Tag Archives: Death

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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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.

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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.

Commemoration Events And Causes of Death

The Stone and Glass Art Installation launch was beautifully done.  Artist Rebecca Houston had a vision along with the Myseum Intersections project. How can we tell stories that reflect the culture of Toronto while including historical dimensions?

Rebecca chose to highlight the numerous homeless deaths that have occurred over the past few decades. Names, initials, Jane and John Doe’s were projected onto the Church of the Holy Trinity’s front façade. This is where the Toronto Homeless Memorial happens every second Tuesday of the month at noon, to remember those who have passed away.

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To open the night, a few remarks were made by Rebecca, Britt Welter-Nolan, street nurse Cathy Crowe, and Reverend Sherman. Andrew Wesley began smudging and recited a prayer and then the Smoke Trail Singers began drumming to initiate the projection of the names.

Visitors were then encouraged to stand vigil as the names scrolled across the church wall. Otherwise, people could go inside and experience other interactive pieces. There was an audio installation where you could hear stories about people’s lives and the intersections of homelessness, as well as a reading of the names.

Cups were placed on a table next to the list of people who have died and you could write one of the names on the cup in memoriam to that person, which was placed on the carpet to act as a “headstone.”  Art pieces and a reflections board were displayed where people could write down any thoughts about the night or about homeless deaths in general.

 

What are the causes?

I have written previously on how death is widespread within the homeless community. However, I want to bring to light the causes of death.  Before I get into some of the research, I will say right up front:

People who die when they are homeless, die because they were homeless.

You may be thinking, “what do you mean? They die from stabbings, and alcohol and other things!” Well, those “other things” are actually just symptomatic. Other researchers have also suggested that homelessness itself is the main risk factor for death that needs to be addressed (Hibbs et al., 1994:308, Barrow et al., 1999:533, Condon & McDermid, 2014:3). Let’s explore further.

We know that both individual AND structural factors are involved with why people become homeless in the first place (Fazel et al 2015:1). We also know several times over that people who are homeless die younger than the general population (Hibbs et al., 1994:307; Cheung & Hwang 2004:1243; Barrow et al., 1999:529; O’Connell 2005:13). In British Columbia, “[t]he median age of death for a homeless person…is between 40 and 49. The average life expectancy for the general population in British Columbia is 82.65 years” (Condon & McDermid, 2014:4). In Copenhagen “[h]omeless people staying in hostels, particularly young women, are more likely to die early than the general population” (Nordentoft & Wandall-Holm 2003:81).

When homeless people are at almost half the life expectancy as the general population, then we have a major crisis that needs addressing.

For people who are homeless, many die from violence and trauma from being on the streets (Wright et al., 1999:244). “In the USA…younger people die disproportionately from external causes of death (suicide, accidental overdoses, and homicide) and infectious diseases, and there is also a spike in older homeless people” (Fazel et al. 2015:5). Some researchers suggest that “[d]rug overdose has replaced HIV as the emerging epidemic” (Baggett et al., 2013:2). The St.Michael’s Hospital Centre for Research on Inner City Health recently released this quick read guide that highlights health problems and mortality rates. Mental illness is a major factor in homelessness, but I will be writing about that in more detail in a future post.

Numbers, numbers and more numbers

The 2015 Annual Review of Statistics on Deaths of Shelter Residents was recently released. This report provides rough estimates of deaths since 2007 specifically of shelter residents, which does not include many others who choose not to go to shelters. People have suggested that we need a count of the number of people who are homeless at a particular point in time. Researchers say that, “…without sufficient provincial data it is difficult to determine the necessary steps to minimize homeless deaths across the country” (Condon & McDermid, 2014:18). I understand how policy makers like to use evidence based decisions to tackle social issues. As a graduate student, I also understand the need for research and providing evidence in order to strengthen arguments.

numbers

However, in this case, do we really need a count? We know people are dying. The government needs a number? How high must the number be in order for these deaths to be seen as a significant issue? For me, one death would be enough. Apparently there needs to be many, but we don’t know what that number is since the government is not making this a priority, nor are its citizens. A child gets shot, we fight for gun laws. A child is hit by a car, we fight for road laws. A child dies on the streets and apparently we don’t give a shit.

Prevention

Researchers have not only mentioned that homelessness itself is a risk factor for death but also that homeless deaths are largely preventable (Hibbs et al., 1994:304,Condon & McDermid, 2014:3). Hwang et al. maintain that “[a] large part of the premature mortality in people living in shelters, rooming houses, and hotels was potentially avoidable” (2009:6).

For individual circumstances, we need to “… include behavioural health integration into primary medical care, public health initiatives to prevent and reverse drug overdose, and social policy measures to end homelessness” (Baggett et al., 2013:2).  For young people it is suggested that they receive “…psychiatric treatment, detoxification treatment, medical treatment, social advice, and accommodation. The prevention of social exclusion should start early in life” (Nordentoft & Wandall-Holm 2003:81). For older homeless people “the management of chronic diseases, geriatric conditions, frailty, and end-of-life issues is more prominent” (Fazel et al. 2015:5).

prevention

In order to prevent people from dying way earlier then they should, we need a national housing program and social supports that include counseling, better access to health care, decriminalization, employment help and training programs. These must be used together. If you only have housing first programs or only have employment training, then they will fail.

Tackling stigma is another factor in preventing homeless deaths from happening in the first place. Some common stigmas include racism, sexism, AIDS, autism, homophobia, and ageism, among others. Attitudes and beliefs can make the difference between someone being housed or homeless.

The fight will be a tough one and we need more people that can speak out against the crisis of homeless deaths. People are needlessly dying. We need to notice and we need to care. Ending homelessness in our towns is not some esoteric unattainable concept, others have done it. So why don’t we?

 

Featured Image artwork by Jim Houston

 

References

Baggett, T. P., Hwang, S. W., O’Connell, J. J., Porneala, B. C., Stringfellow, E. J., Orav, E. J., Singer, D.E., & Rigotti, N. A. (2013). Mortality among homeless adults in Boston: shifts in causes of death over a 15-year period. JAMA internal medicine, 173(3), 189-195.

Barrow, S. M., Herman, D. B., Cordova, P., & Struening, E. L. (1999). Mortality among homeless shelter residents in New York City. American Journal of Public Health, 89(4), 529-534.

Cheung, A. M., & Hwang, S. W. (2004). Risk of death among homeless women: a cohort study and review of the literature. Canadian Medical Association Journal, 170(8), 1243-1247.

Condon, S., & McDermid, J., (2014). Dying on the Streets: Homeless Deaths in British Columbia. Street Corner Media Foundation. https://d3n8a8pro7vhmx.cloudfront.net/megaphone/pages/7/attachments/original/1415231881/Dying_on_the_Streets_Homeless_Deaths_in_British_Columbia.pdf?1415231881, accessed Mar.10, 2016.

Fazel, S., Geddes, J. R., & Kushel, M. (2014). The health of homeless people in high-income countries: descriptive epidemiology, health consequences, and clinical and policy recommendations. The Lancet, 384(9953), 1529-1540.

Hibbs, J. R., Benner, L., Klugman, L., Spencer, R., Macchia, I., Mellinger, A. K., & Fife, D. (1994). Mortality in a cohort of homeless adults in Philadelphia. New England Journal of Medicine, 331(5), 304-309.

Nordentoft, M., & Wandall-Holm, N. (2003). 10 year follow up study of mortality among users of hostels for homeless people in Copenhagen. Bmj, 327(7406), 81.

O’Connell, J. J. (2005). Premature mortality in homeless populations: A review of the literature. Nashville, TN: National Health Care for the Homeless Council, 1-16.

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.

Stone and Glass: We Are All Transient

Myseum is a non-profit organization that celebrates diversity and helps the community to further understand it’s culture and urban spaces. The collective is launching its first annual festival of exhibits exploring different perspectives on the city’s natural, cultural, and historical diversity.The festival runs March.6th-31st.

On March.9th from 6:30-9:30pm at The Church of the Holy Trinity and Trinity Square, the event launch will be taking place that includes an art installation, live music, drumming, historical church tour, food and activism.

The event is a collaboration between The Church of the Holy Trinity, The Toronto Homeless Memorial Network and community artist Rebecca Houston. The premise for the installation is that most people aren’t aware of how many people die homeless and without support. The names of those who have passed away will be projected onto the front face of the church in order for people to take notice.

This is an excerpt from the flyer:

“We all pass briefly through the world, but we are not all treated the same. In Toronto alone nearly 800 people have died on the streets and in temporary shelters since 1985. Many die without a name, listed only as Jane or John Doe. Come for an evening light and sound installation honouring them and calling for change in their memory”

memorialflyer

 

The following is a list of what she is looking for if you are interested in volunteering:
Volunteers to arrive early, (5pm) help set up sound, tables, chairs, food (5-10 people)
Crowd greeting and handing out programs- “Ambassadors” (10-15 people) (from 5:45-7pm)
Help serving food (5 people) (from 6-8:30pm)
Clean up (10-15 people) (9-10pm)

If you are interested in volunteering, please contact Rebecca Houston:rebeccajanehouston[at]gmail.com

Here is the official website.
Twitter: Stone and Glass @homelessevent

Toronto Homeless Memorial

Another month…more names.

I try to make it out to the memorial service when I can. The ceremony is not long and it’s a great way to show support and remember those homeless people who have passed away. The service is also a reminder that this shouldn’t be happening in the first place, people should not be dying because of homelessness.

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People come together to read poetry (focusing on what is a priority to the homeless community for that month) and hear music that speaks to the systemic problems that contribute to poverty. Michael Shapcott gives us a run down of the political climate and of course there is a reading of the names, tribute speakers and a moment of silence.

Community members also take the opportunity to announce any initiatives, projects or protests during the service.

If you are in the Toronto area, feel free to stop by and remember. The memorial happens every second Tuesday of the month at noon.

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Importance of Names

“The dead cannot cry out for justice; it is a duty of the living to do so for them” 

– Lois McMaster Bujold

Every second Tuesday of the month, some community members gather at the Church of the Holy Trinity in downtown Toronto in order to remember those homeless people who have passed away. One of the hardest parts of attending the Toronto Homeless Memorial, is hearing the list of names that are read during the ceremony. If that wasn’t difficult enough, many of the deceased could not be identified and therefore are read as “Jane Doe” or “John Doe.”

We pride ourselves on our “first world” status, on how “developed” we are compared to other countries. The truth is, we are far from developed. People…and I will repeat this again…people who have died homeless should not have been in that position in the first place. But even further, we cannot even keep track of our citizen’s names? Who were they? And at the very least, what were their names? Where is the dignity?

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Kumar and colleagues suggest that we are born with an identity and we deserve to die with one, as it is a fundamental right of being born a human (2014:80). Michael Stoops informs us that “[w]hen a homeless person dies they do no often get the same sense of dying with dignity as a housed person” (2007:6). What most of us might take for granted here is that for many, burials and funerals are commonplace. Gravestones are often marked with the names of the dead. Unknown soldiers are also another group that do not get named in death, however, they are much more exalted in our society.

In a recent paper I wrote, I unpack some of the answers surrounding Judith Butler’s question of “what makes for a grievable life?” (2003:10). In neoliberal times, those people engaged in economic gains and productivity tend to be considered more valuable than those people who “do nothing.” We think to ourselves that money makers are more valuable than John Doe’s who die on the streets because they never contributed to society in a productive economic way. Thomas Laquer would agree, “[w]e have a history of commemorating the dead through monuments, which include war veterans, public workers and political figures. Some of these sites only include those who have “done something for humanity” (2015:423). However, if you learn about people who are homeless and hear their stories, then you will learn some of them were “productive” members of society (which is actually beside the point, but needed to be mentioned).

A human life is a human life, and because we have labelled and stigmatized homeless people, we just don’t care enough as a society to learn their names. Tipple and Speak suggest, that “[t]he negative and exclusionary language used to describe and discuss homeless people helps to construct homeless people as ‘other’ and institutionalize their stigmatisation keeping them dissociated and disconnected from society” (Tipple & Speak 2004:2). Society in general seems to be ok with this, to see homeless people as parasitic and therefore who cares about when they die or what their names were, right?

Despite this, some of us are working to change that.

baby feet

Laquer has also pointed out that “[n]aming marks the entry not into biological but into human life” (2015:367). In Ontario, when we are born, we are required to submit our children’s names to the province that in turn, provides a birth certificate. This is an important societal ritual, not only because it is an official government act, but on a personal level, we can understand its importance. Psychologists have done research on the importance of names. The field has also labelled a phenomenon called “The Cocktail Party Effect” which is being able to recognize our name being said in a noisy room and a good overview of the literature can be found here. Nisbett and Ross (1980) inform us that we pay more attention to identifiable victims than statistical ones.

It is clear. Names are important to us all. We should not live in a society where we cannot keep track of our dead. If this is something important to you as well, contact your local MP and MPP and support affordable housing and social supports as a priority in order to prevent this tragedy from happening in the first place.

References

Bujold, L. (2002). Diplomatic immunity. Riverdale, NY New York: Baen Books.

Butler, J., (2003). Violence, Mourning, Politics. Studies in Gender and Sexuality. 4(1): 9-37.

Colman, A. M., Hargreaves, D. J., & Sluckin, W. (1980). Psychological factors affecting preferences for first names. Names, 28(2), 113-129.

Kumar, A., Harish, D., Singh, A., & Kumar, G. A. (2014). Unknown Dead Bodies: Problems and Solutions. Journal of Indian Academy of Forensic Medicine, 36(1), 76-80.

Laqueur, T. (2015). The work of the dead : a cultural history of mortal remains. Princeton, New Jersey: Princeton University Press.

Nisbett, R., & Ross, L. (1980). Human inference: Strategies and shortcomings of human judgment. New Jersey: Prentice-Hall, Inc.

Stoops, M. (2007). Dying without dignity: homeless deaths in Los Angeles County, 2000-2007. Los Angeles Coalition to End Hunger & Homelessness.

Tipple, G., & Speak, S. (2004). Attitudes to and interventions in Homelessness: Insights from an International Study. In paper delivered to International Conference Adequate and Affordable Housing for All, June (pp. 24-27).