Throughout the legislative process, Casey House appreciated the opportunity to comment on Bill C-22. As outlined in our most recent submission to the Senate Standing Committee on Social Affairs, Science and Technology (SOCI), we highlighted the importance of ensuring that the CDB is designed and delivered to: 

• Support people with episodic disabilities living in poverty: examples of episodic disabilities include chronic conditions and diseases such as HIV, mental illness, and substance use disorder. People with episodic disabilities face unique barriers to financial security and require supports that enable them to meet their basic needs. 
• Reach people with disabilities living in poverty who face barriers to filing income tax returns: the CDB will be based on annual income tax returns, however for people living in deep poverty, such as those without housing, it can be difficult to file their taxes regularly. If barriers to tax filing are not addressed, we risk the CDB not reaching those who need it most. 
• Ensure that people with disabilities living in poverty continue to have uninterrupted access to health benefits through provincial disability support programs: most Casey House clients receive income support from the Ontario Disability Support Program (ODSP), which also provides coverage for life-saving medications. Implementing the CDB will require coordination between different levels of government to ensure people have continued, uninterrupted access to provincial health benefits to meet their health care needs. 

As a specialty hospital in Toronto providing care for people living with and at risk of HIV, Casey House serves people who face multiple barriers to having their basic needs met. We acknowledge that systemic inequities have a profound effect on people’s lives, and believe that everyone deserves judgment-free care – both within and beyond our hospital. With the continuing drug poisoning crisis, housing crisis, and rising cost of living, the need to address the social factors that determine health and well-being is beyond urgent; and tackling these challenges requires thoughtful, transparent, accountable, and compassionate leadership that views people for their humanity amidst the challenges they face.

It is well known that homelessness and precarious housing are at crisis points in Toronto; in fact, Toronto City Council recently declared homelessness an emergency. In addition to a lack of affordable housing options for all income levels, there is a constant lack of emergency shelter spaces to accommodate the volume of people experiencing homelessness – a population in which Black, Indigenous, and other racialized groups continue to be over-represented. Given this reality, many people are sleeping outdoors, including in homeless encampments. The absence of a safe, stable place to sleep and access to the necessities of life makes it difficult to attain stability and adhere to a daily routine, which negatively impacts people’s physical and mental health, particularly during periods of inclement weather. As one Casey House nurse expressed, “For people without housing, managing their health requires so many things they just don’t have access to.”

The city’s housing charter and action plan recognize that housing is essential to the inherent dignity and well-being of the person, however this human right to housing is far from realized. While progress has been made, and while other orders of government have a role to play, there is much more work to do. The next Mayor of Toronto must exercise their power and responsibility to uphold and fulfill the human right to housing for all Torontonians. This entails allocating the maximum available resources, and using all appropriate means, to provide equitable, low-barrier access to adequate housing; and heeding the recommendations of Toronto’s Ombudsman to ensure a fair, consistent, transparent, and accountable response to homeless encampments.

Despite substance use being a health issue it is treated as a criminal justice issue in Canada, which creates barriers to health services, particularly for people living in deep poverty. It leads health care providers to require that people stop using drugs in order to receive care; deters people from accessing services and supports which would build their resilience and improve their well-being; and drives the inevitable market of illegal drugs which have become increasingly toxic. Moreover, the criminalization of drugs is rooted in colonialism and racism, not in science or public health, and disproportionately impacts Black and Indigenous communities.

In Toronto, promising work is underway to address this systemic barrier: Toronto Public Health’s request to Health Canada to decriminalize illicit drug possession is a decisive policy action. Allowing the possession of drugs for personal use is imperative for decreasing stigma, creating pathways to health care, and improving health outcomes. Equally critical is how this policy change is implemented: it must be supported by a wide range of health and social services that respond to the diverse needs of people who use drugs, including harm reduction – a people-centred and evidence-based approach that aims to reduce the risks of substance use without judgment or preconditions of support. The next Mayor of Toronto must continue to lead and support the critical work underway to help protect people from a toxic drug supply; reduce the harms of substance use, including stigma and discrimination; and respect the health, dignity and human rights of people who use drugs.

While progress has been made in communities across the province, there is much more work to do – particularly to support people in high need for housing, mental health, and substance use supports. As a hospital, Casey House encourages the Ontario government to increase and improve access to:

• Supportive housing for people coping with mental health and substance use challenges
• Mental health and addictions care that doesn’t require abstinence from substance use
• Wide-ranging harm reduction services and supports as part of overall health care

While progress has been made to improve the health and well-being of people in Toronto, there is much more work to do – particularly to support the estimated 18,000 people experiencing homelessness in our city, while they continue to wait for more safe, affordable, and supportive housing. As a hospital, Casey House encourages the City of Toronto to increase and improve access to:

• Emergency shelter spaces with citywide locations that enable people to remain geographically close to their support systems and networks.
• Low-barrier 24-hour drop-in spaces, respite sites, warming centres during winter months, and fixed-site cooling centres during summer months.
• Storage services for personal belongings, such as medications and critical documentation.
• Income tax clinics and identification clinics to enable more people to apply for long-term housing and income support programs.

The Budget Committee wraps up its review process January 24, Mayor John Tory releases proposed budget by February 1, City Council votes on the budget February 14.

With the rising cost of living and risk of a recession, the need for the CDB is urgent. Casey House calls for the swift passage of Bill C-22 so that this disability benefit can be designed and delivered as quickly as possible to:

1. Support people with episodic disabilities living in poverty: examples of episodic disabilities include chronic conditions and diseases such as HIV, mental illness, and substance use disorder. People with episodic disabilities face unique barriers to financial security and require supports that enable them to meet their basic needs.

2. Reach people with disabilities living in poverty who face barriers to filing income tax returns: the CDB would be based on annual income tax returns, however for people living in deep poverty, such as those without housing, it can be difficult to file their taxes regularly. If barriers to tax filing are not addressed, we risk the CDB not reaching those who need it most.

3. Ensure that people with disabilities living in poverty continue to have uninterrupted access to health benefits through provincial disability support programs: most Casey House clients receive income support from the Ontario Disability Support Program (ODSP), which also provides coverage for life-saving medications. Implementing the CDB will require coordination between different levels of government to ensure people have continued, uninterrupted access to provincial health benefits to meet their health care needs.

This bill is currently being studied by a Parliamentary Committee in the House of Commons, and must pass both the House and Senate in order to become law. The faster Bill C-22 is passed, the faster the Canada Disability Benefit can be designed and delivered to reach all working-age people with disabilities living in poverty, to improve their financial security and health and wellbeing.

For many people, substance use is a way to cope with intersecting challenges such as trauma, poverty, homelessness and mental health concerns, which can create multiple barriers to having one’s basic needs met. At Casey House, our clients face many of these hurdles, which have an impact on their health and well-being. Our hospital is committed to understanding our clients’ health concerns in the broader context of their lives, and to actively dismantling barriers to care and safe living. All levels of government have a vital role to play in addressing the social factors that determine health and well-being, and in improving health care and outcomes for people in high need. While considerable progress has been made in recent years, there is much more work to do.

For many of our clients, an extremely low income creates barriers to safe and healthy living. For those who qualify for income support programs, the amount of money a single person receives is not nearly enough to cover basic needs and shelter. For instance, many clients receive support from the Ontario Disability Support Program (ODSP) or Ontario Works (OW) – the maximum monthly rates for which are $1,228 and $733 respectively. Even in stronger economic times, these rates are far below the poverty line, let alone during this period of high inflation, when even higher income earners struggle to make ends meet.

Unsurprisingly, a related challenge is access to safe, affordable, and supportive housing – the demand for which far exceeds supply. The constant lack of emergency shelter spaces affects the ability of hospitals like Casey House to safely discharge unhoused patients so they can manage their health beyond their stay. As one long-time Casey House nurse expressed, “We call Central Intake [for emergency shelter space], and no beds are available…I’ve never seen it worse.” The situation is further aggravated by obstacles to obtaining required documentation to apply for potential housing. Our team of social workers see these roadblocks far too often: “getting ID is a nightmare for people” because of the limited services available, and “it can be difficult for people without housing to get their taxes done regularly”.

Even when people are housed and have access to programs like ODSP, it is still not enough to pay for food, transportation, and other basic needs.

Since 2016 there have been more than 30,000 opioid toxicity deaths in Canada, an accelerating crisis that is claiming lives in communities across the country. In 2021 , Toronto Public Health reported 574 opioid-related deaths. As recent research from the Office of the Chief Coroner for Ontario shows, there has been an increase in stimulants contributing to opioid-related deaths, the circumstances surrounding drug-related harms have been changing significantly, and there is an urgent need for harm reduction services that respond to the diverse needs of people who use drugs.

In Toronto, many harm reduction services are available, but limited. Supervised consumption services (SCS) are contained to the downtown core; don’t always accommodate the range of drugs used and varying effects they have on the mind and body; and often don’t include vital drug checking services, which help people make more informed decisions about their drug use. The few options for safer supply (prescribed alternatives to the illicit drug market) have long waitlists and are limited to opioids.

In addition, many people providing support do not have lived experience of drug use, which can limit the full potential of these services. As one Casey House client expressed, “you want someone who ‘speaks your language’” when accessing care.