With trepidation, outreach workers knock on a door uncertain of what will happen next.

There could be rats, bedbugs, lack of heating, lack of water, or flooded rooms. There might be nakedness. Likely there will be no privacy, because people who live precariously, one small step away from homelessness, are not afforded courtesies when it comes to rental spaces.

Sometimes the only thing in the room is a dirty mattress. But this space might not even be a room. It might be a section of floor behind a furnace in the basement. It might be a haphazard loft space inside a garage. It might be a shed. It might be a dumpster.

And always, when outreach workers knock on a door, there is the possibility of finding someone dead.

The situation of the homeless and the precariously housed, today in 2022, is absolutely Dickensian and asking for more is out of the question. People are expected to be happy that they have anything at all.

Nothing but despair can grow in this unjust system.

Situation is not new

From the beginning of formal psychiatric care in Canada, some 200 years ago when lunatic asylums and asylum for idiots and imbeciles were first opened, this has been the snapshot of Canadas most vulnerable.

In the 1800s, people were held in poorhouses or jails described as deplorable under the same conditions we see today; housing without sanitation, without heating.

The original intent back in the 1800s appears to have been to improve the inhumane conditions and treatment of those suffering with unknown afflictions.

But the changes elicited had a short lifespan and, before long, the overcrowding, the range of extreme behaviours and lack of any deep systemic understanding of the complex presenting ailments resulted in a shift from kind refuge to custodial care.

By the turn of the century, it was common for those suffering with mental health issues to be restrained, shackled or in straight jackets, which continued to be used in Canada into the 1980s. Patients were still living in deplorable conditions.

During the recruitment of soldiers during the Second World War, medical applications revealed the role of stress in affecting a persons state of mental health. The sizeable scope of this documented level of stress was a fairly new unearthing.

After the war, when soldiers returned home with acute psychiatric disorders, there started to be clearer recognition and categorization of mental health issues. The first Diagnostic and Statistical Manual of Mental Health (DSM) was penned in 1952.

In the 1970s, with the advent of new psychiatric medication on the horizon, doctors believed that patients could be released from hospitals and treated within the community with medication. It was the era of deinstitutionalization, a clarion call granting independence to those who didnt require perpetual lockdown.

This movement away from institutions was supposed to create space and opportunities for people to have access to housing and other basic human rights. Yet despite this well-intentioned appeal for autonomy, this shift in thought, people with mental health issues and limited life skills (after years of institutionalization) still continued to live in deplorable conditions, in rooming houses that were neither adequate nor safe but, in fact, dangerous.

Remarkable insight

Pat Capponi was one of those patients released from a psychiatric hospital to a boarding house. She would go on to become the author of seven books, an advocate for mental health issues, champion of those living in poverty and outspoken critic of government policies.

With her sharp wit, Capponi pricked the balloons of so-called positive change. Her first book, Upstairs in the Crazy House, shone a light revealing that people were still living in the same shockingly disgraceful conditions noted more than 150 years previous.

However, Capponi wrote that even with the squalor of boarding houses, infested with mice and lice, the idea of leaving and heading out into public was worse. After numerous, lengthy psychiatric stays, she no longer was a part of that world. It was a world that did not understand her. She would spend the rest of her life convincing the medical community that medication alone was not an acceptable treatment.

Capponi was a force, psychologically huge, vocal and spot on with her indictment of flawed government policies and medical practices. She asked where was the money saved from closing hospitals money that should rightly be directed to the patients now living in boarding houses and on the streets. She asked what is wrong with a society that sends five members of her family to institutional living while the abuser, her father, got to stay home.

She spoke to the unfairness of non-profits who profited and presumed to speak for Capponi and her peers in what Capponi called a closed, self-congratulatory system. Instead, what Capponi demanded on behalf of all those living on the street and in boarding houses was the absolute baseline entitlement to a home, a job and a friend.

Outreach workers arrive

In 1980, the term concurrent disorder was coined describing the co-occurring diagnoses of addiction and mental health issues.

In the 1990s, there was a shift in Waterloo Region with the creation of outreach workers. Instead of asking clients to be proactive and make their way to an office where they would have an appointment with a person who might help them, outreach workers walked the streets, searched people out, and visited community kitchens where people were congregating.

Sitting with people for stretches with no time limit, making phone calls and advocating on their behalf, and accompanying people to appointments went a long way for relationship development and trust.

In short time, outreach workers saw that most of the people living on the street and boarding houses did indeed struggle with both addiction and mental health issues. A nurse in the community who worked specifically with Acquired Brain Injury helped outreach staff understand that probably 80 per cent of this population also suffered from trauma to the brain.

Added to all this trauma is the frequent early deaths of mates and street family. In fact, one bout of homelessness is equated with losing 20 years off your life. People on the street typically dont live past their 50s.

Government response in the early 2000s was to conduct surveys that questioned everything about a persons life on the street. The work of the surveys was sent up through the tiers, reaching someone who had no direct contact or relationship with the person on the street. As can be expected, the important items were lost in translation. It might as well have been a game of telephone.

Places of worship step up

Around the same time, in the mode of charity, many places of worship in Waterloo Region generously opened their doors, clothing, feeding, sheltering and giving financial support for those without a home. Seven churches in the region began The Out of the Cold Program in 1999, one for each night of the week, offering in most cases a dinner, a place to sleep and a breakfast.

Places of worship stepped up and did the work of the government, waiting for the government to understand the need for structural change; waiting for the government to proceed with a justice model, waiting for the government to understand that a variety of housing options are needed.

Relying on a charity model for a long stretch of time puts too much pressure on the givers who eventually have nothing left to give. The needs are too overwhelming, the issues too complex. The charity model plays an important role, but it is temporary. It is not sustainable without the justice of giving people the housing, food, clean water, sanitation and safety they have a right to.

Eventually, the Region of Waterloo invited outreach workers to the table, validating the work that had been done and showing a willingness to hear the unedited, unscripted thoughts from the people living on the street, who know best what is needed for street-involved people.

This perhaps marked the first time that the dominant culture wasnt in control of speaking for people with addiction and mental health issues.

Today, there are health care workers, medical staff and outreach staff working in downtown areas of Waterloo Region who deliver trauma-informed care with a wide scope that recognizes the complexity of patients who score high on the adverse childhood affects scale, patients who have spent time in prison, who carry the scars of being brutalized.

Today, care is being delivered by staff who understand substance use and proceed in caring for people without shame and stigma, with a model of harm reduction.

And yet it is easy for social service organizations to lose their vision. The work becomes exhausting, not because of the street folks, but because of an unjust, miserly government system that fails to give its citizens their basic human rights. A system that watches people with a punishing Orwellian eye, looking over their shoulder as people attempt to share space creatively, or make extra money to complement the meagre amounts earned on Ontario Works or Ontario Disability amounts that fall far below any reasonable standard of living.

Will to live

And yet ... and yet the remarkable piece of being invited into this community, the golden egg in the face of perpetual calamity, is that mostly people want to live.

Against all odds, people continue to live and not only live, but bring joy, hilarity into their community, revelling in the absurd. They are like pirates, rough-talking rogues who live by their own set of codes, who make you walk the plank if you cant entertain the truth of how Canada treats its most vulnerable.

As a culture we still believe that being born is Canada is a fortunate thing. However, even though opportunities may be offered to all of us, the conditions are not the same for all, making the opportunities inaccessible, making food inaccessible, not because there isnt enough but because it is not affordable.

The social determinants of health are the social and economic conditions that a person experiences, including where you were born, whether your mother had the opportunity of good prenatal care, whether you had access to nutritious food, health care, education, jobs.

The World Health Organization says this unequal distribution of experiences is a result of a toxic combination of poor social policies, unfair economic arrangements and bad politics.

For outreach workers, the process includes constant learning, listening and bending because the needs are forever fluid. Therefore, thought goes into knocking on a persons door, hoping for the best but preparing for the unpredictable, the unfathomable.

It includes reading unspoken needs, such as someone walking in shoes without laces, indicative of just being released from jail. It includes understanding the obstacles in entering a doctors office, beginning with remove your shoes outside the office. It includes consideration for all the many needs being attended to behind a locked public washroom door, perhaps the only time that person is truly safe.

None of this can be taught to a government that is not on the ground. And the landscape and needs of the street world are ever changing.

It must be witnessed with full engagement, without expectations.

Bearing witness

Perhaps bearing witness is the most important thing we can do as a beginning point. The person may be silent about their trauma, but the witness should be a vocal, informed observer.

The responsibility for change certainly doesnt lie at the feet of those who are living below all standard measures of what are considered basic human needs. Surely, we can ensure that we see what is in our own communities; that we are witnessing the dismal truth of what it means for the most vulnerable of our population to live in Canada in the 21st century.

In bearing witness, we can say: I see you, I hear you, you are not invisible.

Because sadly many in our community continue to live in circumstances first documented in the 19th century: deplorable conditions with poor sanitation, inadequate food and heating.

People have been waiting for change, for housing, for centuries.

Decent housing for all.

Leslie Morgenson is a longtime advocate for people experiencing homelessness, addiction and mental health issues in Waterloo Region.

Patiently waiting for something to happen. Im waiting for nothing, nothing is coming. I sit and I wait, I pace and I wait, but nothing, still nothing, nothing will happen.

A message found scrawled on the wall of a vacant boarding house room. Author unknown.

More here:
A surprise behind every door | TheRecord.com - Waterloo Region Record

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