Thank you, Mr. Chair and members of the standing committee, for the opportunity to take part in this historic study on LGBTQ2S health.
My name is Alex Abramovich and I am an independent scientist at the Institute for Mental Health Policy Research at the Centre for Addiction and Mental Health and an assistant professor at the Dalla Lana School of Public Health at the University of Toronto.
I have been addressing the issue of LGBTQ2S youth and young adult homelessness for over 10 years. I'm currently leading a study on transgender health more broadly. Today I will be speaking about these two topics.
I will use the term “youth" to refer to those between the ages of 16 and 29 and the term “cisgender”, which refers to people who identify with the sex they were assigned at birth.
There are approximately 40,000 young people experiencing homelessness in Canada and up to 7,000 young people experiencing homelessness on any given night across the country. Of youth experiencing homelessness, 25% to 40% identify as LGBTQ2S.
Identity-based family conflict resulting from a young person coming out as LGBTQ2S is a major contributing factor to youth homelessness and the most frequently cited cause for LGBTQ2S youth experiencing homelessness. The experience of homelessness is different for LGBTQ2S youth versus for heterosexual and cisgender youth. LGBTQ2S youth tend to become homeless at younger ages and experience homelessness for longer episodes compared to cisgender and heterosexual youth.
Some LGBTQ2S youth experience discrimination and violence at higher rates than do others. For example, transgender people of colour, especially young transwomen of colour, face the highest rates of discrimination and violence in shelters and housing programs and on the streets. They are more likely to experience violent crime, sexual assault and murder.
One of the biggest issues that LGBTQ2S youth face in shelters and housing programs and institutions more broadly is safety. Over the years my research has looked at the different ways that LGBTQ2S people are further marginalized and erased in institutional settings such as shelters and housing programs, making it difficult to quantify how many LGBTQ2S individuals are experiencing homelessness in Canada.
While research in this area has certainly expanded in recent years, there is still minimal investigation into these issues and large-scale data collection remains limited. Most of the research and point-in-time counts, or PiT counts, up until very recently have not included any questions regarding sexual orientation or gender identity.
Accurate prevalence rates are also dependent on a community's or system's data management program having been set up to include data on sexual and gender identity as well as the larger data management systems at the national level having been designed to capture and integrate this type of data.
For example, HIFIS, which is a comprehensive data collection and case management system used by housing and shelter programs across the country, provides individuals options to identify only as female, male or gender diverse and does not collect any data on sexual orientation. Even when we do collect inclusive data, many youth are missed because they do not access services given their safety concerns and difficulty fitting into the gender binary, since most programs are segregated by male and female floors.
Hidden homelessness, such as couch surfing, remains a significant issue among LGBTQ2S youth, especially for those living in rural and remote communities, making it difficult to accurately determine the scale of the problem. A lack of inclusive services and supports as well as the availability of fewer housing options to youth experiencing homelessness in rural areas may force youth to relocate from their communities and leave behind important social networks and emotional connections. Relocating to big cities in order to obtain inclusive services and supports can introduce a whole host of consequences, including worsened health, fewer social networks and support and increased risk of victimization and exploitation.
I recently worked with the homelessness partnering strategy on the development of two new questions focused on sexual orientation and gender identity, which were included in the 2018 national PiT count and were administered in over 60 communities across Canada. It has been only in recent years that the first population-based housing programs for LGBTQ2S youth have opened their doors in Canada.
A major milestone was the opening of the YMCA's Sprott House in Toronto in 2016, Canada's first LGBTQ2S transitional housing program. The biggest difference between Sprott House and many other housing programs is that all of their programs have been designed through an LGBTQ2S lens with the needs of LGBTQ2S youth at the centre of all aspects of the housing program. This has been an important step in the right direction and has inspired more programs to open and others to rethink how they deliver their services and whether or not they are inclusive. But we still have a long way to go.
Discrimination and social stigma have serious consequences on the health and well-being of LGBTQ2S youth, leading to significant mental health issues, substance use, anxiety, depression and high rates of suicide, especially for young transgender people. It is well documented that transgender individuals experience negative physical and mental health outcomes and high rates of disease burden, including high prevalence of mental health issues.
Still, trans health continues to be an understudied area. Gender identity information has yet to be routinely collected in administrative data, electronic health records and provincial and federal surveys, making it difficult to identify trans individuals within population-based data sources.
I'm currently leading a study that investigates the health care utilization trajectories and health outcomes among transgender individuals in Ontario, by linking health service data. This study uses high-quality data from primary care and psychiatric settings to identify a large number of transgender individuals in Ontario over the entire age range. It is the first study to identify transgender individuals in the ICES data repository.
This study is still in its early stages, so I can only speak to some of the very preliminary findings. So far, over 2,000 transpeople have been identified, and 50% of them are living in the two lowest neighbourhood income quintiles, compared to 37% of the general population. There are very strong links between income and health. Those living in the lowest-income level neighbourhoods tend to experience poor health outcomes compared to those who live in higher-income level neighbourhoods.
The preliminary data are showing significantly higher rates of mental health-related primary care and psychiatry visits, as well as higher rates of hospitalizations and emergency department visits due to self-harm and mental health-related reasons, compared to the general population.
There are different solutions to these issues, and I'd like to close with some recommendations.
Targeted strategies and prioritizing LGBTQ2S populations, especially youth, in Canada's homelessness, national housing and poverty reduction strategies provide an important opportunity to more comprehensively end homelessness in Canada. When government policies and plans to end homelessness prioritize disproportionately represented populations, including LGBTQ2S youth, they create life-saving policies.
The Government of Alberta has done some exceptional work in this area. I developed a targeted provincial strategy on addressing LGBTQ2S youth homelessness with the Government of Alberta and a provincial working group. This work was a result of their youth plan, which prioritized LGBTQ2S youth and stemmed from their 10-year plan to end homelessness, a first of its kind in Canada, and a truly important response that emphasizes longer-term solutions and prevention.
Six key recommendations were made in the final report, all of which were approved by the Alberta government and are in the process of being implemented. Targeted strategies such as this involve population-based housing programs, comprehensive education and training for all staff, and inclusive housing and shelter standards and policies, ultimately creating a standardized model of care and service delivery that meets the needs of everyone experiencing homelessness, regardless of their gender identity or sexual orientation.
I also recommend including sexual orientation and gender identity questions in all federal surveys, data collection systems and administrative health data to provide a better understanding of the health disparities and circumstances of LGBTQ2S individuals across the country.
When surveys do not present inclusive questions and response options, they perpetuate data erasure towards LGBTQ2S individuals and make it extremely difficult to collect data that accurately reflect the population.
I echo the recommendation to prioritize LGBTQ2S health research in Canada, particularly within the Canadian Institutes of Health Research and to develop the capacity for research focused on LGBTQ2S health. This is an incredible opportunity for Canada to better understand and address the health disparities experienced by LGBTQ2S individuals, and I'm truly honoured to be part of this important discussion.