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A homeless encampment at the intersection of College St. and Borden St. in Toronto on May 15.Tuan Minh Nguyen/The Globe and Mail

One of the most urgent tasks awaiting Toronto’s next mayor will be to turn council’s recent declaration of a homelessness emergency into action.

City council made the declaration in May in the face of the converging crises of housing unaffordability, mental health and addictions, which together have had lethal consequences for the city’s most vulnerable. Three people experiencing homelessness died each week last year, on average, according to city data, for a total of 187 deaths in 2022. More than 220 died while homeless in 2021.

Food bank usage has reached record highs, the shelter system remains chronically full and psychiatrists warn that demand on the mental health care system has reached a breaking point.

The result has been a mayoral campaign in which homelessness, mental health and addiction have become top issues in platforms and debates ahead of the June 26 by-election to replace John Tory.

“Every major mayoral candidate is talking about mental health,” said David Gratzer, a psychiatrist at the Centre for Addiction and Mental Health and co-chief of the General Adult Psychiatry and Health Systems Division. “It’s about time.”

But while almost every candidate has pledged to build more affordable housing while addressing mental health and addiction, they have proposed different approaches, with some favouring bolstered social supports and others focusing on enforcement.

Former NDP MP and perceived front-runner Olivia Chow has pledged a citywide expansion to the Toronto Community Crisis Service, a pilot that provides a non-police response to mental health calls. She has also pledged to create drop-in centre spaces for the homeless, as well as bolster rent supplements, which she said would be funded in part through a luxury homes tax.

“If you talk to the folks that have the expertise, they all say it has to be a housing-first policy,” Ms. Chow said in an interview.

“Without a roof over a person’s head, you can have counselling, you can have treatment programs, you can have detox programs, it’s not going to work. If they have a roof over their head, that they feel secure, then you can do the service.”

Ms. Chow said services are working in “silos” that aren’t co-ordinated. “It’s not the person at the centre and that’s what we need.”

Former police chief Mark Saunders, who polls have shown to be her strongest competitor in the race, said in an e-mail statement Friday that he has “always believed and repeatedly stated that homelessness and mental health and addiction are social and health issues, not law and order issues.”

But while he emphasized the need for “24/7 resources” and affordable housing, he has also framed the election as “a choice between crime and chaos versus law and order.”

Mr. Saunders has pledged to “stop normalizing” encampments and drug use in the city, and said in a public statement Friday that he would “immediately crack down on panhandling, sleeping and disorderly conduct on the TTC to keep riders and staff safe, while also focusing on bridging those who need help to the appropriate service.”

“I’m never going to accept disorder on the TTC. We must crack down on every incident, every time,” he wrote. “Here’s what Chow doesn’t understand: The TTC isn’t a homeless shelter. The TTC isn’t a mental health agency. Its job is to move people from point A to point B, safely and quickly.”

Advocates have expressed concern about framing the problem as primarily about public safety.

“There’s a really strong link being developed between public safety and mental health. And that’s being done with … anecdotal evidence at best,” said Michael Anhorn, chief executive officer of the Canadian Mental Health Association Toronto.

“I think the attention is on the TTC, rather than on how we are doing as a community, as a society. And that’s the conversation we are much more interested in having.”

City councillor Josh Matlow has said that, if elected, he would also expand mental health crisis teams, and would freeze the police budget in favour of a “community health and safety fund” to address root causes of violence through shelter improvements and increased services for at-risk young people and those experiencing homelessness.

Ana Bailão, a fellow councillor, has pledged to take a housing-first approach, and pointed to the success of the Dufferin Grove model that was implemented to house people directly from an encampment in her ward. She also said she would expand the Toronto Community Crisis Service citywide.

After 16-year-old Gabriel Magalhaes was stabbed and killed in a seemingly random attack at the Keele subway station in March, his mother pleaded with politicians to address the root causes of violence. Andrea Magalhaes told the CBC that more needs to be done to help people in crisis as she called for better social services and housing

The man charged with first-degree murder of her son was homeless at the time of the attack, according to court records, and has a history of mental health issues and run-ins with the justice system for violent offences.

City council voted in May to declare a homelessness emergency, following other cities including Hamilton, Niagara Falls and Ottawa. Though largely symbolic, the near-unanimous council vote was intended to spur support – and funding – from other levels of government.

Mr. Anhorn said such emergency declarations are only important, “if they are matched with the kind of resources that were put into other public health emergencies.”

“I think COVID was a really good example of how, as a city, as a province and as a country we mobilized resources and changed systems at breakneck speed because there was a lot of motivation,” he said.

A chronically full shelter system, stagnant social assistance rates and a decade-long social housing wait-list have left thousands of people with unmet needs in Toronto – visible in the more than 170 encampments that remain today across various city parks, alleys, sidewalks and underpasses.

At the same time, Dr. Gratzer and his CAMH colleagues say the mental health care system has reached a “breaking point,” with emergency department visits reaching all-time highs.

Between July 2022 and January 2023, the number of young people visiting CAMH’s emergency department because of substance use problems increased by 50 per cent. And the number of people visiting the emergency department for issues specifically related to amphetamine (primarily methamphetamine) use increased by more than 700 per cent between 2014 and 2021.

Dr. Gratzer cites this rise in methamphetamine use as a particular problem.

“Just as fentanyl replaced Percocet, because of its potency, and perhaps a couple of other things, crystal methamphetamine is displacing other drugs. And it’s deeply problematic.”

He and his colleagues have called on the mayoral candidates to commit to supporting solutions, including scaling up supportive housing, investing in the expansion of an early psychosis intervention program and creating a stimulant hub, a central location to support methamphetamine and other stimulant users.

“I’d like to see us move past the rhetoric. It’s important to recognize problems that exist. It’s also important to start working toward solutions,” Dr. Gratzer said.

“It’s acute, and it’s just so sad. I mean, we’re living in one of the most prosperous societies in human history and we’re stepping over people who need care.”

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