Searching for home: Addressing the need for culturally appropriate supportive housing
CrossCurrents
By Avril Roberts
By the time Binh* made the phone call to Toronto's Hong Fook Mental Health Association, he had nowhere else to go. He had
just about exhausted all of his options – renting apartments and getting evicted four times; rooming in a boarding house with
19 strangers, none of whom spoke his languages (Cantonese and Vietnamese) or ate his kind of food, and where he was bullied
by a burly male resident; returning to the family home where his now-divorced wife called the police and had him removed to
a detention centre; spending three months on a psychiatric ward with people he could not get along with; and, on discharge
from the hospital, seeking temporary shelter with a sister-in-law who asked him every morning when he was going to find his
own place to live. It seemed the only thing left was the streets. But Binh remembered that someone, either a landlord, or
his sister-in-law or his psychiatrist, had mentioned Hong Fook. He made the call.
Three years later, Binh, who has schizophrenia, is still living in the one-bedroom apartment that Hong Fook found for him.
He makes his own meals and does his own household chores. He meets with his case manager, Teresa Ng, every three weeks, down
from twice a month. He has completed a series of anger management workshops delivered in Cantonese. And he is honing his paddling
skills while learning how to be part of a team, the team of 20 mental health consumers that Hong Fook is sponsoring in the
Toronto International Dragon Boat Race Festival this summer. Binh is beginning to feel like a regular guy again, thanks to
this network of housing and support. Three years is the longest time he has lived in one place over the past six years.
Finding safe, stable, affordable housing is a problem for many Canadians with mental health and addiction issues, but for
members of racialized communities, a host of additional issues come into play – language, culture, unfamiliarity with Canadian
systems and community resources, immigration status, racism and discrimination. Then there is stigma – cultural attitudes
toward mental illness and addiction that prevent people from seeking services or using the services that are offered, including
housing.
“Because of stigma, people don’t come out, even to our office,” says Gladys Cheung, a team leader with Hong Fook, which offers
mental health services and support to Vietnamese, Chinese, Korean and Cambodian individuals and families. When people do brave
community censure and seek help, they encounter new hurdles. “One of the biggest challenges in working with our clients is
the lack of linguistic and culturally appropriate services in the community,” says Cheung. “Often, when people have housing
issues, they don’t want to go to places where no one speaks their language. Or they say, ‘I don’t want to go there because
they don’t eat rice.’ When you’re not well, cultural food is a comfort.”
Deqa Farah, a community mental health consultant with Community Resource Connections of Toronto (CRCT),a mental health agency
that provides services in Somali and Tamil, among other languages, says that food is also a part of religion. A homeless Somali
man, who was referred to a shelter, told Farah, “I’d rather starve than eat something that’s forbidden in my religion.” That
was during the month of Ramadan, when Muslims fast during the day and eat a small meal in the evenings.
“Some clients [in supportive housing] might go for days without food, due to the lack of availability of food that’s permissible
for Muslims,” says Farah. Those who eat the restricted foods feel guilty and alienated from their community for doing something
wrong.
For the CRCT’s women clients from traditional cultures, mixed-gender accommodation is forbidden. “Mixed-sex housing renders
most supportive housing or rent-geared-to-income housing uninhabitable for people who feel strongly about that,” says Farah.
“They’d rather be homeless or live in some other extreme situation.”
Physical design can also be a hindrance. A Korean client of Hong Fook turned down a housing offer because there was no bathtub
where she could take her ritual weekly bath; there were only shower stalls.
Family size and make-up may also pose challenges. “Supportive housing tends to focus on individuals, but even if the person
is single, there is often family involvement,” says Sajedeh Zahraei, a community support research and development specialist
with the Centre for Addiction and Mental Health (CAMH) in Toronto. “Sometimes eligibility criteria are limited and make it
difficult for people to live with the family members they get support from. The few family units that are available are usually
small and don’t allow for siblings living together or a grandmother or aunt.”
Poverty is another factor. “In many ethnoracial communities, particularly if people have mental health problems, they are
often living in poverty,” says Zahraei. “Rental units in Toronto are so expensive that for affordability, families have to
double up. There is hidden homelessness. People have to live with other family members in over-crowded situations. With mental
health issues, it makes it more challenging for them to be able to recover and remove themselves from he situation.” These
individuals and families may also be unaware of mental health housing services and resources in the community.
To address these issues on a system-wide basis, eight Toronto agencies in the mental health, addiction and supportive housing
sectors formed a working group called Supportive Housing and Diversity (SHAD) in 2002,with the goal of improving housing stability
and reducing homelessness among members of racialized communities who have mental health and addiction issues.
A 2003 SHAD survey of 15 supportive housing providers in Toronto confirmed the barriers that clients encounter in accessing
and receiving services and highlighted the providers’ own concerns. They include a lack of funding to develop more housing
units and hire more culturally competent staff, a shortage of training opportunities for staff to learn about cultural needs
and gain practical skills for dealing with discrimination, and a desire to become more participatory and action-oriented in
dealing with systemic and individual issues.
The survey also underscored the need for a centralized data system coordinating access to supportive housing. Toronto has
3,595 units of supportive housing at 325 sites, but it is difficult to know how many members of racialized communities are
in that housing or on the waiting lists, because there is no coordinated access system, and most agencies do not keep formal
statistics on their clients’ cultural backgrounds. Without credible research and data on service utilization, it is often
difficult to effect change.
This spring, SHAD embarked on a one-year project to identify evidence-based best practices in developing culturally competent
supportive housing models. The project is funded by the Canada Mortgage and Housing Corporation (CMHC) and has three major
components: consultation with people who work in community mental health, addictions, support housing and immigrant and refugee
services; focus group sessions with consumers and family members; and a literature review of Canadian and international studies,
which is unique.
“There is literature on what it means to provide culturally competent mental health services, and there are studies on supportive
housing best practices, but they haven’t looked at the specific populations we’re looking at,” says Zahraei. “We will be reviewing
those two bodies of literature and linking them.”
The goal is to create a practical resource manual that housing providers can use to design and develop culturally appropriate
supportive housing that meets the needs of the target population, and that mental health and addiction and other community
agencies can use to make changes in the way they practice, for example, to make their intake process and application procedures
more flexible and accessible. When the project is completed, CMHC will help make the best practices manual available nationally.
“Culture and language are very important in the way we conceptualize problems, seek help and address our issues,” says Farah.
“A person who is not seeking or receiving the appropriate mental health services may likely come into conflict with the law,
end up in hospital emergency rooms or in harmful situations. It is better to take a person’s culture and language into consideration
than have them going through a revolving door.”
*not his real name
Centre for Addiction
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