A RIGHT TO HOUSING
FOR PEOPLE EXPERIENCING MENTAL HEALTH ISSUES
by
Deborah Turner
BSW, University ofNorthem British Columbia, 1998

A Practicum Report Submitted in Partial Fulfillment of
the Requirements for the Degree of Master in Social Work

The University of Northern British Columbia

May, 2010
© Deborah Turner

UNIVERSITY of NORTHERN
BRITISH COLUMBIA
LIDRARY
Prince George, B.C.

Abstract

Housing makes a difference to our health. Decent, safe, and affordable housing contributes to
our mental and physical well-being, while inadequate housing or even homelessness can do
the opposite. Having a pre-existing mental illness or substance use issue often restricts a
person ' s options to access, afford, and maintain the kind of home that would enhance and
promote recovery.
On the foundation of reviewed literature, as part of a practicum placement with N orthem
Health and Mental Health and Addictions, I undertook this quantitative, descriptive study in
Prince George, and set forth to develop an understanding of the need and type of housing
required for individuals with a serious and persistent mental illness (SPMI). As well, I took a
look at the current housing available in Prince George, BC Canada, including speaking with
landlords and in some cases, doing some education around mental illness as there was clearly
some stigma present.
A survey questionnaire to learn from people with SPMI was prepared and conducted at three
separate locations in Prince George. Participation was completely voluntary.
The second part of my practicum project involved developing an !portal system in which
information on current housing availability became assessable to the case managers on the
Community Outreach and Assertiveness Team (Coast Team). The Coast team works with
individuals who have a serious and persistent mental illness that is chronic in nature.
This is an important part of my practicum as case managers are continuously looking for
adequate housing for their clients and by having a system in place such as the !portal, it will
substantially reduce the number of hours spent on trying to find housing.

A RIGHT TO HOUSING
I hope to share the final results and recommendations stemming from my study with those
individuals at the decision making levels. In Prince George, that would include upper Managers
in Northern Health ' s Mental Health and Addiction services.

11

A RIGHT TO HOUSING

111

Acknowledgements

I sincerely thank everyone who generously gave their time to participate in my research and to
supervise my practicum.
A sincere thanks to Professor Dawn Hemingway for her ongoing help, advice, and support. As
well, thank you for steering me in the right direction when I was considering supported
housing as a research focus.
I am grateful to Professor Glen Schmidt for being an excellent teacher and mentor from day one
of my social work program. The cons-tructive advice and positive atmosphere that you
created for your students was appreciated.
The value of a good undergraduate education becomes very clear in graduate school. Thank you
to the faculty at the University of Northern British Columbia who worked hard to prepare
me for the challenges of graduate studies. Finally, thank you to all of my classmates for
your encouragement, sense of humor and fun times. And to Catherine Karigey, thank you
for everything.

A RIGHT TO HOUSING

IV

Dedication

To the late Paul Becklake, my practicum site supervisor- "you talked the talk and walked the
walk my friend. " You were an inspiration to so many people, friends, colleagues, and consumers.
Thank you for your words of wisdom, advice, direction, and support. By example, you have
shown me that I can achieve anything with hard work and dedication. Thank you for being such
a wonderful person.
I would like to thank my parents, Linda and John Ormiston, for their unwavering support and
encouragement.

A RIGHT TO HOUSING

v

Table of Contents

Abstract .... ................................................. .... ..... .... .. ...................... ...... .............. ................... ..... i
Acknowledgements .................................................................................................................. iii
Dedication ... .......... .... ...... ......... ..................... ......... ............................ ...... ...... ................. ......... iv
Table of Contents ...................................................................................................................... v
List ofTables ............................. ... ..... ... ........... ........... ..... ..... .. .............. ............ ........ ............... vii
List of Figures ........... ... ....................................................... ...... .... ....... .................................. viii
Preface ...................................................................................................................................... ix
Chapter One ................................................................................................................................. 1

Introduction and Description of Practicum ............................................................................... 1
Chapter Two ................................................................................................................................. 5

.·

;

··•.•.

-"

Literature Review ..................................................... .. ........ .... ........ ......... .... ........ ... ..... .............. 5
A Glimpse of the History .......................................................................................................... 5
Deinstitutionalization ..... ... ................... .... .... ...... .. ... ........... ... .. .............................................. . 8
Housing for People with Serious Mental Health Issues ...................... .... ................. ..... ....... 12
Custodial Model ...... ........... .. ... .... ...... ... ......................... ... ............... ..... ............. ... ........ ........ 14
Supportive Housing ............................................................................................................. 15
Supported Housing ............................................................................................................... 16
Best Practices in Mental Health Housing ............................................................................ 17
Homelessness ..... ... ............. .. ... .. ... ... ... .................. ...... ...... .. ...... ...... ...... .. ....................... ... .... 20
Mental Health and Housing Policy .. ....... ................. ................ ... ................... ........ ..... ......... 29
Chapter Two ............................................................................................................................... 31

Practicum Research Plan ......................................................................................................... 31
Methods ................................................................................................................................... 33
Sample .... .. ..................... ................ .... .... .... .... .... ..... ...... ................ ...... .. ..... .... ... ...... ........... ...... 34
Survey Tool ............................................................................................................................. 34
Procedure ..... ....... .............. ................. ........ ................ ........ ....... .. .... ......... ... ........ ........ ........ ..... 35
Ethics ..... .................. ............. .... ... ...................... ... .......................... ............. .... .......... ...... ........ 36
Data Analysis ..... ................ ........ ................................ .. .......... .. ....... .... ..... .................. ......... ... . 37
Chapter Three ............................................................................................................................ 38

Data Results ............................................................................................................................ 38

:

A RIGHT TO HOUSING

Vl

Descriptive Statistics ........... ................... ... .......... .... .......... ...................................... .... .. .. .... . 38
Summary of Results ............ ............... ...... .. ........ ..... ................... ........... ... ...... .. ..... .. ......... ... . 40

Chapter Four .............................................................................................................................. 41
Limitation of Research and Suggestions for Future Research ................................................ 41
Limitations .. ........................... .. ......... ... ............ .. ..... .... ... ... .. .......... ....... ...... .... ....... ......... .... .. 41
Future Research .. ......... ......... ....................... ........... ....... .... .......... .... ... ..... ... ..... ... ................. 41

Chapter Five ............................................................................................................................... 43
Investigating Housing in Prince George and Developing iPortal ........... .................... ......... .. . 43
Purpose of iPortal ................. ...... ...... .. ..... ..... ..... ................................... .......... ................ ... .. . 43
Audience ...................................... :.... ....... ............. .. ...... ................ ... .... .. ........ ...................... 43
iPortal Roles and Responsibilities ....................................................................................... 43
Policies and Principles .. ................................................ .. ........... ...... .. .... .............. ... .. ....... .... 44
Laying the Groundwork for iPortal ... ......... ... ............... ....... ..... .......................................... .. 44
Figure 1: Screen Shot of!portal Face Page ................. ....... ..... ............................... ... .......... 45

Chapter Six ................................................................................................................................. 47
Review ofPracticum Objectives ..... ... ..... ......... ... ....................................... .......... ............... .... 47
Conclusion .............................................................................................................................. 48

Chapter Seven ............................................................................................................................ 50
Recommendations for Policy and Practice Change ..... ....... ..... ......... ... ... ....... .... .. ... .......... ..... . 50
Why the Current Approach to Housing is Not Working .. .... .......... ....... ................. ... ... ..... .. 50
Recommendations ..... ........................................ ....................................... ... .......... ........ ........ .. 51
Advocacy ........... ..... ....... .. ................. .. .. ..... ............................................ ........... .. ...... .. ... .... .. 51
Solutions at the Local Level. ................................................................................................ 52
The Federal and Provincial Solutions ............ ........... ........................................................... 53
Dissemination of Research Findings and Practicum Work. .................................................... 54

References ................................................................................................................................... 55
Appendix A: Cover Letter ......................................................................................................... 70
Appendix B: Informed Consent ................................................................................................ 72
Appendix C: Housing Survey ................................................................................................... 73

A RIGHT TO HOUSING

Vll

List of Tables
Table 1: Current Types ofHousing ..................... .............................. .... .................................. l4
Table 2: Age Range and Mean Age ........................................................................................ 38
Table 3: Demographics: Gender, Disability, Homelessness, Living Arrangements, and
Housing Types ........................................................................................................................ 39
Table 4: Housing Preference According to Mental Health Diagnosis .................................... 40

A RIGHT TO HOUSING

Vlll

List of Figures
Figure 1: Screen Shot oflportal Face Page .......................... .... ............... .......... ......... ... .. ...... .. 45

A RIGHT TO HOUSING

lX

Preface

As the primary research instrument in the research component of my practicum, I would
like to take the opportunity to briefly introduce myself.
I have had no prior experience in doing research in the area of housing and people with
serious and persistent mental illness. I do, however, have considerable knowledge and
experience in working alongside individuals with mental illness as a case manager in the area of
Mental Health and Addictions in the Northern Health Authority.
I tried to approach the issue of housing for people with serious and persistent mental
illness objectively. Having worked with this population for eleven years, I do believe, that this
group of people are marginalized in most aspects of their lives including their housing needs.
Through my practicum and especially the research component, I have tried my best to find out
what type of housing is currently available in Prince George, BC and what type of housing is
important to those living with a mental illness. My greatest hope is to be able to give a voice to
this group of people so their wishes are heard by those who make policy decisions. I believe my
own experience and personal history have added to my practicum and my research. Prior to, and
during this practicum, I have been a part of a housing committee that addresses housing needs
for those people with mental illness. This has afforded me an opportunity to keep abreast of
current issues in mental health housing and has complimented my academic learning.

Chapter One
Introduction and Description of Practicum

Finding appropriate housing for people with mental health issues is a subject that has
captured the attention of many academics for years. Psychologists have done a tremendous
amount of work looking at the positive and negative psychological outcomes associated with
different models of housing and support (Baumohl, 1989; Caton, 1983, Goldstein & Lehman,
1983; Kennedy, 1989; Rosenfield, 1992). Planners and geographers have cast a great deal of
attention toward the location of housing for people with serious mental health and addiction
issues, particularly in urban areas (Dear & Laws, 1986; Taylor, 1989). Canadian social
worker Hulchanski (2008) has focused on research around policy options for addressing
homelessness in Canada while Plyler, Ricciardi, Sakamoto, & Wood (2008) have focused on
research pertaining to homelessness, social supports, and housing.
There is a common thread that joins inquiry across all of these disciplines and
diversity of theory guiding research problems in the area of mental health housing. That is,
there has been an almost exclusive focus on the objective characteristics of people ' s housing
experiences. Historically, quantitative research has been the methodology of choice (Dear,
1977).
Access to, and retention of appropriate housing is necessary for everyone ' s well being
and is a critical factor in the recovery of people with mental illness (Mental Health
Commission, 1999). The direction of service provision for people with mental health
problems has been toward deinstitutionalization, with an emphasis on independence and
interdependence (Kadmos & Pendergast, 2001 ). Interventions chosen should be the least

A RIGHT TO HOUSING

2

restrictive when possible and promote and encourage the development and maintenance of
independence.
Beaulieu, Dorvil, Morin, and Robert (2005) confi1m the typology that is currently
being used in Canada by Horgan, Nelson, and Parkinson, (1998) which distinguishes among
three approaches to housing for people with serious mental health issues. They are referred to
as custodial, supportive, and supported and each varies according to three main
characteristics: the profit orientation of the support-provider, the nature and terms of support

·"

provided, and the degree of resident empowerment. Authors Horgan, Nelson, and Parkinson
(1998) describe the types of housing as follows:
Custodial care homes provide room and board, 24-hour supervision, basic assistance
with activities of daily living, and medication monitoring. They are typically run for private
profit and they are the least empowering for the residents.
Supportive housing focuses on rehabilitation and community integration. They are
developed and run by non-profit agencies.
Supported housing involves normal integrated housing with no staff on site. Housing
is both affordable and adequate, combined with individualized mental health support
services.
A main focus of this practicum was to assess the need for housing and the type of
housing required for those individuals with a serious and persistent mental illness as well as
to look at what kind of housing is currently available in the community in Prince George,
British Columbia. The research conducted as part of this practicum makes a modest attempt
at understanding the type of housing needed for people with serious mental health issues and
advancing that understanding to the decision-making level.

..

A RIGHT TO HOUSING

3

At the time of my practicum, there were 350 individuals receiving services from the
Community Outreach and Assertive Services Team (COAST) at Northern Health. There
were only 70 individuals who received some form of supported housing.
The COAST team under Northern Health (NH, one of the five regional health
authorities in British Columbia) is a community-based multi-disciplinary team that consists
of a psychiatrist, physicians, community nurses, social workers, and a life skills worker. The
team also has access to a vocational rehabilitation counsellor and recreational therapists.
The COAST team provides direct clinical services inclusive of assessments, case
management, and consultation to families, consumers, and the medical community;
education, family support, health promotion and prevention, medication administration,
monitoring and support, and we partner with the BC Schizophrenia Society to provide
educational groups. The client population served is comprised of individuals over the age of
19 who have a serious and persistent mental illness such as schizophrenia, bipolar disorder,
or a delusional disorder.
The practicum took place on a part-time basis over an extended period of time from
September 1, 2007 to June 1, 2008 . The practicum learning objectives were as follows and
were agreed to by Paul Becklake, agency practicum supervisor, Dawn Hemingway, academic
supervisor, and Glen Schmidt, practicum supervisory committee member, and the student:
1.

To become familiar with both the private and public sector landlords within Prince
George.

2.

To create a data-base of housing listings to be utilized and monitored by the COAST
team.

A RIGHT TO HOUSING
3.

4

To conduct a housing survey amongst individuals currently receiving services from
the COAST team. To assess for the 'need' and 'type' of housing individuals may
require based on the outcomes of Objectives 1-2, along with the housing survey
findings.

4.

To assist with the creation of new opportunities for supported housing for individuals
served by the COAST team.

A RIGHT TO HOUSING

5

Chapter Two
Literature Review
The care of people with mental and behavioral disorders has always reflected
prevailing social values related to the social perception of mental illness.
(World Health Organization, 2001 , p. 3 8)

A Glimpse of the History
Historically, individuals who experienced mental illness were either abused or
revered, depending upon the cultural biases. An example of abuse can be illustrated by the
treatment of individuals in Greece. In ancient Greece, people who had a severe mental illness
were thought to be influenced by angry gods and believed to have experienced abuse. Those
people with a mild condition were treated with contempt and humiliation (Prince, 2003).
Conversely, during the middle ages, Moslems believed that the insane person was loved and
chosen by God to tell the truth. They were worshiped as saints (Mora, 1985).
The cyclical pattern of reverie and abuse was not limited to a one time period. During
the 15th and 16th centuries, there was a trend of witch mania where the mentally ill were
persecuted and the cause of mental illness was attributed to possession by the devil
(Friedman & Romrn, 1994). Individuals were not recognized as sick people but rather were
accused of having abandoned themselves to shameful and forbidden practices with the devil,
sorcerers, and other demons. During the 18th and 19th centuries, hospitals and asylums
assumed the care for the mentally ill. It was during the 18th century that the moral movement
emerged in France, England, and Italy. This movement' s belief was that people could be
cured when exposed to an accepting, healthful, and moral environment. Individuals were
treated firmly but kindly (Mora, 1985). Individuals were closely attended to and cared for by

A RIGHT TO HOUSING

6

staffwho treated them with respect and deference (Grob, 1973). The treatment often used
was the tranquilizing chair. This device was intended to heal by lowering the individuals'
pulse and relaxing the muscles. It was designed to hold the head, body, arms, and legs
immobile for long periods of time (Bloom, 2006). In the late 19th century, both upper and
lower Canada borrowed from the European experience and designed and developed small
institutions for persons with mental illness based on the moral theory (Grob, 1973).
Appalled at the conditions in jails and mental institutions, an American woman by the
name of Dorothea Dix began a quest to champion the mentally ill. Upon entering the
confines of jails, she discovered prostitutes, alcoholics, criminals, mentally challenged
individuals, and the mentally ill were all housed together in unheated, unfurnished, and foulsmelling quarters (Viney & Zorich, 1982). Dorothea Dix, also known as the Gentle
Reformer, became a well-known activist who worked untiringly in creating clean, safe, and
curative asylums (Greenstone, 1979). The intention ofthe asylums was to provide safe
settings for physical, and spiritual care, as well as to shield residents from the harm and
danger common to people with a mental illness (Burgess, 1898). A contrary view identified
fewer humanitarian motivations for asylum development: the segregation of those with
mental illness from a society that did not want the discomfort of eccentric behaviour in its
midst (Foucault, 1961 ). Families would often submit their elderly relative to an asylum
because they lacked the resources or time to deal with them. Problems arose quickly as
overcrowding occurred because institutions had not established criteria for accepting or
rejecting a patient. The outcome led to a sharp decline in patient care and the revival of old
procedures such as the tranquilizing chair surfaced. Having said that, the establishment of
asylums in Canada brought some relief to the mentally ill who had previously been placed in

A RIGHT TO HOUSING

7

jails, almshouses, or who had been left to care for themselves (Sussman, 1998). Once
admitted to the asylums, many individuals spent the rest of their lives in these institutions.
Despite the humane motives that drove much of the professional input for the
institutionalization process, the results for the next century were very mixed. Eventually
institutionalization in Canada became a synonym for an inhumane response to mentally ill
people, often because of a scarcity of resources (Tuke, 1985). There appeared to be no
therapeutic plans in place and often people were left with nothing to do with their days which
led to an exacerbation of symptoms of their illness. People were fed and housed, nothing
more. By the mid-1940s, treatment of the mentally ill took a new tum. Inhumane psychiatric
treatment was forced upon residents. Insulin shock therapy, frontal lobotomy, and
electroconvulsive therapy (ECT) were introduced (WHO, 2003). In modem times, insulin
shock therapy and lobotomies are viewed as barbaric. ECT is still used in the West but is
only used as a last resort for the treatment of mood disorders and administered much more
safely then in the past.
It is worth noting that in Canada during the process of institutionalization, efforts

were made to promote mental health and de-stigmatize mental illness. For example, in 1948,
the federal government established Dominion Mental Health Grants which contributed funds
toward training and services and the establishment of Mental Health Week (WHO, 2003).
Funds from this source also led to the development of public awareness campaigns to
promote the mental health of infants and children. Mental health week was designated in
Canada for the first time in 1951. Similarly, during this period, the Canadian Mental Health
Association (CMHA) fought to change the language used in legislation and in public
discourse, which referred to individuals as "idiots" and "lunatics."

A RIGHT TO HOUSING

8

After World War Two, provincially operated psychiatric institutions operated at more
than one hundred percent capacity. Understaffing, overcrowding, and ineffective treatments
led to the emphasis on custody or housing rather than therapy (WHO, 2003). Contrary to the
initial intent of the ' moral' movement, institutional care became restrictive with a reliance on
methods involving seclusion, chemical, and physical restraints (Appleton, 1967). All these
negative consequences contributed to the eventual process of deinstitutionalization.

Deinstitutionalization
In my view, deinstitutionalization makes sense for most-not all-but only if the
community has the service capacity; if society has been informed in an
appropriate public education policy; if safe and affordable housing exists; and
if enhanced employment opportunities exist. Can you imagine a time sensitive
institutionalized consumer is suddenly discharged to find employment in a
stigmatized society where a "not-in-my neighbourhood" housing policy
exists? (Michael J. Grass, 2006)
' Deinstitutionalization' is a word that conjures up different images. In the 1970s, its
meaning was positive and referred to the discharge of long term psychiatric patients from
obsolete custodial mental hospitals that had seemingly outlived their usefulness (Grob,
1995). The presumption from medical professionals and government officials was that these
patients could successfully transition into the community with proper supports.
Unfortunately, when this process occurred, supports such as case management, housing,
financial assistance, and vocational rehabilitation were not in place. Individuals were
discharged to halfway houses or shelters and eventually, many of them ended up on the
streets with no resources to assist them. Today, deinstitutionalization suggests an image of

A RIGHT TO HOUSING

9

homeless former mental health patients who now inhabit the streets of every major urban
area (Grob, 1995). The process of deinstitutionalization was a long journey that began in the
1950s. For example there was an effort throughout the United States to remove mentally ill
patients from psychiatric facilities and place them in community-based treatment programs
(Goldman, 1983). The impetus of this movement came from a convergence of several social
forces. First, with the success in treating soldiers in World War Two, psychiatrists became
optimistic about their ability to treat mental disorders outside the hospitals. Second, there was
a growing feeling that abusive conditions existed in many psychiatric facilities and negative
effects from long-term institutionalization were at least as harmful as chronic mental illness
itself. As well, many came to believe that the civil rights of the mentally ill were being
violated. Third, fiscal conservatives in government were concerned with the enormous
expense of caring for patients in large institutions and fmally in 1954, the application and use
of chlorpromazine (the first effective anti-psychotic medication) made it reasonably possible
to manage the care of persons outside ofthe hospital (Goldman, 1983). During the 1950s,
Western countries paid close attention to their mental health system. A gradual shift began
away from the provision of custodial care in large, overcrowded hospitals towards short term
care in community hospitals, and community housing and support services (Goldman, 1983).
In Canada, the process of deinstitutionalization began in the late 1960s and 1970s.

The idea of deinstitutionalization was born out of the perception that the policy was a fiscal
and legal necessity and not of logically analyzed mental health considerations (Sealy, 2004 ).
There were two important national reports that helped to shift towards the idea of
deinstitutionalization. First, in 1963, the National Scientific Planning Council of the
Canadian Mental Health Association (CMHA) released More for the Mind, which insisted

A RIGHT TO HOUSING

10

that mental illness be dealt with in the same professional, administrative, or organizational
framework as any physical illness. The report recommended that the psychiatric services be
integrated with the rest of the health care system (CMHA, 1963). This report was what really
propelled community-based housing and support services. Secondly, in 1964, the Royal

Commission of Health Services, chaired by Emmett Hall, recommended that patients capable
of receiving care in general hospital psychiatric units should be moved there with due speed
(1964, p. 4). The process consisted of three distinctive phases.
The first phase involved a shift from care in psychiatric institutions to care in
psychiatric units within hospitals. It was intended that this shift from psychiatric institutions
to general hospital psychiatric units would have a significant impact, in particular, by
lessening the stigma associated with mental illness and psychiatry as the illnesses and
practitioners who treat them become closely integrated with the rest of medicine
(Wasylenski, 2001). Problems did occur because human and financial resources were not
reallocated to the general hospitals as individuals were discharged from institutions. More
importantly, the closing and downsizing of institutions was achieved without allocating
adequate funding at the community level to provide for psychological support and
rehabilitation. The establishment of new community-based services did not keep pace with
deinstitutionalization. However, many newly discharged patients received inadequate care in
the community though services were stretched beyond capacity. Unfortunately, this is still
the case today. Chronic under funding and allocation of resources has historically been a
problem in the mental health system. Communities were not prepared to make all the
necessary support available to individuals in need. This resulted in a high frequency of
relapse and ultimately increased readmission rates to hospitals; the "revolving door

A RIGHT TO HOUSING

11

syndrome." Patients, after readmission to hospitals, were discharged back to inadequate care
in the community, only to become ill again, resulting in an increase in homelessness, along
with an increase in criminal behaviour and incarceration.
The second phase focused on the need to expand mental health care into community
and to provide supports to individuals with mental illness and their families. In this phase,
provincial governments began to fund mental health services outside of the hospitals.
Services such as education were provided by community-based mental health organizations
and agencies. In addition, there was a focus on an extensive array of community support
services such as income support, rehabilitation, and housing. During this phase, proponents
of community care were pitted against facility-based care and hospitals were seen more as a
problem than a solution. Unfortunately, we are still seeing this happen today. Additionally,
provincial governments became less involved with professionals and focused on consumers
and their families (Wasylenski, 2001). By the end of the 1980s, although mental health
services and supports existed in most provinces of Canada, these were not well integrated.
In the third and current phase, the emphasis tends to be on integrating the various

mental health services and supports within communities and enhancing their effectiveness
(Wasylenski, 2001). This phase is marked by increasing reliance on empirical research or
evidence based research and a trend towards adopting the best practices frameworks by
policy makers, professionals, consumers, and families.
The rationale for pursuing deinstitutionalization, which combined elements of
idealism and pragmatism, reflected justifiable concern for the well being of mentally ill
persons, many of whom were living miserable lives inside institutions (Bachrach, 1993). This
rationale encompasses several critically important assumptions. First, it was widely, even

A RIGHT TO HOUSING

12

passionately, assumed that community-based care would be intrinsically more humane than
hospital-based care (Bachrach, 1976). Second, it assumed that community-based care would
be more therapeutic than hospital-based care (Bachrach, 1978). Third, it was further assumed
that community-based care would be more cost effective than hospital-based care
(Bebbington & Thomicroft, 1989). It is unfortunate that plans were carried out based on
assumptions and not based on empirical data or research.
However, these assumptions have never been tested empirically, and there has been
cause over the years to question their validity (Kovaleski, 1993). We have begun to realize
that community care may indeed hold the potential to be more humane and more therapeutic
than hospital care; however, this promise cannot be realized unless comprehensive services
for the most severely mentally disabled persons are mandated and adequate resources are
provided to ensure the implementation of these services (Geller, 2000).
The evolution of community mental health support services has many facets. The
underlying theme, however, is the idea that long term hospital care is not the best method
with regard to either cost effectiveness or rehabilitation for most people with mental illness.
The community mental health movement places a huge emphasis on the empowerment of
people with serious mental health issues and on affordable, safe housing and supports with
each person's community.

Housing for People with Serious Mental Health Issues
The Universal Declaration of Human Rights states "that everyone has a right to an
adequate standard of living, including housing" (UN, 2009, p. 2). Unfortunately, in Canada,
housing is not recognized as a right; it is a commodity that is bought and sold in a market

A RIGHT TO HOUSING

13

system. This system fails to meet the enormous housing demands of those who are unable to
afford the market rates.
Housing stability is an on-going issue for people who are living with low incomes or
paying a large proportion of their income on rent. Stable housing is essential to individuals
with a mental illness. The alternative is that their mental wellbeing deteriorates. Carling notes
(1995, p. 87) that "relapse is a reality in living with a psychiatric disability." In communities
where there are strong support services, relapse is not as disruptive to an individual ' s life as it
is in communities where support services are unstable or nonexistent.
The cost of housing is not the only factor in secure tenure for people with serious
mental health issues. There are different types of supportive and supported housing for
individuals, and a logical connection can be made linking the individual ' s choice between the
types of residencies and stability. For example, if a person is told to live in a residential and
supported environment, it can be said that this arrangement is not as stable as compared to
someone who has the ability to choose the type of residence he or she may desire. Choice is
inextricably linked to stability, and stability in turn, to mental health. People living with a
mental illness should have choice and stability in their housing.
There is evidence to support the importance of decent, affordable, and safe housing,
associated with proper supports, in improving community integration and quality of life for
people with serious and persistent mental illness (CMHA, 2005). If the permanent housing
needs of this population are not addressed in both policy and practice, their situation will
deteriorate. Having already established the importance of choice and stability, I will examine
the types of community-based housing that exist for people with mental illness. The process
and outcomes that lead to community integration and improved quality of life will be

14

A RIGHT TO HOUSING
discussed in the context of different housing styles. Horgan, Nelson, and Parkinson ( 1998)
propose three types of housing. They are custodial, supportive, and supported. In Prince
George, we have the following:

Table 1: Current Types of Housing
Custodial

Supportive

Supported

Housing

Boarding Home (1)

Iris House
Urquhart House

Subsidized Independent
Living Place (SILP)

Support
Provided

24-hour care

24/12-hour care.

Consumers live on own

Some recreation
provided

Vocational
rehabilitation provided

Life skills are provided.
Vocational rehabilitation
& recreation provided

Staff has control in
the house

Staff and consumers
work together

Consumers choose
services they wish

Empowerment

Custodial Model
The supportive housing strategy in Ontario was an approved homes program
launched in the 1930s (Simmons, 1990). Approved homes were based on foster care and
boarding home models, privately operated. They were not designed to offer mental health
rehabilitation: rather supervised housing. Paid staff was responsible for meal preparation,
medication dispensing, and cleaning.
The inadequacies of custodial housing models are well known. For example, Baker
and Douglas ( 1990) and Ballantyne et al. ( 1993) have said that people with serious persistent
mental health issues prefer the freedom of the streets to living in a restrictive custodial
setting. The focus of these for-profit homes is often long term care, not rehabilitation.

A RIGHT TO HOUSING

15

Supportive Housing

In the late 1960s, a movement towards community development and services for
individuals with mental illness began (Simmons, 1990). CMHA (2010) suggests that the
fundamental difference between custodial and supportive housing is that the latter empowers
and rehabilitates individuals within the residential environment. Supportive housing presents
a continuum of residential facilities, with residents graduating from homes with high
supports, such as Iris House in Prince George, to ones with lower supports, such as Urquhart
House, as their condition improves. The desired end to this housing system is to see residents
graduate to live independently with flexible, individualized supports. Supportive housing is
run by non-profit agencies and staff members are usually trained in rehabilitation. In Prince
George, staff is comprised of trained life skill workers whose goal is to provide assistance in
teaching/assisting individuals with activities of daily living. In Vancouver, this type of
housing was adopted by Vancouver City Council on June 6, 2007. The housing was to be
scattered throughout the city, located to support the geographic balance (VRHA, 2007).
There is extensive evidence that would suggest that supportive housing provides
positive outcomes and is cost effective. In a document by VCHA, (2002), it suggests that the
following are positive outcomes of supportive housing:
(1) reduction in emergency room visits by 32 percent and hospital beds by 57 percent;

(2) reduction in symptoms for conditions such as schizophrenia and psychosis;
(3) increased residential stability with people staying in one place longer;
(4) increased consumer satisfaction;
(5) increased independence and empowerment.

A RIGHT TO HOUSING

16

The report also suggests that this type of housing is cost effective:
(1) saving of $6000 per person per year from $42,400 for those that are homeless;
(2) savings of $950 per day in hospital bed use.
Having said that, there still exist barriers to community-based mental health housing
such as the Not In My Back Yard (NIMBY) Syndrome.
Dear (1992, p. 288) defines NIMBY as "the protectionist attitudes of and oppositional
tactics adopted by community groups facing an unwelcome development in their
neighbourhood." There appears to be a perceived threat of lowered property values, issues of
neighbourhood security, and community character. With the move toward a supported
housing model in community mental health, an escape from NIMBY is conceivable.

Supported Housing
In the 1990s, supported housing emerged. This newer model ' s focus is on personcentred support, self-help, and natural supports with a de-emphasis on professional service
(Horgan, Nelson, & Parkinson, 1998). This is the first model which moves away from the
medical model of community residential housing. The impetus behind supported housing is
that, by empowering people to choose, obtain and maintain the housing and supports they
want, they will experience their residence as a home rather than housing (Carling, 1993).
The goal of custodial, supportive, and more recently supported housing has always
been deinstitutionalization and integration of individuals with serious and persistent mental
health into the rest of the community. All of these models of housing operate today; however,
supported housing is emerging in popularity.

17

A RIGHT TO HOUSING

It is important to note, that none of these housing models will be effective if there are

no supports in place such as financial assistance, qualified staff, and appropriate location of
the housing (Simmons, 1990).
Best Practices in Mental Health Housing

The Healing path has Pot Holes Too!
Rupert Ross, 1996, p. 283
In 1997, the Best Practices in Mental Health Reform was published and has since
been the standard reference for guidance to mental health agencies and planners. This
project, which included officials from Health Canada and the provinces and territories, was
funded by the FederaVProvincial/Territorial Advisory Network on Mental Health. The health
systems research unit (HSRU) of the Clark Institute of Psychiatry was commissioned to
complete the project.
This report indicated that, over the past decade, there has been a shift from residential
custodial models of care to supported housing. Research findings summarized from HSRU
show that:
(1) supported housing is preferred because it allows for choice;
(2) it can serve a variety of people including the homeless;
(3) assertive case management can successfully support individuals in various
housing situations.
The evidence suggests that supported housing should be the first choice of housing
option rather than residential care. Residential care should be considered as a "flow through"
to prepare for future supported housing (Ross, 1996). In recognizing this, planners and policy
makers warn not to embrace supported housing simply because it is the most cost effective

A RIGHT TO HOUSING

18

thus re-directing saving away from the mental health system, and in doing so, under funding
the support component of the supported housing model. This would be a repeat following
deinstitutionalization.
While supported care has been identified as a best practice, there is still a need to
develop a continuum of housing that provides a selection of models and levels of supp01i.
This allows individuals to find the most suitable housing based on their needs.
There are several challenges to providing housing and support to those individuals
with a severe and persistent mental illness. A number of literature reviews and focus groups
have explored related issues (Anderson & Burt, 2005). The conclusions to these st4dies
highlight a wide range of challenges which can be summarized in three sections;
organizational/community challenges, personal issues and/ or limitations, and systemic
challenges.
1) Community and organization challenges include:
•

Waitlists that require regular updates from the applicants in order to retain
their place on the list;

•

The length on the waitlist (often more the one year);

•

Rules that ban individuals from using certain services, resulting in
homeless people with complex mental health and addictions problems
being unable to obtain help;

•

Restrictive rules about having pets, overnight guests or substance use.

2) Personal issues and/or limitations include:
•

Not having a social support system;

A RIGHT TO HOUSING
•

Lacking income or being unable to keep employment;

•

Language and cultural differences;

•

Individuals not having access to a phone;

•

Aggressive and violent behaviour.

19

3) Systemic challenges include:
•

There are long wait times for subsidized units;

•

Homeless individuals have reported facing barriers getting onto waitlists and are
disadvantaged when there is no local system for coordinating access to subsidized
units;

•

Individuals who are homeless require a broad range of services including housing,
health and mental health care, substance abuse treatment and social services. The
burden of coordination falls on the individual who is often ill- prepared to
navigate a fragmented service system.

In BC, the housing market is the highest priced in Canada (Frischmuth, Johnson, &
Morrow, 2006). This is important to note because individuals with a mental illness who are
receiving disability benefits have limited amounts of money each month and cannot afford to
pay the high costs of rent. Rental costs for houses and apartments were especially high in the
wake of the 2010 Olympic and Para Olympic Games. Individuals on disability benefits
receive $375 per month for shelter. This payment does not come close to meeting the rental
costs and forces many people to reside in unsafe housing (Goldner, 2002). Best Practices
recommended that individuals with mental illness be entitled to a subsidy similar to the
Shelter Aid for Elderly Renters (SAFER) program (Goldner, 2002). The Shelter Aid for
Elderly Renters helps make rent affordable for BC seniors with low to moderate incomes.

A RIGHT TO HOUSING

20

SAFER provides monthly payments to subsidize rents for those who are age 60 and older.
The program reimburses part of the difference between 30 percent of total income and rent
(Mental Health Reform, 2002).
Housing is fundamental to the health and vibrancy of our communities. An ideal
housing market would provide affordability and choice for individuals in all income groups.
The supported housing model nonnalises the housing experience of people with
serious and persistent mental health and, as a result, much of the stigma and social
marginalization associated with group homes can be eluded.
Homelessness

We have weapons of mass destruction we have to address here at home.
Poverty is a weapon of mass destruction. Homelessness is a weapon of mass
destruction. Unemployment is a weapon of mass destruction. (Dennis
Kucinich, 2006)
Many people think of the homeless as a relatively homogeneous group largely
composed of older, alcoholic, and vaguely "crazy" men. However, this image does not
correspond to the current composition of the homeless population. The pictures that we now
see are women, children, youth, immigrants, and those with a mental illness. Caring for a
mentally ill person has become one of the greatest challenges to mental health service
providers and to society in general (Bachrach, 1987). Homeless individuals who have
psychiatric disabilities and concurrent substance addictions constitute an extremely
vulnerable population (Wright, 1990). The vulnerability is evident among persons who are
living on the streets, carrying their bundled belongings, sitting in transportation terminals,
and huddled in doorways or other public spaces (Wright, 1990).

A RIGHT TO HOUSING

21

Aside from poverty and changing housing markets, illness itself, particularly poor
mental health, can precipitate homelessness. In much of the literature on homelessness, the
common themes appear to point at deinstitutionalization, unstable housing, inadequate
discharge planning and community follow-up, lack of affordable housing, changing
economic factors and inadequate mental health services as the catalyst for homelessness.
A study done by the Mental Health Policy Research Group (1997) found that only
3 percent of those interviewed lost their housing because of mental illness. This makes sense
that mental illness by itself would not be a direct cause of homelessness. However, mental
illness does limit one ' s ability to work and earn a decent living. In today's rental market,
social assistance and housing allowances such as the Subsidized Independent Living Program
(SILP) are insufficient for meeting the rising of costs of housing. The plight of people with
mental illness is not unlike other disadvantaged groups like single parents. There is simply
not enough income, supports, and housing available (Dietrich, 1999). What distinguishes this
population from the others is that without adequate mental health supports, the risk of losing
their housing increases.
There are varying degrees ofhomelessness. Therefore, the United Nations has
categorized the variances. These two categories are absolute homelessness and relative
homelessness. According to the United Nations, "absolute homelessness" is described as the
condition of people without physical shelter who sleep outdoors, in vehicles, abandoned
buildings, and other places not intended for human habitation. "Relative homelessness" is
described as the condition of those individuals who have shelter but do not meet the basic
standards for safety and health (United Nations, 2004). "Homeless people" are referred to as
those who are sleeping in shelters and those who are "absolutely homeless" (United Nations,

A RIGHT TO HOUSING

22

2004).In the Hook magazine, an article entitled Northern Exposure: Prince George's

homeless services pushed to the brink, states that, in a town of 70,000, a one-day homeless
count was conducted by the Prince George Community Partners addressing homelessness.
The Partners found 375 homeless people. The same article described the 2007 report d by
NDP MLA David Chudtrovsky. He estimated the numbers to be around 1050 including
couch surfers and bush campers (The Tyee, 2009).
Shelters are a good starting point for estimating the number of homeless people in
Canada (Population Census, 2006). Census data suggests that about 8000 homeless people,
that is, five per 10,000, are sleeping in shelters each night (Wright, 1995). Having said that,
shelter counts typically underestimate the true number of homeless people. These counts do
not account for those sleeping on the streets or in cars.
In Vancouver, as many as six hundred homeless people, or three per ten thousand, are
possibly sleeping outside every night (Hwang, 1998). In Toronto, Goldens (1999) concluded
that between 30 and 35 percent of homeless people are living with mental illness.
Homelessness remains a persistent phenomenon, but its characteristics have changed
considerably over the years. Controversies continue regarding how the homeless should be
defined and their numbers counted, but the changing composition of the homeless population
is not in doubt. In Prince George, families and individuals are working diligently towards
breaking the cycle of homelessness and poverty by getting assistance from the government of
Canada. With more than 20 communities across British Columbia joining with the provincial
government to recognize Homelessness Action Week, it is hoped that more partnerships will
be created to find solutions so that individuals will have an opportunity to access safe, secure,
and affordable housing. I am unclear as to whether or not this will be a yearly event.

A RIGHT TO HOUSING

23

An article written in the Human Resources and Social Development website entitled

Th e Government of Canada delivers support to help those who are homeless in Prince
George (2009), states that the government is delivering on promises to help those who are
homeless or at risk of becoming homeless by providing funding for transitional housing and
support services such as alcohol and addictions counselling. The article also states that a
Homelessness Partnering Strategy (HPS) was formed to provide $269.6 million over the next
two years to prevent and reduce homelessness in Canada. The government's main objectives
are the Homelessness Partnership Initiative, the Homelessness Accountability Network, and
the Surplus Federal Real Property Homelessness Initiative. So how does this affect Prince
George? The HPS provided $93,015.00 in funding for transitional housing and supports to
the Native Friendship Centre (March 2008). As well, they provided $120,178.00 in funding
for the expansion of services to St. Vincent de Paul Society Drop in Centre. This money
provides daily meals to 300 people, 100 emergency food hampers and assistance with
employment, life skills and social services (January 18, 2008).
A news release from the Ministry of Housing and Social Development stated that the
provincial government and community partners teamed together to provide a 30-unit
apartment building for adults who are homeless and are working at managing their mental
illness and addiction issues. The Friendship Lodge is operated by the Prince George Native
Friendship Centre Society in conjunction with community partners such as N orthem Health
(September 12, 2008).
The prevalence of mental illness and concurrent disorders among homeless people is
hard to determine precisely, but consistent patterns have emerged from rigorous studies that
have been conducted in Canada and the United States (CMHA, 1998). Contrary to popular

A RIGHT TO HOUSING

24

misconceptions, only a small number of homeless people have schizophrenia. The prevalence
of schizophrenia is only six percent among Toronto 's homeless, while a report conducted by
Barbara Schnider and Jeanette Waegermars Schiff (2007) indicates that there is a seven
percent prevalence rate of schizophrenia among the homeless population in Calgary. There
are more homeless mentally ill men than women; however, women with schizophrenia and
who are homeless outnumber men with the same disorder (North, 1993).
Alcohol and drug abuse is considered the most prevalent health condition among
today' s homeless. Problems with alcohol are six to seven times more prevalent among
homeless people than in the general population (Breakey & Fischer, 1991). Introduced in the
mid-1980s, crack cocaine was much cheaper than alcohol and other "hard" drugs and offered
an intense but short "high ." Its low price and easy availability made it a popular drug (Adlaf
& Smart, 1991). In a longitudinal study of 1,399 homeless adults in California, it was

reported that, while 45 .6 percent had no medical or psychiatric illness upon becoming
homeless, 9.3 percent of these became excessive users of alcohol; 4.4 percent became users
of illegal drugs; and 0.9 percent were hospitalized in a psychiatric facility within 12 months
(Winkleby & White, 1992). A 1992 survey of Ottawa street youth notes that drug use was 14
times higher among street youth (Adlaf & Smart, 1991 ), and that nearly 90 percent of street
youth reported either drug or alcohol problems. In Canada, more specifically in Ottawa,
among 160 persons using shelters or drop-in services, 36 percent had some form of mental
illness. Among those over 65, this soared to 66 percent ( Adlaf & Smart, 1991). As a student
who works in the area of mental health, it is evident through work with clients or disclosures
by individuals themselves that many people who use alcohol or drugs are treating their own

A RIGHT TO HOUSING

25

symptoms. Further, the late teen years to early adulthood is a time period when individuals
may be affected with the onset of psychosis.
Psychosis is a brain disorder that manifests as a loss of contact with reality. The main
symptoms of psychosis include hallucinations, delusions, and/or disorganized thinking. The
onset of illness, severity of illness, and propensity for relapse are viewed as the results of an
interaction of one or more environmental stressors with an inherent biological vulnerability
that has arisen as a result of genetic predisposition, or of pre- and peri-natal factors (Bilsker,
Garvin, Goldner, & Parikh, 2000). Addington and Linszen (1998) state that stressors can
include drug use and situational life stressors. Drug use frequently appears as a factor
associated with the first episode and with relapse.
Homelessness, which is a focus of increasing concern in Canadian cities and on an
already overburdened health care system, has important health implications. Individuals may
suffer from a wide range of medical problems. Disease severity can be remarkably high
because of factors such as extreme poverty, delays in seeking care, non-adherence to therapy,
and cognitive impairments (Wood, 1992). Medical problems that are particularly prevalent
among homeless adults include seizures, chronic obstructive pulmonary disease, and arthritis
(Crowe & Hardill, 1993). Conditions such as hypertension, diabetes, and anaemia are often
inadequately controlled and may go undetected for long periods. Skin and foot problems are
frequently seen as well. People living on the street are prone to develop skin diseases such as
cellulitis, impetigo, venous stasis disease, and body lice (Moy & Sanchez, 1992). Homeless
people are at risk of contracting tuberculosis (TB). Conditions favouring outbreaks in shelters
include crowding, large transient populations, and inadequate ventilation (Barr, Earth, Nolan,
Risser, & Saeed, 1991 ). Common risk factors for HIV infection in homeless youth in Canada

A RIGHT TO HOUSING

26

include prostitution, multiple sex partners, inconsistent use of condoms, and injection drug
use (King, Radford, & Warren, 1989).
The homeless have high levels of morbidity and mortality and may experience
significant barriers to healthcare. They may also have high levels of health care use
(Andrews, Padgett, & Struening, 1995), and most of their care is obtained in Emergency
departments of hospitals (Andrews, Padgett, Pittman, & Struening, 1995). Homeless people
are admitted up to five times more than the general population to the hospital resulting in
higher health care costs (Hartz, Kuhn, Mosso, Salit, & Vu, 1998). Unfortunately, they are
sometimes discharged to shelters, even when their ability to cope in such a setting is marginal
at best.
Homeless people face many barriers to accessing health care (Stark, 1992). In the US ,
lack of health insurance is a problem, while in Canada, although there is universal health
insurance, many people do not possess proof of coverage as their ID has been lost or stolen
(Hwang, Sullivan, Svoboda, & Windrim, 2000). In Toronto, homeless people report having
been refused health care because they do not possess health insurance cards (Crowe &
Hardill, 1993). In addition, many homeless people (up to 7 percent), do not fill prescriptions
as they do not have insurance benefits and they cannot afford to pay directly for medications.
This is still a problem faced by many homeless people today.
Homeless people face other barriers to health care that are unrelated to health
insurance. For those who are homeless, daily struggles for the essentials of life are in the
forefront. Competing priorities may impede adults from accessing health care services,
particularly those perceived as discretionary (Anderson, Gallagher, & Gelberg, 1997).

A RIGHT TO HOUSING

27

The health care system fails to adequately provide treatment to those with a mental
illness who are homeless. Service providers describe enormous difficulties in engaging
homeless mentally ill persons who are living on the streets (Cohen & Thompson, 1992).
Conflicting agendas between service providers and those experiencing homelessness is most
often the problem. Interventions today range from persuasion, such as service providers
offering to buy the person a cup of coffee as a way to develop rapport and trust, to a
prolonged period of outreach (Keyes, 2002), to involuntary transportation to the psychiatric
hospital (Cohen & Marcos, 1986). Some researchers argue that this population rejects
services because of distrust and frustration with the still fragmented mental health and
addictions services, which lack coordination and are unable to meet their needs (Assmussen,
Beatty, & Romano, 1994).
Some survey studies have shown that those who are homeless have different
perceptions of their service needs than do service providers (Dattalo, 1990). Homeless
individuals believe that their basic needs should be a priority, whereas even today, service
providers focus on their mental health needs (Martin, 1990). Consequently, service providers
are not servicing this population well.
The Aboriginal population presents some difficulty as well. In addition to facing
racism, Aboriginal persons may be unable to discuss their health problems with mental health
professionals because of a language barrier; they may lack access to trained Aboriginal staff;
and they may find programs culturally inappropriate (City of Calgary, 1996). This population
also experiences many of the factors discussed above; however, one must explore the
historical and colonial legacy that has destroyed families, communities, and an Aboriginal
way of life (SPARC-BC, 2006). Aboriginal peoples are over-represented in low income

A RIGHT TO HOUSING

28

groups; for example, 41 percent of registered Indian families are at or below the low income
cut-off rate (United Native Nations, 2001). Furthermore, with a younger population than the
general population, unemployment is higher. The roots of Aboriginal homelessness also lie in
the multi-generational experience of residential schools, and economic and social
marginalization from mainstream society (SPARC-BC, 2006).
Despite such findings, mental health programs, especially those involving housing,
have not been characterized by consumer-driven service approaches. As a social worker who
is currently working with mental health consumers, I believe that stigma is one of many
reasons why consumers are not participating in developing programs to serve their needs.
Stigma reduces consumers' access to recent resources and opportunities and can lead to
isolation and hopelessness. The Mental Health Commission of Canada (2009) discusses at
length how discrimination and stigma will prevent someone from accessing services they
need and deserve. Discrimination can occur at both the mental health and broader care
systems. For example, research has shown us that individuals with a mental illness do not
receive the same quality of health care as those without a mental illness (Doebbeling,
Malone, & Mitchell, 2009). Stigma and discrimination of all kinds are often anticipated by
people with a mental illness, and are among the key barriers that keep many people who
could benefit from help from seeking it. This is referred to as self-stigma.
Homelessness for most people generally consists of a short stay in a shelter or
transitional house, where such services exist, where they can recover economically and
personally (City of Vancouver, 2005). For those who are unable to recover stable shelter,
living on the streets is typically only one of the many subsistence patterns, including shelters,
hospitals, staying with friends, and rooming houses, that occur over a period of time.

A RIGHT TO HOUSING

29

Homelessness places enormous strains on communities across BC. In urban and semiurban centres, homelessness is highly visible and affects many business areas (Hume, 2006).
In major cities such as Vancouver and Victoria, business and tourism report losses; and with
the homelessness population expected to triple by 2010, many officials were concerned with
this in the wake of the Olympics. It is estimated that businesses such as hotels have lost
contracts due to increased homelessness and visible poverty (Hume, 2006).
Having established homelessness is an important concern in mental health, the question
remains how best to provide housing. The answer given in the Best Practice guideline
suggests "a wide variety of housing option and supports be provided" (HSRU, 1997).

Mental Health and Housing Policy
In September 2004, the premier of British Columbia announced the formation of the

Task Force on Housing and Mental Illness at the Union of British Columbia Municipalities
annual convention. The mandate of the task force is to develop strategies on moving away
from shelters and to look at long term housing as a solution (BC Housing, 2004).Under the
Canada and BC Affordable Housing agreement, federal and provincial governments matched
funding which allowed the task force to provide five hundred and thirty three new housing
units.
In October 2006, the province of BC announced Housing Matters BC, a housing
strategy which provides assistance to those in greatest need for safe, affordable housing. The
province allocated 750 new supportive housing units under the provincial Homelessness

Initiative. The task force also broadened its original mandate to include perspectives of
smaller communities and regions trying to cope with the rise in homelessness (BC Housing,
2006).

A RIGHT TO HOUSING

30

BC Housing was created in 1967 through an Order-in-Council under the Housing Act
to assign in fulfilling the government commitment to develop, manage, and the
administration of subsidized housing (BC Housing, 2004 ). BC Housing works with several
partners including non-profit housing provider, the private sector, as well as other levels of
government, health authorities, and community agencies, to create more affordable housing.
Several initiatives have been underway to address the glaring gaps within the housing
continuum. For example, the administration of the emergency shelter program was
transferred from the Ministry of Employment and Income Assistance (MEIA) to BC
Housing. The objective was to create an integrative system of housing and support. In
addition, administration of federal housing has been redelivered to BC Housing allowing for
a smooth transition of various programs and reducing the administration burden on housing
providers (BC Housing, 2004).
Canadian Mental Health Association (CMHA) received funding from MEIA to
deliver outreach services to individuals with mental illness who are homeless in eight
communities throughout BC for the year 2006-2007. Outreach workers engaged individuals
to connect to income assistance, housing, primary care, and mental health services and
supports.
Based on the Kirby Commission Report (2006), the federal government has
agreements with the provinces and territories to share the cost of building new affordable
housing as well as to the provinces for rental supplement to low income earners, through the
Affordable Housing Initiative. Having said this, the federal government does not have any
housing programs to meet the glaring needs of those with a mental illness.

31

A RIGHT TO HOUSING
Chapter Two
Practicum Research Plan

Housing ranks as a priority concern of individuals with serious mental illness and
professionals that work with them. Locating affordable, decent, safe housing is often
difficult, and out of financial reach (US Department ofEducation, 1998). The same can be
said in Canada. Having a pre-existing mental illness or substance abuse problem often
restricts people's options to access, afford, and maintain the very kind of help that would
help promote recovery (BC Housing, 2005).
The actual proportion of people with severe mental illness who lack affordable and
decent housing has not been assessed directly. Yet, one could imagine that this might be a
serious problem. In 1994, the US Department of Housing and Urban development (HUD)
reported that half of all low income disabled residents, including those with a mental illness,
have "worst case" needs for housing assistance. Furthermore, it was reported that most of
these people live in inadequate housing (US Department of Housing and Urban
Development, 1994; US Department of Education, 1998). In Canada, there have been many
attempts to research and measure how many low income families or individuals are without
affordable housing. However, the findings have not been conclusive due to the low response
rates to the research. Having said that, the TD Bank posted their findings in January, 2007
which indicated that "1.7 million households in Canada, or about one in five , could not find
adequate and suitable housing without spending 30% or more of their pre-tax income"
(CMHC, 2007 ). The report went on to further say that there are currently 14,000 households
in BC on the provincial wait list for affordable housing. A study was conducted in Toronto,
which looked at the total number of patients admitted to a general hospital for treatment but

A RIGHT TO HOUSING

32

who were also homeless. Authors Hay, Hopper, Jost, and Welburg (1997) concluded that,
within one year, 330 patients admitted to general hospitals were homeless. This number
represented two percent of the total psychiatric admissions to general hospitals in Toronto.
Deinstitutionalization has led to the need for more community housing but the
residential programs that were developed were essentially replicated institutional programs
(Carling, 1989). Residential programs proved to be ineffective in meeting consumers' needs
as they did not provide any rehabilitation in te1ms of vocational rehabilitation, recreational
therapy, or support groups. Moreover, living in such programs added to the already rampant
stigma. As a result of these shortfalls, greater emphasis has been placed on conventional
housing, supplemented by appropriate assistance tailored to individual needs (Gordon, King,
Livingston, & Srebrik, 1995). This new concept, called supported housing, moves away from
"placing" clients, grouping clients by disability, staff monopolizing decision making, and use
oftransitional settings (Carling, 1989; Letiman & Newman, 1996). Instead, supported
housing focuses on consumers having a self-chosen permanent home. Even if they become
ill, such housing ensures they will have a home to return to that is integrated into the
community, and encourages skills development and empowerment.
Much of the type of housing needed for those with a serious and persistent mental

health problem has been decided by individuals who work in management, government, or as
health professionals. For the purpose of the research component of my practicum, I tried to
discover what people living with a mental illness feel they need in terms of their own
housing. I used the following approach to attain the information.

A RIGHT TO HOUSING

33

Methods
Quantitative research is defined as "the numerical representation and manipulation of
observations for the purpose of describing and explaining the phenomena that those
observations reflect, "and qualitative research is described as "the non-numerical
examination and interpretation of observations, for the purpose of discovering underlying
meanings and patterns of relationships" (Babbie, 1992, p. 6). Reviewing these definitions of
what is meant by quantitative versus qualitative research has helped me focus on the types of
methods I have used for my research: Specifically, I have incorporated aspects of each
method in order to provide the most useful results.
For the purpose of my research, I did a primarily quantitative, descriptive survey. The
study provides information on the demographics of the individuals with mental illness
participating in the survey as well as the type of housing they currently have and that they
would like to have access to. However, in order for me to capture additional input that might
not be captured through close-ended survey questions, I incorporated open-ended questions
at the conclusion of each question to allow for additional responses.
The type of study I conducted was descriptive. Descriptive research makes no
attempts to change behaviour or conditions. Things are measured as they are. For example, in
my survey, one of the questions I ask is: Have you ever been evicted from your home? Yes
or No and if Yes, Why? I am attempting to describe if and why a person may have been
evicted from their home. The study is a cross-sectional study to which the variables of
interest have been evaluated and the relationship between them is determined at one point in
time (Hopkins, 2000).

34

A RIGHT TO HOUSING

Sample
The participants are adults over the age of 19 and include both male and female
subjects. Participants were sought from among those clients accessing services through the
Community Outreach Assertive Service Team (COAST) in Prince George. Potential
participants were identified by five COAST case managers and all had been diagnosed by a
psychiatrist with an AXIS 1 diagnosis of Bipolar Disorder, Schizophrenia, or Delusional
Disorder. Potential participants were assured that participation was completely voluntary and
that non participation would in no way impact the services they receive. Housing is very
important to those with a mental illness and at the time of my research there seemed to be
very high level of interest among consumers in Prince George about my Project. At least, two
hundred and fifty individuals had access to the survey via their case managers and
approximately one hundred more had access via the Connections Clubhouse (a club house
run by consumers for consumers and their families and friends) , and the Activity Centre for
Empowerment (ACE), an activity centre for consumers, families, and health professionals.
As stated previously, there were 350 consumers being served by the COAST team. I
anticipated a good response rate of at least 200 participants for my survey.

Survey Tool
For the purpose of this study, a survey questionnaire, which consists of both closed
(Yes/No) and open-ended questions (Why/Other), accompanied by a letter of explanation,
were available to the sample of potential participants as described above. The letter of
explanation and the survey can be found in Appendix A. The survey entails questions that are
primarily quantitative but with a qualitative component which will allow for more complete

35

A RIGHT TO HOUSING
and thorough responses. An example of the type of question being asked on the survey is:
Have you ever been evicted from your housing? Yes I NO If Yes, Why?

Procedure
As described previously, I chose three separate locations from which to conduct the
survey. Prior to commencing the survey, I conducted a pre-test at a consumer and family
meeting. These meetings are held bi-weekly or more often if the need arises. The feedback
from this meeting was used to make any needed adjustments to the survey prior to the actual
launch. The first location to make the survey available was at the Northern Interior Health
Unit on the third floor in the Mental Health office. Consumers who came in for their
appointments with their doctor or case managers were able to participate in the survey. The
second location to conduct the survey was at the Connections Clubhouse. This is a clubhouse
run by mental health consumers for consumers and their families and friends. The third
location was the Activity Centre of Excellence (ACE). As mentioned earlier, the centre is
open to consumers, family members, and health professionals and provides activities such as
playing pool, video night, and computer access. At all of the locations, a case manager or
physician was on site to encourage those individuals about the opportunity to complete a
survey regarding their housing needs. At the same time, all potential participants were
assured that participation was completely voluntary.
Prior to conducting the survey, I advertised at each location at least two weeks in
advance by posters as well as attending a meeting at each location to talk about the survey
and its importance to the consumers.
Once the survey was underway, I was on-site to answer any questions that came up.
Participants were asked to complete the survey on their own. Each was able to take a survey

A RIGHT TO HOUSING

36

out of a drop box and use one of the pens provided to answer the questions. I informed
participants that they should read the cover letter prior to starting the survey and that I was
available to answer any questions. Once they read and understood the reason for conducting
this type of research, participants began answering the questions. When they completed the
survey, they were asked to fold the survey in half and place it into the drop box. There was
no remuneration for participating in this research. For individuals who had literacy barriers, I
was available to provide assistance. The survey was available over a one-week period. I spent
two days at each site, which allowed for maximum participation by consumers. At each site,
there was a drop box where consumers could place their completed survey. This drop box
was emptied at the end of each day and the surveys stored in a locked filing cabinet in my
locked office at work.

Ethics
Having first read the cover letter (Appendix A) and completed the informed consent
sheet (Appendix B) as well as having any questions answered, all participants agreed
voluntarily to participate in the research. The cover letter explained that each person could
withdraw from the research survey at any time without having any impact on the services
they receive from Northern Health. Participants who may have required additional
counselling/therapy due to the emotional distress arising from the research were referred to
their clinicians/case managers for additional support. It is important to note that the research
components of this practicum proposal were submitted to both the UNBC and Northern
Health Ethics Boards and received approval.
There was no remuneration given the participant to complete the survey. To ensure
anonymity and confidentiality, the cover letter stated that the participants should not put their

A RIGHT TO HOUSING

37

names anywhere on the survey. All information from the survey was transferred to a
password-protected electronic data file and hard copies are stored in a locked filing cabinet in
the locked office of the researcher and may be kept for up to seven years. On or before the
time limit is up, hard copies will be shredded and disposed of, and electronic files deleted
according to UNBC REB policies.
Data Analysis
I undertook a primarily quantitative data analysis. Quantitative responses to the
survey were entered into a statistical software package called SPSS (Statistical Package for
Social Sciences). Data was organized in a spreadsheet format and descriptive statistics
calculated. Specifically, responses to the quantitative questions were tallied and frequencies
and percentages are provided.
I did not receive any written qualitative feedback from any of the participants and
therefore had no data from which to identify qualitative themes. This was unfortunate and
unexpected. As a result, I did not collect any information that would allow me a more in
depth look at their living situation, or how they thought a change in their living situation
might affect them. For example, my research data shows that 48 percent of those identifying
as having a mental health disability would choose to live in an apartment but it does not
speak to the kind of surroundings or geographical location a person might prefer. Had I
obtained some qualitative research feedback, it might have provided some of this
information.

A RIGHT TO HOUSING

38

Chapter Three
Data Results
Descriptive Statistics
As part of my practicum, research was conducted to identify the population in terms
of age, disability, and gender. As well, I wanted to reveal what type of housing was important
to individuals with a serious and persistent mental illness.

Table 2: Age Range and Mean Age
N
88

Minimum
19

Maximum
66

Mean
40.66

Standard Deviation
12.940

There are 88 participants, men and women, and the mean is= to 40.66. This means
that the average age of the participants was 40.66.
Table 3 (following) presents information on the variables of gender, disability, ever
homeless, living and housing arrangements, calculating both frequency and percent. Results
for the variable shows that there appears to be approximately 10 percent more men who
answered the survey then women- 55.7 percent of the participants were men; 44.3 percent
were women. There appears to be a pretty even split between Bipolar Disorder and
Schizophrenia. Results for the variable ever homeless shows that approximately one third or
34.1 percent were homeless at some point in their life. Approximately 43 percent of the
participants said that they prefer to live on their own while almost half- 48.9 percentprefer to live in an apartment.

A RIGHT TO HOUSING

39

Table 3: Demographics: Gender, Disability, Homelessness, Living Arrangements, and
Housing Types
Frequency

Percent

Male
Female
Total
Disability

49
39
88

55.7
44.3
100.0

Bipolar
Schizophrenia
Other
Total
Ever Homeless

39
40
9
88

44.3
45.5
10.2
100.0

Yes
Living Arrangements

30

34.1

Alone
With family
Roommates
Other
Total
Housing Types

55
17
13
3
88

62.5
19.3
14.8
3.4
100.0

House
Apartment
Town home
Duplex
Resident House
Other
Total

25
43
7
3

28.4
48.9
8.0
3.4
6.8
4.45
100.0

Gender

6

4
88

A RIGHT TO HOUSING

40

Table 4: Housing Preference According to Mental Health Diagnosis
House

Apartment

Town Home Duplex
2

Resident
Housing
2

Bipolar

11

22

1

Schizophrenia

11

18

3

4

1

Other

3

3

2

0

2

Other

Table 4 shows the types of housing that those with a serious and persistent mental
diagnosis would like. However, both people with schizophrenia and bipolar prefer to live
independently in an apartment.
Summary of Results
There are 350 individuals who are being served by the COAST team and 200 had an
opportunity to participate in my research survey. I was disappointed that only 88 people
participated (44 percent of possible participants). However, my supervisory committee has
pointed out that is actually a good response rate.
As the Literature Review indicated, people with a Serious and Persistent Mental
Illness (SPMI) want to be able to make the decision as to the type of housing and level of
support they might need. The results from my data clearly indicate that people with SPMI
prefer to live on their own with supports.

A RIGHT TO HOUSING

41

Chapter Four
Limitation of Research and Suggestions for Future Research
Limitations

A limitation of my research is the fact that if individuals wanted to participate in my
survey, that they had to come to one of the three sites as already described earlier.
Transportation is often a problem for this population, so, based on this, I may have missed
having some potential participants. As well, the size of the sample was considerably smaller
than anticipated. The results of my survey were solely descriptive and not inferential. There
were no qualitative responses which, had there been, could have provided a much clearer
picture of individuals living with a mental illness and their housing needs or wishes.
Future Research

An interesting direction for future research might include a qualitative analysis which
involves interviewing a group of individuals with a mental illness and who are struggling to
maintain their housing. By doing so, one would be provided with clear, in depth information
on the concerns, daily struggles, and future desires of individuals trying to maintain or have
access to appropriate, safe, clean housing.
Another direction for future research might be to compare and contrast the housing
needs for those who are mentally ill by interviewing policy and decision makers with those
who work with this population on the front line. Historically, decisions are made by those not
directly working on the front lines and who may not have worked the front lines for many
years. Historically, decisions are made by following examples of other regions and here in
Prince George, we follow what is being done in the south in bigger centres. This often does
not work in the north or in smaller northern remote communities. What does work is talking

A RIGHT TO HOUSING

42

to those individuals who have either direct experience (consumers) or with those who work
every day on the front lines and understand completely the needs and struggles of this
population.

A RIGHT TO HOUSING

43

Chapter Five
Investigating Housing in Prince George and Developing iPortal

In addition to the literature review and research, another aspect of my practicum
project was investigating housing availability in Prince George and devising a system in
which information about current housing availability would be more easily accessible. At the
same time as my practicum, Northern Health was coming up with a system that provided
information to all areas in Northern Health and hence, iPortal Project was first drafted
February 27, 2007 and the last revised version was submitted for approval May 11 , 2007. I
was able to create an iPortal for housing availability for clients with mental illness.
Purpose of iPortal

Northern Health has an intranet as a web-based service offering one single location to
access news, policies, procedures, forms, and other information and knowledge. This service
is referred to as the Northern Health iPortal.
Audience

In time, all Northern Health corporate services departments and clinical departments
will establish and maintain content in respective iPortal Areas. These are to be sponsored by
senior executives, managers, and department heads ofNorthem Health, and administered by
individuals within those departments.
iPortal Roles and Responsibilities.

The management and administration of an iPortal intranet Area Is shared between a
number of individuals within Northern Health, each of whom has specific roles and
responsibilities. On my site, the team site sponsor or manager assumes overall responsibility
for the site. This person is my direct manager, Donna Bernard. The site administrator, which

44

A RIGHT TO HOUSING
is myself, maintains the site, adds or removes web parts, and provides support to other site

members. The site contributors add content to any documents on the site including members
of my immediate team. In some cases, one individual may have more than one role or
responsibility.
Policies and Principles

To date, there is no Northern Health policy regarding iPortal. There are, however,
guiding principles that promote consistency with content within each site that must be
ensured. To accomplish this, content has been identified and is required for each site.
Mandatory content includes the purpose and objectives of the department, any news
pertaining to the department, and proper contact information. Standard layout is also
mandatory. Each site must be displayed in a consistent way on all respective iPortal areas.
The initial template for iPortal was generated by Northern Health ' s Information and
Technology Services (ITS) .
Laying the Groundwork for iPortal

As part of my practicum, over several months I visited apartment buildings in Prince
George and spoke to landlords -

at the same time collecting relevant data on the apartment

to be included in the housing iPortal site. This data included the name of the apartment, the
name of the landlord and phone number, address, apartment description, price of rent, utility
costs, and vacancies. Once all of the data was collected, a colleague and I came up with a
way of displaying this information within the mandatory layout features of iPortal. Each
apartment site and related information was then entered into iPortal to create a housing
database. As well, I included a general guide to housing for individuals with mental illness
who are currently students, and other websites for housing vacancies. I also provided a

45

A RIGHT TO HOUSING
general description of what Subsidized Independent Housing (SILP) is, and made a spread
sheet of all the consumers currently on SILP.

Figure 1: Screen Shot of Iportal Face Page

ST Housmg - Microsoft Jrltemet Etcp!orer provtded by Northern Health Authority

COAST Housing Database

Debbie · add blurb here

II ~ Home • COAST Hoosin••

I have included the face page to my iPortal site. Contacts and links are located to the
right of the screen while the site contents are located to the left of the screen. Case managers
on the COAST team can access this site at any time.
As previously described, the iPortal site was created to assist case managers on the
COAST Team so that they have easier access to current housing availability which in tum

A RIGHT TO HOUSING

46

saves them time and energy to use to focus on the other needs of the consumers who they
serve. Each case manager has been granted access to the iPortal site. They are able to access
housing by rental costs, area, or by other descriptions. Feedback from my colleagues has
been quite positive. To maintain the site, future students are given the role of updating
information and imputing it on to the site.

47

A RIGHT TO HOUSING
Chapter Six
Review of Practicum Objectives
1.

To become familiar with both private and public sector landlords within Prince
George.
This was the most time consuming part of my practicum as I physically went to

apartment buildings and met with landlords and introduced myself. During the course of my
conversations with landlords, I found myself providing some education about mental illness
as I found many landlords reluctant to rent to this population of people. In doing so, I feel I
have created a unique relationship between the landlords and myself and it has made it easier
for other case managers to approach landlords with regard to renting to individuals with a
mental illness. This was a very positive and practical outcome of my practicum work.
2.

To create a database of housing listings to utilized and continuously monitored by the
COAST team.
I was given a very unique opportunity to be a part of a new intranet web-based

service offered through NH. As described previously, this web-based service known as
iPortal was to provide information on a topic relevant to each department. I created a service
that provides information on current housing opportunities within Prince George. I provide
information on rent, utilities that are offered, the location, and safety. The site is updated
regularly by either future nursing or social work students.
3.

To conduct a housing survey amongst individuals currently receiving services from
the COAST team. The survey was to learn more about the need and the type of
housing individuals may require based on the outcomes of Objectives 1-2.

A RIGHT TO HOUSING

48

A survey was conducted among individuals over the age of 19 and who were
currently seeking services on the COAST team. The individuals were diagnosed by a
psychiatrist with an AXIS 1 diagnosis of Bipolar Disorder, Schizophrenia, or a Delusional
Disorder. Three separate locations were chosen to conduct the survey. The first location was
held at the Health Unit where individuals who were coming to see their doctor or case
manager had an opportunity to participate. Secondly, Connections Club House provided an
opportunity for club house members to participate in the survey. Thirdly, ACE provided the
final location for the survey. As described previously, my findings concur with what current
literature says: Individuals with SPMI have a desire to live independently rather than in a
custodial setting.
4.

To assist with the creation of new opportunities for supported housing for individuals
being served by the COAST team.
Augmenting my practicum work, I have also had the honour of sitting on a mental

health housing committee for the past eight years as part of my job as a case manager. In
doing so, I have had the opportunity to witness and participate in providing safe housing to
individuals who may be just moving out for the first time on their own or who have been
homeless. Along with providing housing opportunities, supports such as a life skills worker
have been provided to help maintain individuals in the community. As well, I have had the
opportunity to work with CMHA in Prince George to put together housing proposals through
BC Housing for current housing bids. This has served to enhance my practicum further.

Conclusion
I have successfully completed my practicum objectives. In review of these objectives,
I was surprised and saddened to learn that in today's society, stigma is still rampant and

A RIGHT TO HOUSING

49

much more education is still needed if we are to move forward to a place where all people are
included in society.

A RIGHT TO HOUSING

50

Chapter Seven
Recommendations for Policy and Practice Change
It was expected that the survey, database development, and other related work (as
described in the practicum learning objectives) will add to the existing knowledge base
regarding housing needs for persons with mental health issues. Further, coupling this
knowledge with policy and program development will serve as a catalyst for creating more
appropriate housing opportunities for individuals with serious and persistent mental illness.

Why the Current Approach to Housing is Not Working
Current housing and support services have evolved on an ad hoc basis, resulting in a
substantial lack of accountability and co-ordination. There are glaring contributing factors
which point to BC's increased rates ofhomelessness among persons with serious and
persistent mental health and addictions issues. Some of these factors include the following:
1.

There is no provincial housing and support strategy for this population.
It seems that we need a provincial strategy, with definite benchmarks, timelines, and

targets that address the housing needs and supports and services of persons with a serious and
persistent mental illness.

2.

There is no comprehensive information system.
There is no province-wide information system to help people in need of housing and

supports to find appropriate housing. This is needed.

3. Availability services are a patchwork at best.
Many individuals with mental illness and addictions fall through the cracks due to a
lack of coordination and collaboration of services. Most agencies have their own linkages
and/or compete with each other. A recent position was created for the entire Northern Health

A RIGHT TO HOUSING

51

area. This position is the housing coordinator who will be responsible for providing housing
opportunities to individuals with a serious and persistent mental illness within the NH
catchment area. This is a positive step forward as checks and balances can now be put into
place and coordination and collaboration will be more streamlined.

4.

Funding is inadequate.
This is a huge problem as there is no mechanism in place to coordinate and prioritize

different funding sources or ensure resources are put towards the areas where they are needed
the most. There is no centralized system across BC and most discussions are made away
from those who are in the front line.

Recommendations
Advocacy
1.

Lobby the Province of BC to implement a rent supplement program that is
attached to individuals and not to the properties.
Most residents of supported housing are in market rent housing that is not affordable

to them. In the United States, the Department of Housing and Urban Development (HUD)
operates a rent supplement program called the Section 8 Existing Housing Program which
targets low income families/individuals and reduces rent to 30 percent of the household
income (Hendrick, Kaneda, Newman, & Reschovsky, 1994). Because the subsidy is tied to
the individual, they can then apply for subsidy without having to move. This model would
have to discriminate between the levels of needs and acknowledge that the number of people
who may qualify for the subsidy may be greater than funding availability.

A RIGHT TO HOUSING

2.

52

Continue to target private and public sector landlords and the public with public
campaigns to demystify mental illness.
It is unfortunate that some of the public still perceive mental illness to look like the

movie One Flew Over the Cuckoo 's Nest or most recently, the Greyhound Bus incident that
took place last summer in Alberta, where it was found that a man with schizophrenia openly
attacked and killed a young man on the bus. Education campaigns may help landlords to
become less reluctant to rent to individuals with serious and persistent mental illness and
addictions and move to a more open communication between landlords and their tenants and
those who provide support services.

Solutions at the Local Level
So what happens if higher levels of government do not recognize housing as a priority
and a basic human right and do not put money back into affordable housing for those with a
serious and persistent mental illness? What can be done at the local level?
Local municipal governments have control over many aspects of planning and
development, and they have many ways to increase the supply of new affordable housing
stock. They could have non-profit agencies invest in single-room occupancy (SRO) hotels,
renovate, and operate these as affordable housing. They have the opportunity to lease the
land at a lower rate to these non-profit organizations. This is currently being done in
Vancouver. Just recently, the province sold the Astoria Inn in Prince George and put out a
bid for local agencies to bid on to provide housing to the homeless. The Native Friendship
Centre was the successful agency. As well, the municipal government can provide zoning
and regulations which allow for homeowners to build and rent out secondary suites. They can
provide cash grants or interest-free loans for affordable housing developers. The municipal
government can create an "affordable housing first" policy, where affordable housing

A RIGHT TO HOUSING

53

becomes not only the first option but a priority in re-development projects, rather than the
last (Ministry of Community, Aboriginal and Women ' s Services, 2004).
The Federal and Provincial Solutions

In my view, housing should be treated as a fundamental right in Canada, and
recognized as a preventative health measure and be prioritized. As well, a comprehensive
federal and provincial housing policy and action plan needs to be developed in partnership
with Canadian municipalities (Hulchanski, 1991). When the federal government does put
money into affordable housing, it needs to be clearly earmarked for affordable housing and
not solely for use with programs such as assisted living. Clearly the federal and provincial
governments need to reinvest in ongoing sustainable affordable housing.
What else can we do?

"Give priority to rural areas, northern and other under-served regions" (Aubry et al. ,
2004, p. 202). The Ministry should give priority to rural, northern, and other underserved
regions to enable consumers to stay in or return to their home communities. Development in
rural land northern areas must address challenges such as transportation, location, and the
availability of housing stock.
Strengthen existing services.

Existing supportive housing should be strengthened to meet the needs of current
consumers and those who are underserved. This might include an increase in financial
support to maintain existing housing. It could also include proper training for housing and
community support staff to be able to work effectively with consumers. Finally, increased
resources need to be made available to effectively support individuals who choose to live in
more independent settings. Currently in Prince George and under NH' s current organization

A RIGHT TO HOUSING

54

cha11, increased resources, such as front line workers like life skill workers and case
managers, don't appear to be a priority. Funding is not made available to create new
positions on the front line.

Dissemination of Research Findings and Practicum Work
In order to assist with implementation of my recommendations, my practicum report

and research findings will be available at the UNBC Library, N orthem Health Library, and
through my availability for possible presentations to both service providers and service users.

A RIGHT TO HOUSING

55

References
Addington, J., & Addington, D. (1998). Effects of substance misuse in early psychosis.

British Journal of Psychiatry, 172(33), 134-136.
Adlaf, E. M., & Smart, R. G. (1991). Substance use and problems among Toronto street
youth. British Journal ofAddiction, 86, 999-1010.
Ad1af, E. M., Smart, R. G., Walsh, G. M., & Zdanowicz, Y. M. (1992). Drifting and Doing:

Changes in drug use among Toronto street youth, 1990 and 1992. Toronto: Addiction
Research Foundation.
Anderson, J., & Burt, M . R. (2005). Program experiences in housing homeless people with

serious and persistent mental illness. Retrieved from
http://www .documents.csh.orgn/documents/ca/csh_ ab2034. pdf.
Anderson, R. M., Gallagher, T. C., & Gelberg, L. (1997). Competing priorities as a barrier to
medical care among homeless adults. American Journal of Public Health, 87, 217220.
Andrews, H., Padgett, D. K., Pittman, J., & Struening, E. L. (1995). Predictors of emergency
room use by homeless adults in New York City: the influence of predisposing
enabling and need factors. Social Science Medicine, 41, 547-556.
Andrews, H., Padgett, D., & Struening, E. L. (1995). Factors affecting the use of medical,
mental health, alcohol, and drug treatment services by homeless adults. Medical

Care, 28, 805-821.
Appleton, V. E (1967). Psychiatry in Canada a century ago. Canadian Psychiatric

Association Journal, 12, 344-361.

-

A RIGHT TO HOUSING

56

Assmussen, S., Beatty, P., & Romano, J. (1994). Old answers for today's problems: Helping
integrate individuals who are homeless with mental illnesses into existing community
based programs. Psychosocial Rehabilitation Journal, 17, 17-34.
Aubry, T., Drummond, D., Durbin, J., George, L., & Nelson, G. (2004). Housing for people
with serious mental illness: Challenges for system-level community development.

Journal of the Community Development Society, 27, 202-206.
Babbie, E. (1992). The practice of social research (6th ed. ). Belmont, CA: Wadsworth
Publishing Company.
Bachrach, L .L. (1978). A conceptual approach to deinstitutionalization. Hospital and

Community Psychiatry, 29, 573-578.
Bachrach, L. L. (1976). Deinstitutionalization: An analytical review and sociological

perspective. Rockville, MD: Gaskell.
Bachrach, L. L. (1987). Deinstitutionalization in the United States: Promises and prospects.
San Francisco: Jossey-Bass.
Bachrach, L. L. ( 1993). Continuity of care. New Directions in Mental Health Services, 35,
63-73.
Baker, F., & Douglas, C. (1990). Housing environments and community adjustments of
severely mentally ill persons, Community Mental Health Journal, 26, 497-505.
Ballantyne, R., Morrell-Bellai, T. L., & Trainor, J. N. et al. (1993). Housing for people with
mental illnesses: A comparison of models and an examination of the growth of
alternative housing in Canada. Canadian Journal of Psychiatry, 38, 494-501.

A RIGHT TO HOUSING

57

Barr, H., Earth, A.M., Nolan, C. M., Risser, D. R., & Saeed, A.M. (1991). An outbreak of
tuberculosis in a shelter for homeless men. Journal of Public Health Nursing, 21,
122-129.
Baumohl, J. (1989). Homelessness in America. London, ON: The Oryx Press.
BC Housing. (2004). Provincial homelessness initiative. Retrieved November 3, 2006, from
http://www. bchousing.or/programs/homelessness
BC Housing. (2005). Provincial housing program. Retrieved November 3, 2006, from
http://www. bchousing. org/pro grams/housing
BC Mental Health Reform. (2002). Best practices in housing. Victoria, BC: BC Ministry of
Health and Ministry Responsible for Seniors.
Beaulieu, A., Dorvil, H., Morin, P., & Robert, D (2005). Housing as a social integration
factor for people classified as mentally ill. Housing Studies, 20,497-519.
Bebbington, P., & Thomicroft, G. (1989). Deinstitutionalization: From hospital closure to
service development. British Journal of Psychiatry, 155, 739-753.
Begin, P., Casuant, L., & Chenier, N. M. (1999). Homelessness. Retrieved September 22,
2006, from http: /I www.parl.gc.ca/36/refmat/library/PRBpub991-e:htm.
Bero, L., & Drummond, R. (2004). Evidence based practices for individuals with severe

mental illness. Retrieved March 1, 2010, from www.the freelibary.com.
Bhugra, D., & Leff, J. (Ed.). (1993). American experience in social psychiatry. Oxford:
Blackwell.
Bigelow, D. (1998). Supportive homes for life versus treatment way-stations: An
introduction to TAPS Project. Community Mental Health Journal, 34, 403-405.

A RIGHT TO HOUSING

58

Bilsker, D., Gavin, A., Goldner, E., & Parikh, S. (2000) . Management of mental disorders
(3rd ed). Darlinghurst, NSW: World Health Organization.
Bloom, D. (2006). The transformation of mental health services to a recovery-orientated
system of care: Canadian decision maker perspectives. International Journal of

Psychiatry, 2, 168-177.
Breakey, W. R., & Fischer, P. J. (1991 ). The epidemiology of alcohol, drug and mental
disorders among homeless persons. American Psychology, 46, 1115-1128.
Burgess, T. (1898). A historical sketch of our Canadian institutions for the insane. Ottawa:
Royal Society of Canada.
Canada Mortgage and Housing Corporation. (2007). National vacancy rate unchanged from

October 2006 at 2.6 per cent. Retrieved from http ://www.cmhcschl.gc.ca/en/corp/nere,2007.
Canadian Homeless Research Network. (2008). The Government of Canada delivers support

to those who are homeless in Prince George.
http: //www .hrds. gc.cal eng/hornlessness/links/index.shtml.
Canadian Mental Health Association. (1963). More for the mind. Retrieved from
http://www.ontario.cmha.ca
Canadian Mental Health Association. (1998). Mental illness and pathways into

homelessness. Toronto: CMHA.
Canadian Mental Health Association. (2005). Housing: A social necessity. Retrieved October
26, 2008, from http: //www. cmha. ca!binds/print_page. asp? cid= 5-916-919-93 7.
Canadian Mental Health Association. (20 10). Housing and mental health. Retrieved from
http: //www.cirrie.buffalo.edu/enclyclopdiea/article.php?id.

A RIGHT TO HOUSING

59

Carling, P. (1989). Access to housing: Cornerstone of the American dream. Journal of

Rehabilitation, 55, 6-8.
Carling, P. J. (1993a). Housing and supports for persons with mental illness: Emerging
approaches to research and practice. Adult Residential Care Journal, 6, 87-96.
Carling, P. J. (1993b) . Homes or group homes? Future approaches to housing supports and
integration of people with psychiatric disabilities. Community Psychiatry, 44, 439449.
Carling, P. J. (1995). Return to community: Building support systems for people with

psychiatric disabilities . New York: The Guildford Press.
Caton, D. (1983). Mental health care costs: Paucity of measurement. Journal of Social

Psychiatry and Psychiatric Epidemiology, 3, 70-77.
Chudtrovsky, D. (2007, May 6). Homeless counts in Prince George. The Hook. Retrieved
from http ://www.thetyee.ca/The Hook/housing 2009.
City of Calgary. (1996). Homeless count in downtown Calgary. Calgary: Community of
Social Development, Department of Social Research Unit.
City of Vancouver. (2005). Homeless Action Plan. Retrieved August 8, 2008, from
http:/ /intraspec.ca/hap05jun. pdf.
Cohen, C. I., & Thompson, K .S. (1992). Homeless mentally ill or mentally ill homeless?

American Journal of Psychiatry, 169, 816-823.
Cohen, N. L., & Marcos, D. (1986). Psychiatric care of the homeless mentally ill. Psychiatric

Annals, 16, 729-732.
Cordray, D. S., & Lehanan, A. F. (1993). Prevalence of alcohol, drug, and mental disorders
among the homeless. Psychiatric Services, 20, 355-383.

A RIGHT TO HOUSING

60

Crowe, C., & Hardill, K. (1993). Nursing research and political change: The street health
report. Canadian Journal of Nursing, 89, 21-24.
Dattalo, P. (1990). Widening the range of services for homeless mentally ill. Administration

and Policy in Mental Health, 17, 247-256.
Dear, M. J. (1977). Psychotic patients and the inner city. Annals of the Association of

American Geographers, 67, 588-594.
Dear, M. J. (1992). Understanding and overcoming the NIMBY syndrome. Journal of the

American Planning Association, 58, 288-299.
Dear, M. J., & Laws, G. (1986). Anatomy of decision: Recent land use zoning appeals and
their effect on group home locations in Ontario. Canadian Journal of Community

Mental Health, 5, 5-17.
Dear, M. J., & Taylor, S.M. (1989). Not our street: Community attitudes to mental health

care. London: Pion.
Dennis, D. L., & Monahan, J. (Eds.). (1996). The perils of outreach work: Overreaching the

limits ofpersuasive tactics in coercion and aggressive community treatment: A new
frontier in mental health law. New York: Plenum.
Denzin, N. K. (1978). The research act: A theoretical introduction to sociological methods.
Retrieved February 2, 2007, from http ://www.nova.edu/ssss/qr/qr-3 /plumb.html.
Dietrich, S. (1999). Understanding the homelessness in Waterloo region. Retrieved
December 10, 2009, from http ://www .social planningcouncil-cnd.org.
Dingemans, P.M., Goldstein, M., Lenoir, M. E., Linszen, D. H., & Scholte, W. F. (1998).
Early recognition, intense intervention and other proactive and risk factors to

A RIGHT TO HOUSING

61

psychotic relapse in patients' with first psychotic episodes in schizophrenia. Clinical

Psychopharmacology, 13(1), 57-62.
Doebbeling, C., Malone, D., & Mitchell, A. (2009). New study shows people with mental
health problems receive inadequate medical care. Journal of Health & Medicine, 9,
16-17.
Florez, J. A. (2003). Mental health and mental illness in Canada: The tragedy and the
promise. The Canadian Geographer, 33, 146-155.
Foucault, M. (1961). Madness and civilization: A history of insanity in the age of reason.
New York: Pantheon.
Friedman, R., & Romm, S. (1994). History ofpsychiatry: The psychiatric clinics of North

America. Philadelphia: W.B. Saunders Company.
Frischmuth, S., Johnson, A., & Morrow, M. (2006). Community-based mental health services

in BC: Changes to income, employment, and housing supports. Retrieved October 24,
2006, from http: //www .policyaltematives.ca/documents/BC_ office.com.
Geller, J. L. (2000). Excluding institution for diseases from federal reimbursement for
services: Strategy or tragedy? Psychiatric Services, 5, 1397-1403.
Goldens, A. (1999). Homeless action taskforce: The Goldens report. Retrieved from
http: //www.uwgt.org.
Goldman, H. (1983). The alchemy of mental health policy: Homelessness and the fourth
cycle of reform. American Journal of Public Health, 75, 727-731.
Goldner, E. M. (2002). Foundational elements for mental health reform in Canada.
Retrieved from http: //www.economics.ca/cgi/jab?joumal/cppu.

A RIGHT TO HOUSING

62

Goldstein, J. , & Lehman, M. (1983). The quality of life ofthe chronically mentally ill: A
comparison of public, private, and voluntary residential provisions. British Journal of

Social Work, 4, 391-404.
Gorden, L., King, D., Livingston, J., & Srebrik, D. (1995). Housing choice and community
success for individuals with serious and persistent mental illness. Community Mental

Health Journal, 31, 139-152.
Grass, M. J. (2006). Quote. Retrieved October 7, 2006, from http://www.brainyquote.com.
Greenstone, J.P. (1979). Dorothea Dix and Jane Addams: From transcendentalism to
pragmatism in American social reform. Social Service Review, 53, 527-59.
Grob, G. (1973). Mental institutions ofAmerica: Social policy to 1875. New York: Free
Press.
Grob, G. N. (1995). The paradox of deinstitutionalization. Chicago: Transaction.
Hartz, A. J., Kuhn, E. M., & Salit, S. A. (1998). Hospitalization costs associated with
homelessness in New York City. New England Journal of Medicine, 38, 1734-1740.
Hay, T ., Hopper, K. , Jost, J., & Welburg, S. (1997). Homelessness, severe mental illness, and
the institutional circuit. American Psychiatric Journal, 48, 659-665.
Health Systems Research Unit Institute ofPsychiatry (HSRU). (1997). Best Practices in

Mental Health Reform : Discussion Paper. Ottawa: Minister of Public Works and
Government Services of Canada.
Hendrick, A. M., Kaneda, K ., Newman, S. J., & Reschovsky, K. (1994). The effects of
independent living on persons with chronic mental illness: An assessment of the
section 8 certificate program. The Milbank Quarterly, 72, 171-198.

A RIGHT TO HOUSING

63

Hopkins, W. G. (2000). Quantitative research design. Sport Science Journal, 4(1), 1-8.
Retrieved November 13, 2006, from
http: //www. sportsci.org/j our/00 1/wghdesign.html.
Horgan, S., Nelson, T., & Parkinson, S. G. (1999). From housing to homes: A review ofthe
literature on housing approaches for psychiatric consumer/survivors. Canadian

Journal of Community Mental Health, 18, 145-164.
Hulchanski, M. (1991). How best to house the needy. Toronto Star, p. Bl.
Hulchanski, M. (2009). The experience and needs of diverse types of homeless families and

their different paths into and out of homelessness. Retrieved from
http://www. social work. utoronto. ca/research/proj ects/hulchanski.
Human Resources Development Canada. (2008). Understanding homelessness. Retrieved
from http: //www .hrsdc. gc.ca/eng.homelessness/ generalinformation. shmtl.
Hume, M. (2006, December, 8). Homelessness. The Globe & Mail. Retrieved from
http: /N 1. theglobeandmail.corn/servlet.story.RTGAM2006.
Hwang, S. (1998). Prevention ofhomelessness. Retrieved October 9, 2006, from
http: //www .city. vancouver. bc.ca/commsvcs/housing/schous/ 1council/1998.
Hwang, S. W., Svoboda, T. J., &. Windrim, P.M. (2000). Physician payment for the care of
homeless people. Canadian Medical Journal, 163, 170-171. Retrieved September 26,
2006, from http: //www .cma.ca/cmaj/vol-163/issue-21 0170.
Jencks, C. (1994). The homeless. Cambridge: Harvard University Press.
Kadmos, C., & Pendergast, P. (2001). Housing needs ofpeople affected by mental health

problems. Perth, W A: A Discussion Paper.

A RIGHT TO HOUSING

64

Kennedy, A. (1989). Why community mental health centres were started. Journal of
Administration and Policy in Mental Health and Mental Health Services Research,
16, 183-185.

Keyes, C. L. M. (2002). The mental health continuum: From languishing to flourishing in
life. Journal of Health and Social Behaviour, 43, 207-222.
Kirby, M. (2006). Kirby Commission Report: Speak out bravely; listen compassionately.
Retrieved from http://www.cpa.ca/cpapadvocacyproject/pdf.
Kovaleski, S. F. (1993). Mental health plan raises ire. Washington Post, pp. D1-D5.
Kucinich, D. (2006). Quote. Retrieved October 7, 2006, from http: //www.brainyguote.com
Letiman, A. F., & Newman, S. J. (1996). Housing: Integrated mental health services. Modern
Community Psychiatry, 28, 145-159.

Martin, M. A. (1990). The homeless mentally ill and community-based care: Changing a
mind set. Community Mental Health Journal, 26, 435-447.
Mental Health Commission. (1999). Housing and mental health: Reducing housing
difficulties for people with mental illness. A Discussion Paper.

Mental Health Commission. (2009). Toward recovery & well-being: A framework for a
mental health strategy for Canada. A Discussion Paper.

Mental Health Research Policy Group. (1997). Mental illness and pathways into
homelessness. Proceedings and Recommendations (a workshop of the mental health

research policy group). Toronto.
Ministry of Community, Aboriginal and Women's Services. (2004). Assisted living units for
the Interior. Retrieved January 2, 2010, from http://www. gov.bc.ca.

A RIGHT TO HOUSING

65

Ministry of Health Services, Mental Health and Addictions. (2003). (2"d ed.) [Brochure]. BC:
Author.
Ministry of Housing and Social Development. (2008). Friendship Lodge. Advance online
publication. Retrieved November 2, 2008, from
http: //www2.news.gov.bc.ca/news_releases.
Mora, G. (1985) . History ofpsychiatry. Baltimore: Williams & Williams.
May, J., & Sanchez, M. (1992). Balancing act: Clinical practices that respond to the needs of
homeless people. Journal of Rehabilitation, 6, 829-839.
North, C. S., & Smith, E. M. (1993). A systematic study of mental health services utilization
by homeless men and women. Social Psychiatry Epidemiology, 28, 77-83.
Plyler, J., Ricciardi, J., Sakamoto, 1., & Wood, N. (2007). Coming together: Homeless

women, housing and social support (updated Internet version). Toronto: Centre for
Applied Social Research, Faculty of Social Work, University of Toronto, available at
http:/ /wwwsocialwork/toronto.ca/index.php?section=4 79.
Pols, H. (2004). Retrieved February 2, 2007, from
http ://www. us yd. ed. au/hps/ course2004/3 01 0 .html.
Population Census. (2006). The census of Canada. Retrieved April 12, 2009, from

http ://www.bcstats.gov.bc.ca.
Prince, P. (2003). A historical context for modern psychiatric stigma in mental health and

patients' rights in Ontario: Yesterday, today and tomorrow. Toronto: Psychiatric
Patient Advocate Office.

A RIGHT TO HOUSING

66

Reid, W., Sherman, E., & Edmund, D. (1994). Qualitative research in social work. New
York: Columbia University Press.
Rosenfield, S. (1992). Labelling mental illness: The effects of received services and
perceived stigma on life satisfaction. American Sociological Review, 62, 660-672.
Ross, R. (1996). Returning to the teachings: Exploring aboriginal justice. Toronto: Penguin
Books.
Royal Commission of Health Service. (1964). Mental health policies: A historical overview.
Retrieved from http://www.llbc.leg.bc.ca.publicbackground/200801.
Schiff, R., & Schnider, B. (2007). Housing needs in Calgary region for persons with severe

and persistent mental illness. Report provided for the Mental Health Housing
Subcommittee, Calgary Homeless Foundation. Retrieved from
http://www.pathwaysregina.com/index.php?id.
Sealy, P. (2004). Forty years of deinstitutionalization of psychiatric services in Canada: An
empirical assessment. Canadian Journal of Psychiatry, 49, 249-257.
Simmons, H. G. (1990). Unbalanced: Mental health policy in Ontario 1930-1989. Toronto:
Wall & Thompson.
Solomon, A. L., & Wong, Y. (2002). Community integration of persons with psychiatric
disabilities in supportive independent housing. A conceptual model and mythological
consideration. Mental Health Services Research, 4, 13-27.
SP ARC BC. (2006). Building bridges together. Retrieved from http://www. SP ARC.BC.CA.

A RIGHT TO HOUSING

67

Stark, L. R. (1992). Barriers to health care for homeless people. Baltimore: John Hopkins
University Press.
Statistics Canada. (2000). Population of census metropolitan areas. Retrieved September 29,
2006, from http: //www.statcan.ca/english/pgdb/people/population/demo05.htm.
Stevenson, A. (2006). Quote. Retrieved October 7, 2006, from http: //www.brainyquote.com.
Sussman, S. (1998). The first asylums in Canada: A response to neglectful community care.
Canadian Journal of Psychiatry, 43, 260-264.
Tuke, D. H. (1985). The insane in the United States and Canada. London: Lewis HK.
United Nations. (2004). Report of the United Nations symposium on population and housing
census. Retrieved September 9, 2009, from
http: //www.escap.org/stat/meet/cencus2004.
United Nations. (2009). The Universal Declaration of Human Rights. Retrieved from
http: //www.un.org/en/documents/unhr/
United Native Nations. (2001). Committee on Economic, Social and Cultural Rights.
Retrieved March 1, 2010, from http: //www.housingagain,web.net.
US Department of Education. (1998). Disability Forum Report 3. Housing and disability:
Data needs, statistics and policy. Washington, DC: National Institute on Disability
and Rehabilitation Research.
US Department of Housing and Urban Development. (1994). Worse case need for housing
assistance in the US. in 1990 and 1991. Washington, DC: Head Office of Policy
Development and Research.

A RIGHT TO HOUSING

68

Vancouver Coastal Health Authority. (2002). Supported Housing for Vancouver Coastal's

Mental Health & Addictions. Retrieved from
http :1/www. vancouver. calcommsucs/housing/supporti vehousingstrategy. pdf.
Vancouver Regional Health Authority. (2002). Homelessness. Retrieved September 10, 2008,
from http://www .gov. bc.ca/premeire/media_gallery/phots/2002/march.
Vancouver Regional Health Authority. (2007). Homelessness. Retrieved September 10, 2008,
from http: //www.gov.bc.ca/premiere/media_gallery/events/2007/oct.
Viney, W., & Zorich, S. (1982). Dorothea Lynde Dix: Positive or negative influence on the
development of treatment for the mentally ill. Social Science Journal, 21, 71-82.
Wasylenski, D. (200 1). The paradigm shift from institution to community. New York: Free
Press.
Winkleby, M.A., & White, R. (1992). Homeless adults without apparent medical and
psychiatric impairment: Onset of morbidity overtime. Hospital Community

Psychiatry, 43, 1017-1023.
Wood, D. (1992). Delivering health care to homeless persons: The diagnosis and

management of medical and mental health conditions. New York: Springer
Publishing.
World Health Organization (WHO). (2001). Solving mental health problems. In Mental

Health: New Understanding, New Hope (pp. 33-38). Geneva.
World Health Organization (WHO). (2003). Historical perspective. In Section 3 in the

Mental Health Context. Mental Health Policy and Service Guidance Package.
Geneva.

A RIGHT TO HOUSING

69

Wright, J.D. (1990). Poor people, poor health: The health status of the homeless. Journal of
Social Issues, 46, 49-64.

Wright, J.D. (1995). Housing dynamics ofthe homeless: Implications for a count. American
Journal of Orthopsychiatry, 65, 320-329.

70

A RIGHT TO HOUSING
Appendix A: Cover Letter

Dear Participants
The quality of housing for everyone, but especially those with a serious and persistent
mental illness is of vital importance. This survey, developed by myself, Deborah Turner, as
part of my Master of Social Work Practicum Project on housing needs and requirements,
asks you to talk about your personal experience in such areas as current living conditions,
homelessness, and housing supports.
I am hopeful that your responses will lead to specific recommendations to improve
housing for those with a mental illness. I am actively seeking potential participants over the
age of 19 including both males and females. Participants must be engaged in services through
the COAST team. Five COAST case managers will assist in the identification of potential
participants. Identified individuals have been previously diagnosed by a Psychiatrist with
either having Bipolar Disorder, Schizophrenia or a Delusional Disorder. The Survey data are
anonymous. Please do not put your name on the survey. Information given from the survey
will be seen by myself, and my Academic Supervisor, Dawn Hemingway. Your written
responses to the survey will be transferred to a password protected electronic data file and
stored in a locked file cabinet in my office for seven years. At that time, files will be deleted
and paper shredded as per UNBC Research Ethics Board policies.
The usefulness of this survey depends on receiving a thoughtful response from
everyone. Participating in the survey is voluntary. You have the right to withdraw at any
time, or choose not to answer any or all of the questions. If you choose to withdraw from the
study, your information will be destroyed and will not be apart of the study. This will not
affect the services you receive from the Community Outreach Assertive Services Team
(COAST). There is no remuneration for participating in the research. Should you choose to
complete the survey, you voluntarily agree to give consent. There are no known risks
identified in participating in the survey however; professional counseling is available to all
participants if needed. Benefits of participation can be great. For example, my findings will
be made available to service providers and policy makers who have the power and
opportunity to make needed changes in housing provisions. Once you have completed the
survey, please fold the survey in half and drop into the large brown box. A copy of the results
of the survey will be made available through each site. Results may also be available through
formal publication, and conference presentations.
Should you have any questions or concerns regarding this survey, Please call Dawn
Hemingway at 960-5694 or the Office of Research at 960-5820 or email: reb@unbc.ca.
Thank you for your time and participation.
Sincerely,
Deborah Turner, BSW
MSW Practicum Student
Phone: 612-4521

Paul Becklake, BSW, MSW
Practicum Supervisor
Phone: 960-9931

A RIGHT TO HOUSING

Dawn Hemingway, BA, MSc, MSW
Academic Supervisor
Phone: 960-5694

71

A RIGHT TO HOUSING

72

Appendix B: Informed Consent

Please read carefully and answer each question.
1. Do you understand you have been asked to participate in a research survey?
Yes
No
2. Have you read the attached cover letter?
Yes
No
3. Do you understand that the answers you provide to the research questions will be
analyzed?
Yes
No
4. Do you understand the risks and benefits involved in participating in the survey?
Yes
No
5. Have you had an opportunity to ask questions?
Yes
No
6. Do you understand that you are able to refuse to participate or withdraw from the study at
any time? This will not affect your current mental health services.
Yes
No
7. Do you understand what confidentiality means and has this been explained to you?
Yes
No
8. Do you understand who will have access to the information you provide?
Yes
No
I fully understand and agree to participate in the Survey.
Participant N arne

Date

Researcher N arne

Date

(re-formatted from original)

73

A RIGHT TO HOUSING

Appendix C: Housing Survey
DEMOGRAPHICS
What is your age?
0

What is your gender?
0 Male
0 Female
What is your marital status?
0 Married
0 Divorced

0 Single

0 Common-law

Are you on Disability Pension?
0 yes
0 No
Are you on CPP Pension?
0 Yes
0 No
Are you on Long Term Disability through your work?
n Yes
n No
What is your monthly income?
0 Less than $700.oo 0 Less than $800.00 D Less than $900.00
What is your level of Education?
n Never attended school
0 Completed Elementary School

0 Other _ _ __

0 Completed High School
0 Other

-------------

DIAGNOSIS
Do you have a mental health disability?
0 Yes
0 No
If yes, what is your Mental Health Disability?

n Bipolar Mood Disorder

n Schizophrenia

n Other - - - - - - - - - -

CURRENT LIVING CONDITIONS
Do you live:
0 Alone

U With family

What is the cost of your rent?
0 Less than $375.00
0 Less than $400.00

U Roommates
0 Less than $500.00

[ Other - - - - -

U Other

A RIGHT TO HOUSING

74

HOMELESSNESS
Has there ever been a time when you have been homeless?
0 Yes
0 No
lfyes,forhowlong? __________________________________________________
Have you ever had to access the Emergency Department of the hospital because you
had not housing?
LJ Yes
IJ No
Have you ever had to access Davis Drive because you had no housing?
0 yes
0 No
Have you ever been evicted from your income?
LJ yes
IJ No
Ifyes,why? _________________________________________________________
HOUSING SUPPORTS
Have you ever received housing supports such as:
0 Moss House
n Urquhart
0 BC Housing
OSubsidized Housing
0 New Directions
0 Other
Have you ever been placed on a waitlist for housing?
0 yes
0 No
For how long?
What type of housing is important to you?
0 Supportive housing (i.e.- Moss House, Urquhart, Iris House)
OSubsidized housing (i.e. SILPS, BC Housing, New Directions)
0 Low- Rental housing with out any supports
O Other _______________________________________________________
If given a choice of what type of housing you prefer to live in, what would you choose?
0 House
0 Townhouse
0 Resident Housing
0 Apartment 0 Duplex
IJ Other _______________________
If you had the choice to live on your own or with others, what would you choose?
0 On own
0 With Others

A RIGHT TO HOUSING

In choosing the type of housing you would like, what things are important to you?
Check all that apply.
C Smoking units
0 Neighborhood
0 Balcony
C Non-smoking units
0 Cost of rent
0 fire place
0 Type ofhousing
0 yard
C access to transportation
0 Utilities
0 Family oriented
C Wheel chair accessible
0 Access to a phone 0 Elevators
C Feeling of community
0 Pets allowed
OWasher & Dryer
[] Other_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

COMMENTS

re-formatted from original)

75