The face of homelessness has “really changed”

Rita* tries to draw a clock on a sheet of paper.

“Place the hands at 11:10,” asks psychiatrist Virginie Doré-Gauthier.

The septuagenarian takes a long time to complete the task. She ends up writing 10:50.

“This shows that she may have executive difficulties or the beginnings of dementia,” the doctor later explained.

The scene would not be exceptional if it took place in the hospital.

But this afternoon, it is rather at L’Amour en action, a shelter for the homeless with around fifty beds opened during the pandemic in the basement of the Saint-Rémy church, in Montreal-North, that she sees his patient.

The D^D Doré-Gauthier is not a psychiatrist like the others: she treats homeless people “where they are”.

His practice is inspired by that of two experienced colleagues: the D^rs Lison Gagné and Olivier Farmer, who discovered, around 20 years ago, community psychiatry in New York, where specialists practice in shelters, community centers and even public transport. They adapted this model to Quebec in collaboration with a large homeless shelter in downtown Montreal.

“In an ideal world, I would no longer have an office at the hospital,” says the psychiatrist who is attached to the Albert-Prévost Mental Health Hospital and member of the new roaming outreach team of the CIUSSS du Nord- from the Island of Montreal.

With 4,690 homeless people in the metropolis according to the latest count of “visible” homelessness, we should not be surprised that there are more and more of them settling in residential areas, far from the city ​​center, emphasizes the doctor. She works in Ahuntsic, Montréal-Nord and Bordeaux-Cartierville.

New faces of homelessness

If you passed Rita on the street, you wouldn’t be able to tell that she was homeless. The woman has a neat, even distinguished appearance.

Since she was evicted from her home in the summer of 2023, Rita has been in four shelters. The elderly lady explains the loss of her apartment by financial problems.

“Oh yes, and problems with accumulating objects,” she said, embarrassed.

Too many elderly people find themselves on the street following a loss of housing, notes the homeless outreach team. The problem is “important”, says the street psychiatrist.

The face of homelessness has “really changed,” she continues.

Shelters receive many people losing their autonomy for whom their resources are not suitable. “Patients with the onset of dementia are victims of abuse there,” says nurse Jia Rui Hou – everyone calls him Jia – who is part of the same team.

“We, unlike other shelters, if they wet the bed, we keep them,” explains Daniel Pitre, a former homeless person who co-founded L’Amour en action.

What are the authorities doing?

The creation of the CIUSSS du Nord-de-l’Île-de-Montréal’s homelessness outreach team is a concrete example of what the authorities are doing to help street people get by. This type of team – funded by the 2021-2026 interministerial action plan on homelessness from the Ministry of Health and Social Services – can be found in all regions of Quebec.

When it was created in March 2022, that of the north of the metropolis was made up of… a nurse. Since January 2023, given the scale of the needs, the team now has seven professionals. The small team works in collaboration with the police and community organizations over a large area including La Petite-Patrie, Villeray, Ahuntsic, Montréal-Nord as well as Bordeaux–Cartierville–Saint-Laurent.

Its mandate: to reach people experiencing homelessness by offering them temporary health and psychosocial services, adapted to their needs.

The proximity team is a “connection” team with a mandate to re-affiliate with standard services. The particularity of that of the CIUSSS du Nord-de-l’Île-de-Montréal is to have quickly integrated a psychiatrist, in order to reduce visits to emergency rooms for the itinerant population.

The septuagenarian could talk for hours about pharmaceutical experiments gone wrong. She doesn’t let the psychiatrist and the nurse leave without giving them natural health magazines. She prides herself on not taking any medication.

Now, Rita would need it, but the psychologist will not address this question today.

The small locker provided at the shelter is overflowing with old magazines.

“Be careful of the accumulation,” nurse Jia told him kindly before leaving the basement of the Montreal-North church.

Go even further

Daniel Pitre finds the CIUSSS team essential: “The people we accommodate need motivation to go to their medical appointments. » But opening a PRISM clinic (Homelessness and Mental Health Reaffiliation Program) in the north of Montreal would be even better, he continues.

Launched in 2013 by the CHUM and the Old Brewery Mission, PRISM aims to install services where people need them. It’s the same philosophy behind that of the local team, but with more resources.

Thus, the homeless people registered in the program follow up with professionals – psychoeducator, nurse, doctor, etc. – in a consultation room, within the shelter. Beds are reserved for them; they are entitled to three meals a day and constant support from the treatment team.

The goal: to get them off the street. And it works. The majority of PRISM program participants found permanent housing at the end of the program, a Montreal study found.

A PRISM clinic would “delight” the D^D Doré-Gauthier, given the pressing needs of the sector, but the partner community organization must be adequately funded.

At L’Amour en action, the psychologist had to meet Rita in a cluttered employee meeting room in the basement due to lack of adequate space. At her age and with her health issues, she should not be sharing a cramped room with seven other women lying on bunk beds in a church basement.

*The first names of people experiencing homelessness have been changed to preserve the confidentiality of their medical information, at the request of the CIUSSS.