“We Don’t Ask People to Change”:

A Conversation on Mental Health, Community, and Collaborative Care

“For people who aren’t familiar with PARC’s history, can you give us some context about why mental health may look different in our community?” 

“Sure. So, this community has deep roots in the psychiatric survivor movement. PARC started out by addressing the needs of folks who’d been through the psychiatric system and came out the other side feeling like it had failed them — or harmed them. And around the same time, inpatient programs at hospitals further west were shut down, so those people were essentially discharged into Parkdale with little to no support.  

Then when the Gardiner Expressway was built, Parkdale became cut off from the waterfront, and those beautiful old Victorian homes were turned into rooming houses. And some of those landlords were predatory. They were slumlords, really. And the people living in these rooming houses were incredibly vulnerable, and that vulnerability was exploited in very egregious ways.  

So that trajectory from deinstitutionalization, poverty, systemic neglect — that was the foundation PARC was built on.”

“We’re doing this piece for mental health week, and there’s this intersection often seen between homelessness and challenges with mental health. I was wondering what your thoughts are on that.”

“I would want to make clear that just because someone is homeless doesn’t mean they have a mental health condition. That’s actually a misconception that needs to be challenged itself.  

What is true is that surviving homelessness — without access to stable sleep, without safety, without security — that is what creates the conditions for mental health crises to develop. Trauma from the experience accumulates. If you’re not sleeping, you’re at a higher risk of psychosis. I’ve worked with people who use substances just to stay awake, so they can keep watch over their belongings in a shelter. Society treats that as a moral failing, but it’s actually a survival strategy, because it can be an unsafe situation to be in. 

So, there’s this dialectical relationship between poverty and mental health that we just can’t ignore if we want to support people. The traditional approach to addressing mental health puts the onus on the individual experiencing the crisis. That’s a societal issue. It’s too much to ask of someone to recover from the ravages of homelessness if they still don’t have a home.”

“Which is why PARC is a Housing First model.”

“Exactly. Housing is often perceived as this reward for recovery, when really it’s the foundation that makes recovery possible. You can’t expect people to stabilize when they’re still in survival mode. A person can’t process their trauma when they’re thinking about where to sleep or how they’re going to eat. 

And that’s something else worth naming too, is that when people do get housed, that’s sometimes when the harder work begins. Because once someone has stability, those experiences [from homelessness] — the grief, the trauma, the things that got pushed down — those start to surface. And that’s hard, but it’s what healing looks like. So, when someone comes into supportive housing, our team has to be ready for that.”

“I feel like PARC talks a lot about offering ‘low-barrier’ services – but what does that actually mean in the context of what we do?” 

“It means we don’t gatekeep support. The people we serve don’t need a diagnosis, or a referral, or a stable address to access our services. They don’t need to be “ready” per se. People come here and they’re respected for who they are and where they’re at in that moment. 

If someone is actively using, that doesn’t exclude them from receiving support from PARC. If they miss an appointment, we don’t discharge them. We go to where they are. We leave a note. We don’t just move on from supporting that person, because routine isn’t always accessible to someone who’s living outside. So, to provide proper care, we can’t punish people for missing an appointment or using strategies that allow them to cope with life. 

Many mental health programs won’t work with someone who’s actively in psychosis, and there are clinical reasons for that. But our work isn’t asking people to do deep therapeutic processing before we help them. We’re helping folks stabilize. And stabilization starts with being seen and treated with dignity.”

“And the drop-in is the entry point for that?”

“Sometimes, but not always. A lot of folks come to the drop-in, and they don’t even know they’re ready for support yet. They don’t even know that they deserve it.  

But the drop-in is where people start to experience being treated with respect, and they build relationships with people who work at PARC. And they watch others, in similar situations, building those relationships. And witnessing it really matters. That inherently builds something. 

The research is clear that earlier intervention produces better outcomes. And the drop-in gives us the opportunity to build a relationship before someone is in crisis. That’s the part that’s central to [PARC’s] model.”

“So what does ‘Collaborative Care’ look like in practice?”

“It’s a team approach. We have short-term and long-term intensive case management for people with complex mental health challenges. We have housing follow-up support for people who have recently been housed. We work together and share with teams who have specialized knowledge, or lived experience, in areas like harm reduction, hoarding, mental health symptom management, and system navigation.  

When it works best, it’s genuinely collaborative across our own teams, and with other service providers.”

“Do you have any stories or experiences that stick out to you?”

“A recent one is we had a member who didn’t speak English, but she needed housing support. And we brought in a colleague from another department specifically because they spoke the same language. So because she had that skill, it made supporting this person a lot easier. And it took time for them to build trust, but we took it slow, and now they have a great relationship. And we worked together across the drop-in, case management, and housing access, and they were able to secure housing for her. And that was a huge achievement and felt like a win for all of us. So that’s what Collaborative Care looks like when it really works.” 

“Is there anything you would want to see change, or grow, in terms of the services we provide?” 

“I think just more collaboration in general. Both across our teams, and across agencies in the city. There are folks who live within a two-block radius and never leave it. And there are others who are all over the city. But either way, if we can make it easier for them to be treated with respect wherever they go, that’s a direct contribution to improving mental health conditions. 

Mental health can’t be a singular thing. It has to be in partnership with poverty reduction, safety, and building community. People need to be seen. They need to be heard. And they need a safe place to do that. Part of our work is also holding them accountable to the journey they’re on – but doing that in a way that’s grounded in respect, as opposed to judgment. 

That’s what we’re trying to build at PARC.”

Chris Friesen is the Manager of Community Care and Recovery at PARC (Parkdale Activity-Recreation Centre), located at 1499 Queen Street West in Toronto. PARC has served the Parkdale community since 1980.

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