“London’s Underground – Part 5

Over the past few weeks, I have been focusing my posts on London’s Underground and our community’s current response to it. I have also outlined my understanding of the continuum of care model needed to provide hope, care and support for our most vulnerable citizens. Unfortunately, despite an extensive investment of time and resources, and the best efforts of Londoners each year, the size and social consequence of our Underground is actually increasing.

Therefore, in an attempt to better respond to and hopefully overcome this community challenge, I have prepared what amounts to a high-level Game Plan that includes:

A list of meaningful, measureable and impactful objectives for the initiative;
A reiteration of the specific elements within the continuum of care model that need to be addressed for our response to be more effective;
A series of strategic responses that I believe will greatly enhance our collective efforts, and ideally improve the lives of both our most vulnerable, and the many community constituents who struggle along with them.

Before continuing I would like to provide some additional background regarding my approach. First, I have reviewed and relied upon several resources, including and most notably The Homeless Hub, a Canadian-based content-rich library of information on many of the key determinants that contribute to the Underground. Second, I have perused a number of case studies, periodicals, and articles to better understand the determinants of these issues and the best methods to resolve them. Finally, I tested the objectives and strategies with a team of local subject matter experts, who have taught me a great deal about the problems in London and willingly shared with me their ideas, criticisms and suggestions. I am very grateful for their level of engagement in this process, the care they exhibited throughout their review, and the unconditional investment of their time in the preparation of this series.

I would also like to preface the outlined objectives, strategies and tactics with the following caveats. The list is by no means absolute nor will it fully resolve the problem. The list is also neither proprietary nor complete. It can be improved upon, amended where needed, and augmented where applicable. Finally, the list should be acted upon now. It should not depend on next year’s election or any election to implement.

Objectives

To recover, rehabilitate and re-engage 80-percent of individuals identified as members of London’s Underground (~400 members) within 24 months of an approved budget.
To provide a clean, safe and supportive civic infrastructure for the most vulnerable members of our Underground, namely women, youth and our Indigenous citizens.
To educate Londoners on the medical (i.e. mental health/addiction) issues confronting our Underground and:

secure their support for this continuum of care model in general and a results-oriented harm reduction initiative in particular.
mobilize the community in this effort through purpose-based donations and volunteerism.

Strategies and Tactical Summary

Expand Housing First Efforts

Housing First is listed first because it matters most and can, by far, have the greatest impact on transitioning chronically homeless individuals away from shelters and stabilizing their lives. In addition to being substantially less expensive, Housing First has the multiple impact of restoring a person’s dignity, providing them with a safe recovery and rehabilitation environment, and minimizing their need for London’s street services. In London, it is my understanding that the Housing First initiative is working, but limited by resources and the number of available accommodations. To help remedy this, our city should consider the following tactics:

Increase the resource commitment and intensity of this program.
Expand the city’s affordable housing portfolio and social housing accommodations.
Redirect the city’s budget allocation from shelter support to the Housing First initiative.
Explore rent-subsidization and/or reduced property taxes for apartment providers in diverse neighbourhoods.
Incentivize builders to increase social and affordable housing stock through reduced development charges.
Consider introducing requirements for developers to direct a portion of their housing projects to include geared-to-income units.
Fast-tracking approved plans through the planning process.

In my opinion, an immediate and heightened commitment to this strategy alone will have a significant positive impact for the Underground and those most affected by it.

Expand Harm Reduction/Education/Prevention Initiatives

Next to housing, a comprehensive strategy encompassing harm reduction, intervention and client care (i.e. wrap-around care), represents the best opportunity for our most vulnerable and challenged citizens to move away from destructive behaviours and towards managing their addiction and improving their lives. For example, in my view, it is not acceptable to provide needles without a full suite of support services in a safe place to welcome, accommodate and intervene in the full range of health-related issues that drive the needle demand. London is in the midst of a community consultation around supervised injection sites (SIS), a service that is clearly in need.

Given the heightened risk and consequences now associated with addictive behaviours and specifically drug use, the city must also engage in an all-out education effort to raise users’ consciousness regarding this issue. This includes conveying a non-punitive, non-coercive environment focused on getting people well. Underground members are suffering from a disease. A disease often borne in trauma and a disease that is manifesting itself in a wide range of self-disruptive and destructive behaviours. As such, they need us and cannot get well without an intense, shared and non-judgemental effort to help them and help us all. This means taking the care model to the streets, including outreach and intervention in the alleys, the parks, and under bridges. Waiting for people needing this type of health service to take ownership of their problem is no longer an option.

Finally, I would like to see our Police resources focused less on the delivery of social services, and more on the prevention and even arrest of drug inflows. While most of the illicit and high-risk drugs are coming from off-shore and need to be managed at a national level, local police can play a significant role intercepting supply lines and arresting the higher-tiered distributors that prey on the street level users/dealers. Local police can also continue to play a key role in first response, protecting our most vulnerable and marshalling resources where needed to aid people in distress. In my view, police should also be given special relief from SIU provisions when administering of Narcan in circumstances where such intervention could mitigate the impact of an opioid overdose and potentially save a life. Specific tactics include:

Intensification of police resources on drug distribution efforts and the identification of intervention candidates.
Expansion of the London CAReS program to serve as the Underground’s lead response and client care team – support first, enforcement second.
Timely and consistent deployment of a mobile SIS unit in hot spots around the city to improve client interaction, minimize fixed site impacts, and acclimate the community to the service’s value proposition.
Distribution of Narcan kits to front-line response teams and even select addicts.
Provision of medicinal opioids to improve client safety and manage dosage.
Engagement of London’s two hospitals and their respective foundations in a collective effort to expand the community’s clinical diagnostics, treatment, and recovery capacity.
Establishment of a local full-service medical detox and extended stay residential treatment hostel.
Contribution to a national scientific research effort to identify antidotes to the next generation of highly-addictive and potentially-fatal street drugs.

Extend Special Support to Women, Youth-Centric and Indigenous Communities

As I mentioned on my last post, I have very high regard for numerous agencies and organizations (i.e. My Sisters Place, Women’s Community House ANOVA, Youth Opportunities Unlimited, At^lhosa, N’Amerind to name a few) that are committing time and resources to the client-specific circumstances surrounding our most vulnerable women, youth and indigenous members. I am also very impressed by the plans now under development by the City and Youth Opportunities Unlimited to create a purpose-built full-service recovery and rehabilitation enterprise targeted at our youngest members. This early intervention will do wonders for this vulnerable segment. However, I am not yet comfortable detailing specific tactics beyond the support for additional resources in this area, until I have garnered a deeper understanding of their respective operations and client needs. Therefore, I shall return to this portion of the plan and amend it accordingly, once I have had a chance to engage with the leaders of these organizations and better appreciate their value proposition and market challenges.

Create a Client Relationship Management System

The CRM strategy is perhaps the most critical new element of this plan. The CRM is a simple system designed to maintain the identification, engagement and progress of all of London’s Underground members. It need not be intrusive or erroneous to manage. In fact, the simpler the system, the more likely it will meet the needs of this cohort and the teams responsible for delivering the service. No amount of investment in this problem area is appropriate without a clear and sustained understanding of the client and their touch points, the response and the outcomes. Specific tactics include:

Design, development, and rapid deployment of a simple, easy-to-use, universal application to be used by and shared with all contact points within the Underground.
Ongoing maintenance and independent reporting of all pre-determined activities and outcomes related to the continuum of care.

Expand Public Awareness Campaign

Any attempt to truly resolve the challenges associated with our Underground must include the engagement of all Londoners in the effort, and such engagement begins with a clearer understanding of the problems, and empathy for its root causes. To this end, London needs to accelerate and amplify the work already underway through its Community Health Collaborative, which is identifying the social determinants of health in our community and exploring ways to mitigate those that contribute to homelessness, poverty, mental health issues and addiction. The public awareness campaign must also better acquaint Londoners with the underlying experiential contributors (e.g. trauma) to these problems so that some of the societal bias shifts from perception of distain to one of empathy.

London also needs to immediately engage the city’s educational institutions and student associations at both the secondary and post-secondary level, and launch a public awareness campaign on the addictive properties and potentially fatal consequences of illicit drug use. Our young people are playing the equivalent of “Russian Roulette” with these uncontrolled substances and the likelihood of them becoming an addict or an casualty increases dramatically with every hit. Specific tactics include:

Initiating a communication campaign (e.g. See One Community campaign) that tells the story of our most vulnerable and the positive results associated with wrap-around services.
Engagement and support of local charities in specific community education plans and outreach efforts.
Clear and sustained reporting to the community on investment requirements, program-by-program progress, and positive and negative outcomes.
Aggressive and sustained outreach into the school system to acquaint students with the dangers and potentially life-terminating consequences of illegal synthetic drug use.

In addition to the above roster of tactics, I would strongly encourage London City Council to appoint one or two of its members to this initiative to provide direct oversight over the program, provide direct updates to Council and the community as needed, and ensure overall accountability across all aspects of the delivery model. Ideally, I would look to Councillors such as Phil Squire and/or Tanya Park, who have reputations for managing tough files and might better identify with this issue by virtue of their direct ward involvement. Regardless, active Council engagement in the solution is a must if this issue is to receive the necessary attention and prioritization it deserves.

As stated earlier, the above strategies and tactics are by no means complete or absolute. However, they do present a clear and measurable approach to understanding and resolving this unrelenting community issue. More importantly, they convey a civic commitment towards a collective effort to enhance the lives of our most vulnerable citizens, while respecting and responding to the needs of the other citizens that live and work around them.

Next week, in the final post of the series, we will focus on the cost associated with delivering this plan, a price tag that I believe will initially create a little sticker-shock in most Londoners, but one with a return I consider well worth the investment.