Thank you for the invitation to speak on this important topic. I'm going to give you an overview of several projects we've done in this area to give you an idea of where it might be helpful for you to ask more questions.
You understand from the introduction that I am a researcher. My Ph.D. is in psychiatric nursing, so I come to this from the perspective of looking at people with various mental health challenges, and I have a keen interest in how people integrate into the community. It's not just about recovering from illness but about having people be part of society.
A few years ago, in finding the overrepresentation of people with mental illness in the homeless sector, I became concerned. Over the last almost two decades I've done quite a bit of work in looking at different subpopulations of homeless, and more than a decade in looking at this group of homeless veterans.
Briefly, because I have only a few minutes, I'm going to highlight in order some of the projects that you can ask me about.
Over a decade ago, with my colleague Susan Ray, I did the first study that actually looked at homeless veterans in Canada. Up to that point, we were completely relying on research from other countries, primarily the U.S. Over 90% of the research at that time, which is a lot different, comes from the U.S., and context really matters. We have a very different military system, a different health care system and a different housing system.
In the U.S., the main issue is around PTSD, which is why I asked Susan Ray to join me on that study, because her expertise was in PTSD. We interviewed over 50 veterans from across the country who were homeless. We wanted to find out their life stories. How did they become homeless? How did that intersect, if at all, with their service for the country? What did they think it would take them to get out of homelessness? That was essentially the basis of the study.
What did we find out? It was very interesting. Most of them believed that their military service was a highlight of their life, so it's very different from that American literature where it was basically a nightmare. They began to drink more heavily during the time of their service; they saw it as part of military culture. The adjustment to civilian life was not easy, but the alcohol also helped them cope with that transition. Ten to 20 years after leaving the military, there was a pattern of losing the job, losing the family, falling deeper into alcoholism—and sometimes other drug use—and eventually becoming homeless. It's a completely different trajectory compared to that of the U.S. literature, so that's very important to understand.
When we talked abut the solution—I'm being very brief here—they talked about how that was the best time of their life and how, because of that, they wanted to reconnect with that identity as a serving member. I think some of the representation we're hearing now is probably going to echo a lot of that. It's about including things like peer support but also about addressing the alcohol use and dealing with some of the issues around culture, such as structure. They often did not access traditional homeless services because they saw them as too unstructured. In fact, they would often be living in the rough rather than accessing services or going to shelters, because they did not like that unstructured nature.
The second study we took on was to take the recommendations that veterans themselves made, develop those into principles and test them out. Would these solutions actually work in practice? We had four sites: London, Toronto, Calgary and Victoria. This project was co-led with Jan Richardson, who is from the City of London and has an expertise in program development.
Again, the principles we were looking at were to address the substance use, particularly alcohol, and by doing so, to look at access to treatment, harm reduction strategies and housing first—housing first meaning that housing is a right. You don't need to be sober, for example, to get housing, or prove yourself to get housing. You become housed first and then you can deal with the other problems.
Reconnecting with military culture is the opposite of what you would do if the issue were PTSD. I'm not saying that PTSD is not an issue. At the Parkwood Institute, we also have our operational stress injury clinic, and that is the most common problem we see. What I'm saying is that it's not the issue underlying veterans' homelessness, just to make that important distinction. Mind you, even in our OSI clinic, substance abuse comes next on the list, but it's a far second.
Again, they wanted to reconnect with military culture and re-identify in that way, and it's about the peer support, but we'll come back to the peer support.
Again, it's about the structure and the self-respect. They needed something separate from the general homeless population. They needed a transition to being housed. It takes time. Again, part of the idea is that many of the people we talked to in both of these first two studies talked about being housed and then losing housing so many times that they almost gave up hope. Nobody likes to see a homeless veteran, so people are frequently housing them, but without adequate support.
In that second study, we saw that the average person, in the previous five years, had been housed six times at intake. Again, there are constantly groups that are going out and saying that they have to get these people off the street and putting them into housing, but then they lose it. They are at the point many times of saying that they almost don't even want to try because this is happening on such a regular basis. They say, “I'm being housed, but I'm not really being supported in the housing.”
Across all those sites, when we put in the service that the veterans themselves said they wanted, we served over 80 people and the really good news is that only one veteran over two years returned to homelessness.
I did bring you some materials in French and English, as directed. On that second project, we have an executive summary. I have one English and one French copy, and there is a website where anyone can download these things for free, as well as a practice manual for communities to set up a similar program in their own community and a peer support manual on how to develop that. It's different from how we traditionally think of peer support, in that it means understanding homeless culture as well as military culture. It means being a cultural broker. There's a full research study, which I'm only giving you very briefly, and as I say, in French and English. This is all available. I will give this to the clerk.
There were other main findings that came out as very important, because some of the sites.... There was a tendency to look at single sites and say, “Let's get a house for these guys.” That was the kind of solution that communities often looked at. The thing is, for one, they're not all guys. No women were served where they went to a single site solution. No families were served with a single site. That only happens if there are scattered sites and neighbourhood of choice. That's the Reader's Digest version of this. You can ask me more later.
On the third project, based on these good results, Jen Richardson and I were getting a lot of requests from communities to help them establish their own programs in their own communities. We partnered with the homelessness partnering strategy and the Canadian Legions. What we did with the Canadian Legions is find out where they were getting the most requests for the poppy fund from homeless veterans, go to those communities and then have workshops in those communities where people from both the veteran-serving community and the homeless-serving community could come together. We would go over the materials and talk about how we could set up something in each of these 10 communities across the country.
The interesting thing is that these were generally not the traditional what we call “HPS communities”, which tend to be larger urban centres. Similar to what we found before, these were mostly rural communities. It was not Winnipeg, but Flin Flon and The Pas. It was not Vancouver, but Surrey. It was not Halifax, but Sackville. That just gives you an idea of where we went.
This is really important, because a lot of these places don't have a VAC office. They aren't HPS communities. It's one of the challenges. We still have many communities that we were unable to get to. In our Victoria project—which we did here—they had a large number of homeless veterans coming from the Northwest Territories. It's the same thing.
One of the big issues we have to deal with is that where we traditionally set up most of our services both for homeless and for veterans is quite often not where they actually are. That was the really important thing, along with partnering with the Legions to find people, rather than through some of our traditional sources of data.
Our HIFIS data comes federally through HPS. That's data on shelters, on the HIFIS community, so they're missing all of these people who are in these small rural communities, who might be living in tents. We found some places where there would be five people camped out who were all veterans. They would even have a schedule up as to who was cooking meals on what day, but they were not being picked up by any of the traditional methods.
For that project, in every community we went to we found that the homeless sectors knew each other very well, and the veterans sectors knew each other very well, but they were completely different cultures and they did not know each other.
There are two final things, which I won't say as much about. We also did two systematic literature reviews to figure out what was going on. In this study we had nine people who were indigenous, and only three women who had served, so we wanted to do some literature review to find out “What about those populations?” These were questions that were constantly asked in those communities. Shockingly, in the entire world, there has been only one study on indigenous homeless veterans. This is an incredible gap in the literature. There's no Canadian study looking at the specific needs of women.
I'll just leave that, again, for future planning. That's my short spiel on a whole pile of studies.