At least forty homeless people lost their lives in 2022 in Montreal, discovered The duty by carrying out its own review. However, this figure is underestimated, since neither the government nor the large cities of Quebec count the deaths of people in the street. Many stakeholders and experts are calling for a centralized registry, as exists in other Canadian provinces, because many homeless people have died in violent or turbulent circumstances — which raises questions about what could be done to prevent these dramas.
Joe, 51, was happy. After being chased several times by the police from the places where he slept, a situation which frustrated him more and more, he finally found “the spot perfect”: at the back of a CHSLD in the Côte-des-Neiges–Notre-Dame-de-Grâce borough, in Montreal, in an enclosure with an unlocked door where a compressor was located. A discreet place, he assured, where no one would disturb him. Since the place was roofless, he had installed canvases to protect against the rain.
“When he talked to me about it, I was worried, even though he knew his stuff,” says Ron Melanson, a community worker at the St-James day center, which Joe had attended for several years. The man never told them where precisely he was sleeping, and in late spring 2022, the center did not hear from him for months. Some called the organization, worried not to see him at the Vendôme and Guy-Concordia metro stations, where he was accustomed.
It was a CHSLD technician who came to repair the compressor who discovered Joe’s body on the 1st.er August 2022, two and a half months after his death.
His death shook the St-James center, where ties are very tight. “Joe was loved,” slips Stéphanie Talissé. “He didn’t get involved in conflicts and he knew how to keep calm. » The speaker organized a small ceremony in her honor in the park next door.
“He was very resourceful, using his charisma, his charm,” remembers his fellow speaker Amanda Dore. When he was begging, he had a poster that read “ Kindness is not a weakness » (“Kindness is not weakness”). Joe also spoke openly about his problems with drug addiction and his turbulent life.
When he died in May 2022, a heatwave was raging in Montreal. But due to the length of time — and condition — before her body was found, it was impossible for the coroner on file to determine the cause of her death.
No register in Quebec
There is no mechanism allowing homeless resources to inform the City of Montreal or the government of Quebec that a death has occurred, and we do not ask them anything. It is therefore in a coroner’s report in his name, buried among hundreds of others, that Joe’s path in the system ends.
It was not possible for the Coroner’s Office to send to Duty reports of homeless deaths only. To find them, we had to go through all the investigation reports available for the year 2022 in Montreal, i.e. around 750 documents.
Unlike Toronto or British Columbia, a registry systematically recording the deaths of homeless people does not exist here, confirmed the Coroner’s Office and the Ministry of Health and Social Services.
If we don’t know who died from what, where and when, it’s difficult to put preventative measures in place.
“It’s a real problem,” says David Chapman, general director of the organization Résilience Montréal. Like all resource managers roaming with whom The duty discussed, he is in favor of implementing such a mechanism.
“We need data that allows us to make good decisions,” adds Heather Johnston, management advisor at Projets Autochtones du Québec. “If we don’t know who died from what, where and when, it’s difficult to put preventive measures in place. » For its part, his organization takes care to include each year in its annual reports the names of people from the community who have died.
Records elsewhere in Canada
Psychological distress
Out of around forty deaths, The duty recorded eight deaths by suicide. Some, like Régent, took action after losing everything. The 61-year-old man had stored his personal belongings in a friend’s garage after being evicted from his home; he had also lost his job. “Please don’t treat me, I want to leave,” he took care to write on his hand.
The latest count, published in 2022, shows high psychological distress among the homeless, and the assistant director responsible for the clinical component of the Old Brewery Mission, Mélanie Richer, notes that the pandemic has had an effect on their health mental.
“I have one in three who commit suicide at the moment,” she says. Deaths are emotional times and are a hard blow for those who work in homelessness resources. Mélanie Richer describes isolated users, who had difficulty getting out of homelessness and who remained stuck in their consumption problems. “We knew they had suicidal thoughts and we put a framework around them to try to protect them. But, unfortunately, it has its limits,” she says.
Long-term psychological support for the homeless represents “a gap in service”, believes Mme Richer. The system is not suitable for this marginal population, particularly vulnerable, who tend to miss their appointments. “The amount of people here who are depressed, in post-traumatic shock…”
Deads outside, early deaths
Many homeless people die outside, and it is often passersby who call 911 to help them. Deaths in shelters are rare. These are also early deaths: the median age of deaths is around 50 years, according to our compilation, while life expectancy for all genders stood at 82 years in Quebec in 2022.
A set of factors means that their lives are shorter, report various experts consulted. Homeless people live in a much more risky environment, with less of a safety net if they get sick or have a chronic illness.
“There are a lot of traumatic deaths on the street, compared to the general population,” underlines Pénélope Boudreault, director of national operations and strategic development at Doctors of the World Canada, who worked for several years as a nurse with the homeless. Poor diet, smoking, cold, consumption problems and the difficulty of fighting illnesses are taking a toll on the homeless. They have a higher risk of cancer and cardiovascular disease.
Homeless people do not necessarily go to see a doctor for all kinds of reasons, and it is difficult for them to follow ongoing treatment. Faced with a medical system poorly adapted to this reality, Mme Boudreault thinks that more initiatives are needed to see people where they are and adapt the care provided to them. “It really takes clinics for one-off treatments, which are not urgent, but which must be taken into account now,” she believes.
However, it is overdoses that are the main cause of death among homeless people. The Montreal Regional Public Health Department has recorded 48 of these deaths within this population since 1er August 2020, which represents 11% of all this type of death. It is stated that the homeless are 30 times more likely to die from an overdose than the general population.
David Chapman, from the organization Résilience Montréal, unfortunately sees this all too well. Several of its users, many of whom are indigenous, have died of overdoses. “When people are in safer situations, they do less extreme things,” he analyzes. The dismantling of camps, the lack of affordable housing or the closure of a homeless resource are all aggravating factors, he maintains.
Changes to come
It is generally through hospitals, police officers, coroners or relatives that homeless workers learn of the deaths of those they are helping.
The duty noted around forty deaths of homeless people in Montreal in 2022, but there were more: deaths listed by organizations are still under investigation, the Coroner’s Office confirmed to us. And not all deaths are investigated.
“If it is determined from the outset that the probable cause of death was due to a natural cause, the coroner will not intervene,” the organization’s media relations manager told us. Coroners only intervene when the causes of death are unclear, violent or negligent, or when the identity of a deceased person is unknown.
The Coroner’s Office also plans to implement “better traceability” of the deaths of people experiencing homelessness in its database. “This measure will be implemented in a future update of our computer system,” we emphasize, without specifying a date.
We also add that it is the Minister of Health and the public health departments who are responsible for “monitoring the state of health of the population and collecting socio-health information”. “We can certainly consider collaboration if public health directors or research teams wish to use coroner’s reports to better understand the phenomenon of homelessness. In the future, we will be better equipped to meet this type of need,” we explain.
However, the Coroner’s Office “does not have a data collection strategy at all” to establish the sociodemographic characteristics, ethnoracial origin or social conditions of the dead, notes Professor Céline Bellot, of the School of Social Work. from the University of Montreal. This can make the picture incomplete — it can be difficult to know if the deceased is Indigenous or determine who is homeless from reading reports, for example. Two problems that The duty encountered during his own review.
There is a social necessity to document these deaths. They are invisible during their journey of homelessness, and are also invisible during their death.
The expert recalls that the mortality rate of homeless people is much higher than that of the general population. “There is a social necessity to document these deaths,” she believes. They are invisible during their journey of homelessness, and are also invisible during their death. »
At the Montreal Regional Public Health Department, only deaths linked to overdoses and heat among homeless people can be identified from coroner’s reports, specifies a spokesperson. Homelessness is not a criterion in death bulletins governed by the Public Health Act, the Quebec Ministry of Health and Social Services confirms to us to explain the absence of a centralized register. Moreover, he is not talking about the possibility of setting one up.