What’s It Like To Provide Homelessness Services? Ask Front Line Workers

closed storefront with sign informing passersby that the staff are trained to administer naloxone
During the current continental opioid crisis, everyone has been pitching in, even retail clerks. COVID has closed down some or all of that assistance. That has added to the burden of frontline homeless shelter staff.

Who are the frontline workers in the COVID emergency? Hospital workers? Yes. Paramedics? Sure. The staff who work at emergency shelters and drop-in centres? Really?

We know it is difficult to follow advice about social distancing and safe hygiene practices in emergency shelters and drop-in spaces. We know something of the difficulties for people who are homeless, which extend beyond the elevated risk of becoming ill to include access to bad drugs and higher rates of drug overdose. But what about the staff who work in the spaces and provide the supports? Here are two research studies from Canada that explore these questions.

One comes from Kelowna in British Columbia. The research draws on interviews and surveys with front line and management staff in May and June in 2020. At the time, national guidelines had been issued on delivering services safely to people who were homeless. The guidelines included providing spaces for self-isolation, reducing occupancy in shelters and adding safe indoor accommodation (often in hotels and motels).

The researchers wanted to find out whether the guidelines were well known and the extent to which they had been adopted. Generally speaking, the news was good. Shelters had reduced occupancy, there were spaces to self-isolate and hotel rooms had been brought on stream. In a short period of time, the service guidelines had been implemented.

The researchers also wanted to find out how the guidelines were working on the ground. They used the opportunity to gather advice from staff about service provision going forward. In this aspect, there was a lot of scope for improvement. Not surprisingly, it was challenging for the staff to provide services while knowing that the people they served had an increased risk of infection.

It was difficult for some clients to follow safety protocols. There was a lot of information circulating about COVID and some of it was inaccurate or out of date. Staff reported it was difficult to obtain Personal Protective Equipment (PPE). Many would not receive compensation if they became sick. The support for their mental wellness was limited to non-existent. A report of the Kelowna study has been published in the International Journal on Homelessness and is available to all readers here: COVID-19 and the Homelessness Support Sector: Perspectives on a Small Community’s Early Response to a Public Health Crisis

In the second study, the researchers were interested specifically in mental wellness in the homelessness workforce. The researchers surveyed the people who worked in emergency shelters and supportive housing as well as those providing harm reduction services. Workers across Canada were asked to complete a survey that went out in December 2020; more than 700 responded.

Let’s be clear: this work is challenging at any time. There is plenty of evidence about the services and supports that will help. Accessing them is a different story. It is rarely possible to offer permanent housing with low rents, because it isn’t available. Nor is it possible to help people to get quick access to supports for mental illness or substance use, because there are long waiting lists.

Still, front line staff do their best to provide support. Their supervisors do their best to support front line staff. Agencies make best efforts to work together to coordinate their services. And people who use the services identify front line staff as a lifeline.

Of course, COVID added another layer of complexity. Staff concerns echoed the responses of their counterparts in Kelowna six months earlier. The researchers forecast that the impacts could be felt for five years. For this reason, they see a need to increase the resources to help people who are struggling with mental illness and/or using illegal substances. This includes improving the wages and supports for people who are providing the services on the front line.

A policy brief provides a high level summary of the results from this Canada-wide study. It is accessible on the Mental Health Commission of Canada’s web site: COVID-19, Mental Wellness, and the Homelessness Workforce – Policy Brief

The full results have just been published in the Journal of Mental Health. An abstract is available here: Workplace trauma and chronic stressor exposure among direct service providers working with people experiencing homelessness

If you have a subscription, you can use the same link to read the full article. If you haven’t a subscription and want to learn more, Nick Kerman at the Centre for Addiction and Mental Health is the corresponding author. His email is nick.kerman@camh.ca

Why does this matter?

The research reported here makes the case that front line homelessness workers are essential workers who have helped us all to get through COVID. They, along with the people who have experienced homelessness, have done their best with the modest resources that have been extended to manage the spread of the virus in the homelessness sector.

These are people who were already working at the front end of the housing emergency and the opioid drug emergency when COVID arrived.

Going forward, we need to do more to end homelessness by guaranteeing a supply of housing that is affordable and increasing the supports offered to people who struggle with mental illness and/or use illegal substances. With these supports, far from being people with their fingers in a dyke, front line workers would be empowered to do much more to help. The workers also need adequate compensation and benefits to thrive both at work and with the friends and family who sustain them.