Homelessness Issue: a failure of health and social policy

According to Christian tradition and teaching, two thousand and twenty years ago a shepherd and his pregnant wife were faced with sleeping on the street.  An Innkeeper was merciful and allowed them to use the stable where, later in the night, the wife delivered her firstborn son.  By modern standards, delivering in a stable with hay, animals and their smells, no hot water, and dim lighting would be thought of as reckless, substandard. 

The celebration of Christmas typically brings memories from childhood and for persons of faith it brings strong and important reflection on the meaning of Christmas as expressed in the Holy Bible.  Along with reflection comes a towering sense of charity amongst people as reflected in year end giving to charities, the Salvation Army, Feed the Family and food banks and others who do great work with thousands of families.  Some specifically target people “living on the street”.

In this civilized, affluent country, why do we have people living on the street?  Prominent Fredericton businessman Luke Randall has drawn attention to some of those persons living in doorways on Queen Street and has invited people to lend a hand in what looks like a desperate situation.  Others of the local homeless group will find shelter in “the shelter”, the winter shelter, or a tent or anything that keeps them from perishing in the cold.  As Luke said, “each one has a story”.  Some mental issues, some abusive marriages, some sexual abuse, with a large proportion with addiction issues.

In speaking with some who interact with Fredericton’s homeless people regularly through services such as the community kitchen, it seems that some homeless people came from terribly dysfunctional families; others were abandoned at some stage of life; others have challenging mental health issues; others have just had a run of bad luck or made a series of very poor decisions.  Many others have serious addictions problems and however they got started, either from a pusher, from peer pressure, from depression and hopelessness, in the battle of life, the addictions are winning.

Watching the media coverage and the three major city mayors in New Brunswick trying to lead to solutions is painful.  Mayor Obrien has played a serious role in trying to develop solutions from the time he was a councilor.  Similarly, Mayor Dawn Arnold, in her opinion piece in the Telegraph Journal on December 18, 2020, stated the obvious very articulately:  cities cannot resolve the local homeless issue alone. And Saint John has apparently had success in reducing the homeless population even during the pandemic.

Years ago, those of my vintage rarely saw homeless or street people; there were, in those days, hostels like the Salvation Army that housed people who were really destitute and these were not seen as permanent but transitional places to go until a permanent arrangement could be found.  There were also mental hospitals in every province where persons with chronic mental health issues were safely cared for on an extended or permanent basis.  The range of clientele went from moderate depression to very acute problems requiring active treatment every day.  In the 1980’s there had been a number of reports of controversial therapies and some movies that cast a very dark shadow over such facilities.

There was a wave of social pressure to abandon those facilities and “place the clients back in the community.”  More temperate perspectives insisted that the health and social network would have to be seriously strengthened to avoid the creation of a new generation of “homeless people”.  While some of the clients were transferred to special nursing homes, others did, in fact, end up on the street; these were persons who, for many reasons, have difficulty living in the absence of structure and supervision. 

Those with addictions represent, I am told, a large percentage of those on the street.  There are many Addiction Treatment programs available, some run by health authorities, others by non-government organizations, many being faith-based programs.  Addictions treatment, like mental health treatment, is contingent on the “patient” submitting willingly to care and following the direction of the program faithfully.  That is what happens with congestive heart failure or cancer or any number of other diseases.

Mental health problems and addictions are so much more difficult to bring into treatment and care until such people become “a danger to themselves or others” in which they can be committed involuntarily.  But that is a high bar to scale. Addiction is commonly defined as a disease in the health care system and people in treatment programs are normally afforded the same respect and dedication as those suffering other illnesses. 

We have the confluence, regrettably, of large volumes of drugs made easily available, at a price, by drug dealers for whom the results of addiction are not their concern; their goal is to increase the numbers of addicts thus creating and maintaining their significant revenue stream, all non-taxable, under the table income.  What, in my youth, was not a really obvious industry has now become very large with huge revenue streams.

At the same time, we have families that are fractured by addiction issues; it starts innocently with a few drinks then the substances are needed to enable coping with everyday living and the beat goes on.  This, then, leads to its own set of social problems.

One of the issues in addictions treatment is that while core principles are somewhat consistent, programming and philosophy differ widely.  The National Institute on Drug Abuse puts the relapse rate at 40-60%.  Some of the leading faith-based programs report relapse rates at 30% (Time Magazine report on Teen Challenge, for instance).

As one recovering addict, that we have known for some time, shared with us, “sobriety in itself, is not a strong enough motivator.  The person must have goals and purpose and a reason to remain sober.”  If his life has been decimated, kids have left, marriage gone, no great career to work in, it is a challenge to help the client focus on a goal beyond sobriety.

Enlightened Medical Practice increasingly recognizes that in dealing with common health care issues, a team approach is often most effective in which various skills and passions are brought to the treatment program.  Cancer Centres of America, for instance, recognize Natural Medicine as “complementary therapy”.  With addictions, behavior often does not change until the therapists are successful in finding the key that unlocks the human spirit.

A successful homelessness strategy cannot be done executed by City Hall, nor by the Health Authorities, nor by the Social Development Department, nor by the Federal Department.  We do live at a very disturbing time in public administration in which entities do operate in silo’s and often struggle to collaborate.  The COVID-19 pandemic, as SARS long before it, demonstrates what can be done when various public entities come together to fight a common enemy.  Homelessness is a blight on civilized society and the way forward needs to have the elements of Transformation in which public entities, faith-based groups, churches, the mental health system all come together to fix this dreadful embarrassment.

As with other elements of our society that scream for reform, the question is:  who will lead?  And will government declare this as an enemy to be defeated?

Ken McGeorge,BS,DHA,CHE is a retired CEO in major teaching hospitals and long-term-care facilities. He was co-chair of the New Brunswick Council on Aging and is a columnist with Brunswick News and author of Health Care Reform in New Brunswick. His email address is [email protected]
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