Individuals who experience psychiatric disability are too often forced to navigate their way through precarious housing situations and manage these situations with little support. The social conditions of our housing economy are deteriorating to a point where they not only provide little alleviation for those suffering from adverse mental health conditions, but they are also too often perpetuating it.
I sat down with Dr. Jijian Voronka to ask about her views regarding the intersection between the need for mental health supports and precarious housing services. An instructor at Ryerson University’s School of Disability Studies and SSHRC Postdoctoral Research Fellow at the Department of Women’s and Gender Studies at Rutgers University, Dr. Voronka also worked as a Consumer Research Consultant for the Mental Health Commission of Canada’s (MHCC) At Home/ Chez Soi project. The project measured the effectiveness of implementing a Housing First approach in municipalities across the country.
I asked Dr. Voronka about what initially drew her to dedicate her life to mental health and housing research. She replied that it has been both a product of her own lived experiences with housing insecurity, combined with issues she uncovered in her early academic studies. As a young adult she saw how mental health interventions, even with the best intentions, can too often produce the opposite of its intended effect. She went on to explain that “helping is not always benevolent” and we need to be careful in the ways in which we choose to address social insecurities. In her academic studies she began to see the problematic paradigm that has persisted in the ways in which mental illness tends to get discussed. Predominantly, it is viewed as a problem that needs to be diagnosed and fixed in the individual, rather than an issue of social justice. She felt that there was a need to have the conversation shift away from disability as a societal ill, towards a conversation that looks at the ways in which society itself can be debilitating.
For the past few years Dr. Voronka has been teaching a course at Ryerson titled “A History of Madness” that seeks to reframe this problematic narrative. She explains that her class is “trying to take a different approach to how we learn and come to understand psychiatric disability and to position those who have experienced the psychiatric system as expert knowers.” The course provides a unique insight into the social history of madness, and seeks to unsettle common held beliefs about madness and disability.
The conversation then turned to her involvement with the At Home/Chez Soi project. In 2008 the federal government allocated $ 110 million to the MHCC to undertake a national demonstration project on mental health and homelessness. The project looked at measuring the effectiveness of a Housing First approach, an approach based largely on the notion that, if you have a safe and stable place to live, it will be far easier to manage your mental health. As such, the program assisted in finding homes and providing rent subsidies to mentally ill homeless people across the country. The project was launched in five cities (Toronto, Vancouver, Winnipeg, Montreal and Moncton) and in each city the MHCC sought to determine whether or not the approach worked, for whom it worked, in which environments, and at what cost.
The project largely determined that Housing First is an effective strategy, both in terms of enhancing the quality of life of its participants and as an efficient cost-savings tool. For every ten dollars invested in the Housing first model, $8.27 was saved in money that would have otherwise been spent on psychiatric hospital stays, shelters, and incarceration.
The basis of Dr. Voronka’s academic work, and what drove her involvement in the project, centers on peer inclusion, which she describes as the practice of including “people who have histories of distress or contact with the mental health and housing system, who in turn go to work for mental health and housing systems”, either as consultants or volunteers. In the At Home/Chez Soi project this “peer labour force” became the support workers, researchers, and organizers, fulfilling some of the project’s most essential roles. Dr. Voronka argued that
“when you have lived through the system you know how it works in ways that other experts don’t.”
We also discussed the municipalities that were selected for the project, as each municipality targeted a different segment or need of their population. For instance in Toronto the project primarily studied the effectiveness of the Housing First approach among new immigrants and people with mental health problems coming from racialized communities, whereas in Vancouver the project focused on those suffering from chronic homelessness, substance abuse, and concurrent disorders. I asked whether or not, given the different needs among the municipalities selected, a national approach to mental health and housing was possible, or if each municipality and/or province should pursue its own version of Housing First in order to meet its particular population needs and demands. Dr. Voronka stated that a one-size-fits-all approach will not work, and that we need to recognize and attend to the different needs among our populations. In order to further illustrate those differences she discussed the Winnipeg experience, in which a significant percentage of the city’s homeless population is Indigenous, and as such, service provision needs to be tailored by Indigenous peoples in order so that services are attuned to their specific service needs and cultural differences.
Returning to Toronto’s housing crisis we discussed issues surrounding redevelopment projects that have been underway across the city. Dr. Voronka provided her take on the changes that the Parkdale neighborhood has been experiencing for the past 20 years in terms of its “revitalization”, and its shift away from a predominantly low-income to become an increasingly more mixed-income neighborhood. Parkdale used to consist primarily of new immigrants who built a community alongside psychiatric survivors, and the commercial businesses in the area used to reflect and target their demographic needs. However, as development increased so did rents, which has led to a massive reduction in affordable housing and rooming houses in the area. As Dr. Voronka explains,
“when developers go into spaces that are understood as slum spaces or ghettoized spaces they tend not to see that there is already a community and culture in those spaces.”
And while there are benefits to mixed-income neighborhoods, we also need to understand how antagonizing and anxiety producing those spaces can be for its lower-income residents.
Lastly, considering the changes that are occurring on the federal level, in terms of governmental priorities, I asked whether or not she sees the conversation finally changing regarding housing and mental health, and whether or not we have come to a window of opportunity to make serious changes to our systems of care. Dr. Voronka believes that in fact we have reached that critical juncture.
Ensuring safe and affordable housing for people who live with psychiatric disability should not only be a government priority, but also needs to be seen and respected as a fundamental human right. The only way to ensuring the security of the person is to fix the insecurity that too often characterizes the place in which they live. It is not in any way a shocking statement to make however, the fact that we have done so little for so long should be.
Shelby Challis is a 2016 Master of Public Policy candidate at the University of Toronto’s School of Public Policy and Governance. She previously completed an Honours Bachelor of Arts degree in Political Science at the University of Toronto, and has since worked for the Ministry of Health and Long-term Care. Her policy areas of interest include healthcare finance, labour relations and security management.