Unfortunately for him, this experience was usually synonymous with being incarcerated, as Mark has experienced chronic and persistent homelessness for over 10 years. Each time Mark was released from custody, he was released to the street with no fixed address. Attempts to get into emergency shelter were rarely successful, as Mark was often labelled as someone who was “defiant” and “noncompliant,” which resulted in property bans and restriction from services, sometimes for up to 10 years at a time. Mark would often attend emergency rooms at hospitals for a place to keep warm for a few hours, but would quickly be escorted off the premises, as he “was not allowed to be there.” Mark would spend countless nights wandering the streets trying to find a safe place to be, which often resulted in a substantial increase in his substance use in order to stay awake to avoid harassment, violence, and his belongings being stolen.
This “survival mode” behaviour can create a vicious cycle, as increased substance use can lead to erratic or unpredictable behaviour, which in turn causes emergency shelters to place bans and trespass orders for being “noncompliant” for said behaviour. Mark’s substance use also had significant impacts on pre-existing mental health conditions, which resulted in frequent interactions with emergency services. Without anywhere for Mark to go, he was unable to meet his basic needs, and police would often be called on Mark for public disturbances, attempting to access services and supports where he has active restrictions, and being in public spaces while under the influence. Unable to access community-based health care, Mark would attend hospital emergency departments for support. However, he would frequently be denied medical care and would often be escorted off the property by security and/or police, despite presenting with legitimate medical needs.
Recently, Mark was released into homelessness after spending five months incarcerated. Mark paid to stay for a few nights at a motel, but on a fixed income of approximately $1,200 a month, this was not sustainable. After three days, he had run out of money. He spent the next week on the streets in the middle of winter with very brief periods of being able to access indoor space. As a result, both of Mark’s hands were black, swollen, and bleeding, which was indicative of severe frostbite. He attended a hospital emergency room for medical assistance, but was instead referred for psychiatric support, as he was displaying behaviours of psychosis. Mark’s frostbite was not treated, nor was he admitted for any medical care. Outreach workers transported him to two other hospitals to advocate for medical care, but he was denied pain management, and his wounds were not tended to, despite having two advocates with him. Mark was advised to set up home-based nursing care, despite Mark and his two advocates clearly stating Mark did not have a home or an address from which he could access this service.
London Cares advocated tirelessly to the hospital system for Mark to be assessed and admitted for severe frostbite, but the hospital system would not admit him. Mark ended up accessing a community-based clinic daily for wound care and to have his bandages changed to lessen the possibility of infection and sepsis. After spending a full week on the street with severe frostbite and unable to access hospital support, London Cares supported Mark into a motel room and collaborated with the community-based clinic to have nursing care attend his motel room. This was also the very first time Mark was provided with any type of pain management for his severe, untreated frostbite.
Over a few months, Mark came to trust and respect the staff supporting him. He began to build rapport with several nurses that became assets in his care plan, and he formed positive working relationships with them. It took approximately two months of consistent daily support from London Cares, during which time he was supported to attend medical appointments and provided basic needs such as food that he could eat easily with two fully bandaged hands, for Mark to feel safe and cared for as he developed trust with these new agencies. Both London Cares and the community-based clinic significantly stretched their services in order to support Mark.
Unfortunately, the lasting impacts of the trauma Mark faced through the hospital system continued to impact his ability to follow his treatment plan. Mark’s follow-up care also included attending appointments with a plastic surgeon at the very hospital that denied him care for his frostbite. When Mark had to attend these appointments, he experienced severe anxiety and did not want to go. Despite both London Cares and clinic staff supporting Mark, several appointments with the plastic surgeon were missed, as Mark felt such a true sense of distrust with that specific hospital that he could hardly bring himself to attend. There were periods of time throughout his journey where Mark and his supports had significant concerns that all 10 of his fingers would not be salvageable due to the level of damage from the frostbite. Through persistent and fierce advocacy, Mark’s hands have been able to heal, and he has regained full function.
Mark remained transitionally housed in a motel room with the support of London Cares until he moved into his own apartment. Having a consistent, safe place to live has given Mark a retreat from street life, a predictable routine, and has allowed him to receive reliable healthcare supports. The working relationships that Mark has fostered have contributed to the positive change in his overall self-image. The connections that Mark has made with staff from London Cares and the community-based clinic have greatly impacted his view of self and his relationship with the community around him.
Mark has been given the opportunity to feel valued and appreciated and has been endlessly grateful for the compassion and love that staff have shown him. Though his journey isn’t over yet, he has come very far from where he began.
“Nobody has loved me as much as you guys have. You saved my life…” – Mark