Diane Walter, Executive Director, Margaret's Housing and Community Support Services

Margaret’s Housing and Community Support Services is a multi-service agency that provides a continuum of housing options and wrap-around supports to women living with mental illness and substance use, as well as community-based support services including several drop-in centres and respite services in Toronto for individuals experiencing intersectional issues tied to mental health challenges and homelessness

The Evaluation Centre posed a number of questions for me to reflect on. I share some brief reflections below. My hope is that such reflections from both me and others on my team and partners at the Evaluation Centre lead to systemic learning and system-level solutions in the future.

At such a difficult time, what has kept you going?

What keeps me going more than anything else since the pandemic is the knowledge that some of the folks that we’re serving really have no options. Recognizing that we can make a difference in someone’s life by making sure that a staff member delivers some groceries, or there’s a wellness check-in, for example, keeps me going.  Also, recognizing that although I’m a minor cog, we might still be helpful during this pandemic in somebody’s life, this gives me energy even when I don’t have energy.

What have you learned during the pandemic?

The generosity of my staff, some partners and Torontonians
The generosity of Torontonians with donations of cash and PPE and both my team and our partners who have worked closely and well inspires me. What I have discovered is there are many staff who weren’t stars necessarily before the pandemic; they did their jobs adequately and met their deliverables; but during the pandemic they have shone and seem to thrive in the chaos – you can call them at any time, and they just step up and deliver in spades. 

Leadership stepping up to the plate
Some leaders in Toronto and Ontario have pleasantly surprised me. I’ve seen some leaders during the pandemic lead with compassion and empathy. I have also grown to respect some leaders’ ability to communicate to the public in a near daily basis that they have the backs of Ontarians, whatever the challenges are.  

This pandemic spotlights the need for housing as a solution
We can only hope that this pandemic is galvanizing all three levels of government in the need for housing.  I hope the government can do an accounting to see if the pandemic has cost them more than if they had addressed the homeless situation 4-5 years ago. For example, the City has opened up multiple hotel programs — rented hotel rooms to put homeless people who have tested positive or are waiting on results and those from encampments. If they had funneled those funds into building the real bricks and mortar of housing, I think things would have been significantly different. Had housing been thought about in a more deliberate solution-based fashion, this pandemic would not have been so costly.

The Importance of Prevention: Reimagining health care
I think most health care is delivered in the community, but hospitals are the recipients of the bulk of our healthcare dollars. If we were to re-imagine what a healthcare system is — not an acute care system or a sickness system, but a healthcare system — where more people in the community are trained to do simple tasks so that folks would not end up in the hospital system, given the fact that when people end up in the hospital it’s often because all the prevention and all the incremental interventions did not occur to prevent them from ending up in an expensive hospital bed, They could have been treated in the community had there been adequate prevention and adequate interventions, even something simple before prevention.

What recommendations do you have in response to this pandemic?

We have to get ready for the next wave. Historically pandemics often have a second wave. Some questions we as a system need to answer: Is it going to be worse than the first one? Is it going to be more decimating? We don’t know. But for us, we certainly have learned some things that we’re preparing ourselves should there be a second wave. For example, we’re making sure that our inventory of PPEs will take us into and perhaps beyond the second wave; some of the protocols around IPAC (Infection Prevention and Control) we are now making sure they’re ramped up, and we’re aggressively following those infection IPAC standards.

There are learnings around how a pandemic like COVID-19 could so comprehensively affect how we operate. For example, within the drop-in respite setting, we were shifting from using Styrofoam to reusable utensils because we wanted to reduce our footprint. We were really gung ho about going Green, but now that is not on the agenda for awhile; it’s totally off the table. We’re back to Styrofoam because clients are more likely to mistakenly pick up and use a reusable utensil or coffee cup that another client has used rather than one that gets thrown out. We’re looking into whether we can use other materials, but the other materials are so expensive.

We can learn some things from this pandemic that are actually positive. In terms of guidelines, we are adhering to those around PPE and making sure staff are spaced — it will affect some of the ways we work in terms of front-facing, client-facing service delivery. But we are seeing the value of virtual interaction – however, we haven’t gotten to that place where we really take a deep dive and assess it. These are things that are just coming up, and where we are thinking, “That we can amend. This we can modify.” For example, we can integrate the virtual piece into our work seeing clients one-on-one. The nurse that we use and the psychiatrist have realized that some people prefer the virtual interaction with the psychiatrist than the one-on-one

The need for learning and developing system-level solutions
My view is that what we desperately need is to learn from the experiences of community organizations providing care during this time of the pandemic. Evaluation teams like the Evaluation Centre have a role in precipitating dialogues that can lead to co-constructed systemic solutions across multiple levels of government.  The partners of organizations serving the homeless need to become learning organizations that better understand the importance of coordinated systemic solutions in addressing problems of chronic homelessness.  It is simply not sufficient to say, “we are all in this together.”  We need to move beyond rhetoric –what is needed is a coordinated system in which all partners feel valued and supported.