Bringing together health care, shelter and education.
The Shelter Health Network is a collaboration of health care professionals and social service organizations established in 2005 in order to reach a high risk population who does not have stable housing and who has complex health problems. Our partners include Good Shepherd Centres, Salvation Army, Wesley Urban Ministries, Mission Services, Wayside House, CMHA, Men’s Addiction Services Hamilton, Womankind and YWCA.
As of 2017, our group consists of 17 family doctors, two nurse practitioners, four registered nurses, eight midwives, two internists and two psychiatrists. Our numbers continue to grow.
We provide primary care to patients at 15 different locations in Hamilton. These include shelters and transitional housing programs, drop-in centres, addiction facilities and mental health facilities. Our patients face numerous barriers in accessing health care: from not having health cards nor the ID necessary to obtain one, to not having a phone or address to receive appointment information, to feeling stigmatized when they do access care. We bring health care directly to people who face the most barriers in accessing it.
The Shelter Health Network is also committed to teaching medical students, post graduate residents and other health professionals. Our experienced health care providers help learners understand the social determinants of health.
In the past two decades, both provincial and federal governments as well as municipalities have issued key mental health and primary health care policy documents concerned with reform. From these reports emphasis has been placed on developing comprehensive care in the community that is accessible, integrated and multi-disciplinary; offering a level of continuity, quality and satisfaction to both clients and providers; and focusing on health promotion, independence and choice (Health Canada, 2003; Kirby, 2002; Provincial Forum of Mental Health Implementation Task Forces, 2002; Romanow, 2002; Metropolitan District Health Council, 1996; Ontario’s Premier’s Council, 1989).
The research evidence tells us that within the context of these reforms those who are impoverished, including the homeless pose special challenges to the provision of health care in terms of: 1) the complexity of health care needs and 2) in the provision of accessible and appropriate levels of health care. People living in poverty or who are homeless have lower levels of general health. They experience multiple and often chronic physical, mental health and addiction problems resulting in higher levels of health care use including emergency room visits and lengthy hospital stays (Policy Forum on Improving Access to Health Care and Social Services for People Experiencing Homelessness, 2005).
In a comprehensive survey of more than 350 people living in relative or absolute homelessness in the City of Hamilton (2004), nearly 1/3 of participants reported being admitted to hospital in the previous year; this in a city with one of the highest poverty rates in the Province of Ontario (approximately 95,000 or 1 in every 5 people). Given the high poverty rate as well as the rate of acute care service use reported by those surveyed, hospitals in Hamilton can expect an alarming rate of at least 1 in every 5 admissions and perhaps as high as 1 in every 3 admissions to be that of someone living in poverty presenting with a complex health care need.
Barriers to accessing and utilizing more appropriate levels of health care services by those who are impoverished is in part attributed to significant gaps existing within the delivery of services. These include lack of coordination and continuity of health care services across sectors particularly from acute care into community settings; lack of integration between health and social services; lack of harm reduction housing; lack of understanding by health care professionals of issues related to poverty and homelessness and finally, a lack of co-ordination across all three levels of government (Policy Forum on Improving Access to Health Care and Social Services for People Experiencing Homelessness, 2005).
The Shelter Health Network is consistent with recommendations from a collaborative study completed in 2002 (Primary Health Care in East Downtown Hamilton), and with the direction of the new Local Integrated Health Network in the Province. The LIHN legislation “places significant decision-making power at the community level and focuses the local health system on the community’s needs, improving health results for patients in every part of the province”. The intent of LHIN is to “break down the barriers that patients face, and ensure that decisions are made in the interests of patient care”.(http://www.health.gov.on.ca/)