Supportive Housing for Heavy Users of Service
In April of 2018, Edmonton celebrated the grand opening of a new place of home and healing for twenty-five of her most vulnerable citizens. First opening its doors to new tenants in late 2017, Balwin Place is an example of Permanent Supportive Housing (PSH), which marries stable housing to staffing and supports designed to help people battling multiple complex needs and challenges.
For many of these folks, life on the street is all that they can look forward to, with many losing years of their life there. Living in a perpetual state of crisis is very hard on a person, with enormous health consequences physically, emotionally and spiritually. It is a life of constantly being under threat:
- Threats from the weather, with the cold and damp causing illness or loss of life and limb
- Threats from physical violence, with few places of safety available
- Threats mental and emotional, with even a relatively brief experience of life on the street causing trauma that can take a long time to recover from.
Who is finding home at Balwin Place?
Every story is different. Some folks were in treatment at Alberta Hospital, but then were released back into the community without any supports or plan; and they fell down long and hard. Some had a more gradual fall, surfing on the couches of family and friends while battling addictions, and exhausting important relationships. Some are there as part of the lasting legacy of residential schools. Others fell hard after a major life trauma, and were simply not able to recover.
One of the first folks to find home at Balwin Place was Ryan Arcand, whose story went viral around the world for his gifts of playing the piano. Along with stable housing, Ryan was receiving help on a number of fronts including Balwin’s Managed Alcohol Program. Sadly, Ryan died recently after only a few months of finding home at Balwin Place, which was a very hard loss for the community there. But they were thankful he was able to die in a place of dignity. The rooftop garden area was given his name as a memorial.
How does Balwin Place work?
Homeward Trust owns the building. George Spady is the operator, overseeing staff and working with the assistance of Alberta Health Services to provide appropriate supports. Balwin Place is a harm reduction facility, which means that people are allowed to continue to use drugs or alcohol without losing their housing. Instead, a stable and supportive environment enables people to get stronger and healther, and that will sometimes result in strength and will to break with their addictions.
Safety is a critical priority at Balwin Place. Cameras and sensors are used to monitor the facility, and staff are on site around the clock to guard the safety of the residents, which includes help with guest management. Natural supports like visits from family and friends are encouraged, but the rule is they can’t stay or live at Balwin. Having staff on site also helps guard residents from gangs and other criminal activity.
Balwin Place employs two case managers to work with the tenants. They also receive visits from a psych nurse, an occupational therapist, recreational therapist, support worker, and on site healthcare from a licensed practical nurse and two health care aides. They also receive support from a crisis worker from the George Spady mobile support team.
Rent is calculated at 20% below market housing. Currently that is $865 per month which covers rent, cable, internet, TV, and a partially furnished one bedroom apartment. This still leaves a few hundred for the resident to live on, but of course, that’s a very tight budget.
How does Change Happen?
Sanders observes that most residents are not used to having the supports or people to coach them. On streets you are in survival mode. Every month when paycheques hit the streets, it’s ‘Mardi Gras.’ People with addictions like gambling, alcohol, or drugs often spend what they get on a binge. The self-talk leading up to payday is usually more hopeful, with many folks saying ‘This month, it’s going to be different. I’m going to get me a place! I have a plan.’ Then the paycheque hits the ground, and they fall down again. Part of the reason they fail again and again is that they don’t have the means and support to follow through.
What helps the resident make a change is having people help them out. The different support staff at Balwin are involved everyday, teaching life skills and living skills. Hands-on coaching and learning in how to wash dishes, do laundry, cook, get groceries, and make budgets and keep their plans. Sanders notes that most people know what they need to do, but they need people to believe in them and encourage them, and help them get up when they fall.
Patience is critical to this effort. Some people have been in crisis for many years, with a lot of damage done. Healing and change is also likely to take years. The philosophy of harm reduction that undergirds the facility gives permission for that incremental change to take place; for the small steps forward, and the frequent failures that may also punctuate someone’s story. Many of the residents have behaviors that get in the way. Sanders observes, ‘Trauma, life history all play a role in behaviors.’ Some residents have poor boundaries or impulse control, and will push buttons to test the commitment of staff. But for many of the residents at Balwin, this is their last stop. Without a strong level of commitment and patience from staff, a resident could be too easily cut loose, ending up back on the street. Staff are reluctant to remove someone from the program if they have nowhere else to go. Instead, they pursue a restorative model that includes strategies of behavior modification; to try and make things work.
One way that staff model that patience is by banning the word ‘eviction’ from their vocabulary. No one receives an eviction notice. Instead a person would receive a conversation letter. Whenever challenging behaviors erupt from a resident, whether its physical or verbal aggression, staff call that resident to a conversation. They talk through what is happening, and look together at what they (staff and resident) can do to make this work; knowing that if they can’t sort it out, then the street is often the only option available. That conversation can help both staff and resident make a plan for how they can change their behaviors; allowing them to stay on board.
Managing Money, Food, Alcohol
Balwin’s case managers sit down with their different clients and help them make a budget and a plan. It’s complex work, of course. Budgets are tight. Some residents have trustees to help manage their funds. Some have volunteers go with them to buy their monthly amount of alcohol. And sometimes help is given with grocery shopping to help people make those decisions early on, before the money is gone. When you do that kind of work with folks you can have some of those conversations, such as: “Okay, you only have $120 left… But you have your rent paid, and food, and when your family comes to visit, you can make something for them. Looks like you won’t be able to use as much this month.” It’s an opportunity to (in gentle ways) reinforce the good decisions.
How about relationship with the local community?
Sanders says the neighbours have been pretty amicable and laid back. They did a tour and held a Q&A with local community folks in March of 2018, where they were able to talk through people’s questions. They have had some neat expressions of support. Balwin Community League organized a movie night to collect non-perishable food items to help out residents. St. Francis of Assisi School is nearby, and helps arrange for food hampers.
Sometimes the police do need to come, or the ambulance. Sanders says that people can be quick to judge, asking, ‘What’s the point of having a place like this if these things continue to happen?’ But once people come and hear what happened, they are more understanding.
As far as giving back to the community, Sanders says that Balwin place is still new, and settling in to roles and responsibilities. Some residents are making their way around and finding ways to give back; like helping with clean sweep. But a lot of folks are still in a lot of distress and aren’t able to give back much yet.
Does it work?
If there can be two observations drawn, they are as follows:
- The work of healing and change takes time, with a lot of small changes. Sanders says, the harm reduction philosophy allows for incremental changes (small steps) that are significant. When change happens in small ways, residents don’t even see it all the time. But when the staff show them some of the changes that are take place, it is exciting for them.
- It takes a community to support this change. There is the community of organizations and funders that make a place like Balwin Place possible. And there is the community of people who are willing to provide support and community in ways large and small.
- Serving as a trustee
- Taking someone out for coffee or to get groceries or alcohol
- People to collect and distribute food donations.
- Simple responses of compassion and understanding.
Permanent supportive housing is an evidence-based intervention that links permanent, affordable housing with flexible, voluntary support services to assist with housing retention and independent living. Susan McGee, CEO of Homeward Trust says that with 900 units of Permanent Supportive Housing needed in the Edmonton area, Balwin Place is a welcome addition to the city. “Increasing Permanent Supportive Housing spaces in neighbourhoods across the city is an urgent priority under Edmonton’s Plan to Prevent and End Homelessness.”