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Indigenous and non-Indigenous people experiencing homelessness and mental illness in two Canadian cities: A retrospective analysis and implications for culturally informed action
  1. Brittany Bingham1,
  2. Akm Moniruzzaman1,
  3. Michelle Patterson1,
  4. Jino Distasio2,
  5. Jitender Sareen3,
  6. John O’Neil1,
  7. Julian M Somers1
  1. 1 Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
  2. 2 Geography, University of Winnipeg, Winnipeg, Manitoba, Canada
  3. 3 Psychology and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
  1. Correspondence to Brittany Bingham; bld{at}sfu.ca

Abstract

Objectives Indigenous people in Canada are not only over-represented among the homeless population but their pathways to homelessness may differ from those of non-Indigenous people. This study investigated the history and current status of Indigenous and non-Indigenous people experiencing homelessness and mental illness. We hypothesised that compared with non-Indigenous people, those who are Indigenous would demonstrate histories of displacement earlier in life, higher rates of trauma and self-medication with alcohol and other substances.

Design and setting Retrospective data were collected from a sample recruited through referral from diverse social and health agencies in Winnipeg and Vancouver.

Participants Eligibility included being 19 years or older, current mental disorder and homelessness.

Measures Data were collected via interviews, using questionnaires, on sociodemographics (eg, age, ethnicity, education), mental illness, substance use, physical health, service use and quality of life. Univariate and multivariable models were used to model the association between Indigenous ethnicity and dependent variables.

Results A total of 1010 people met the inclusion criteria, of whom 439 self-identified as Indigenous. In adjusted models, Indigenous ethnicity was independently associated with being homeless at a younger age, having a lifetime duration of homelessness longer than 3 years, post-traumatic stress disorder, less severe mental disorder, alcohol dependence, more severe substance use in the past month and infectious disease. Indigenous participants were also nearly twice as likely as others (47% vs 25%) to have children younger than 18 years.

Conclusions Among Canadians who are homeless and mentally ill, those who are Indigenous have distinct histories and current needs that are consistent with the legacy of colonisation. Responses to Indigenous homelessness must be developed within the context of reconciliation between Indigenous and non-Indigenous Canadians, addressing trauma, substance use and family separations.

Trial registration number ISRCTN42520374, ISRCTN57595077, ISRCTN66721740.

  • homelessness
  • indigenous
  • mental health
  • substance use
  • service use

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • Contributors BB is the lead in the development of the manuscript. AM carried out the primary statistical analyses. MP, JD, JS and JO contributed to the editing of the manuscript. JMS was the principal investigator, contributed to the research design and writing of the manuscript. All authors read and approved the final manuscript.

  • Funding This work was supported by a grant to Simon Fraser University from Health Canada and the Mental Health Commission of Canada Grant Number: 2009s0231.

  • Disclaimer The views expressed herein solely represent the authors.

  • Competing interests None declared.

  • Ethics approval Ethical review and approval was conducted by the Research Ethics Boards at Simon Fraser University, the University of British Columbia and the University of Manitoba with endorsement from the University of Winnipeg.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data are stored at St. Michael’s Hospital in Toronto and are available to external investigators who sign a data sharing and use agreement that stipulates the responsibilities associated with transfer of datasets. Carol Adair at the University of Calgary is the data access coordinator.

  • Patient consent for publication Not required.