Tag Archives: #homeless

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.


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.



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).



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).



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.



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.


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


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 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.


Human Capital
Social Exclusion
Hard Skills
Soft Skills


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.


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.


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.


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.


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).


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



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.

Technology and Homelessness: Please Don’t Judge

What does technology use have to do with homelessness and death? Well, that will become clear in another post. But for now, I want to use this post to contextualize homelessness and technology use in general.

As a society we have become more reliant on the internet, since access has become more common (Guadagno et al. 2013:86). Other researchers believe that cell phones are thought to be the most rapidly adopted technology in history (Kim et al., 2013). We also know that more people who are becoming homeless are regular and frequent users of technology (Pollio et al. 2013:174).

Imagine if you didn’t have internet access or a cell phone, how would you function in the world today?

cell phone

Part of the problem is that people who have not lived in poverty, or who have not experienced homelessness, tend to generalize their situations onto people who lack resources. For example, I’ve heard someone with the individualist point of view saying “well, I went through hard times, but I managed to get back on feet without any help from the government, poor people just aren’t trying hard enough.” For the purposes of this post, I want to illustrate how this is problematic and then show how this way of generalizing relates to technology use.

Firstly, the rhetoric that people get to where they are without support is complete bullshit. The fallacy lies in not being able to recognize the support that was there, and how people take support systems for granted. Secondly, people do not recognize their own privilege. If you have been lucky enough to have been born in a society that doesn’t discriminate against you because of your race, gender, sexual orientation, or disability, then you probably don’t realize how far ahead you are than other people.

People who are not favoured by society will come across roadblocks that you may not have experienced and therefore you have no clue as to what they are going through.

Thirdly, people who judge others in poverty will typically have their mental faculties in place. “I was able to suck it up, why can’t you?” Ignorant statements like this completely discount how mental illness operates. Furthermore, even if those living in poverty do not have any mental illness, the day to day struggles are taxing. When you have little, if any, coping skills, “getting ahead” can actually become further behind.

How can they afford it?

old phone booth

Take this judgement and then the generalization it purports to the idea of technology use. “My phone bill is expensive! They are homeless, they shouldn’t have that luxury.”

Knowing how imperative it is to have a communication device today, hopefully it becomes easier to understand the importance of having a cell phone when you are homeless. Not all cell phones used by homeless people are the latest models, and not all people who are homeless have cell phones or laptops. An excellent post written by Emma Wooley discusses in detail the cost of different cell phone plans, which are not as expensive as you might think.

From research we know that some people had the phone before they were homeless, some acquired it just after they became homeless, some used security retirement funds, some worked periodically, some used welfare, some received money from family (Kim et al., 2013).

If you were to lose everything you had, but got to keep one item, my guess is that most people would choose to keep their cell phones or laptop.

What do they need it for?

What do you need your cell phone for? Think about how you would fair in this world without one. Imagine finding a job, using the internet, archiving photos, finding resources without having limited or no access to technology.

Let’s get into the research. Mobile phones allow people who are homeless to learn where resources are, find employment, to stay in contact with friends, family, probation officers, doctors and homeless support programs (Kim et al., 2013). From Guadangno’s research we know that “…college students and homeless young adults appear more similar than different in terms of their social network site use” (2013:88) and that “…homeless young adults use social networking more for the purpose of communication, particularly private messaging and blogging” (2013:88).

Roberson and Nardi explain that “…although homeless are often seen as marginalized, isolated, and out of touch with society, they skillfully use digital technologies to promote survival and social inclusion in important arenas of activity” (2010:445). One participant mentioned that he used his laptop to “cope with homelessness” (2010:446) and in general, technology “allowed the homeless to be included with the larger downtown community, and with the housed” (2010:447).

There have been some stories that have gone viral online recently. You can read about how people who happen to be homeless use their phones. For example, this article from Kat Ascharya about a man and his blackberry and this man’s post on Reddit.

social media

The use of technology for people who are homeless isn’t always positive. Many people living on the streets have to deal with theft of their technology (Kim et al., 2013; Roberson & Nardi 2010). Additionally, if you are someone who does not have a home and you deal with social exclusion on a daily basis, using the internet and social media can make someone feel even more excluded. Research by Abe Oudshoorn says “…youth talked about negative social capital, the fact that their social networks often were a detriment to their well-being, rather than helped them do better. All that internet access provided was more frequent and thorough access to this negative social capital. Youth talked about deleting their social media accounts as part of a process of exiting the street.”

One of the worst things you can do as someone who has never experienced homelessness is to judge others who are. Beliefs that stem from ignorance and lack of experience hurts people who are on the street and can lead to apathy when trying to make fundamental changes in policy and funding. If you are someone who has never been homeless, then try thinking outside of your own experiences, you may just find that there are other perspectives out there worth seeing.


Guadagno, R. E., Muscanell, N. L., & Pollio, D. E. (2013). The homeless use Facebook?! Similarities of social network use between college students and homeless young adults. Computers in Human Behavior, 29(1), 86-89.

Kim, M., Cameron, M., & Fung, A. (2013). Designs on Mobility: Perceptions of Mobile Phones Among the Homeless. Retrieved from: http://homelesshub.ca/resource/designs-mobility-perceptions-mobile-phones-among-homeless, accessed Feb.12, 2016.

Pollio, D. E., Batey, D. S., Bender, K., Ferguson, K., & Thompson, S. (2013). Technology use among emerging adult homeless in two US cities. Social work, 58(2), 173-175.

Roberson, J., & Nardi, B. (2010, February). Survival needs and social inclusion: technology use among the homeless. In Proceedings of the 2010 ACM conference on Computer supported cooperative work (pp. 445-448). ACM.

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”



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