Tracking Homeless Deaths

As of January.1st, 2017, the City of Toronto has begun tracking homeless deaths. The process is still in its infancy and has taken the city a while to speak to the public about how the new system is working and what their findings have been.

A press conference was held on January.10th with public health officials, some city councillors discussing how this is a problem that needs addressing in order to fully understand the scope of how many people are dying while homeless. We need this information for raising awareness and improving health.

cathy crowe press conference

Street Nurse Cathy Crowe

Up until now, tracking deaths has involved some volunteers from the Toronto Homeless Memorial Network who have called around to a few agencies once a month to find out who has died. The only other information provided by the city are lists of deaths that have occurred in city-funded shelters and even so, this page is not always up to date.Therefore, this does not include any deaths in hospitals or any other locations in the city.

Needless to say, there are many deaths that are not being recorded and we need to do better. Hopefully this new system will show us the extent of the homeless crisis in our city, but we have yet to hear more.

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Homeless Memorial Quilt Project

Art is a fantastic form of expression that can inspire, motivate and heal. The Red Wagon Collective Saturday Art Group has put together a wonderful project. They have been working on a quilt project in partnership with the Toronto Homeless Memorial Network.

The Red Wagon Collective Saturday Art Group is a collective of low income; homeless (shelter users and street sleepers); inadequately/institutionally housed; recently incarcerated; and low income people.  

They refuse to forget those whose lives have been abandoned by the state. Instead, they choose to remember, mourn, and organize.

name-quilt-black-and-white

The project has inspired conversations around the housing crisis and the neoliberalization of homelessness. The quilt is a public way to remember those who have died while homeless and includes members of the community who wish to mourn the loss of loved ones.

The Homeless Memorial Quilt Project aims to create a mobile, accessible means of mourning in the homeless community. As many street involved folk are buried in unmarked graves in the far ends of the city. The collective plans to continue on in this project and have begun a second quilt for the year 2016. The Quilt Project will be shown at every memorial. They will have a table set up in the church for people to participate in the ongoing quilt project by painting the name of a friend or loved one who has died of homelessness on a fabric square. Each square will be sewn together for the next quilt.

The collective believes art and art praxis to be crucial to our survival and resistance. Thus, demands the following:

1. A national subsidized housing strategy

2. The CREATION and MAINTENANCE of CLEAN, SAFE and ACCESSIBLE SUBSIDIZED housing in TORONTO.

3. Increased shelter beds and improved shelter conditions (including the Out of the Cold program).

4. The emergency measure of opening the armouries in the winter months to prevent freezing deaths and meet the lack of the already exhausted shelter system.

5. An end to the freezing and/or cutbacks of city budgets by Mayor John Tory and city council.

5. An end to councillor support of gentrifying projects like the Seaton House Revitalization (Kristyn Wong Tam) and the Moss Park redevelopment.

For more information about their projects, please visit their website, or
follow them on Facebook

 

Fentanyl overdoses are just the beginning — sqwabb

Yesterday, August 31, was the 15th International Overdose Awareness Day. The worldwide harm reduction movement used the occasion to warn that only the widespread adoption of evidence-based strategies—particularly supervised safe injection facilities—will stem the growing global epidemic of overdose deaths caused by the cheap and ultra-powerful opioid painkiller fentanyl. What advocates of harm reduction are […]

via Fentanyl overdoses are just the beginning — sqwabb

The Death of a Service User

When a homeless person dies, not only do friends and family members of that person become affected, but so can front line workers. Richard Lakeman, Mim Fox, and R. Dean Wright and colleagues conducted separate research on how service workers are affected by deaths of people who are homeless. Lakeman tells us that service workers can encounter deaths frequently (2011:928). Wright et al., suggest that service workers may feel self-doubt and might ask questions such as “Did I do enough?” or “Was there something that I could have done differently?” (1999:245). Fox explains how social workers see the deaths and continually feel powerless (2005:196).

I volunteered with two different agencies a while back, doing street outreach for homeless youth. Luckily, I never did experience the death of someone I knew directly, probably because I had only volunteered for a few months. However, I did counsel some youths who had friends pass away on the streets. At this point, I was out of school from Child and Youth Work, so that support system was no longer available. There were people that I volunteered with and the service providers who understood, but many of them were dealing with their own problems. This was a tough time for me personally, as I was finding myself burning out and nowhere to turn for help.

stress

 

Maslach et al., define burnout as “…emotional exhaustion, depersonalisation, and reduced personal accomplishment” (1997:192). I know this feeling all too well. You simply feel as though you no longer have the mental capacity to handle day to day situations, let alone help anyone else.  There is a sense that things will never change and you can even start doubting yourself and your abilities.

Research shows that depersonalisation can happen when a service provider loses someone. Even the terminology we use at times is depersonalising. “Service user” and “Client” are ways to distance our professional selves from those we serve. Wright et al., found that “[a] common, although dysfunctional, response among staff to the multiple losses they experience is professional distancing. They may deny any feelings for the deceased and detach from other guests so as not to be ‘affected’ or place themselves in jeopardy of suffering more loss” (1999:244). Lakeman says workers may expect more deaths in the future and that a feeling of uselessness may occur (2011:933).

When front line workers don’t get the services they need after dealing with many deaths in the community they may suffer from intrusive memories or experience anxiety, wondering who will be next (Lakeman 2011:942).

burnout

 

What can be done?

Few organizations have the capacity or resources to fully attend to the needs of service workers (Wright et al., 1999:247). Lakeman suggests that a positive response to the death of a service user includes the ability to preserve the memory of that person, like a picture on a wall (2011:942).

Some organizations have their own ways of dealing with the loss of people they work with. Lakeman learned that some service providers would do things like “…convening a special group, planting a tree, or having a sing-along…lighting a candle or spending a few moments in quiet reflection at some point during the working day” (2011:937). Wright et al., made a similar finding that staff may hold a moment of silence, or have an annual service to recognize those homeless people who have died throughout the year (1999:241).

candles

 

An organization here in Toronto has a Reflections Memorial Project that helps everyone grieve and remember those who have passed away. The project was inspired by the need for people to process loss and encourage healing through art, expression and memorial.

Firstly, they have an ongoing scrapbook, where photos, artwork and writings are added when someone dies. The book can be looked at by service providers whenever they want to remember. Secondly, they have a wall mounted display which is magnetic.  Small circular buttons are placed on the wall that contain initials, artwork, photos or writings that each represent someone who has passed away. The display is hanging on the wall in a visible space in the organization. Lastly, they hold a Reflections Memorial Event in the fall every year, symbolic of change, transition and reflection. Poems are read, candles are lit and the memory book is available for others to read.

These are just some great suggestions for how other organizations may approach remembering people who have died while homeless.  These rituals are a way for service providers to mark death, which “…serves a therapeutic function in that it helps people to experience emotions and is part of properly framing death. Marking death is undertaken in highly personal and private ways as well as collectively through formal mechanisms such as memorial services and funerals” (Lakeman 2011:936).

Working with socially excluded people is a tough job. It requires resiliency, stamina, support, compassion and coping strategies in order to keep going. Much respect goes out to those who continue to serve others despite the hardships, your efforts are greatly appreciated.

 

References

Fox, M. (2005). To die destitute today: What are the implications for social work?. Australian Social Work, 58(2), 188-198.

Lakeman, R. (2011). How homeless sector workers deal with the death of service users: a grounded theory study. Death studies, 35(10), 925-948.

Maslach, C., Jackson, S. E., & Leiter, M. P. (1997). Maslach burnout inventory. Evaluating stress: A book of resources, 3, 191-218.

Wright, R. D., Wright, S. E., & Jones, A. (1999). Dying homeless but not alone: Social support roles of staff members in homeless shelters. Illness, Crisis & Loss, 7(3), 233-251.

What Do Homeless People Think About Death and Dying?

John Song and colleagues conducted research that asked people who are homeless about their thoughts and experiences surrounding death and dying. The following post is a summary of that research.

What is this research is about?

Many people who are homeless are not treated in the same way as the rest of the population. This study explored what homeless people think about death and dying and what their experiences are with death and dying.

What you need to know

People who are homeless have specific needs when it comes to coping with their own mortality and those they have lost. Typically, being exposed to death early on in life and also in their present lives leads to further problems. Issues such as mistrust of health care workers, risky behaviours, isolation, serious illness or injury and overall fears of death can inform how their end of life care is addressed, or not addressed.

alone

What the researchers did

The researchers went to six different agencies that serve people who are homeless and recruited 53 people over 18 years old. They used both focus groups and in-depth interviews with people who are homeless over a 5-month period to understand their thoughts, feelings, desires and experiences about death.

What the researchers found

After transcribing the information from the interviews and focus groups, the researchers found two different themes that arose, which were personal/internal experiences and relational/external experiences.  Personal themes that were common included the experience of loss early on in life, death of loved ones both past and present, life-threatening experiences, many fears and uncertainties about death, unhealthy coping strategies, and behaving in risky ways or more cautiously in life.  Relationally, the researchers found that people who are homeless are influenced by their experiences with health care practitioners, most claimed to have had negative experiences.

Using this research

Knowing the attitudes and experiences of people who are homeless can help us to better understand ways to prepare them for death and to cope and advocate for themselves. Researchers suggest using this information to improve end of life care by addressing issues of trust of health care providers and legal documentation.

About the researchers

John Song Center for Bioethics, and Department of Medicine University of Minnesota
Edward Ratner Department of Medicine, University of Minnesota
Dianne Bartels Center for Bioethics, and Department of Medicine University of Minnesota
Lucy Alderton Division of Chronic Diseases, Philidelphia Department of Public Health
Brenda Hudson Office of Clinical Research, University of Minnesota
Jasjit Ahluwalia Department of Medicine and Office of Clinical Research, University of Minnesota

Reference

Song, J., Ratner, E. R., Bartels, D. M., Alderton, L., Hudson, B., & Ahluwalia, J. S. (2007). Experiences with and attitudes toward death and dying among homeless persons. Journal of general internal medicine, 22(4), 427-434.

 

Homeless Deaths Motion at City Hall

There is a motion recommended by Paul Ainslie and Joe Cressy regarding homeless deaths in the Toronto community.

The following is a list of their recommendations from the City of Toronto website.  City council will be considering this motion on March.31st, 2016.

UPDATE: Motion passed 36-1!!

Recommendations
Councillor Paul Ainslie, seconded by Councillor Joe Cressy, recommends that:

1. City Council direct the City Manager to instruct the appropriate City staff to collect all relevant data related to the deaths of homeless individuals for occurrences within and outside homeless shelters.

2.  City Council direct that the data collected be shared with the public, agencies, City divisions and Provincial Government ministries for the purposes of influencing decision making through policy and legislation.

3. City Council direct the City Manager to correspond with the appropriate staff within the Government of Ontario in support of introducing a provincial mandate to track all deaths of homeless individuals for the purposes of data collection to introduce policy and legislation.

Homeless Youth: Problems and Solutions to Finding Employment

Stephen Gaetz and Bill O’Grady did some research by examining the role that employment training has on homeless youth and how social exclusion plays a part as well.  Here is a research summary of that work.

What is this research about?

The research is about questioning the beliefs and current processes surrounding youth homelessness and work. Specifically, the researchers look at the role of employment training programs and their effectiveness by looking at existing literature and then offering ways in which those programs can become better.

What you need to know

Current employment training solutions and informal money making strategies for homeless youth are problematic. In order to be effective, training programs must address issues surrounding social exclusion, meeting basic needs, and understanding around the instability of everyday life. Programs must offer solutions that will be successful in the long-term.

What the researchers did

The researchers compiled existing research that explains the many issues involving street youth and work. They offered a new framework for organizations to consider in order to make employment training programs more effective.

social exclusion

What the researchers found

The researchers looked at the informal money making strategies outside of the traditional market. They found defining features that inform how homeless youth engage in the work force, which include social characteristics, background, and highly flexible cash-in-hand jobs. With these come negative consequences such as risk of criminalization and stigma. Past research showed an overwhelming percentage of homeless youth with the desire and motivation to want to work.

There are three main approaches to the employability of youth that currently in effect; the informal learning from family and community, obtaining education, and improving human capital by teaching hard and soft skills such as computer training or interview skills.

Employment programs rarely address how social exclusion collides with the ability to find and maintain jobs for homeless youth. Social exclusion can restrict people’s access to spaces and institutions, structural factors can limit people’s participation in society, and it informs myths about how people perceive youth which can gloss over inequalities.

The limits of employability were broken down by researchers to include the following: housing and shelter, lack of income, unstable education, compromised health, chaotic lifestyle, weak social capital and an interrupted adolescence.

When programs fail to see beyond stereotypes of street youth, they weaken the effectiveness of employment training.

Using this research

Researchers offer a social inclusion framework to provide a philosophical basis that suggests activities must support the developing adolescent, address barriers that prevent participation in employment and employment training. They also suggest structural supports are needed such as stable housing, a basic income, appropriate health care and social supports. Program components need to include marketing skills, personalized case management, supporting special needs, mentoring, job shadowing and opportunities for educational advancement. Institutional components must include ongoing funding, strategic partnerships, ongoing program evaluation and corporate engagement.

About the Researchers

Stephen Gaetz is a professor and the director of the Canadian Observatory on Homelessness. He is also the President of the Raising the Roof Campaign. His interests focus on youth homelessness and using evidence based research to inform policy and practice.

Bill O’Grady is a sociology professor at the University of Guelph and is currently a member of Raising the Roof’s advisory board.

Keywords

Neoliberalism
Panhandling
Squeegeeing
Human Capital
Social Exclusion
Hard Skills
Soft Skills

Reference

Gaetz, S., & O’Grady, B. (2013). Why Don’t You Just Get a Job? Homeless Youth, Social Exclusion and Employment Training. Youth Homelessness in Canada: Implications for policy and practice, 243-268.