A Wasted Expensive Band-aid for Homelessness, addiction and Mental Illness
By Marvin Ross
The Hamilton Spectator just published a three part series based on one of their reporters having been embedded in the Emergency Room (ER) at St Joseph’s Hospital in downtown Hamilton. The term embedded is usually used for press who embed with a military unit in an active war zone but the reporter who spent a total of 40 hours in the ER probably felt like he was in a war zone.
What the reporter described is a condemnation of how our society and our government deal with homelessness, addiction and mental illness. Most European countries do not have these problems because they deal with them. A friend who has relatives in Switzerland and travels there regularly once asked where all the homeless are. “They’re in hospitals”, he was told. Most of ours aren’t in hospitals or in them long enough for the stays to be effective. When they are discharged, we have too few community services to support them.
St Joes is located in downtown Hamilton and it actually has two emergencies. One of them deals with physical emergencies and the other, the Psychiatric Emergency Service (or PES), gets those who need psychiatric help. I’m familiar with both and a fan of the main ER but I’ve had problems with PES on behalf of my son’s care. All that was a few years ago so I will assume they have improved but the problems (in 2019) resulted in three psychiatrists and all their resident doctors refusing to work there because of the violence.
The key point is that the number of homeless going to the ER has doubled since the pandemic. “In 2024, St. Joe’s received about 4,000 emergency visits from 1,400 unhoused patients, a 43 per cent increase from pre-pandemic times.” Unhoused is a nicer word than homeless. This past December, the hospital discharged at times two homeless people to the streets every hour. One patient described in the article was discharged and back again within a few days. He was admitted 8 times within one month.
The reporter cites a study that showed that 29% of patients seen in the ER between 2018 and 2023 would not have needed that expensive service if they had a primary care physician.
It’s been awhile since I’ve been in the PES but I do remember vividly that it was more like a prison centre behind locked doors where patients waited for hours to see someone and then they would be discharged. The Spectator does mention there are plans to expand and improve it over the next 18 to 24 months. They will add more assessment rooms and even a family consultation room.
A family consultation room is a big step forward for the hospital and they are to be commended for planning that. Usually, families have been shunned. On one occasion when my son was in the PES, I called in the morning to see how he was doing. I was told they had no patient there by that name so I explained I was the father and he was there last night. I was told they could not tell me where he was because of patient privacy. I called the switchboard, asked for patient information and was told he was in an inpatient unit and they put my call through. So much for privacy. Why the big deal of refusing to tell me if he was discharged or admitted to an inpatient unit? Did that violate his personal privacy? If he had cancer, would they refuse to tell family where he was?
As street drugs are are a major problem in the ER which often leads to violence with some of them, there is no talk about increasing rehabilitation programs for addiction – one of the leading causes of homelessness. One mental health worker told the journalist that “one day (we will) enhance substance-use support offered to the homeless. The ED already offers these patients supplies including clean needles, meth pipes and condoms when they are discharged.” He added that he “hopes the ED will ultimately act as a safe-injection site, given the political push in Ontario to reduce their number in the community.”
The hard work and dedication to their jobs by the staff comes through in these articles very clearly. But what really comes through is the futility of their work because it is never ending, there is little relief for these victims and it is costing a huge amount of tax money. People are homeless for a number of reasons – mental illness, addiction, both combined and abject poverty. The people who are seriously mentally ill are not getting the services they need. We have too few hospital beds, psychiatrists and programs for them as comparisons with other first world countries shows. People become addicted for a variety of reasons and need publicly funded rehab programs to help them recover. With the addicted mentally ill, many of them use drugs to treat their symptoms. They need treatment for their mental illnesses and drug rehab.
All of them, including those who are homeless because of poverty alone, need a decent income and affordable places to live. For many, those affordable places need proper supports to keep them well.
All of these connected problems require a co-ordinated strategy and plan that will take time to develop, implement and to see results. Government negligence has created this problem and all levels of government need to work together with experts in these fields to resolve it appropriately with sane co-ordinated planning. One place to start is to look at what countries who have solved or prevented these problems are doing and to try to adapt them here. Business as usual is giving a pot of money to a problem with no oversight, little or no accountability and then saying look what we are doing regardless of outcome.
That does not work and governments need to finally take some responsibility. As the Fraser Institute put it “among developed countries with universal health-care systems, Canada ranks 22nd out of 28 for the availability of psychiatric care beds and 16th out of 28 for the number of psychiatrists per person. Perhaps unsurprisingly, Canadians in need of psychiatric care face a typical wait of nearly 25 weeks after GP referral (up more than six weeks since the early 2000s).”
One other point to make is that this series did not make any observations on how those with serious mental illnesses without addictions and who were not homeless were treated. The reason, I suspect, is that they get lost in the shuffle or are ignored. Just last December, the hospital tried to cut a successful mental health program in the community presumably to save money while they throw money away on supplying needles, drug supplies and condoms to those addicted and homeless with little or no proven benefit.
Patients of that program and a staff psychiatrist contacted me to complain and that was the second time that has happened. The first time in 2016 when I exposed those plans, the hospital backed down. I’m not sure if they did this time. What does that say about a hospital when two senior psychiatrists complain to a journalist about cutting services for the mentally ill.
Our society and our political leaders should all be ashamed of themselves over this treatment or lack of treatment) of the ill, homeless and poor
