Moss Park: Homelessness in a Changing Community
A man who is homeless waits in the hallway of an emergency department. He spies a food tray on a cart — there is still food on it.
He takes something from the tray.
In what seems like only moments, security guards have forced him to the ground and handcuffed him.
This is scene that Cathy Crowe, an activist and long-time street nurse, has seen before in a Toronto hospital. She says it is a reaction that is indicative of a failure to apply a social lens in healthcare.
“For a person who has a family or money, waiting six hours in an emergency room is not a big deal. For someone who is homeless waiting six hours means missing a meal at a shelter,” she explains.
Applying this type of understanding can make a world of difference when trying to approach the population which, in Toronto, tends to be most visible in the downtown core.
Toronto’s Moss Park neighbourhood in particular is anecdotally known for being a meeting ground for members of the population, in part because so many services are located there. There are six shelters in the neighbourhood. The neighbourhood also falls in the Mid-East subregion of the Toronto Central LHIN, which is home to 24 community mental health and addictions organizations.
Street Health is one such community organization. The clinic serves clients who are homeless or underhoused and have “serious mental health issues,” according to clinic manager and nurse, Joyce Rankin. Many of the clinic’s clients also have comorbid substance abuse issues.
Street Health’s mission at first glance is not exceptional. “We want to keep them healthy,” Rankin says of the clinic’s clients. However, working with a population with highly complex needs in many ways requires an exceptional approach.
Improving the health of members of the homeless population necessarily requires treating the social determinants of health, in addition to medical needs. Stigma, affordable housing, income disparity, and the criminalization of the poor — to name a few.
“When you’re talking about social disadvantage you are talking about the social determinants of health and this requires a holistic approach. You can’t isolate it,” says Dr. Vicky Stergiopoulos, physician-in-chief at CAMH.
Stergiopoulos has been working with the homeless community in Toronto’s east-end for over 15 years. She says the biggest challenge comes when providers try to compartmentalize care. “It’s not just mental health and addictions care. It’s holistic care,” she says.
For Stergiopoulos, holistic care also means understanding the story behind a patient’s immediate circumstances. “Most have a diagnosable mental health condition, but almost all of them are people who are broken by the adversities they have had to experience — often beginning in childhood.”
And while the complexity individuals’ circumstances is perhaps the biggest challenge, there are everyday barriers to providing care as well.
Allana Sullivan, one of Street Health’s nurses, says that it can often be difficult to track down clients, given that may do not have cell-phones. There’s also an immediacy to their needs, says Sullivan.
“A client might come through the door with a problem that wouldn’t necessarily be considered urgent in other settings, but because this population is so transient, every problem is urgent,” she adds.
Rankin indicates that mobility — and the capacity to meet the population where they’re at — is key. “Sometimes [clients] come here, other times we’ll meet them at a McDonald’s or a TTC station,” she says.
There are other, numerous barriers to care. Community members may have lost their identification or had it stolen. Many have had negative experiences with conventional health care spaces, including the emergency department.
“It’s not really geared for people [who are] homeless and people with impulse control issues,” says Rankin. “[For example] a lot of our clients already have less than stellar relationships with the police department and yet when you go into the hospital the security desk is right next to triage.”
However, even the most creative, individualized approaches to healthcare wither without adequate shelter.
“I can only do so much to help them improve in terms of their mental illness if they are still in the shelter or on the street,” says Stergiopoulos. “They need housing, they need income support, they need opportunities for social inclusion and integration.”
Rankin says that Street Health’s philosophy is that housing equals health. However, finding affordable housing in the city is increasingly impossible particularly within the downtown core.
“There are programs in the city who are trying — and succeeding — to find housing for people, but the housing is outside of this community,” says Rankin.
The problem is, that community is a critical part of her client’s lives. The downtown core is where they access most services and supports, yet the cost of transit to get there can be prohibitive.
“Some of the clients that we’ve worked with have gotten housing outside of the downtown core, but they hate it so much that they’d rather stay in shelters,” says Rankin.
Gentrification is an increasing problem across the city, but recent changes in have dramatically impacted the Mid-East subregion. The revitalization of Regent Park, the development of Queen St. East and Sherbourne St., and the George Street redevelopment to name a few.
The changes are concerning. “This is the community that is known for drop-in services, meal programs, laundry programs — I understand wanting to clean up the city, but make sure you’re not cleaning up the city on the backs of people in the most need,” says Rankin.
Stergiopoulos says that after over a decade working with the population, she has seen some progress. “We offer medical care in shelters and drop-ins. We developed models of care. We’ve made progress and we’re bringing sectors together,” she says. However, she says there is still more work to be done, particularly in terms of formalizing intersectoral collaboration.
Organizations like Street Health will continue to combine care with understanding to meet individual needs in the population. “We will see them, and they know that,” says Rankin, simply. “They are they most resilient people I have every worked with in my entire career.”
More About Moss Park
Below are some striking statistics about Moss Park, relative to the 72 neighbourhoods in the Toronto Central LHIN. More stats like these can be found at the Toronto Central LHIN website.
Lone parent families: 51.7% (rank 72 of 72)
People living below low income measure: 38.6% (rank 70 of 72)
People on social assistance: 21.5% (rank 69 of 72)
Low primary care continuity: 25.4% (rank 69 of 72)
Mental health visits: 11.2% (rank 70 of 72)
Emergency department visits per 1,000: 621 (rank: 72 of 72)
Age-adjusted rate of hospitalization per 1,000: 123 (rank: 72 of 72)
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