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Sandy Simpson is a senior scientist at the Centre for Addiction and Mental Health (CAMH) and the chair in forensic psychiatry at the University of Toronto. Roland Jones is a forensic psychiatrist at CAMH and assistant professor of forensic psychiatry at U of T. Tonia Nicholls is a psychiatry professor at the University of British Columbia. Amanda Butler is an assistant professor of criminology at Simon Fraser University.

Right now, one in five Ontario jail detainees becomes homeless upon release, and that rate has increased significantly over the past six years. Homelessness causes individuals much stress and uncertainty, and can aggravate other problems detainees may be struggling with.

Two of the co-authors of this piece (Sandy Simpson and Roland Jones) work at the Vanier Centre for Women and the Toronto South Detention Centre, which both have high rates of homelessness (about 24 per cent) for all persons released. We have data from over 17,000 persons who have used our mental-health services while in custody at these facilities over the past seven years. Of this group, 40 per cent of the men and 33 per cent of the women have experienced homelessness.

This is not a problem unique to Toronto. In their research, two of the co-authors (Tonia Nicholls and Amanda Butler) have demonstrated growing rates of homelessness among individuals entering provincial correctional centres in B.C. that have increased from 17.3 per cent in 2009 to 23 per cent in 2017. The health and social marginalization of people with criminal-justice involvement in B.C. has also increased over the past decade according to several other critical indicators. The percentage of new admissions to custody reporting mental-health needs rose from 9.9 per cent to 14.8 per cent. The percentage of people admitted to B.C. provincial correctional centres with both a mental illness and serious drug use more than doubled (14.5 per cent to 32 per cent). And 79 per cent reported having no community supports.

We know that, in combination, inadequate mental-health services, the rising availability of toxic street drugs, and grossly inadequate housing provision and income support are major factors in reincarceration for people with serious mental illness. They have often committed minor public-order offences and minor thefts. Incarceration is disruptive – existing (and often already fragile) social supports can be lost when they are incarcerated, making it harder to cope on return to the community. In addition to a lack of mental-health and substance-use services, homelessness supports are also inadequate.

This is the story we hear so often: Where can I get my medication? Where can I live? How can anyone contact me when I have no home or phone? How can I resist the bullies and the dealers if I don’t have the sanctuary of my own place to live? Many agencies are striving to overcome these huge levels of need, but demand is outstripping supply in all these areas.

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How large are these gaps? Mental-health and addiction services are only funded to about half of the level that is necessary. The waiting time to be cared for by an Assertive Community Team (ACT) – the level of care needed for people with mental illness who have been in the criminal-justice system – is currently between nine and 11 months in Toronto. The waiting time for subsidized housing is eight years, though a man told one of us last week he has been on that waiting list for 11 years. Structural poverty is perfectly illustrated by the fact that the Ontario disability benefit only supports a single person up to a level that’s still 40 per cent below the poverty line. Yet the cost of effectively supporting someone in the community is less than a third of the cost of incarcerating them.

There need to be more alternatives to incarceration, and in prisons we must have better services to detect people with needs and engage them in community services. There are demonstrably successful models of housing that we can emulate, such as the Housing First approach. There are evidence-based and cost-efficient models of income support that we can try, such as guaranteed basic income. As experts in the field, we know the models of delivery that work best for people with serious mental illness, namely ACT teams delivering flexible and assertive recovery-oriented services. There are methods to support safe transitions to the community (including transition teams with Indigenous navigators and peer support workers). There are too few of these well-established strategies implemented into practice in Canada, despite evidence they are far more effective than our current structural neglect.

None of this is unknown, none of it is without solutions. It is time governments turned their attention to adequately funding income support, housing, and mental-health and substance-use services.

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