Ricardo Maddalena has lived in many places over the past four decades: fleabag apartments, a psychiatric hospital, prison, rooming houses and on the streets.
Four years ago, he finally found a home.
The 58-year-old, who suffers from severe schizophrenia and has struggled with alcoholism since his teens, moved into an innovative housing project in downtown Montreal that is operated by Chambreclerc, a non-profit group in the city that offers housing to long-time homeless men and women with severe psychiatric disabilities.
“Since I moved here, I've gone through a metamorphosis,” Mr. Maddalena says.
While he is eloquent and charming, his conversation veers routinely into improbable tales of wartime heroism and worldwide fame, belied by the grizzled look (including a missing finger, cut off in a knifing) and modest surroundings.
“We're not a shelter; we provide housing,” says Isabelle Leduc, Chambreclerc's executive director.
“Our philosophy is: housing first. You can't be healthy if you don't have a roof over your head. And that's particularly true of our tenants. Stability is the key to managing their illness, and they can't be stable living on the streets.”
Before moving into their apartments, tenants at Chambreclerc lived on the streets for up to 30 years and most, like Mr. Maddalena, spent their adult lives in the revolving door between institutional care and the margins of society. “Contrary to popular belief, people on the streets are not lost causes. They're just people society has given up on,” Ms. Leduc says.
In its landmark 2006 report entitled “Out of the Shadows at Last: Transforming Mental Health, Mental Illness and Addiction Services in Canada,” the Senate health committee placed a tremendous emphasis on housing.
The report said that investing in housing – not just temporary shelter or institutional care – was the key to transforming the mental-health system and improving care.
The committee, led by Senators Michael Kirby and Wilbert Keon, noted that there are at least 140,000 people suffering from mental illness in Canada who lack adequate housing.
This is, in part, a legacy of deinstitutionalization. The number of long-term psychiatric beds in Canada plummeted from a high of close to 60,000 in the 1950s to just over 6,000 today.
That, in itself, was not a problem. But mental illness did not miraculously disappear and governments did not invest in community supports for sufferers, creating legions of homeless men and women who panhandle on street corners and sleep on grates.
Mr. Kirby, who is now chairman of the Mental Health Commission of Canada, said of the issue last year: “Very little is known about the most effective ways of providing services to people living with mental illness who are homeless. What they require is a complex basket of services including supportive housing, access to primary health care and a wide range of other supports.”
As a result, the commission has made this a priority issue, investing $110-million in research. The money is being invested in five demonstration research projects – in Vancouver, Winnipeg, Toronto, Montreal and Moncton – each of which will focus on a distinct subgroup of homeless people living with mental illness, such as those who also have substance-abuse problems, aboriginal Canadians and non-English-speaking new immigrants.
“Collectively, the projects will develop a body of evidence which will enable Canada to lead the world in providing services to people living with mental illness who are homeless,” Mr. Kirby says.
Ms. Leduc says that while it is nice to see the importance of housing recognized, she is not convinced that more research is needed. “We don't need to demonstrate that housing makes a difference to people's lives. We know that. What we need to do is invest in housing.”
Chambreclerc, which has been operating since 1987, has already learned a lot about providing housing to those with mental illness.
For example, Ms. Leduc says, the group owns and operates its own apartment buildings rather than contracting with private landlords. That's because Chambreclerc tenants sometimes have particular needs.
“We tolerate the manifestations of symptoms – screaming, behaving oddly, maybe not smelling so good – that get them kicked out of other places,” she says. Tenants are also allowed to smoke (smoking rates among those with severe mental illness hover around 80 per cent).
Staff members also help to facilitate access to social services and provide much-needed interaction with tenants who have often lived socially isolated for years.
The result is success stories like Mr. Maddalena. He is sober, takes his medication, lives independently, pays his rent ($335 a month) and has found stability and comfort he never believed possible.
He doesn't allow himself to dream of the house in the suburbs with a two-car garage, but, after so long on the street, he appreciates his modest home. “It's so wonderful to have my own bed, my own room. I've decided to stay here for a while.”
André Picard is The Globe and Mail's public health reporter.
