2010, Building Foundations: Building Futures,23 and the Social Assistance Review‘s Brighter Prospects: Transforming Social Assistance in Ontario24. Both reports speak to making the current housing system less complicated by revising rent geared to income calculations, and introducing standard rates as well as housing benefits. However, housing affordability, and supports for persons with mental illness are not addressed in any significant way.


Current Activities

CMHA Ontario is active in monitoring and addressing housing concerns experienced by individuals living with mental health conditions. We do this in partnership with other housing providers and community advocates. We are also involved in promoting mental health through highlighting public issues and recommending options to create inclusive and supportive environments.


References

1 United Nations, Office of the High Commissioner for Human Rights, “International Covenant on Economic, Social and Cultural Rights,” 1976, http://www.unhchr.ch/html/menu3/b/a_cescr.htm.
2 J. Trainor, E. Pomeroy and B. Pape, eds., Building a Framework for Support: A Community Development Approach to Mental Health Policy (Toronto: Canadian Mental Health Association, 1999).
3 M.J.L. Kirby and W.J. Keon, Out of the Shadows at Last: Transforming Mental Health, Mental Illness and Addiction Services in Canada, Chapter One: Voices of People Living with Mental Illness, Final Report of the Standing Senate Committee on Social Affairs, Science and Technology, 2006.
4 Leff, H.S., Chow, C.M., Pepin, R., Conley, J., Allen, I.E., & Seaman, C.A. (2009) Does one size fit all?What we can and can’t learn from a meta-analysis of housing models for persons with mental illness. Psychiatric Services, Vol. 60, No. 4, 473-482.
5 Nelson, G., Aubrey, T. & Lafrance, A. (2007) A review of the literature on the effectiveness of housing and support, Assertive Community Treatment, and Intensive Case Management interventions for persons with mental illness who have been homeless. American Journal of Orthopsychiatry, Vol. 77, No. 3, 350-361.
6 Ibid.
7 Nelson, G., Hall, G.B. & Walsh-Bowers, R. (1995) An evaluation of supportive apartments for psychiatric consumer/survivors. Canada’s Mental Health, Vol. 43, No. 2, 9-16.
8 Canadian Mental Health Association, Ontario, “Backgrounder: Poverty and Mental Illness,” November 2007, http://www.ontario.cmha.ca/backgrounders.
9 C. Walker, “Homeless People and Mental Health,” American Journal of Nursing 98, no. 11 (1998): 26-32.
10 T. Morrell-Bellai, “Becoming and Remaining Homeless: A Qualitative Investigation,” Mental Health Nursing 21, no. 6 (2000): 581-604.
11 P. Goering, G. Tolomiczenko, T. Sheldon, K. Boydell and D. Wasylenki, “Characteristics of Persons Who Are Homeless for the First Time,” Psychiatric Services 53 (2002): 1472-74.
12 R. Benger and B. Cameron, “Asylum: Falling through the Cracks,” Witness, Canadian Broadcasting Corporation, 2000, retrieved January 31, 2003, from http://www.tv.cbc.ca.
13 T. Middelboe, “Prospective Study of Clinical and Social Outcome of Stay in Small Group Homes for People with Mental Illness,” British Journal of Psychiatry 171 (1997): 251-55.
14 McCarthy and Nelson, “An Evaluation of Supportive Housing.”
15 Toronto District Health Council, “Toronto Mental Health Housing Study,” September 2001.
16 Ontario, Ministry of Health and Long-Term Care, “Provincial Summary – Average Costs for CMH&A Service Recipient Activity,” 11 August 2006.
17 B. Moloughney, Housing and Population Health: The State of Current Research Knowledge. (Ottawa: Canadian Institute for Health Information, June 2004).
18 Cathexis, (2012). “Evaluation of the Ontario Disability Support Program (ODSP) Employment Supports
Program. Final Report. http://cathexisconsulting.ca/our-work/
19 Canada Mortgage and Housing Corporation, “Rental Market Report – Ontario Highlights,” Fall 2011, http://www.cmhc-schl.gc.ca/odpub/esub/64507/64507_2011_B02.pdf.
20 Income Security Advocacy Centre (November/December 2012). Social Assistance Rates Update.
21 Ontario Non-Profit Housing Association (2011) Where’s Home 2011. http://www.onpha.on.ca/Content/ONPHA/About/ResearchReports/WheresHome/WheresHome_2011.pdf
22 Pomeroy, S. (2009, August). Understanding the Affordable Housing Issue: Background Diagnostic in Support of ONPHA Response to the Long Term Affordable Housing Strategy. Toronto, ON: The Ontario Non-Profit Housing Association, p. 8.; After adjusting for inflation, 37,941 units were lost in the $400 to $599 range and 40,754 units were lost in the $600 to $799 range for a total of 78, 695 units.
23 Ministry of Municipal Affairs and Housing (2010) Building Foundations: Building Futures: Ontario’s Long Term Affordable Housing Strategy.
24 Commission for the Review of Social Assistance in Ontario (2012). Brighter Prospects: Transforming Social Assistance in Ontario. http://www.socialassistancereview.ca/final-report

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