Lecture 22 Flashcards
What approximate percentage of people who experience homelessness experience transitional homelessness?
- 80%
What is Mean annual societal cost associated with people experiencing both homelessness and serious mental illness in Canada?
$59000
Which promises were made but not kept of housing?
◦ Funding/implementation of community-based housing and supports
◦ Patients were transferred to general hospitals, or discharged to families, some became homeless, others were eventually incarcerated and others…
Explain custodial housing
◦ Congregate housing with staff providing custodial care (subsistence & medicine)
◦ Typically for-profit
◦ Dependency maintained (no expectation of chores, responsibilities, or rehabilitation to increase independent functioning)
◦ No choice (in housing, services, nor roommates)
◦ Usually located in inner city (e.g., board and care homes, SROs)
◦ Custodial housing provided similar custodial care provided in psychiatric hospitals
What is the assumption with custodial housing?
people experiencing mental illness “required caretaking… and [were] seen as disabled object of care…”
What were the custodial housing outcomes?
- Generally poor outcomes beyond having relatively low rates of psychiatric re- hospitalization
◦ Increase mental health symptoms
◦ Low independent functioning
◦ Poorer overall health
◦ No difference in community integration
What is the consumer/survivor rights movement?
Consumer/survivor rights movement involved people experiencing mental illness directly organizing and advocating for right to self-determination, community integration and against stigma/discrimination
What was developed in the 70s and 80s and addressed some of the criticisms/limitations of custodial housing
- supportive housing
what is the conceptual framework of supportive housing
While custodial housing was based in large part on the same institutional model, supportive housing was based on the “linear residential continuum model”
◦ Also commonly called “continuum of care” or “staircase” model
What is the focus of supportive housing?
- skills building and independent functioning
What is the staircase approach?
- Clients move up the staircase as their independent functioning improves
- Restrictions/rules, treatment intensity, supervision decrease and independence increases with every step up
- Clients moved down to a previous step if independent functioning deteriorates
- Amount of time spent in each setting predetermined by the average of previous clients
What is at the bottom of the staircase?
◦ Congregate settings (e.g., halfway houses, hospital)
◦ Greatest amount of restrictions/rules
◦ (Mandated abstinence, treatment engagement, curfew)
◦ Intensive treatment (Rehabilitation)
What is at the top of the staircase?
independent apartment in the community
What is the assumption of the staircase approach?
- mastery of rules and rehabilitation is needed before independent housing/living
What are some positive outcomes associated with supportive housing relative to hospital or custodial housing settings?
◦ Reduced hospitalization rates
◦ Increased employment
◦ Improved independent functioning
◦ Increased social support
◦ Increased participation in leisure activities
What are some criticism of supportive housing
- Many people did not complete the staircase
◦ Many were asked to leave as a result of non-adherence to rules
◦ Many didn’t access program in first place because of all the restrictions - For people completing the staircase, there was often no available independent housing
- Unreasonable to expect everyone completing the staircase to not require supports during independent living
- Continuums of housing/services used were inconsistent
- Undue stress imposed by mandating multiple moves according to continuum/staircase approach
- Housing was segregated based on mental illness status
- In addition to the above criticisms of supportive housing, a number of other developments prompted a paradigm shift in housing and support, including mass homelessness, the consumer/survivor movement, new service/treatment models, and mounting evidence of recovery
What was the paradox of supportive housing?
The more independent (hence demanding) the living setting, the less intensive the services
What is social safety net?
- services from government that help guide or aid life, pension, healthcare services, etc.
After WWI, the social safety net strengthened in Canada. For example:
◦ Introduced Dominion Housing Act (1935; first housing legislation at national level)
◦ Employment insurance (1940)
After WWII, social safety net strengthened :::::
the Canadian federal government treated housing as human right without formal legislation
◦ 1945 Canada Mortgage and Housing Corporation (CMHC) created to “administer the federal role in housing as described by the National Housing Act”
◦ Tens of thousands of social housing funded annually by the government (growth especially in 60s and 70s)
◦ Rent subsidies in private market
Canada’s social safety was strengthened after WWII and especially in 1960s. LIKE:::::
◦ 1965: Canada Pension Plan
◦ 1966: Universal Health Insurance
◦ 1966: Guaranteed Income Supplement (senior citizens)
◦ 1966: Canada Assistance Plan (made welfare universal right and funded social assistance programs like income assistance, vocational services, health care costs not covered)
define stagflation
- high inflation and unemployment
What drove stagflation into the 1980s?
- global oil crisis (1973) and other influences
define neoliberalism
- “a term used to describe an ideology that promotes adherence to the free market principles of classical economics while opposing state interventionist theories”
