When Allana Sullivan walks through the neighbourhood in Moss Park, people often stop her to say hello. Many don’t know the Street Health nurse’s name, but they know her. Sullivan is easily recognizable by her sneaker-clad feet, glasses and no-nonsense ponytail, but her quick smile and kind banter are the young nurse’s true trademarks. Patients greet her, ask how she’s doing, promise to stop by soon. Hello, nurse. What’s going on, nurse. I haven’t seen you in a while, nurse. These client relationships are what has kept Sullivan at the health agency for nearly nine years. Smiling, she says it sounds “corny,” but she became a nurse to give back, to help make the world a better place. Seeing her clients’ progress, and knowing she’s helped them meet their goals and improve their wellbeing is what keeps her motivated.
I met Sullivan for a tour of Street Health one rainy day in July. The not-for-profit, located just east of Dundas Street East and Sherbourne Street, serves the health needs of the area’s homeless and under-housed. The organization’s on-site care centre is housed in a separate building and was recently renovated to add a dedicated primary health care space, which looks like a doctor’s office, but isn’t one. That’s because Street Health is nurse-led and has been so since its 1986 founding. Today, there are three registered nurses and one nurse practitioner at the primary care centre. On any given clinic day, up to 30 people can drop in, and last year Street Health provided 13,000 client visits through its nursing and community health programs. In addition to health services, the organization also provides harm reduction kits for substance users, as well as identification storage and replacement services. In a neighbourhood where few things are easy, Street Health wants to take accessing care off the “hard” list.
As we head back inside the main building, we pass through the small lobby. A woman picking up clean socks greets her, “Hi nurse, can I come see you today?” While they chat, I examine a bright painting of the Street Health building. The artist has imagined a new sign over the front windows: “Vote for housing!” Mental health and housing are intrinsically connected, says Sullivan. “The two do not exist on separate parallels,” she adds. “How do people maintain health if they don’t have a safe place to rest, to call home, to store their belongings, to store their identification?”
In short: they don’t. That’s why Sullivan, as well as other Moss Park and Toronto downtown east side community members and advocates, are all wary of the area’s lurch toward so-called “revitalization.” They fear building developments in the area, including a new community centre and new condos, will push out residents, squeeze services, reduce already-sparse affordable housing, and drastically, negatively alter the area. “We call it revitalization, but revitalization of what and from whose perspective is it revitalization?” wonders Sullivan. “Who said that this is what a better Dundas and Sherbourne would look like?”
Moss Park is a bit like a thin rope in the centre of a great tug of war, with developers on one side and community advocates on the other. If development wins, too swift a transformation could cause the rope snap, and those currently in the community to tumble into a proverbial mud pit. In July 2013, for instance, Toronto city council approved the $562-million George Street Revitalization plan — a feel-good overhaul that will provide a “dynamic” range of housing, shelter, long-term care and community services to the downtown east side. Its flagship project is the “redevelopment” of the area’s 634-bed men’s shelter, Seaton House, which will be demolished and rebuilt. City planners and councillors have stressed that nobody will be displaced, but they have also not yet figured out what to do with the 2,800 men who use Seaton House on a yearly basis. The question rattles through the neighbourhood, mostly unanswered: where will they go in the meantime?
And that development is just one part of the larger planned change. Other proposals include looming condo developments southeast of Moss Park and the $100-million replacement of the John Innes Community Recreation Centre — changes pushed by pro-development neighbourhood groups more concerned about new buildings casting shadows on gardens than about what will happen to the area’s most vulnerable. Meanwhile, says Sullivan, negative perceptions of the neighbourhood are often false. “Have you talked to the people who live down here?” she asks. “How is it going to affect where they’ve lived for so many years? Are they still going to be welcome here after we’ve modernized the place?”
Moss Park is a bit like a thin rope in the centre of a great tug of war, with developers on one side and community advocates on the other.
Helen Jefferson Lenskyj worries the answer will be a loud “no.” Lenskyj is a professor emerita at the University of Toronto and a member of the Queer Trans Community Defence, an organization that formed in 2015 in response to the proposed gentrification of Moss Park. Lenskyj believes that community consultation to date has been skewed toward those supportive of the redevelopment, excluding meaningful feedback from the neighbourhood’s poorest and most vulnerable. Instead, she wants to see consultation start with acknowledging the reality of people’s lives in Moss Park. The first question should be: “Will the people who have called it their home be able to continue to call it their home?”
It seems unlikely. According to the 2011 census, 30 percent of those in Moss Park were considered low-income, compared to a Toronto average of 19 percent. Considering how difficult it is to collect data on homelessness, however, it’s likely that number is much higher. What’s more, homelessness doesn’t always follow stereotypical images: people sleeping on park benches and on the streets, in shelters and in ravines. Many people who are homeless, under-housed, or precariously housed may have a place, but it may not be safe or healthy. Common problems include: lack of heat in the winter, no doors, no water, rodent and pest infestations, unsafe and violent housemates, dilapidated and unsafe housing, and on and on. And even such places can disappear under gentrification, whether it’s from demolition or rising costs, leaving people on the streets.
The health effects of homelessness are devastating. Moss Park has more emergency room visits per person than any other neighbourhood in the city. Not having a safe, healthy place — or living under threat of losing one and being pushed either onto the streets or out of the neighbourhood — can severely affect both mental health and addiction. Moss Park has the third-highest rate for mental health visits out of all 72 neighbourhoods in Toronto. Contrary to public perception, which often paints the homeless and under-housed populations as most commonly dealing with psychosis, many are more likely to experience depression and anxiety, and at much higher rates than the general population. In the Street Health survey, 12 percent of respondents said they needed mental health care but couldn’t get it, for a variety for reasons, including: having no health card; having no doctor; not knowing where to get care; and being declined care. Low levels of sleep and high levels of stress, both of which are conditions of homelessness, can exacerbate both anxiety and depression. Precarious housing can make people feel hopeless and ashamed, which can lead to people not bothering to access services at all. More than 70 percent of survey respondents said they used drugs to help cope with mental and physical illness, trauma, stress and pain. Others used them just to feel better about their lives.
Patricia Edwards, the single mother of two older daughters, has felt the isolation and shame that can come with living in sub-standard housing. A gregarious woman in her fifties, Edwards has lived in public housing with horrific cockroach infestations — bugs so bold they skittered over her teenage daughter’s bed at night. Living there, she was always, always cleaning, fighting against the mold in the walls and the feeling of being infested. It’s hard to feel healthy and full of self-worth when “you yourself feel like you’re dirty.” It’s difficult to keep trying, to not lose yourself to anxiety, depression, or both. This year, she joined the Toronto chapter of the Association of Community Organizations for Reform Now (ACORN) to help advocate for better, affordable housing. It helps to feel like she’s doing something, to have a community.
Living on the brink is stressful, says Edwards, but she’s learned to strategize. She never, ever throws food out. She knows the exact time to hit the grocery store for the half-off coupons on pre-made meals. She is always hustling and is very careful about how she wears out her shoes. She is always looking for better places with lower rent and, in recent years, has moved from Keele and Lawrence to Islington and Rexdale, where she now lives. She is no longer anywhere near any services, or any of her friends. Every month she carefully budgets her and her live-in daughter’s social assistance cheques (her other daughter is married and lives with her husband’s family), parceling out money for food and rent. Both she and her daughter work at the same restaurant, and a friend also lives in the small home, contributing to the rent. Yet, Edwards doesn’t want her daughter to feel the strain of providing for their family. She wants her to focus on school; she wants her to break the cycle.
Later on, when I ask Edwards how she copes with such daily high-stakes pressure, she grows briefly quiet, pausing before telling me it’s simple: “I try to wipe wants out of my head.”
In mid-July, longtime Toronto street nurse Cathy Crowe invited me to meet her at Holy Trinity’s homeless memorial. The church, located behind the Eaton Centre, holds the monthly vigil held every second Tuesday to honour, remember and raise awareness of those who died (and continue to die) on the streets. Both names and cause of death — in this case four names and causes including cancer and heart troubles — were read outside, loudly. Attendees spoke of remembrance and action as they clutched white-cupped candles. At service’s closing, a man wearing a “No More Homeless Deaths” T-shirt spoke to the crowd. “It’s just too late to find out who Jane and John Doe are,” he said, referring to unidentified and forgotten on the list. “It’s never too late really.”
Like Sullivan at Street Health, everybody here knows Crowe, who started street nursing in the late 1980s. Inside the church and over a free lunch of hotdogs and salad, we chat with her friend Berrick, another longtime activist who introduces himself as a senior living in Toronto Public Housing. We talk about the interconnectedness of health and housing and the need for a national housing strategy that recognizes good, affordable housing as a basic human right. We talk about the need for better economic opportunities in Moss Park. Until that happens, however, the neighbourhood continues to need people like Crowe. Street nursing highlights the importance of providing care to people no matter where they live — of taking care to clients, rather than expecting they’ll be able to access services through typical pathways. The idea of meeting the population where they’re at — and recognizing that finding good health care may be secondary to immediate needs, like finding a place to sleep or finding food — is a core tenant of many organizations in the downtown east side.
Back at Street Health, Sullivan tells me about a woman who travelled from Jane and Wilson for the foot clinic. When Sullivan casually remarked the woman should come to the clinic more often, the client told her she wanted to, but wasn’t always able to make the trip. Others who travel in for services may be stuck in the area for days before they can scrounge up return transit fare. As we chat, she shows me the centre’s harm reduction kits. One is for crack, which Sullivan calls the clients’ most common drug of choice; the other is for safe injection. Street Health distributes 100 kits every day from its office, plus more on the streets.
After an hour, Marty, one of the organization’s harm reduction workers who’s also in recovery for crack use, joined us. He uses a cane to walk, he tells me, because somebody shot him in the legs during a drug dispute. Both he and Sullivan worry what will happen if the community gets pushed out and can’t easily access things like harm reduction kits. To help illustrate this point, harm reduction workers in the neighbourhood launched a pop-up safe injection and overdose prevention site in Moss Park in August. Unsanctioned, the site is technically illegal, but even Toronto Police agreed the need for the site — overdoses increased over the summer — overruled legalities. The pop-up tent contains 140 naloxone kits in case of narcotics overdose, and has already saved lives, reversing 20 overdoses in its first month, according to Street Health. But it, like the neighbourhood, is impermanent.
Marty has first-hand experience with what happens when residents are pushed out of their communities. He grew up in Regent Park with his four brothers and two sisters. But, over time, he says, community centres and programs shuttered. Boredom and drugs moved in. Marty, like many others in the neighbourhood, began using crack. When the 15-year Regent Park Revitalization Plan started in 2005, Marty and his brothers started to lose track of people. During the various construction and relocation phases, their friends and neighbours were displaced far outside the downtown. Most of them seemed to disappear, he says, shaking his head. They are not the ones, he adds, who are using the new aquatic and community centres in the neighbourhood.
“We call it revitalization, but revitalization of what and from whose perspective?”
Marty moved out of Regent Park almost a decade ago when got housing near Keele Street and Rogers Road. Having a home was an invaluable part of his recovery, which he started through Street Health’s Crack Users Program (now defunct, thanks to cut funding). Instead of spending money on drugs, he spent it on furniture. He bought a cute cat. When he relapsed — a common step in the recovery process — he at least knew he had a place to go back to, a place that was safe and his. Still, I asked him how it felt to be forced out of his neighbourhood, away from services like Street Health, away from his friends and family. Marty is an expressive, engaging talker, all popping hands and nodding head, but at this he stopped, stared right at me. Fixed me with his rich brown eyes and didn’t miss a beat as he told me: “I didn’t leave my community; my community left me.”