[urbanclient]

Problems like homelessness and crime stems from chronic government underfunding of health care, education, housing, but we mostly look for band aid solutions like more police, jail beds, shelter beds, or even blame government intervention in the case of housing, which is too bad.

Fair.

I'll oversimplify things: I do think that the government building housing takes time though. Canada already has more of its labour force in construction than the US. So it's not easy to increase housing supply growth. If Ford decided to throw money at a provincial crown corp to build subsidized housing (assuming he would, and could) homelessness wouldn't decrease overnight. We're talking closer to 3-5 years. That's why shorter-term solutions like shelter beds and involuntary treatment are talked about. I don't think these things are mutually exclusive either. Then there's the political issue of providing housing to the homeless, when even the middle class is struggling with housing.

Also I don't think any well-informed person thinks jail for homelessness is fiscally responsible. Jails and prisons cost way more per person than other "band aid solutions".

There isn't a simple solution because borrowing more money to increase funding for healthcare, education, transit, and housing today risks reducing those services in the future. If we were running surpluses, it would be a no brainer to increase services. The last time Ontario ran consistent surpluses was before the Great Recession. If we're consistently running deficits, then the government should prioritize spending that effects positive returns. Not all public services / public spending lead to positive returns. Especially returns that come about within an election cycle.

For reference, federal interest payments now exceed federal health transfers to the provinces. The feds borrowing more money to increase some services, would be an indirect cut to all services in the future.

 

[evandyk]

I'll oversimplify things: I do think that the government building housing takes time though. Canada already has more of its labour force in construction than the US. So it's not easy to increase housing supply growth. If Ford decided to throw money at a provincial crown corp to build subsidized housing (assuming he would, and could) homelessness wouldn't decrease overnight. We're talking closer to 3-5 years. That's why shorter-term solutions like shelter beds and involuntary treatment are talked about. I don't think these things are mutually exclusive either. Then there's the political issue of providing housing to the homeless, when even the middle class is struggling with housing.

Also I don't think any well-informed person thinks jail for homelessness is fiscally responsible. Jails and prisons cost way more per person than other "band aid solutions".

"Involuntary treatment" is jail. I think there are situations where it's appropriate, but you're depriving the person of their liberty.

 

[urbanclient]

"Involuntary treatment" is jail. I think there are situations where it's appropriate, but you're depriving the person of their liberty.

That absolutist, unnuanced thinking is why we are behind the Nordics on many social files. I would argue it's an overreaction to the prison-industrial excesses/failings of the United States.

Canada did not have involuntary addiction treatment for adults in any province until very recently. Why are we ok with involuntary treatment for mental health, but not specifically addiction?

Modern involuntary treatment is not jail. It's not prison. It's time limited with an emphasis on rehab. 6 months maximum in the case of Sweden.

https://www.stat-inst.se/globalassets/lvm/engelska-information-till-dig-som-vardas-pa-sis-lvm-hem.pdf

Also below:

Look how quickly they came out of the woodwork to say [involuntary treatment] bad, the moment involuntary treatment is brought up, as if the asylums of old are anything like the LVM-hem in Sweden.

Jurisdictions in developed countries with involuntary treatment that is used in practice without requiring a court ruling beforehand (addiction without other mental health issues):

Norway, Finland, Switzerland, Australia, New Zealand, Singapore, Saskatchewan, and more.

The involuntary treatment with court ruling list is longer [includes Sweden]. The involuntary confinement for mental health list is even longer.

The social services must initiate an investigation under the Act on the Care of Drug Abusers in Certain Cases (LVM) if it becomes known that there may be grounds for compulsory care. This may be if an individual, as a result of ongoing drug abuse, is putting their health at serious risk and the need for care cannot be met in any other way.

Based on the investigation, social services can make a decision to apply for compulsory care for the individual with the administrative court.

Translated from: https://www.vardochinsats.se/skadli...nde-lag-om-vaard-av-missbrukare-i-vissa-fall/

 

[evandyk]

That absolutist, unnuanced thinking is why we are behind the Nordics on many social files. I would argue it's an overreaction to the prison-industrial excesses/failings of the United States.

Canada did not have involuntary addiction treatment for adults in any province until very recently. Why are we ok with involuntary treatment for mental health, but not specifically addiction?

Modern involuntary treatment is not jail. It's not prison. It's time limited with an emphasis on rehab. 6 months maximum in the case of Sweden.

I think it's important for people to understand the stakes of what you're talking about when you talk about involuntary treatment. You're locking someone up without having the choice/ability to leave. They call it "detention in a hospital".

So when we say "we need to force people into treatment, whether or not they consent", we should understand the gravity of that. It's appropriate in some cases, but it's very serious. That's why there's such a high bar to have someone committed to treatment for mental health reasons. And the tools already available for involuntary detention for mental health reasons would include mental health reasons arising from addiction.

 

[urbanclient]

Got it. Fair point.

I would add that people with severe substance use disorders already have their liberty sapped away by addiction. How much freedom do you have if your life revolves around drugs?

And the tools already available for involuntary detention for mental health reasons would include mental health reasons arising from addiction.

Not sure I'm understanding you here? Are you suggesting involuntary / compulsory addiction treatment is a thing in Canada?

For all intents and purposes, it is not. Sask and Alberta passed a law, but haven't actually started it as they are still preparing the treatment facilities etc. Saskatchewan has had a youth addiction law for 20 years that allows involuntary treatment for up to 15 days (not very long, it was more like detox), but it did not apply to adults.

When people get admitted under the Mental Health Act in Ontario, they are not specifically treated for their addiction. The system isn't designed to be a mental hospital + drug rehab. It's just a mental hospital.

Addiction-specific involuntary treatment was not a thing in Canada. And I suspect some part of that is due to ideologues being rabidly against mental asylums, involuntary treatment, incarceration and the like. As if they're all the same thing, or they're irredeemably evil and cannot be reformed.

In my short time on UT, it's been the same people parroting this absolutist thinking.

 

[evandyk]

Not sure I'm understanding you here? Are you suggesting involuntary / compulsory addiction treatment is a thing in Canada?

There's no reason the tools can't be used for addiction mental health issues.

Involuntary Treatment

ontario.cmha.ca

What is involuntary treatment for mental health and substance use?
Involuntary treatment refers to detention in a hospital, for the purpose of providing mental health and substance use treatment against a person’s will. [6] It is often time-limited, and intended to be delivered to individuals who:

1. Have a mental health and substance use issue that could result in serious harm to themselves or others, or if they are at risk of serious physical impairment, and;
2. Decline voluntary treatment and/or do not have the capacity to make decisions about treatment.

It may also be referred to as forced treatment or compulsory treatment, although some provinces are now using terms such as “compassionate treatment”, or “compassionate intervention”.

 

[urbanclient]

There's no reason the tools can't be used for addiction mental health issues.

Involuntary Treatment

ontario.cmha.ca

You linking a definition for involuntary treatment does not mean involuntary treatment for addiction is a thing in Ontario or Canada (until very recently). I've already mentioned the two new laws passed in Alberta and Saskatchewan.

Ontario does not have involuntary treatment for addiction only, be it health professional ordered or court ordered. You are free to google this. Comorbid general mental health and addiction leads to stays in mental hospitals. They are not facilities tailored to drug rehab.

Having a substance use disorder in itself does not lead to involuntary treatment.

You denying this with spurious evidence does not change the reality of the matter. You've misread what the CMHA says as well.

The CMHA states that involuntary for substance use disorders is not a thing in Ontario. The CMHA opposes any proposal to implement involuntary treatment (for addictions). They are also financially incentivized to oppose direct state intervention in matters of addiction and mental health. They are a non-profit that operates off government grants, but are arms length from the public healthcare system.

 

[nfitz]

When people get admitted under the Mental Health Act in Ontario, they are not specifically treated for their addiction. The system isn't designed to be a mental hospital + drug rehab. It's just a mental hospital.

Or, more often or not, just a regular hospital. Here's the list of Schedule 1 designated psychiatric facilities and hospitals in Toronto from https://www.ontario.ca/page/designated-psychiatric-
facilities-and-hospitals - which is most of them. I think the issue isn't so much that the legal system, etc., isn't already mostly designed for this. It's just that the system doesn't deal well with the situation once the immediate emergency is over. More the long-term situation than the short-term. With the system just not designed to handle the "demand".

 

[urbanclient]

Or, more often or not, just a regular hospital. Here's the list of Schedule 1 designated psychiatric facilities and hospitals in Toronto from https://www.ontario.ca/page/designated-psychiatric-
facilities-and-hospitals - which is most of them. I think the issue isn't so much that the legal system, etc., isn't already mostly designed for this. It's just that the system doesn't deal well with the situation once the immediate emergency is over. More the long-term situation than the short-term. With the system just not designed to handle the "demand".

View attachment 736845

Yes exactly.

The notion that people are getting actual addiction treatment / drug rehab while admitted to regular hospitals is incredibly ill-informed.

They'd be lucky to get admitted long-term. Many homeless addicts, IF they end up in the healthcare system, end up in the ER. Not even admitted for more than a day or two. Much less admission into a mental hospital. Certainly not involuntary treatment for addiction.

I mean the opposition to involuntary/compulsory addiction treatment I've heard is farcical, how can all of these be true?

• It strips people of their liberty
  • (ok...we can discuss if that infringement is worth it, considering how unfree drug addiction can be)
• Involuntary treatment is evil and/or tantamount to asylums
  • (they're not the same as asylums?)
• Mental asylums were evil and incapable of reform
  • (ok, but that's not the same thing as what we're talking about, involuntary psychiatric admissions are still a thing in Ontario too...)
• Involuntary addiction treatment already exists
  • (No, it does not? Except for Sask and Alberta where implementation is planned in the next few years)
• Housing first is better
  • Housing first does not seem to be better than treatment as usual / no intervention for many outcomes (see below)
  • No peer-reviewed studies comparing housing first to involuntary treatment, and there appears to be no political/financial incentive to do so

Here's a systematic 'review of reviews' on Housing First:

"The evidence indicates that Housing First does not lead to significant changes in substance use. Evidence regarding housing and other outcomes is mixed."

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0254729

Here's a Ottawa study comparing housing first to standard care in the community:

"Results: Housing First clients moved into housing more quickly, reported a greater proportion of time housed, were more likely to spend the final six months housed, and had longer housing tenure at 24 months. There was a group by time interaction on problematic alcohol use with more rapid improvement for the comparison group; however, both groups improved over time. The comparison group had a greater decrease on problematic drug use by 24 months. There was no change in physical health and only the comparison group had improvements in mental health by 24 months. The groups had similar improvement on community functioning by 24 months. The comparison group had a greater increase in total quality of life. More specifically, the comparison group had an increase in the family relations-related quality of life, whereas the clients did not. [...[ The Housing First clients reported higher levels of satisfaction with living conditions than the comparison group at baseline and 12 months, but not at 24 months."

https://pubmed.ncbi.nlm.nih.gov/28414579/

Ultimately, no treatment is what many, if not most homeless end up with. AFAIK: 1. there are no peer-reviewed studies comparing involuntary treatment to no treatment for homeless addicts. 2. There are no studies comparing involuntary treatment to treatment as usual for homeless (cycling through shelters, ERs, jail, little to no treatment depending on TAU definition). 3. There are no studies directly comparing involuntary treatment to housing first for homeless.

I'll add that housing first can fix things for a good chunk of the homeless population, provided they're not suffering from severe substance use disorders. I'm in favour of the government building housing again. But some people do not do well in housing with no strings attached. See the trashed shelter hotels during covid. If they can't handle a hotel room, what makes them capable of handling a studio apartment?

 

[McGillicuddy]

We can put all he effort in the world until getting people treated for conditions and made fit for release into society, but many of these people are effectively unemployable, and some of them are unhouseable. Releasing such a person from treatment is essentially courting a relapse, while keeping them in permanent "care" amounts to indefinite imprisonment for the crime of being socially inconvenient.

 

[evandyk]

They'd be lucky to get admitted long-term. Many homeless addicts, IF they end up in the healthcare system, end up in the ER. Not even admitted for more than a day or two. Much less admission into a mental hospital. Certainly not involuntary treatment for addiction.

Well, yeah. We don't have enough addiction (or general mental health) treatment facilities for people who would voluntarily like to access it. For involuntary mental health treatment, we're in a position where only people in the worst type of crisis will access it.

 

[Northern Light]

We can put all he effort in the world until getting people treated for conditions and made fit for release into society, but many of these people are effectively unemployable, and some of them are unhouseable. Releasing such a person from treatment is essentially courting a relapse, while keeping them in permanent "care" amounts to indefinite imprisonment for the crime of being socially inconvenient.

Any strategy for treatment, be it voluntary (ideal), or compulsory (if necessary) must (in the future) come with an appropriate discharge plan in place.

That means several things to me.

It means you give someone who seems ready to re-enter the community day passes at first, and more, then evaluate/test them to ensure they are able to resist relapse when unsupervised for a few hours.

It also means the person must have housing arranged, that can be with family, if appropriate, it can be in private housing (including their own) if they have it/can afford it, or it can be a rent-geared-to-income housing unit.

But discharging someone to the street is a non-starter.

Where someone is presumed to be employable, they should not be discharged until employment-ready ( someone sets them up a Linked-In, they have an email and phone number where they can be reached, and better still we get them a first job before they're even released). * (if they need education/training I would not suggest keeping them in care for months longer than needed for that; but they must be discharged into said education/training).

When someone requires on-going support, that too should be addressed, as should mitigating any other ongoing/pre-existing causes for the addiction. ie. (pain management, poor self-control, association w/problematic people etc)

The point of any effort is to succeed; at the very least in allowing a person to be housed in the community, self-sufficient in some fashion, and able to be a good neighbour, stay housed and out of serious trouble.

No system will ever be perfect or foolproof; some people will remain perpetually challenged,, but we need to be as successful as the best systems/societies in the world; which is to say, do much better than we are now.

 

[Northern Light]

Well, yeah. We don't have enough addiction (or general mental health) treatment facilities for people who would voluntarily like to access it. For involuntary mental health treatment, we're in a position where only people in the worst type of crisis will access it.

No question, we need to radically step up the level of access to voluntary treatment, including on an in patient basis.

To my mind, the appropriate standard of care for anyone urgent (for anything) is that service be available to meet needs in real-time. ie. if someone comes into an ER or a Doctor's office and says 'help, I've hit bottom'. They should be in care the same day. I'm fully aware we're not there, and not close, but we should be aiming for that.

 

[turbanplanner]

Problems like homelessness and crime stems from chronic government underfunding of health care, education, housing, but we mostly look for band aid solutions like more police, jail beds, shelter beds, or even blame government intervention in the case of housing, which is too bad.

We look for "band aids" because it's not realistic or fair to ask innocent people to deal with issues for the next 30 years to fix a structural issue in society.

‘Destroyed in less than a year’: Granville St. SRO resident wants public to see conditions - BC | Globalnews.ca

Stewart Holcombe said the bathroom roof in his fourth-floor unit at the SRO had caved in due to flooding from all the fires over the years, and his new accommodation is way better.

globalnews.ca

Just giving people housing doesn't seem to work either. The public keeps seeing colossal failures, whether the issue is "fixable" or not, you can only spend money if the general public feel it's worthwhile. When the average person is struggling, you have a massive drop in sympathy, to help those who "made bad choices".

"“All the stuff in the hallways, pictures were taken off the wall, the TVs were all taken and sold – like, it was destroyed in less than a year,” Holcombe said, adding he believes the public should be able to see the conditions."

Even if you spend all the money in the world, what do you do for someone who is "unfixable"
Even if you implement after school programs, to help the young what do you do about the hundreds of thousands who come to Canada well into adulthood?

 

[zang]

Just giving people housing doesn't seem to work either.

Actually, it’s one of the few things we know does work, regardless of what you might think. Study after study after study and trial after trial show it.

The public keeps seeing colossal failures, whether the issue is "fixable" or not, you can only spend money if the general public feel it's worthwhile.

It’s routinely shown to be more cost effective on the system to give people housing and treat them for mental health and addictions in-place.

It’s not about cost; it’s selfishness and lack of empathy getting in the way of Housing First strategies.

When the average person is struggling, you have a massive drop in sympathy, to help those who "made bad choices".

This sounds like projection.

Even if you spend all the money in the world, what do you do for someone who is "unfixable"

Do you think these people come out of the womb “unfixable”?

Perhaps years of being homeless had something to do with it; and by housing people we might be able to reduce the chances of people getting to that stage.

Regardless, not helping 99 people because it doesn’t work for 1 is just dumb policy.

Even if you implement after school programs, to help the young what do you do about the hundreds of thousands who come to Canada well into adulthood?

Is this now an attack on immigrants?