Mark is fighting a war on two fronts: he’s homeless and living with a mental illness.
Mark, who asked to be identified by his first name only, suffers from dysthymia, a form of depression. For the past three months, he’s called the Ottawa Salvation Army shelter home.
He’s not alone. Studies show that mental illness is more common among the homeless, although exact numbers are hard to determine.
“The reality is, if you’re in a shelter for more than a year, there’s something deeper than just financial problems or personal problems,” says Julie Gousignant, a social worker from the Royal Ottawa Mental Health Centre.
Mark, 39, says living with his illness is hard enough, and being homeless makes it more of a
challenge.
For one thing, the mentally ill are more vulnerable to violence on the street, he says.
Caroline Giekes, who manages a drop-in centre for the homeless called Centre 507, says there’s a street culture that governs behaviour.
“There’s a hierarchy on the street,” she said. “You do things to make sure you’re not singled out as someone who can be bullied by others.”
Mark says he can’t always play by the rules. The mentally ill sometimes don’t recognize danger, or know how to keep themselves out of trouble when they’re angry or frustrated, he says.
Mark believes the stress of homelessness exacerbates his depression.
On top of worrying about his everyday necessities, he says he gets frustrated about not having his own space.
“Sometimes when you have a mental illness you don’t want to be around anybody.”
That feeling can make living with dozens of people at a shelter tough, he says.
“There’s nowhere you can go where you can have privacy. It makes it a lot harder to feel comfortable, or even safe.”
Mark says homelessness hasn’t helped the crack addiction he’s been fighting for years. He started using again soon after he lost his home, he says.
Self-medication with recreational drugs is widespread among the homeless and mentally ill, says Giekes. Crack is so common on the street that Mark says he couldn’t resist forever.
Mark sees a doctor, a social worker and a counsellor weekly, and takes medication for his illness.
But Gousignant says it’s difficult for many homeless people to get this treatment.
“They don’t have identification, money to make it to appointments, a family doctor, or medical records,” she says.
Gousignant says the lack of routine in homeless people’s lives makes keeping appointments and taking daily medication difficult.
“Your life doesn’t work like the average person with a nine-to-five job.”
The homeless generally don’t seek out mental health treatment because of the stigma attached to mental illness and because of low self-esteem, Gousignant says.
“They think, ‘Oh, I don’t deserve this.’”
Giekes says drop-ins like Centre 507 help people overcome these anxieties by creating a safe space where they can go and connect with mental health services whenever they’re comfortable.
Giekes says people with mental illnesses have good days and bad days, and on their bad days, “they keep to themselves.”
“Most of the time when they’re not well, they won’t come at all.”
Mark, who visits Centre 507 occasionally, says that approach can work sometimes, but many people are still hard to reach.