Disability, mental health & health care

Living with a disability while homeless

People with disabilities are far more likely to become homeless, and far more likely to stay homeless. This includes physical disabilities, chronic illness, mental illness, brain injury, intellectual and developmental disabilities, FASD, and addiction. The system is hard to navigate. But you have rights, and there is money and support you may not be getting.

Disabilities that often go unnoticed

Many people who are homeless have a disability that has never been diagnosed. That matters, because a diagnosis can unlock income, housing priority and support.

• Brain injury. Research suggests about half of people who are homeless have had a traumatic brain injury, from falls, assaults, accidents, sports, or overdoses that cut off oxygen. It can cause memory problems, trouble planning, headaches, mood swings and anger. If you've had head injuries and struggle with these things, tell a doctor.
• FASD (Fetal Alcohol Spectrum Disorder). A lifelong brain-based disability from alcohol exposure before birth. It can make it very hard to follow rules, manage money or remember appointments, and it's often mistaken for "not trying".
• Intellectual and learning disabilities, and difficulty reading or writing.
• Mental illness, such as depression, bipolar disorder, schizophrenia, PTSD and anxiety.
• Chronic pain and physical conditions from injuries, arthritis, diabetes, COPD, heart disease, hepatitis or HIV.
• Addiction itself. Under Canadian human rights law, dependence on alcohol or drugs is generally recognized as a disability.

Getting assessed

To apply for most disability benefits you'll need a doctor or nurse practitioner to fill out forms about your condition. If you don't have a family doctor:

• Go to a community health centre or a clinic for people who are homeless. Many cities have them, and many have doctors who fill out disability forms regularly.
• Ask street nurses or outreach health teams.
• Ask a drop-in or shelter worker to help book appointments and keep your forms safe.
• Ask for copies of everything, and keep them somewhere safe or photographed.

Disability income in your province

Every province and territory has income assistance ("welfare"), and all of them have a higher rate or a separate program for people with disabilities. Disability programs pay more than basic income assistance, often have fewer work requirements, and usually include health benefits like prescriptions and dental.

Federal disability benefits

In shelters and services: asking for accommodation

Shelters, drop-ins, housing programs and government offices are required under human rights law to accommodate your disability, unless it would cause them undue hardship. You can ask for things like:

• A lower bunk, a bed near the washroom, or a wheelchair-accessible space.
• A quieter space, or permission to wear headphones, if noise and crowds are hard for you.
• Somewhere safe to keep medication, including fridge storage for insulin and other medicines.
• A support worker or advocate with you at appointments.
• Written instructions, reminders, extra time, or help filling out forms.
• Being allowed to keep your service animal with you.
• Flexibility around curfews or rules because of a medical or mental health condition.

Put important requests in writing if you can, and keep a copy. A letter from a doctor or nurse helps.

Mobility aids, equipment and medications

• People on provincial disability or income assistance can usually get wheelchairs, walkers, hearing aids, glasses, and medical supplies covered or partly covered. Ask your worker.
• If your equipment is stolen or broken, tell your worker and your doctor. Most programs have a replacement process.
• If your medications are stolen, go to the pharmacy that fills them, or your prescriber. Many pharmacists can give an emergency supply, and a police report or a shelter worker's letter may help.
• Ask your pharmacy about blister packs or daily dispensing, so your medications are organized and you can't lose a whole month's supply at once.

Mental health

Being homeless is traumatic. Many people were already carrying trauma before they lost their housing: childhood abuse, residential schools and their effects, violence, grief, war. Mental illness and addiction often go together, and treating both at the same time works better than treating either alone.

If you are thinking about suicide

Call or text 988, any time, anywhere in Canada. It's free and you'll reach a trained person who will listen. You don't have to be about to act to call. Feeling hopeless, or like people would be better off without you, is reason enough. If you're in immediate danger, call 911 or go to any hospital emergency department.

Getting mental health care

• Walk-in and community mental health clinics. Many cities have free walk-in counselling, sometimes on the same day.
• Community health centres often have mental health workers, psychiatrists and counsellors on staff.
• Assertive Community Treatment (ACT) and Intensive Case Management teams are teams that come to you wherever you are, for people with serious mental illness. Ask a doctor, hospital or outreach worker for a referral.
• Crisis teams. Many cities now send mental health workers, sometimes with police and sometimes instead of police, to people in crisis. 211 or 988 can tell you what exists locally.
• Peer support, from people with their own lived experience of mental illness, addiction or homelessness, is available through many community organizations.

If you've been hospitalized

Before you leave hospital, ask to speak with the social worker. Tell them you are homeless. Ask for: a discharge plan with somewhere to go, your medications and prescriptions, a follow-up appointment, and a referral to housing or case management. Hospitals are not supposed to discharge people straight to the street without a plan. Ask, and keep asking.

Health care without an address

People who are homeless die decades younger than people who are housed, mostly from things that can be treated. You have a right to health care. Here's how to get it when you don't have a home, a family doctor or a health card in your pocket.

Where to go

Your health card

Your provincial health card is what gets you covered care. If you've lost it:

• Apply to replace it at your provincial health insurance office or service centre. Many shelters and drop-ins help with this.
• If you don't have a fixed address, you can usually use a shelter or agency address.
• Even without your card, a hospital or clinic can often look up your coverage using your name and birth date.
• If you've just moved from another province, you're usually still covered by your old province during a waiting period. Apply in your new province right away.

Dental care

Tooth pain is one of the most common health problems for people who are homeless, and it drives a lot of drinking and drug use. Options:

• The Canadian Dental Care Plan (CDCP) is a federal plan for people with no dental insurance and low income who have filed their taxes. It covers cleanings, fillings, extractions, dentures and more. Apply online or call 1-833-537-4342.
• Provincial disability and income assistance usually include emergency and basic dental coverage.
• Free and low-cost clinics at community health centres and dental schools. Ask 211.

Common health problems, and what to do

• Foot problems. Wet socks and tight shoes cause trench foot, blisters and infections. Keep feet dry, change socks daily, and get any wound checked early. Many drop-ins have foot care nurses.
• Wounds and abscesses. Anything red, hot, swollen, spreading or leaking needs to be seen. Infections that reach the blood or bone can kill.
• Chronic conditions like diabetes, high blood pressure, COPD, HIV and hep C need regular medication. Tell your prescriber you're homeless and ask for a plan that works, like shorter supplies, pharmacy storage, or a clinic that holds meds for you.
• Vaccines. Flu, COVID, hepatitis A and B, tetanus and pneumonia shots are free. Ask a pharmacist or clinic.