Report #3 Factors Influencing Poverty and Homelessness in Dartmouth

Report #3

Factors Influencing Poverty and Homelessness in Dartmouth-Cole Harbour

Summary of Dartmouth North Studies (Attached Tables for Dartmouth South and Dartmouth East)

1. Harm Reduction in Dartmouth North: planning for addiction

2. Housing Trilogy, Dartmouth North Report, November 2017

3. The Highfield/Pinecrest Neighbourhood Housing Initiative: A Working Proposal, September 2016 • PDF attachment, Dartmouth South and Dartmouth East

1. Harm Reduction in Dartmouth North: planning for addiction

Juniper Littlefield Undergraduate Honours Thesis Proposal Advised by Ren Thomas April 9th, 2018 Bachelors of Community Design, Honours Urban Design Dalhousie University School of Planning Halifax, NS

Dartmouth North stands out as having no focused mental health or addictions supports available to everyone. There are no public health locations in the area, and only one private practitioner—resulting in poor health care access.

Drug-related charges (accessed through police records) and community consultation (Between the Bridges, 2015), indicate that alcohol, cocaine, and opiate dependencies are likely major concerns for the Dartmouth North community. Cannabis related charges are also frequent through each of these neighbourhoods, which based on literature, may indicate the presence of other mental health and addiction issues (Rhodes et al., 2006).

Dartmouth North, located just inside the circumferential highway (Figure 1), has some of the lowest incomes and shelter costs in the Halifax Regional Municipality (HRM). 43% of households spend 30% or more of their income on shelter, signaling income-induced housing poverty (Statistics Canada, 2011). At 33.6%, this area has the highest neighbourhood rate of individual poverty in HRM, according to 2015 data included in United Way’s Poverty Solutions report (2018). According to Capital Health research, Dartmouth North also has the highest rate of utilization for addiction and mental health1 services in HRM (Capital Health, 2014).

Drug users are an especially vulnerable group and likely to experience the effects of poverty and social deprivation in unique ways (Linton et al., 2013). Drug strategies have historically focused on enforcement, aiming to rid communities of users, and ‘clean up’ public spaces (de Montigny et al., 2011). This approach tends to displace addicts and associated criminal behavior, disrupting social connections and creating new issues with housing (Rhodes et al., 2006). In my thesis I intend to form a spatial analysis of addiction and mental health in Dartmouth North, and investigate the ways in which social and land-use planning can use harm reduction to support mental health. Harm reduction has proven successful in reducing the open drug scene, minimizing overdose deaths and the spread of diseases such as HIV/AIDS and hepatitis. This approach is now commonly used as a way to foster safe and healthy communities (City of Vancouver, 2017).

According to a 2014 report by Capital Health, Dartmouth North had 53.2 adults and 41.5 children per population of 1000 accessing community mental health services. IWK reproductive mental health services saw a utilization rate of 4.67 per 1,000 women within this community. All of the above numbers represent the highest rates within the HRM. This neighbourhood has the highest rate of utilization for Addictions Community Based Services in the HRM, with an average of 22 visits per client (Capital Health, 2014).

Incomes in Dartmouth North are also the lowest among the three communities, with a median household income of $22,816 after-tax (compared with a municipal median of $59,240), and 43% of households living in housing poverty, almost identical to Gottingen levels (though this community had wider variation in income and shelter costs). For context, shelter costs in Downtown Dartmouth average at $997, with a median income of $49,109, and 30% in housing poverty. Gottingen area has average rents of $889, with a median income of $34,532.

As mentioned in Capital Health’s 2014 report, and Between the Bridges 2015 consultation, 41% of households in Dartmouth North have at least one person living with limitations to daily activity (this includes a wide variety of disability), while Gottingen comes in at the regional average of 36%, and Downtown Dartmouth has a total of 27%. Downtown Dartmouth has quite a low population of visible minorities, totaling 7%, while the marginalized Gottingen area and Dartmouth North neighbourhoods feature 29% and 17% respectively.

3 Downtown Dartmouth North Dartmouth (CT HRM (CMA 205) (CT 0114.00) 0102.00)

Population 2016 6,569 4,623 403,390

Population change (5 yrs) 7.60% 3.30% -2.50%

Median household income after tax $22,816 $49,109 $59,240

Average rent $751 $997 $1,035

Renters 88% 62% 40% Moved in last 5 yrs 57% 52% 40%

Spending over 30% of income on 43% 25% 30% shelter

Household with activity limitations* 41% 27% 36%

17% 11% Visible minority 7%

Aboriginal identity 4% 7% 4%

Table 1: Demographic neighbourhood comparison. Statistics taken from the 2016 Census, *Activity limitation info pulled from CMHC's Housing Portal (2011)

Bozinoff et al. (2017) cite the issue of service centralization, which can be problematic for addicts attempting to avoid trigger areas and seeking quality housing outside the zone of drug-related services. This common thread carries into Dartmouth North, where residents must travel to health care located largely in Halifax’s hospital system…

As with many issues in planning, NIMBYism is a common barrier in siting harm reduction services. Bernstein and Bennett (2013) completed a policy review of land use bylaws in British Columbia, revealing that several BC (and Ontario) towns have amended zoning codes in order to prohibit harm reduction facilities. Municipalities have expanded, narrowed, or added definitions to their index of health care uses in order to limit or altogether ban provision of harm reduction facilities.

Dartmouth North needs our focus, and planning as a profession has yet to take seriously its role in mental health and addiction. Poverty as a social determinant of health has

4 important effects on health and crime, and mitigating these inequities can only be achieved by working collectively to shape our environments. This community is experiencing effects of many interconnected factors, and the segregation and isolation of this neighbourhood only perpetuates the issue. Public Consultation Public consultation in the Dartmouth North area, pulled from consultation by Sperry/MacLellan (1991)17, and Between the Bridges (2015), showed the following themes:

Safety

Between the Bridges cited this as a main concern, with residents raising the issue of unsafe parks, negative relationships with police, and high crime rates (2015).

Pride Residents responding to Between the Bridges outreach give examples of broken street lamps, roads and buildings in need of repairs, a lack of outdoor public spaces, and issues with trash and pollution (2015). Consultation by Sperry MacLennan in 1991 suggested similar concerns around property maintenance, to which the city responded by planning for enforcement of minimum standards. They did note however that many of the area’s apartment buildings were too small to afford a full-time superintendent, suggesting that a rental education program may be useful in this area18 (1991). Concerns around public open space and streetscapes have been around since Sperry and MacLennan’s 1991 plan, with little change seen since.

Youth

Residents suggests that programs run by outsiders aren’t reflecting their community’s needs, and families cannot afford extracurricular programs in their area, and children need more help with schoolwork and job searches. One outcome suggested by residents was addiction specific supports for youth, as well as general supports and programming, and emotional learning in schools (2015).

17 Sperry/MacLellan’s review is included in the Dartmouth MPS (2010) Secondary Municipal Planning Strategy (SMPS) for the Highfield/Pinecrest area. 18 Almost two decades later, the Affordable Housing Association of Nova Scotia and Metro Works Employment Association have just launched a new Nova Scotia chapter of the RentersEd program (Personal Communication, AHANS, 2018).

Community supports

In addition to the need for affordable programming and addiction services, residents also reference discrimination based on location, race, and mental illness. A need

5 was identified for services that are delivered in a way that fits the community and culture, stable funding programs, as well as affordable daycare (something also brought up in 1991 consultation for Dartmouth’s Highfield Pinecrest Secondary Municipal Planning Strategy or SMPS), a diversity in social services, a walk-in medical clinic, and food banks (2015). 1991 consultation from Sperry MacLennan suggested the lack of long-term residents as a barrier to social capital.

Income

Income concerns about social assistance revolved around the difficulties of moving into employment, the lack of financial literacy and local job opportunities (2015). Residents described difficulty accessing the nearest grocery store, choosing instead to shop at the drug store for unhealthy and expensive food. Affordable housing as well as access to shelters and living wage are mentioned in this Between the Bridges report (2015). The Dartmouth SMPS suggests zoning supports for cooperative housing, subdivision, and density as some solutions to the affordable housing issue (2010). However, Littlefield’s 2017 housing report for the area shows that statistics suggest a concern around suitability and maintenance of existing stock, rather than a lack of affordable housing.

Health

There is a need for a 24 hour mental health clinic and affordable follow-up supports and medical access within the community. More support for the Direction 180 methadone bus and community wellness navigator were requested, as well as addiction supports and prevention outreach (2015).

Each HRSB school hosts counselling services available on request. John Martin High School in Dartmouth North also has an IWK/NS Health Authority as well as a Family SOS connection in house. Within the 800 metre service area, the local community centre hosts weekly AA meetings for women, and the Dartmouth Family Centre provides general help for families in the area, including peer support. The Dartmouth North Community Food Centre hosts weekly visits from the Direction 180 methadone bus.

• Downtown Dartmouth has three private practice psychologists in its service area, as well as a mental health branch of NS Health Authority, four weekly AA meetings, one weekly Al Anon meeting (a group for families of alcoholics), two mental health related self-help groups, and two non-profit offices for mental health associations.

Service Totals by Neighbourhood

Dartmouth North Downtown Dartmouth Community Centre 2 2

Childcare 1 1

Convenience Store 1 1

Fire Station 1 2

Hair Care 2 5

Pharmacy 1 3

Post Office 0 2

Primary Healthcare 1 5

Religious Institution 3 6

Restaurant 5 20

0 Secondary Grocery 2

Seniors Housing 0 0

Laundromat 0 0

Bank 0 5

CarShare Parking 0 2

Looking at Table 5, Dartmouth North houses very few everyday services, especially as it

7 is a primarily residential neighbourhood. The services that are available are located mainly along Highfield Park Drive, which is difficult to access by foot, and has few street connections to the Pinecrest community, leaving this area with no pedestrian main street. In contrast, Downtown Dartmouth… houses a wider diversity of services, as well as retail and office space not included in these inventories. Everyday Service inventory sourced from: Dartmouth Helping Tree (2018), Deep Water Church (2018), Rec Connect (2018), 211 NS (2018), Yellow Pages (2018), and HRM (2012).

8 9 10 11 Transit Access varies widely throughout these three neighbourhoods. Dartmouth North transit has very low frequency, and the heavy focus on rush hour service is likely ill- suited to many residents’ needs. Downtown Dartmouth has a wider variety of transit routes…

Harm and Harm Reduction

Looking to Figure 6, mental health and addiction services (in particular private counselling) are generally spread evenly throughout the Halifax Peninsula, with concentrations around the hospital network in the city’s South End and Gottingen Street. On the other side of the harbour, services are clearly centralized in the downtown, with very little access to the North and South Ends. It is important to note here, that although the South End has little quantity of services, the Nova Scotia Hospital hosts two crucial programs, one for opiod treatment, and one for withdrawal management. With the next door Dartmouth General Hospital, this area has very centralized but comprehensive health care.

As noted in community engagement, Dartmouth North is lacking in medical services generally, and mental health is no exception. Aside from some family resources which may include general peer-support, and mental health professionals available through schools on a request basis, there is no focused mental health or addictions support available to all residents. The one weekly AA meeting within the 800 metre service area is available to women only, and does not include professional supports. In the wider area surrounding this service area, there is little else. In contrast, Downtown Dartmouth offers more office space, with private practice counselling, offices for two mental health organizations, a mental health branch of the Nova Scotia Health Authorit,y and several peer-support groups. Gottingen Street area has all the offerings of this Downtown, as well as offices for the two harm reduction services in Halifax, Mainline needle exchange, and Direction 180 methadone clinic.

15 All of these services are available to the general public, and while most are covered by MSI, Nova Scotia’s health insurance, psychology and social work counselling are not currently included. This is one of the barriers to accessing some of these services, along with things such as location hours, wait lists, and the physical accessibility of buildings. Although I have included walkability, which is one aspect of physical accessibility, there are many other reasons why these services may be out of reach to some.

What are the patterns and themes in drug- related harm in Dartmouth North? Drug- related harm can consist of many things, including stigmas, health concerns, crime, and arrests. Each of these affect both the user and the greater community.

A large portion of the drug charges in Dartmouth North are related to cannabis trafficking and possession, which brings up some interesting questions. Likely many cases of cannabis possession stem from other searches and charges, or reflect the greater police presence in the area. These statistics do not necessarily reflect a higher proportion of cannabis users in the neighbourhood, though if this is the case, intake may relate to the high instances of mental illness, addiction, and disability in the area. Cannabis is often used to manage issues such as drug addiction, depression, or chronic pain (Bozinoff et al., 2017). The connection is worth investigating in Dartmouth North, as this could further reinforce the need for inclusive and collaborative mental health access in the area.

This data must be examined with a critical eye, however, it is likely from looking at this data that alcohol and cocaine are among main concerns for Dartmouth North.

Considering the success of the Direction 180 methadone bus (Between the Bridges, 2015), it is likely that opiate dependencies are also common. There could be many reasons this doesn’t show up in crime rates. While Halifax Regional Police has data on heroin possession, there is no category for trafficking of this substance. Opiates go by many names, and methadone treatment could be related to prescription drug dependencies. It is also possible that opiate trafficking may be more organized, and use could be more private, or this particular drug is simply not police priority in the region. Additionally, it is likely that while these crime rates do accurately reflect the spread of drug use, opiate use is more harmful for the select residents that do use them, requiring additional services such as Direction 180’s medical supports. According to the literature, stigma and health effects (eg. disease spread through intravenous drug use) often affect harm injection drug users disproportionately (Tempalski and McQuie, 2008).

Examining intricacies of crime rates not only paints a picture of drug-related harm, but also helps in creating evidence-based plans for harm reduction. Public consultation supports the need for further addiction services in this area, and keeping these specific needs in mind will help in strategizing this. Providing flexible and adaptive supports for these drug users, including supportive housing (Table 4) with medical and mental health professionals on staff (including controlled use for alcohol and other substances), and

16 making room for integration of mobile services such as Direction 180 and Mainline (Table 3). Cannabis use is popular, and the NSLC’s planned Portland Street dispensary location (NSLC, 2018) will likely help fill this need, although it is difficult to say if new laws will positively support access. Cannabis also suggests a need for more general health and mental illness supports in the area. Existing services do not appear to be supporting the needs of Dartmouth North residents at this time, and the services are in need of evaluation and adjustment.

How can planning intervene to reduce drug- related harm?

I have touched on some of the ways planning can intervene to reduce drug- related harm, and this topic is examined in- depth in my recommendations (see page 62). I look at the city’s current approach to harm reduction (working on the understanding that this strategy holds the most positive outcomes), and these findings are also summarized in an evaluation matrix in Table 6. Next, logic models (Tables 7 and 8) hold suggestions for planning moving forward, were the city to adopt harm reduction as its approach to drug and mental health strategies. These recommendations are based on five pillars, many of which I have already touched on, synthesized from my results and literature review. Pillars are as follows: evidence-based planning, planning with a mental health lens, eliminating barriers, clarity and transparency, and evaluation.

17 2. Housing Trilogy, Dartmouth North Report, November 2017

Social Environment Demographics: Vulnerable Populations

Groups identified as vulnerable are visible minorities, aboriginal peoples, children, seniors, young adults, immigrants and re- cent immigrants. These are based off populations identified by CMHC, and HRM’s Housing Needs Assessment as most in need of housing assistance. Dartmouth North has higher than average populations of many of these groups, creating an area of vulnerability. These groups are likely drawn to the affordable housing in the area, and have fewer choices as to where they live.

Key Findings:

• Low populations of children, seniors immigrants (except in 0113.00) • Large aboriginal population (Tawaak Housing), high percent of visible minorities • Large population of people with disabilities (see: page 20) • 38% (1,590 households) in core housing need • Median shelter costs for households in core housing need*: $625 • Median household before-tax income: $15,401 • Female lone-parents experience the highest rate of core housing need, followed by women living alone • Households led by people in the 15-24 range also experience high rates of core housing need

This census data could be useful in selecting targeted services for the area. Perhaps school catchments could be rearranged, and affordable daycare provided, targeting low- income single mothers. Cultural populations may also have specific needs for their housing and services. This could be reflected in dwelling layout, housing support programming, healthcare services, or shopping and food retail .

Dartmouth North has younger primary household maintainers on average, especially in the 15-24 age range. Young people are leaving their family homes earlier, and there is a high rate of births in this age category. This age group is just starting their careers, and according to the Housing Needs Assessment, has the largest proportion of individuals with housing affordability issues.

*Core Housing Need: Spending more than 30% of income on housing, living in housing that is unsuitable, inadequate or unaffordable.

Sources: Capital Health Community Health Profile, Dartmouth-Southeastern (2014) Statistics Canada (2011), CMHC (2011), Affordable Housing Working Group (2016), HRM (2015)

18 Income

CT 0114.00 has very low incomes, with over 2 times the HRM average of households within the low-income brackets below $10,000, and below $20,000. The median household income after-tax is about $20,000 below the HRM median of $53,383. The tract has only about 12% owned dwellings, and monthly shelter costs for these owned homes fall just above median at $1,142. Rented dwellings fall just below average at $676. HRM’s percent of shelter-to-income ratios >30% is 25%, and this tract ranks at 43%, signalling a large portion of housing poverty. Dartmouth North as a whole also has higher than average amounts of government transfers, though this number is still quite small, and difficult to interpret.

CT 0112.00 is also about $20,000 below the HRM’s median household income. Shelter costs for owned and rented dwellings are below average, at $776 and $609 respectively. 38% of households are spending more than 30% of their income on housing. This area is very similar to the Highfield/Pinecrest neighbourhood, though demographics are slightly more diverse.

CT 0113.00 is not a focus of our study, but its income demographics stand out. This development is composed of completely rental housing, with higher than average shelter costs of 949.00, higher incomes than surrounding areas, and low incidence of housing poverty. Surprisingly, this neighbourhood also has a higher proportion of people receiving government transfers, with most of these being child benefits and employment insurance. This shows that a lot of these households are composed of families, and the percentage of employment insurance could just be an anomaly highlighted by the neighbourhood’s small population. Employment insurance is a vague term which may also include maternity leave, compassionate care, sick leave, etc.

• 20% of households in HRM cannot afford market rent • Households earning $29,566 or less cannot afford average market rent without spending more than 30% of their income on housing

Health

In their assessment of the upcoming Centre Plan, The Nova Scotia Health Authority identifies mobility, sustainability, food systems, and housing as key indicators of health in the regional centre.

Case in point, Dartmouth North has been struggling in each of these categories, and has high rates of health issues. If you look to page 20, you can see that there are higher rates of disability in this area as well. This is likely connected to the high proportions of mental health and addiction issues in the area. Here disability is defined as anything leading to limitations in daily activities.

19 Dartmouth North Health Statistics

• Highest total deprivation within Dartmouth/Southeastern • Highest rate of births among women 15-19 in all of HRM • Highest rate of emergency department visits in Dartmouth/ Southeastern • Highest usage of Capital Health Addictions Community Based Services within • Dartmouth/Southeastern, and one of the highest rates in all of HRM • Highest rate of utilization of Capital Health Community Mental Services and • Reproductive Mental Health Services in HRM • High amount of children and youth accessing mental health services • Twice the HRM average of children accessing IWK Dentistry Services Note: • Neighbourhood boundaries for this data are larger than our interpretation of Dartmouth North. Source: HFPA (2017), Capital Health (2014), NS Health Authority (2016)

Food Insecurity

• Dartmouth North is a food desert, with no walkable grocery store since Sobeys moved out of Primrose Plaza in 2012, and a noticeable lack of secondary grocery suppliers (eg. bakeries, convenience stores). The Dartmouth North Community Food Centre and weekly Mobile Food Market help to address this issue, but cannot fill the gap. According to the Hali- fax Food Policy Alliance, some ways this need can be addressed are: • Living wages and affordable housing • Zoning and land-use (requiring healthy food in neighbourhoods with a need) • Ensuring good transportation and connectivity • Updating home-office rules to enable small-scale food operations • Providing food through public facilities such as community centres and schools

Housing

• Low rise apartments are predominant throughout Dartmouth North, with few single-family houses remaining, and 69-100% of this housing is rental. All census tracts consist of primarily 1 and 2 bedroom dwellings, reflecting the HRM average. CT 0113.00, West of Victoria Road contains significantly more 3+ bedroom dwellings than average but the Highfield/Pinecrest area lacks these family units. • One person households are the majority, as is the norm for HRM, but Dartmouth North also has a high percentage of lone-parent households, which is often a characteristic of lower income areas. This may be due to the higher birth rates, among youth in particular. Stresses of poverty and poor health likely have a factor in these social demographics. These two populations (singles and lone

20 parents) have the highest rates of housing affordability issues in HRM. • Dartmouth North shows high amounts of housing built before 1990 compared to HRM. Within Highfield/Pinecrest most housing was built from 1960-1980, with very little construction after 2000, featuring more housing in need of major repairs than surrounding areas. Especially notable is the high incidence of movers within this neighbourhood compared to the municipality. This indicates a very transient population, likely a result of poor quality rental housing and lacking amenities, as well as dominating social issues (such as crime). • Going forward, demand for ownership is expected to decline, as will household sizes. Especially with the aging population in Nova Scotia, there will be an increasing need for non-market and seniors housing. This neighbourhood has a lot of affordable housing, but with incomes so low much of it lays vacant and out of reach or in disrepair. Rental and income supplements as well as more non- market housing are needed to fill the gap. The existing stock needs to be improved and secured, as investment goes into the surrounding community. Förster and Menking (2016), look at how Vienna’s housing first model creates flexible floorplans and public spaces that allow for a diverse range of uses, and future modifications. Infill development, open-concept accessible floor plans, and shared amenities feature heavily.

4. The Highfield/Pinecrest Neighbourhood Housing Initiative: A Working Proposal, September, 2016

….the community of Dartmouth North repeatedly stood out with respect to broad issues of housing quality, affordability and the larger portion of residents living in core housing need. Most starkly perhaps the rate of low income among its residents is more than double the rate for HRM, and the rate of child poverty is three times the rate for HRM. A walking tour complete with site visits in the spring of 2015 confirmed that the neighbourhood indeed is impoverished and lacks in certain amenities and services.

Table 1 Summary of key indicators of housing, income and population for High filed/Pinecrest (CT 0114) as compared to HRM

Housing • 3,775 households • Majority of households rent (87% vs 37% in HRM) and there are no condominium corporations in the area • Housing stock dominated by low-rise apartment dwellings (80% of all housing is in the form of apartments of less than 5 stories and only 13% is in the form of single unit dwellings, duplexes and townhomes) • Significantly higher rate of households spending 30% or more of their income on shelter (41% vs 25% in HRM) • Much higher rate of households in core housing need (37% vs 13% in HRM in

21 2011) • Lower average rents ($778 average for 2 bdrm unit in Oct. 2015 vs $1,048 for HRM) • Significantly higher vacancy rates (5.7% in Oct. 2015 vs 3.4% for HRM) • A high number of housing units are in need of major repairs (13% vs 7% in HRM) • Nearly half (44%) of the housing stock was built prior to 1990 and no stock was built after 2006 Income & Employment • Significantly lower median household income ($32,228 vs $62,049 in HRM) • Significantly higher rate of low income (35.9% vs 15.1% in HRM) • Over-representation of population in the two bottom income deciles (46% vs 20% in HRM) • Participation and employment rate is similar to HRM average (69.4% vs 69.1% in HRM) • Slightly higher rate of unemployment (7.9% vs 7.2% in HRM) • Over 43% of those working were employed in service and related occupations Population • Population of 6,625 • High turn-over of residents (64% moved in the past 5 years as compared to 40% in HRM) • Lower than average rate of immigrants (6% vs 8% in HRM) • Higher than average rate of Aboriginal residents (7% vs 3% in HRM) • A lower proportion of seniors (8% vs 12% in HRM) • A lower proportion of children and youth under 18 (15% vs 19% in HRM) • A much higher use of transit, walking and biking to work (43% vs 22% in HRM).

As illustrated by the above statistics and as noted by community members, some of the critical challenges related to housing include: an aging housing stock, some of which is in urgent need of repair and upgrading; high vacancy rates in otherwise relatively inexpensive rental housing; low income levels and widespread poverty; food insecurity and lack of access to a grocery store within a walking distance; social isolation; limited access to basic commercial and institutional services and public amenities; and personal health, security, safety and quality of life concerns1. Declining school enrolment is also of concern to the community.

1 Government of Nova Scotia and United Way of Halifax. Between the Bridges. Working Together for Children and Families. 2015.