The main obstacle for our mental health program clients is often not their health; it’s housing

As an Advocate, I work closely with my clients while they challenge their certification under the Mental Health Act. A common concern repeatedly raised by clients is about access to and the quality of affordable housing moving forward from hospitalization. A common concern that facilities have before releasing a patient into the community is whether that patient will have a safe home to return to and supports in place to avoid a relapse and subsequent re-hospitalization.

As discharge plans often encompass accommodation, there are times when patients are required to spend more time than necessary as an inpatient while housing is explored and applications are submitted. This causes strain on an already overstretched healthcare system. Some common themes accounting for patient’s difficulties in finding appropriate and affordable housing include inadequate financial support from the government, lack of access to supportive housing, level of care required, illness, triggers, and location of affordable housing.

There is a shortage of affordable housing

Often, psychiatric inpatients and outpatients are not able to work when unwell and may not be able to return to steady employment for an extended period of time.  A patient can apply for Persons with Disabilities (PWD) benefits if their disability severely limits their functioning. However, as living costs rise in Vancouver and the Lower Mainland, our clients find they only have enough from their PWD cheque for rent, basic bills, and often find themselves seeking outreach for food and other necessities. PWD for a single person is $906.42 each month.

Of that $906.42, $375 is taken from PWD for rent in Semi-Independent Living (SIL) apartments or related subsidized housing. If the person is in a facility undergoing care for their illness, they are left with $95 dollars a month; the rest goes to the facility. Unfortunately, only a small minority of our client have access to these housing options that, while more affordable than the private housing market, still create major financial hardship for a client on PWD benefits. The rest of our clients have to find housing through the regular rental market and, according to the Canada Mortgage and Housing Corporation, average rent in Vancouver for a bachelor apartment was $864 and a one-bedroom was $982 in 2012.

The inability to afford housing and basic necessities forces people into substandard accommodations in undesirable and sometimes dangerous neighbourhoods, or living on the streets.

Housing must support health needs

Individuals living with chronic mental illness may require different levels of care throughout their lifetime. There are organizations and programs in place that provide group home settings, transitional homes, SIL apartments, and other mental health housing options. These housing options often have criteria applicants must meet when applying to the housing, and once accepted many rules and regulations a client must continue to follow to remain there. When unwell individuals can lose housing and have to be placed on long wait lists again while in hospital for appropriate accommodations. The client may now have to stay in a psychiatric inpatient facility until suitable housing can be obtained, or be discharged to temporary accommodations, shelters, or the street. Neither are good options.

Another common complaint from our clients is that they do not want to return to their current housing for valid reasons. For example, an individual might live in a neighbourhood saturated by addiction and crime, a trigger for them to relapse into addiction. Our clients sometimes develop delusions around family members, neighbours, or staff at their residence and do not feel safe returning.

As the availability for affordable housing is limited and waitlists continue to lengthen, the individual must decide whether to return to housing that poses a risk of triggering relapse, go on another waitlist for comparable housing, or move to somewhere they can afford, which often has similar environmental factors and sometimes no mental health support.  Clients who are focused on improving their mental health well-being are, unsurprisingly, requesting affordable housing in areas of Vancouver and the Lower Mainland that are nice places to live, not in typical transitional zones consisting of deteriorating housing, shelters and abandoned buildings.

The bottom line: three recommendations

Based on client concerns, stories, and observations, there is a need for more resources for both inpatients and outpatients to access affordable and safe housing. Hospitals need to have an adequate number of staff to help patients make a quick transition from the hospital to the community when well enough to do so. A common concern from many of our clients is that they do not want to be held as an inpatient while awaiting access to housing applications, application approval, viewing accommodations, and acceptance.

There also needs to be an increase in supportive housing on both the transitional and long-term care spectrums to avoid patients getting trapped in the psychiatric system’s revolving door after discharge. The time used to ensure the patient is placed in appropriate housing should limit the risk of relapse, hospitalization and possible eviction in the future.

Lastly, affordable housing needs to be spread out around Vancouver and the Lower Mainland and not centralized in low income, transitional neighbourhoods like the Downtown Eastside. Our clients often wait longer if they request to be removed from their previous accommodations due to self-identified triggers and unsafe environments in order to lower the risk of relapse and hospitalization. Not much will change unless government assistance or PWD rates increases. However, with the introduction of more affordable SIL apartments in the Vancouver and surrounding areas we hope to see barriers decrease and opportunities for our clients to find suitable long-term housing that will meet their current needs grow.