Health challenges for

homeless migrants

Carol Kauppi, PhD, School of Social WorkPhyllis Montgomery, RN PhD, School of NursingHenri Pallard, Doct. Department of Law and Justice

Laurentian University, Sudbury, Ontario

28 May 2014

Public Health 2014, Toronto

CPHA’s Annual Conference 1

Background

• Migration, a complex and dynamic social process.

• Movement within regions, between provinces and across country borders. • Inter-regional, provincial, national, international.• Rural ↔ urban.

• Physical, psychological, social, economic, cultural, racial, political, and religious reasons.

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Background• Some evidence that people with poor mental health

are more likely to migrate for a better life [Stillman et al., 2009].

• Persons with severe mental illness: • 2 times as likely to move [Lix et al., 2006].• 3 times the risk for developing schizophrenia

[Bhugra, 2000; Cantor-Graae & Selten, 2005].

• ‘Having to migrate’ contributes to lower post-migration psychological health outcomes [Gong et al. 2011].

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Background

• Experiences are influenced by:• Pre-migration factors (e.g., reasons for migration);• Preparation for migration and process of moving

(voluntary/forced vs. planned);• Post-migration factors (e.g., acceptance by host

community).• Migration produces stress:

• Exacerbated by racism, discrimination, social disadvantages.

• Contributing factors are poverty, poor housing and low SES.

• Bhugra (2000) argued that severe social and economic disadvantages increase the incidence of mental illness. 4

Objectives of this presentation

1) To compare the profile and migration patterns of northern and rural persons.

• Compare 2 groups:• Those who self-identify as living with mental

health issues.• Those who do not self-identify [self-report

migration/mental illness].

2) To describe migrants to northern Ontario cities: • socio-demographic characteristics.• histories of homelessness.• physical illness 5

Northern Ontario CURA: Poverty, Homelessness and Migration (PHM)• A 5-year research project of the Centre for Research

in Social Justice and Policy at Laurentian University. • Working with 11 communities in northeastern

Ontario, from Sudbury and North Bay up to the James Bay.

• Partner communities include 3 northern cities, 4 towns and 4 First Nations.

• PHM is bilingual and tri-cultural: working with Anglophone, Francophone and First Nations communities in the vast area of northeastern Ontario. 6

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Sample

• Database collected using a survey.• Service providers in Sudbury, Timmins and North Bay

invited homeless people to complete the questionnaire (2009 to 2011).

• Sample = 1528• Migration analysis draws on 468 participants who

provided information about migration and mental health.• 118 participants who self-reported mental health

issues: Mental Health Sample• 350 who did not cite mental health issues:

Comparison Sample 8

Total sample: MH vs. Comparison• Significant gender difference (.01)

• More men in mental health group.• More women in comparison group.

• Significant difference on marital status (.01)• More single/unattached people in mental health group.• More married/common law relationships in comparison

group.

• Significant difference on custody of children (.01)• Fewer people with custody of children in mental health

group. 9

Total sample: MH vs. Comparison• No significant differences with regard to socio-cultural

backgrounds.

• Similar proportions of people of Indigenous, Anglo-Euro, Franco-Euro origins and racialized others in both groups:

Group %•Anglo-Euro 53.4•Franco-Euro 15.9•Indigenous 29.6•Racialized others 2.1

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FINDINGS ON MIGRANTS:Physical health problems in last year

(p<0.01)

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Health problems

• Mental health group of migrants self-identified health problems in year prior to the study:

• 5 main categories of problems:

Category %• Musculoskeletal 58• Circulatory 10• Respiratory 8• Substance use/abuse 7• Infections 6• Other 11

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FINDINGS ON MIGRANTS: Absolute homelessness in lifetime

(p<0.01)

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FINDINGS ON MIGRANTS: Slept outdoors in last year

(p<0.01)

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FINDINGS ON MIGRANTS:Profile of migrants who cited mental health reasons for homelessness• Male (55%)

• Anglo-Euro (48%)

• Single, divorced, separated or widowed (70%)

• Not accompanied by children (72%)

• No custody of children (67%)

• Physical health problems (68%)

• Has been absolutely homeless in lifetime (76%)

• Has been absolutely homeless in last year (50%)

• Main source of income was government (e.g. OW, ODSP) (81%)

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FINDINGS ON MIGRANTS Profile: main reasons for migration

1. Housing/ poverty/unemployment/seeking work.

2. Encouraged to go to destination community by family, friends or services.

3. Illness or to access health services.

4. Challenges with family, violence, divorce.

5. Due to mental illness.

6. Due to addictions/substance use.

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Migration patterns

A place near the study community

Within 50 km of Sudbury, Timmins or North Bay

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Northeastern OntarioMoose Factory, Kirkland Lake,

Matagami FN28

Northwestern Ontario Wawa, Thunder Bay 10

Eastern or western Ontario

Cornwall, London 10

Southern Ontario Toronto, Barrie, Waterloo 21

Another province, territory

BC, AB, QC, NB, PEI, NFLD 11

Another country USA 4

Migration from: Examples: %

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Discussion

• The study has shown that migrant homeless persons who experience mental illness have:• extensive histories of absolute homelessness;• experience with sleeping rough and;• problems with physical health.

• Our qualitative studies also show that they experience impacts in various ways:• emotional/mental (anxiety, fear, depression, mental illness), • physical (health impacts), and • social (e.g. through the loss of relationships).

Conclusion

• Homeless migrants may lose both dwelling space and social ties.

• Migration may occur by force as homeless people are sometimes encouraged to move or are given bus tickets to move to other cities. This practice has been referred to as “greyhound therapy”.

• Absolutely homeless persons are often excluded from public places through laws pertaining to loitering, surveillance of inhabitants, regulations regarding access to certain public places (e.g., parks, malls) and the closure of shelters during the day time.

• Exclusionary practices may erode the sense of self and cohesion among homeless people who rely often on public locations to conduct day to day life functions. 19

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Future directions

• The results indicate the complexity of migratory homelessness.

• Services for homeless, migratory people experiencing mental health challenges must take into account varied needs• Must address anxiety and stress that results from loss of

place and migration.

• More research is needed to extend concepts of place to understand better the experiences of migrant, homeless persons with mental illness in Ontario and Canada.

Contact us:Poverty, Homelessness and Migration

Laurentian University935 Ramsey Lake RoadSudbury, ON P3E 2C6

Tel. 705-675-1151, ext. 5156homeless@laurentian.ca

www.lul.ca/homeless www.lul.ca/sansabri

ckauppi@laurentian.ca pmontgomery@laurentian.ca hpallard@laurentian.ca 21