An exasperated London doctor is calling out city hall and city residents after four homeless patients died in four days, amid a months-long jump in homeless deaths.
“Where is the public outcry? People are dying on the ground in London,” Andrea Sereda, a family physician at the London InterCommunity Health Centre (LIHC), said Wednesday.
The four recent deaths, from April 30 to May 3, come only a week after city hall shut down one of two innovative shelters for “high-acuity” homeless people — those with the most complex problems and greatest needs — without anything to replace it.
“What is the exit plan for people with high acuity? Is it just death at this point? Because we have nothing for them,” Sereda said.
She took to Twitter Tuesday night after learning of the most recent death of a patient.
“4 people lost in 4 days 4 vibrant souls gone. When my patients die, they die on the concrete of #ldnont They get more attention from the ‘community’ when they are dead, now there’s a body to clear I guess they’re not high acuity anymore, I guess the numbers look better now.”
By Wednesday, Sereda said, she had lost some, but hardly all of her anger.
The past three to four weeks have been “horrendous. Our team feels like we are dealing with loss every other day, and that’s just us,” she said.
“So often now I will have somebody from the community come into my office and say, ‘Everybody I know is dead.’ That’s what it feels like to people and that’s what it feels like to us. We have real gaps where human beings used to be and their absence is profoundly felt.”
Other front-line agency leaders also report a devastating increase in the number of overdose deaths among homeless Londoners the past month or two.
“We’ve had a ton recently. The hard piece, too, is we’re seeing younger and younger people,” said Sonja Burke, director of harm reduction at Regional HIV/AIDS Connection London.
In her first year as executive director of Ark Aid Street Mission, Sarah Campbell said she’s seen nothing like the past few months.
“Our community has been impacted by deaths in the last two or three months more than any other time in the year I’ve been here,” she said.
The uncertain quality and level of fentanyl responsible for most overdoses, the lack of appropriate shelter and services, and the ongoing isolation caused by the pandemic are all factors in the deaths, agency leaders say. Not all homeless deaths are from overdoses, but the bulk lately have been, they say.
Sereda prescribes a safe supply of the opioid hydromorphone to patients in one of her programs, but said that’s not enough to help the many more people using fentanyl, who have no place to get a safe supply.
“I would like to prescribe fentanyl. People don’t die from fentanyl, they die from not knowing the concentration of fentanyl in their drugs,” she said. “If I give fentanyl at a known dose and known schedule, I guarantee you I can stop those overdoses.”
And the longer people live exposed on the street, the more likely they are to use increasing amounts of drugs to cope, Sereda, Burke and Campbell all said.
“Almost everyone’s street-level drug use increases when they are living rough,” Sereda said. “They’re uncomfortable, they’re sleeping outside, they’re stressed, they’re scared, they’re cold, they’re hungry. They need medications to cope with that. We know that we bring people inside, when we bring them into appropriate supportive housing, the overdose risk goes way down.”
Over the winter, LIHC was part of a coalition of agencies called Winter Interim Solution to Homelessness (WISH) that operated two pop-up shelter sites. The sites offered shelter in converted construction trailers and 24/7 support to roughly 60 of the estimated 200 to 300 high-acuity homeless people in London unable or unwilling to seek traditional shelters or housing.
The city shut one shelter in late April and the other one is scheduled to close at the end of June.
“There is an absolute deficit of appropriate housing options for people labelled high acuity,” Sereda said. “They are stuck in this grey world where they are most in need of housing and the least able to access those supports. Just saying we can’t house everybody is a big shoulder shrug to the risk of death that folks are facing.”
City hall is preparing a plan for politicians on the next steps for sheltering and housing high-acuity homeless people.
“It’s meeting people where they’re at. That can look like low-barrier, it can be temporary, meeting their most basic needs. So let’s not talk about permanent housing if you don’t know where your next meal is coming from,” housing manager Kevin Dickins said.
“How do we battle four deaths in four days?” he asked. “Municipalities in Ontario don’t typically fund mental health and addiction agencies. But we get nowhere by saying, ‘That’s your job, not our job.’ So we try to inject ourselves into those discussions. We invite the Ministry of Health to our discussions, we look at how we create a system response to — it’s not a municipal response, not a non-profit response, not a hospital response, it’s a system response.”
Dickins said none of the four who died were recent residents of the WISH shelter. One was recently housed and the others were connected to shelters or have been living unsheltered for months, he said.