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<h2><b>Statement from Sanguen Health Centre regarding the proposed motion "Chronic Homelessness, Mental Health, Safety and Addiction Crisis”.</b></h2>
<span style="font-weight: 400;">November 4, 2024</span>

<span style="font-weight: 400;">Dear Cambridge City Council Members,</span>

<span style="font-weight: 400;">On behalf of Sanguen Health Centre, we are writing to express our deep concerns regarding the proposed motion going forward on Tuesday November 5th -</span> <i><span style="font-weight: 400;">"Chronic Homelessness, Mental Health, Safety and Addiction Crisis”</span></i><i><span style="font-weight: 400;">  </span></i><span style="font-weight: 400;">that would criminalize encampments and could mandate involuntary treatment for those arrested. While we recognize the challenges surrounding homelessness and substance use, we know from the evidence that this approach will not yield effective or humane solutions. Instead, it is likely to exacerbate harm and prevent meaningful or sustained recovery.</span>

<span style="font-weight: 400;">Research and lived experience consistently show that forced treatment for substance use disorder (SUD) is ineffective and often increases the risk of overdose and death post-treatment. This is of particular concern in our community with the closing of the Consumption and Treatment Services Site in Kitchener in March of 2025. </span>

<span style="font-weight: 400;">Studies document a significant rise in overdose deaths for individuals forced into treatment. Loss of tolerance, especially to opioids, makes these individuals more susceptible to overdose when returning to unsupportive environments post-treatment. This includes folks who are released from treatment and are still without access to housing, food and other support. Forced abstinence, without a comprehensive and trauma-informed approach, can result in severe health consequences and little to no sustainable recovery.</span>

<span style="font-weight: 400;">Voluntary care has consistently proven more effective in achieving positive, long-term outcomes. Studies show that individuals who voluntarily seek help experience better results, as they are more committed to their recovery journey. Cambridge has a clear opportunity to address the root causes of homelessness and substance use by investing in accessible, community-based programs that are rooted in person-centered care rather than punitive measures.</span>

<span style="font-weight: 400;">The ethical concerns around involuntary treatment are also severe. Reports from Canada, including a recent study by Health Justice, describe the traumatic impact of forced treatment, including misuse of restraints, sedation, and even gender-based violence. These practices only compound trauma and erode trust in our health and social systems, which the Sanguen team along with many other local agencies work each day to build in an approach rooted in dignity, respect, and person-centered care.</span>

<span style="font-weight: 400;">Moreover, forced treatment is extremely costly, diverting resources from already limited voluntary services, where demand and waitlists are high. Funds used for secure facilities and additional staffing could be more effectively allocated toward expanding voluntary treatment options and providing timely support to those seeking help.</span>

<span style="font-weight: 400;">We encourage everyone, including the residents of Cambridge to consider the following questions and ask your elected officials for clear answers:</span>
<ol>
 	<li style="font-weight: 400;" aria-level="1"><b>How will this motion address the root causes of homelessness and substance use, rather than simply penalizing those experiencing these challenges?</b></li>
 	<li style="font-weight: 400;" aria-level="1"><b>What evidence supports the effectiveness of forced treatment over accessible voluntary services, and what safeguards will ensure ethical, trauma-informed care?</b></li>
 	<li style="font-weight: 400;" aria-level="1"><b>How does Council plan to fund this approach, and is it sustainable compared to investing in preventative, community-based services?</b></li>
 	<li style="font-weight: 400;" aria-level="1"><b>With limited treatment resources including long waiting lists for treatment, how will the City prioritize access for individuals who are voluntarily seeking help but currently face long wait times?</b></li>
 	<li style="font-weight: 400;" aria-level="1"><b>What accountability measures are in place to ensure that any intervention respects individual rights and does not exacerbate trauma or risk of harm? </b><b>The Province of Alberta has adopted a similar approach (mandatory treatment and closure of CTSs) and has seen a spike in overdose deaths, Hep C and HIV infections which is costing the health care system and the taxpayer exponentially more money.</b></li>
</ol>
<span style="font-weight: 400;">We urge the City Council to reconsider this motion and shift focus toward accessible, voluntary services that respect individual choice and support effective recovery. Forced treatment is not the answer. A compassionate, evidence-based approach that addresses systemic barriers will lead to better outcomes for individuals and our community as a whole. </span>

<b>Alternate Motion and Amendments:</b>

<span style="font-weight: 400;">To address these concerns in a human rights-focused way, the following amendments are suggested. Amendments to the motion should emphasize respect for human rights as well as the importance of healthcare-informed decisions, and ensure compassionate, evidence-based approaches to supporting individuals experiencing homelessness, mental health challenges, and addiction. </span>
<ol>
 	<li><b> Human Rights and Right to Housing</b></li>
</ol>
<ul>
 	<li style="font-weight: 400;" aria-level="1"><b>Amendment 1</b><span style="font-weight: 400;">: Emphasize a "Housing First" approach, which ensures that eviction from encampments only occurs if alternative, safe, and supportive housing is available.</span></li>
 	<li style="font-weight: 400;" aria-level="1"><b>Amendment 2</b><span style="font-weight: 400;">: Include a clause affirming the commitment to uphold the Charter of Rights and Freedoms, specifically the right to housing, by avoiding displacement without accessible housing solutions in place.</span></li>
 	<li style="font-weight: 400;" aria-level="1"><b>Amendment 3</b><span style="font-weight: 400;">: Request that all policies related to encampments and homelessness prioritize voluntary, supported transitions into housing rather than forced relocations.</span></li>
</ul>
<h3><b>2. Healthcare Decisions Led by Health Experts</b></h3>
<ul>
 	<li style="font-weight: 400;" aria-level="1"><b>Amendment 4</b><span style="font-weight: 400;">: Clarify that healthcare treatment, including mental health and addiction services, should be directed by licensed healthcare professionals and should align with current best practices and ethical guidelines.</span></li>
 	<li style="font-weight: 400;" aria-level="1"><b>Amendment 5</b><span style="font-weight: 400;">: Propose that any legislative changes to the Mental Health Act or the Health Care Consent Act be subject to review and consultation by healthcare experts, service providers, and human rights organizations to ensure treatment options respect individual autonomy and medical ethics.</span></li>
</ul>
<h3><b>3. Compassionate, Voluntary Support Systems over Forced Treatment</b></h3>
<ul>
 	<li style="font-weight: 400;" aria-level="1"><b>Amendment 6</b><span style="font-weight: 400;">: Adjust the language around Diversion Courts, suggesting a focus on voluntary access to mental health and addiction services rather than coercive treatment, aligning with evidence-based practices in harm reduction.</span></li>
 	<li style="font-weight: 400;" aria-level="1"><b>Amendment 7</b><span style="font-weight: 400;">: Encourage the province to invest in a spectrum of harm reduction and supportive programs, such as safe consumption sites and peer-support initiatives, which are proven to reduce harm and improve health outcomes without mandating treatment.</span></li>
</ul>
<h3><b>4. Evidence-Based Support Services</b></h3>
<ul>
 	<li style="font-weight: 400;" aria-level="1"><b>Amendment 8</b><span style="font-weight: 400;">: Call for a commitment to fund and expand evidence-based, low-barrier support options tailored to individual needs, such as mobile health clinics, mental health crisis teams, and lived-experience outreach workers who can provide immediate and consistent support.</span></li>
 	<li style="font-weight: 400;" aria-level="1"><b>Amendment 9</b><span style="font-weight: 400;">: Request transparency in policy formation, with a call for ongoing review of the outcomes of new programs or laws related to homelessness, mental health, and addiction to ensure they are effective and uphold human rights standards.</span></li>
</ul>
<h3><b>5. Increased Shelter Capacity with Appropriate Supports</b></h3>
<ul>
 	<li style="font-weight: 400;" aria-level="1"><b>Amendment 10</b><span style="font-weight: 400;">: Specify that any transition out of encampments must correspond with increased shelter capacity that includes gendered, accessible, and culturally appropriate services.</span></li>
 	<li style="font-weight: 400;" aria-level="1"><b>Amendment 11</b><span style="font-weight: 400;">: Emphasize investment in permanent supportive housing, rather than temporary shelter solutions, to foster long-term stability and recovery, thereby reducing the cycle of homelessness.</span></li>
</ul>
<h3><b>6. Balanced Language on Public Safety and Social Disruption</b></h3>
<ul>
 	<li style="font-weight: 400;" aria-level="1"><b>Amendment 12</b><span style="font-weight: 400;">: Revise the language around public safety and social disruption to avoid stigmatizing individuals experiencing homelessness, focusing instead on community wellness and support through non-punitive measures.</span></li>
 	<li style="font-weight: 400;" aria-level="1"><b>Amendment 13</b><span style="font-weight: 400;">: Advocate for community-based models that work collaboratively with people experiencing homelessness, ensuring their voices and needs are central in shaping local policies and practices.</span></li>
</ul>
<span style="font-weight: 400;">These amendments aim to create a more compassionate and human rights-centered motion, addressing immediate community needs while respecting the autonomy, dignity, and rights of individuals. They also reinforce that healthcare professionals should lead healthcare-related decisions and that supportive housing should be prioritized over punitive or forced interventions.</span>

<span style="font-weight: 400;">Thank you for your consideration of our recommendations in this ongoing crisis.</span>

<span style="font-weight: 400;">Sincerely,</span>

<span style="font-weight: 400;">Dr. Chris Steingart &amp; the Sanguen Leadership Team</span>
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