I am a huge believer in harm reduction. You have to be in the right place for abstinence and when social supports do not allow for harm reduction many people experiencing addiction can fall through the cracks.
Wet shelters limit options for city’s alcoholics
LUCAS OLENIUK / TORONTO STAR
John Bowley, who has been staying in shelters on and off for five years, outside of Osgoode Hall, where he often sleeps.
This day is no different. It’s shortly after 2 p.m., and his last drink was around lunchtime, a premixed whisky tallboy. Bowley, 50, says he’s also on methadone to kick a heroin addiction.
He doesn’t know where he will go tonight. While the official policy of Toronto shelters is not to deny people access solely because they’re drunk, Bowley’s experience tells a different tale.
There used to be two shelters Bowley could have gone to where he could drink inside, known as wet shelters. But now that the Schoolhouse Shelter has been converted to emergency beds as of Jan. 1, there’s only one left for adults.
That’s the Annex Program at Seaton House, where residents are given one standard drink every 90 minutes. The program helps prevent them from harming themselves, by getting into fights or becoming unconscious and vulnerable. It also helps connect them to health care and the system.
Harm-reduction advocates, like Holly Kramer, the co-ordinator of the Toronto Harm Reduction Task Force, warn that losing the Schoolhouse will have negative effects.
“If it’s not there, believe me I don’t think that means they’re going to stop drinking. We’re going to have more alcohol consumption in public places,” she said.
Operators of both abstinence-based shelters, where residents can’t drink, and the Annex Program agree on the need for shelters that allow the homeless to drink.
There are about 3,800 beds in city-run shelters on any given night. The Schoolhouse accounted for 55 beds, and the Annex program has 140 beds.
That doesn’t meet the need. “Alcoholism is quite high among the homeless — it’s probably on the order of 30 per cent. Mental illness and addictions are 70 to 80 per cent in total,” says Dr. Tomislav Svoboda, a physician at the Annex Program who wrote his thesis on the initiative.
He noted about 10 per cent of the residents will die in a shelter, but in conditions better than they would have experienced on the street.
Dr. Svoboda found an 85 per cent drop in days spent in prison overall and an 84 per cent drop in ER visits among problem drinkers in the program.
“(That’s) a pretty huge impact when you compare it to the lack of such a program or what it was like for them before they entered the program,” he said. “Their drinking improves … They have better access to health care, their emergency visits drop … Incarcerations on average drop from 30 days a year down to hardly anything.”
It also brings people on the street closer to doctors like Dr. Svoboda, allowing them to monitor their drinking and its effects on medications. Six months after the Annex Program launched in 1999, 14 of the clients were found to have tuberculosis, according to an article in the CMAJ. Drinking while on medication would have severely damaged their livers. Thanks to the program, they all stopped or cut back and the tuberculosis treatment was rendered effective.
The approach has met with success elsewhere in Canada too — a similar program in Ottawa was shown to dramatically reduce drinking.
“Typically we see over a period of time a reduction of about two-thirds (of alcohol),” said Wendy Muckle, executive director of Ottawa Inner City Health. She noted that it takes about three to five years to see change.
“For the first period of time you are what stands between them and chaos, then gradually they are able to take over more,” said Muckle.
Seattle has taken harm reduction a step further by offering alcoholics permanent housing, not shelters. The Housing First Initiative housed 95 chronic alcoholics in 2005 without demanding they change how much they drank.
Daniel Malone, director of housing at the Downtown Emergency Service Centre in Seattle, says the Housing First Initiative has been applied to chronic alcoholics in Seattle, which led to a drop in alcohol consumption for participants, and also saved taxpayers millions and has become a model for other cities.
“The net reduction in total cost of these crisis services of the initial cohort that moved into the building was $4 million (USD) over one year,” said Malone, adding the savings came from the reduced cost of emergency services, jail and outpatient care. The participants also reduced their “average peak drinks” — the most they would drink in a given day — from 40 to 26 drinks after a two-year period.
The Schoolhouse Shelter on George St. is in transition. Eleven men still call the shelter home as they wait for housing workers to find them a place to live. Meanwhile, construction crews are upgrading the building and staff are waging a never-ending battle against bedbugs.
Shelter manager Haydar Shouly stands in the shelter with David Reycraft, director of housing and homelessness services at Dixon Hall, a non-profit that has operated the shelter since 1999.
It was Dixon Hall that first approached the city about changing the Schoolhouse Shelter.
The program was running at a deficit. Dixon Hall would have needed $225,000 more a year to keep the wet shelter initiative going, which required around-the-clock support and programming.
“Really what we needed to change was to ensure that our per diem was enough to keep us whole financially,” said Reycraft, adding that the age of the 130-year-old building was also an issue.
The structure, built as a schoolhouse in 1886, requires $300,000 in repairs over the next five years. The city has committed to these repairs, but is reducing the number of beds and eliminating the wet shelter program, converting it into emergency accommodations, which are cheaper.
Like other city shelters, residents have to check their liquor into a booze lock-up on entry, and retrieve it when they leave.
John Lever, 59, a former resident of the Schoolhouse who is now sober, stayed there between 2005 and 2006.
“They did treat you a little bit like a human being. It really wasn’t that bad compared to the other ones,” says Lever. “If you came in with a couple drinks on your breath, that was fine.”
But by no means was it a party. Lever remembers doing odd jobs for cash so he could afford a few drinks. Asked how he felt during his time in the Schoolhouse, Lever is blunt: “Terrible,” he says.
“You’re (drinking) as a form of escapism because you’re depressed. You’re there, you’re going to do anything you possibly can, be it drugs, be it alcohol, be it even sex.”
Lever says he has been kicked out of shelters but was too drunk to remember where he ended up staying. He works as a part-time driver now, although he’s still in the shelter system, waiting for a permanent place to live.
John Bowley ended up sleeping in the crawl space under the steps of Osgoode Hall that Wednesday, with a bag full of beer to keep him warm while the temperature dipped to minus 6. He is still sleeping outdoors more than a week later.
His shaggy black hair has a few wisps of grey, but it’s clean thanks to the facilities at the Good Neighbours’ Club, a daytime drop-in centre in downtown Toronto. Bowley’s slouches into his chair in the second floor of the centre, out of the cold, and describes how he sometimes warms up by sleeping on the vents.
“You’re so tired and it’s so cold,” he says, pausing sporadically, his eyes drooping. “The warm air that’s blowing up, especially the ones on University, it can be so, just perfect. Just cross your legs and you don’t think about the embarrassment, or people that might know you … all your (humiliations) are — they all go away when you’re in that state.”
Hundreds of homeless people like Bowley have died while sleeping outdoors. The Annex program at Seaton House was established after a coroner’s inquest into the freezing deaths of three homeless men in 1996.
One of the recommendations was that the Toronto shelter system adopt harm-reduction principles. “Everyone is entitled to shelter services, whether or not they use substances,” reads the policy, which was adopted in the city’s shelter standards in 2002.
But stories from the streets reflect a different reality. “We often hear guys here talk about the challenges they have accessing shelter beds when they’re under the influence,” says Lauro Monteiro, director of the Good Neighbours’ Club.
Aklilu Wendaferew, assistant executive director at the Good Shepherd Ministries, an abstinence-based shelter on Queen St., says they deny people access only for inappropriate behaviour, and that the major concern with allowing alcohol to be consumed on-site is safety.
“If people are using, then there’s the possibility for all kinds of things to happen, including violence, including interfering in the ability of other people to have a safe environment during the night,” says Wendaferew.
The question is one of balance, experts say: Toronto needs both abstinence-based shelters and ones that accept people who have been drinking.
“There absolutely needs to be more wet shelters,” says Dion Oxford, director of the Salvation Army’s abstinence-based 108-bed Gateway shelter. “(A lot of people) stuck in the abyss of addiction simply cannot go cold turkey right away. There needs to be a place where people can use and be safe at the same time.”
Oxford, who has been working with people on the streets for more than 23 years, says the Gateway centre also turns people away because of behaviour, not on whether they’re under the influence.
Still, he noted, it can be difficult for clients trying to kick the habit to have people stay in the shelter who’ve been drinking.
Oxford says that Toronto’s services have always been weighted against harm reduction, and losing the Schoolhouse only made it worse.
“We need to understand addiction as far less black and white than we used to. There is a spectrum and we need to partner with each other,” says Oxford.
“We’ve lost yet another way to respond to the dire needs of homeless people in Toronto.”
The Annex Harm Reduction Program at Seaton House is the last remaining wet shelter for adults in Toronto.
The 550-bed facility cuts an imposing presence on George St. High metal fences surround a yard where men mill about, smoking and chatting.
Inside, a program on the fourth floor is underway. It’s a 140-bed wing with an alcohol dispensary that looks like a campground tuck shop. A chalkboard shows the times when drinks are served.
A handful of men sit in chairs, chatting while they wait for the metal grate to open and for staff to pour white wine from pitchers into Styrofoam cups.
“Hi, good morning,” shelter manager Karen Smith says to the men.
“You’re too late,” one of the men jokes to Smith — she just missed the first serving of the day, at 8:30 a.m.
“I’ll come back in an hour and a half,” she replies. The men laugh and continue to chat, holding their empty cups.
The clients pay a fee for their alcohol, usually around $100 a month. They can supply their own booze, in which case it is given to them in measured doses, one standard drink at a time.
The program is geared toward those who are not ready, willing or able to stop drinking.
“Our goal isn’t to reduce the amount of drinking, but to help manage it from the perspective of a person not getting so intoxicated that they’re incapacitated. It prevents them from getting into harms way, getting beaten up on the street, falling unconscious,” says Dr. Svoboda.
Harm-reduction centres can also provide respite until people are ready to quit completely, says Dr. Patrick Smith, CEO of Renascent, an abstinence-based drug and alcohol rehab centre.
“Jurisdictions that have done it best have been able to have a developmental model of all the right things in place, so that when someone reaches the next level of stability there’s an easy next step for them,” he says. “(Then) it isn’t like talking to someone in first grade about going to university.”
Peter Leslie, 53, is a former alcoholic who went to rehab 11 times before becoming clean for good — including two attempts while he was working as a paramedic for Toronto EMS, fighting alcohol and cocaine additions. After relapsing, he fell further, until he was smoking crack in the washroom at Tim Hortons.
In 2002, Leslie stayed in the Schoolhouse Shelter for a year. He now works as a peer educator with the Toronto Harm Reduction Task Force, which advocates for harm-reduction policies and educates front line workers on its benefits for people with drug problems. He protested the Schoolhouse’s closure this fall.
“I don’t think (the City) likes the fact that people drink, which is reality, and people use drugs, which is a reality. I think they see (harm reduction) as accommodating or enabling,” he says. “But every time there’s someone who dies outside, there’s a s—storm.”
After moving through transitional housing, Leslie now lives in an apartment. But he considers himself lucky. “I met hundreds and hundreds of men and women that abstinence was just not in the books for,” he says.
“Some people just can’t quit.”
The videos from the You and Your Meds panel are up! Here they are for your enjoyment!
Mayor Ford ousted from office; found guilty of conflict of interest
Chris Kitching, cp24.com
Last Updated Monday, Nov. 26, 2012 11:02AM EST
A judge has found Mayor Rob Ford guilty of a conflict of interest and ordered him to be removed from office.
Ford was accused of not declaring a conflict of interest when he participated in a city council vote on whether he should repay donations he made to his football foundation.
Ford can appeal the judge’s decision.
In his 24-page decision, Superior Court Judge Charles Hackland disqualified Ford from running again during this term in office, which expires in late 2014.
“It is difficult to accept an error in judgement defence based essentially on a stubborn sense of entitlement … and a dismissive and confrontational attitude to the Integrity Commissioner and Code of Conduct,” Superior Court Judge Charles Hackland wrote.
“In my opinion, the respondent’s actions were characterized by ignorance of the law and a lack of diligence in securing professional advice, amounting to willful blindness,” Hackland wrote. “In my opinion, a high standard must be expected from an elected official in a position of leadership and responsibility.”
The lawsuit was launched by Toronto resident Paul Magder.
At a trial in September, Ford told court he believed he did nothing wrong, while lawyer Clayton Ruby argued the mayor acted in bad faith by not familiarizing himself with the city’s conflict of interest rules.
Ford said he didn’t remember receiving or reading a handbook for municipal councillors that outlines when to declare conflict of interest or the Municipal Conflict of Interest Act, which he was accused of breaking.
In 2010, Ford used his staff to help send out donation requests for his football fund and mail them to donors who had officially lobbied the city government.
The city’s integrity commissioner found Ford’s actions broke the conduct code for councillors and recommended he pay back $3,150 to the donors from his own pocket.
City council adopted the commissioner’s findings and sanction in a resolution Ford voted against — but he never made the repayments, despite several reminders from the commissioner.
Council later voted to overturn the integrity commissioner’s penalty. Ford voted in favour of the motion that would allow him to keep the money.
Because of my new temporary full time job I have to reorganize my life. I do not have the same amount of time to devote to blogging or interacting with all of you the way I used to, which is the way I liked it.
I’ve decided that throughout the week I will at the least “Like” what you have all posted and then on the weekends I can whip out the comments since I have time to be thoughtful!
It’s going to be another busy week and I’m feeling overwhelmed already.
Tomorrow I have to go to the police station because they returned my vulnerable sector screening form to work along with the check. They do not accept personal checks. Now I have to line up and pay with my Visa, which is what I wanted to do in the first place.
Wednesday I hopefully have the rescheduled CAMH meeting!
Thursday I have group.
Friday nothing but Saturday I’m going to another Fringe Festival show! This should be relaxing and I know I’ll enjoy myself but I see it as another thing I have to get up, get ready for and show up at the right time. Only I could make something fun into something stressful!
Yesterday, Sunday, Michael and I went and saw the Fringe Show, Gay Nerds which was REALLY FUNNY!!! This Saturday we are seeing The Princess of Porn: The Musical. Both shows star individuals Michael worked with in the past on his web show.
I need to go to bed soon! Good night!
I have a great job for the summer! I’m really excited and my team is great!
One problem….I need a vulnerable sector check and the agency is requesting information about my involvement (if any) with the police under the Mental Health Act.
I have no concerns that something will come up because I have never been in contact with the police under the Mental Health Act.
My concerns are strictly principal. I should not have to give the agency access to this information.
This says to me, “we don’t want crazy people working for our agency.”
This says to me that there are some out there who will have this information given to their employer and will possibly be denied the job.
This says to me that I cannot ever go to the police when I am in crisis for fear that I am “arrested” under the Act.
I have asked my partner to please never call the police if I get out of hand. He never has or has never threatened to but I just wanted to make sure that he knew that call could potentially ruin my life, especially since I work with children.
I live across the street from a police station. I’m thinking I should go in and ask them if I can refuse the mental health part of the check and not have my employment compromised. I also want to know under what grounds can someone be apprehended under the Mental Health Act. Does this person have to be wielding a knife or will being in extreme chaos, crying and screaming, simply be enough?
On the form is says (in bold), “The Agency has explained to the applicant how the responsibilities of the position relate to the request…” This was not explained to us. I was going to email the agency and ask how and I may still. I just don’t want to step on any toes. Which is unfair seeming how this request stomps and breaks my toes.
I’m going to talk about this tonight at YO Group and see what other people have to say.
The Eaton Centre is a mall in downtown Toronto. A lone gunman decided it would be a fantastic idea to go down into the food court (which is freaking amazing) and start shooting.
A 25 year old man is dead.
7 people are injured, including a 13 year old boy.
A woman because of the commotion went into early labour.
Police believe the shooting was targeting the young man was is now dead.
It happened at 6:30pm.
I’m very angry.
I’m mad that someone believes they have the right to take someones life!
I’m mad that other innocent people were hurt because of something that had nothing to do with them!
I’m mad that thousands of people are possibly traumatized from seeing, hearing or knowing that the space they were in was not safe!
I’m mad that a space I frequent was the scene of pain and death!
This doesn’t happen in Toronto, it is not a violent city. This is random. That is a comfort but I’m still angry. I feel invaded. The university I went to is right beside the Eaton Centre. I basically lived at that mall! I bought my shoes there a few weeks ago! I brag about that food court because it is so amazing and now someone has been shot and killed there.
Someone has died where I’ve eaten.
People have been injured where I shop.
A man with a gun has walked through the halls where I have laughed with friends.
They haven’t caught the gunman yet. I hope they catch him soon.
The Eaton Centre will be closed for a bit.
I swear I used to not be the type of person that experienced anxiety but ever since I stopped living in a constant cloud of depression I’ve been getting that sick, tight feeling in my stomach.
I have a job interview today for another day camp in downtown Toronto. After the first horrible interview experience with another camp (see: A Success in a Failure) I have become even more anxious about being late to anything.
This is my second job interview since the ‘late incident’ and not knowing the area is killing me. I would rather still be laying in bed, reading and cuddling with Michael (who returned home yesterday from a weekend camping with friends). I’m tempted to pretend I went to the interview and just didn’t get the job. I of course am not in the position to do this.
I’m leaving an hour and a half early so I can have the time to find where I need to go. The building appears to be fairly large, may have lots of doors and I’m worried that I’ll wander around like a fool! I was given a phone number for who is probably interviewing me so I can call them if I get lost.
I want this job. I applied for two counsellor positions at a generic camp (usual athletic games, arts and crafts etc.) and the other is a literary camp which is all about writing!
Having a counselling session tomorrow. Going to fill J in on the interview and my reward system that has already failed but I still think is a good idea. I know I can do it.
Ugh! Good luck to me!
Candy Chang is an artist based in New Orleans and she has created a great piece of interactive art!
Using chalkboard paint she painted the side of an abandoned and stenciled the words “Before I die…”
Anonymously, people could use chalk to share what they wanted before they died.
This installation is coming to Toronto in the summer! I can’t wait to be apart of it!
Before I die I want to find peace in myself.
Now I ask you the question.
“Before I die I want to…”
Surprisingly, perhaps, more than a few people are cheerfully claiming that label at Ryerson University this weekend. Also on hand are the “mad-identified,” “the mad-positive” and various “psychiatric survivors” from around the world.
To be frank, the uninitiated might reasonably fear they wouldn’t be able to tell the players at the school’s international conference on Mad Studies without a program cribbed from the Diagnostic and Statistical Manual of Mental Disorders.
The Ryerson conference is certainly different. It might even be the first of its kind. What Kathryn Church hopes is that it’s also a watershed moment in her professional journey of a quarter-century — or perhaps the entire complex history of the turbulent, often troubled mind of mankind.
Church is director of Ryerson’s School of Disability Studies, established in 1999. Two of its most popular courses are Mad People’s History and the History of Madness — courses taken by students from across Ryerson faculties, by students of engineering, theatre, nursing, by students with and without a history of mental illness.
The curriculum was pioneered by Geoffrey Reaume, who was diagnosed at 14 with paranoid schizophrenia, twice admitted to psychiatric facilities, who dropped out of high school in Grade 9 and for a time worked in a sheltered workshop.
Prof. Reaume has since earned a PhD (his doctoral thesis a history of asylum life from the point of view of patients at 999 Queen St. W.), designed the Ryerson course and now teaches at York University. This weekend, he got married in his hometown of Windsor.
Since 2004, Ryerson’s “Mad” courses have been taught by former Toronto city councillor and New Democrat MPP David Reville, who coined the delightful term “high-knowledge crazies” to describe those who are picking up academic credentials to go with their diagnostic label, adding formal knowledge to their first-hand understanding about how life with mental illness feels, looks, sounds and smells.
As a young man, Reville spent time in the 1960s in three “madhouses,” knew the stigma, became familiar upon discharge with society’s margins. Yet, he found a way to make a living as a plumbing contractor, got politically active, was elected to two terms on city council, then to two at Queen’s Park.
During that time, Kathryn Church recalls, Reville was probably the only “out” former mental patient in Canada.
The slow change in attitudes and practices — in society and academia — “started with people like David who began to speak publicly about their history, challenging the way people would conventionally talk about it, insist on being included in decision-making forums.”
Church dispatched him to a conference in England in 1988 to deliver a paper they’d written “and, in a sense, this event here started there.”
“There was a kind of bubbling up in Canada and elsewhere of people who had the label and were beginning to really push back, challenge the way that psychiatry was shaping their lives, challenge the discrimination that went with being considered mentally ill.”
When he began teaching at Ryerson, Reville hadn’t set foot in a university — other than for the odd guest lecture — in 30 years. He had no credentials. This did not prove an insurmountable barrier.
“Because mad people’s history is happening all the time,” he once explained, his habit was merely “to incorporate breaking news into my lectures.”
Church says that “what we’re trying to do is offer a counterpoint to the history of psychiatry, which is sort of a professional and a disciplinary history, with the lived experience of madness.”
At Ryerson, that experience increasingly shows up in the curriculum. It shows up in how students bound for work in the mental-health sector are trained. Perhaps most important, it shows up in the appearance of more and more faculty members with first-hand experience.
As Geoffrey Reaume explains, is no small thing.
“Throughout mad people’s history, the academic elite have literally organized against mad people through a multitude of oppressive practices and ideas,” he says.
Through their medical faculties, universities conferred “power and legitimacy to enforce imposed practices ranging from lobotomy, ECT insulin-coma shock, excessive drug treatments, discriminatory labels.
“Now that some of us are in these elite positions within academia, it is essential to ensure we use this power and privilege to organize, to promote, research, write and engage the public about a topic that has too often in our history been interpreted through the views of medical-model academics.”
Reaume says there have always “been mad people within the academy.” But they hid their histories for fear of losing jobs and credibility.
“The fact that a course like this is available at all, and a conference like (Ryerson’s) is taking place, is one indication about how much has changed since the early 1990s.”
Ryerson has invited scholars from the universities of Edinburgh, Columbia, Central Lancashire, as well as community-based advocates — people who “work at the intersection of mental health, formal education and social movements.”
There’s little ethereal idealism about it. One of the sessions addresses how universities and the mental-health sector cope with tough economies.
“These are austere times,” Church says. “That’s the challenging sort of global context that we have.”
Neither is there any naivete about the entrenched nature of problems and challenges.
“We’re concerned about the ongoing problems of employment, housing, discrimination, human rights violations, institutionalization,” Church says.
“The same litany of problems that has not changed since I entered this field in the mid-’80s.”
“We’ve really just begun to see this coalescing (of both academic knowledge and lived experience, of expertise from different parts of the world) in the last few years,” she says.
That is why this “mad-positive” professor with “mad-identified” colleagues and friends is so thrilled to welcome the assembly of “high-knowledge crazies.”
“It’s time that people who are being trained to work in the mental-health sector aren’t just steeped in formal knowledge, but in knowledge of the personal narratives of people who’ve been through the system.”
It’s also time, she says, that higher education is made more accommodating to those who have the lived experience of mental illness and its shaming labels.
And, as the ever-mischievous David Reville decided, it’s time the mad got to invent a few labels of their own.
I am attending Toronto’s Occupy APA which is Sunday May 6th, 1pm at CAMH 250 College Street.