Programs keep chronic alcoholics off the street
The Northwest LHIN has funded two managed alcohol programs for the region – one in Kenora operated by the Morningstar Centre and one in Thunder Bay operated by the city’s Shelter House.
The Kwae Kii Win program in Thunder Bay began operating in 2012, but only received dedicated funding in January. The Morningstar Centre program received funding in November and began operating January 23rd.
“A managed alcohol program is about maintenance and diverting people away from using non-beverage alcohol,” said Gary Mack, executive director of Shelter House. “It’s a harm reduction approach and a housing-first approach.”
Kwae Kii Win is staffed 24 hours per day by two employees and accommodates up to 15 people in shared bedrooms. Residents pay $670 per month, which covers their food, alcohol and accommodations, but the program costs $300,000 over and above the rent to break even. Until now, it scraped by on donations and miscellaneous funding.
“Our residents are people who have been chronically homeless for at least five years,” said Mack. Prior to entering the program, “they were drinking mostly non-beverage alcohol – hairspray, hand sanitizer and mouthwash. It’s cheaper and you get drunker off it. Hairspray is the favourite and the health consequences of that are quite severe. We only serve one kind of alcohol – white wine that we get from a U-Brew place. They get six ounces every 90 minutes from 8 am to 11 pm.”
All of the residents of Kwae Kii Win are Indigenous.
“These are people who have been drinking alcohol under the bridge for years and years,” said Mack. “Now, they’re housed and have have access to regular medical care.”
Physicians and nurses from the Norwest Community Health Centre visit every week to monitor them.
“These folks are people who were super users of emergency departments and EMS, but in 2016, not a single Kwae Kii Win resident went to the ER for intoxication reasons,” said Mack.
A study by the University of Victoria found that every dollar spent on managed alcohol programs saves between $1.09 and $1.29 in legal and health-care costs.
“Our residents are at the bottom,” he said. “There’s nowhere else to go and leaving them at the bottom is not leading them to the change we would want. It seems to me that it’s unethical to not have some sort of intervention for them.”
Participation in a managed alcohol program can lead to sobriety, but sobriety isn’t Kwae Kii Win’s goal. The goal is harm reduction and giving residents a roof over their head.
“That’s our main priority, but once people are stable and feeling better, their health is improving and they’re part of a community of people who care about them, they start to see themselves differently and can more easily make different choices in life,” said Mack.
“This past Christmas we were visited by someone who was one of our original residents. She’s from a northern reserve and is now working in health care. She dropped in to say thank you and to make a donation. She was chronically homeless, a non-beverage drinking alcoholic.”
Kwae Kii Win keeps the residents busy with food preparation and shopping. “We also take them out on excursions to the museum or the art gallery, to Kakabeka Falls, ribfests, dog sledding and fishing,” said Mack.
The managed alcohol program in Kenora is operated by the Lake of the Woods District Hospital’s Morningstar Centre, a detox facility.
Residents sign a service agreement agreeing to stay in the centre for a period of time during the day and participate in other programming, said Bruce Sicilliano, the vice-president of the hospital’s mental health and addiction program.
The Morningstar Centre managed alcohol program only had one resident when Sicilliano was interviewed the day after the program began operating, but the plan is to gradually ramp up to its full 10-bed capacity.
Residents agree to a nutrition assessment and to working in the kitchen. They get assistance with budgeting and agree to work with a mental health therapist.
“It’s more than just providing people with alcohol – although that may be the initial motivation for them,” said Sicilliano. “They have to agree to be part of an entire holistic intervention.”
The centre’s detox clients have been informed about the program, “but when they understand that it’s a holistic, interprofessional intervention that involves some commitment, it’s very scary for them.”
Lake of the Woods District Hospital advocated for the program because of “some very simple clinical and philosophical beliefs we had around how people change their behaviour and with the practical understanding that we were only going to be given $450,000 annually to run the program,” said Sicilliano. “It was the best we could do because we received no capital dollars. We would have liked to construct apartments or a group home for these people, but there was no money for that.”
At some point, chronically homeless alcoholics require long-term care, but “it’s hard enough getting a middle class person with clinical dementia a nursing home bed in Northern Ontario,” said Sicilliano.
Long-term care homes are not keen to accept people with serious mental health and addiction issues, “but if we can stabilize them to the point where we can make them more attractive to a long-term home placement, that would be one of our goals,” he said.
“If people who are using the managed alcohol program decide they would eventually like to wean themselves off alcohol and other substances, we would help them with that, but if the best we can do for them is to break their pattern of hitting the streets and stay in our centre, then that’s a goal as well.
“A lot of homeless people are developmentally disabled and have fetal alcohol spectrum disorder, but because of their chaotic lifestyle, it has been very difficult for us to secure supported independent living through an association for community living or even a group home placement,” said Sicilliano.
One successful outcome in Sioux Lookout, where Sicilliano served as director of the mental health and addictions program for eight years, involved a patient who wound up in Emerg after almost freezing to death.
“He made a decision at some point that he wasn’t going to drink anymore, but every once in a while he would smoke pot, which was fine with us,” said Sicilliano. “He was developmentally disabled and cognitively impaired. We had to work very hard with the Association for Community Living to take him, which they did, but with the caveat that every once in a while, he was going to smoke up. He would be buying (marijuana) illegally and could get caught by the police, but please don’t throw him out, we said.
“He’s not coming to the emergency department anymore. He’s not getting thrown in jail. When police see him smoking pot, they just look the other way. It kind of works as long as everyone’s reasonable.”
The Kwai Kii Win managed alcohol program in Thunder Bay received one-time funding of $184,000 from the North West LHIN, which will allow it to continue operating until June.
Sustained funding for the program is subject to further study and engagement with community stakeholders to ensure it is aligned with evidence-based practices and is positioned for long-term success.