Gautam Mukherjee is the Executive Director of Houselink and Mainstay Community Housing, the largest supportive housing provider in Ontario. Gautam has worked in the housing and homelessness sector for 20 years and is a passionate advocate for social justice, inclusion and housing for all. In this episode, Gautam and MAP Director Stephen Hwang discuss and explore a recommendation from MAP's Equity Roadmap Report: the expansion of permanent supportive housing programs with high fidelity to the Housing First approach.
MAPmaking brings you Canada’s leading voices on the health equity issues that affect us all. Together, we will discuss and explore the scientific evidence and real-world solutions that we believe have the potential to transform our country. Our vision is a Canada where everyone has the opportunity to thrive. MAPmaking is brought to you by the scientists, community, and research partners of MAP Centre for Urban Health Solutions, a research centre at St. Michael’s Hospital, Unity Health Toronto.
Stephen Hwang, MAP 0:04
Welcome to MAPmaking, a podcast series that brings you Canada's leading voices on the health equity issues that affect us all. I'm Stephen Hwang, director of the MAP research centre at St. Michael's Hospital, Unity Health Toronto. In this first season of MAPmaking, we're exploring the recommendations from our Equity Roadmap Report, a set of 13 recommendations for a more equitable COVID 19 pandemic recovery in Canada.
Gautam Mukherjee, Mainstay 0:41
There is a moral cost to us as a society to accepting this, to stepping over people, to having people, you know, freeze outside in the winter. There is a cost on all of us, that I think impoverishes us on a moral level.
Stephen Hwang, MAP 0:56
Hi, I'm Stephen Hwang, MAP Director and co-author of the Equity Roadmap Report. Today I'm speaking with Gautam Mukherjee, Executive Director of Houselink and Mainstay Community Housing. With a portfolio of nearly 60 properties and 1400 units, Houselink and Mainstay is the largest supportive housing provider in Ontario. Gautam has worked in the housing and homelessness sector for 20 years, and is a passionate advocate for social justice, inclusion, and housing for all. Hello, Gautam, and welcome to MAPmaking.
Gautam Mukherjee, Mainstay 1:29
Hi, Stephen. It's great to be here. And thanks so much for having me.
Stephen Hwang, MAP 1:33
So I'm just going to read the recommendation from our report. It says "During the pandemic recovery period, we strongly recommend the expansion of permanent supportive housing programs with high fidelity to the Housing First approach that entails assertive engagement and case management, less than 30% of income spent on housing, the choice of housing, and the choice of supportive services without coercion to participate for individuals with serious mental health problems, or who use substances, experiencing homelessness." What's your reaction to that recommendation, Gautam?
Gautam Mukherjee, Mainstay 2:11
I guess, Stephen, I would say that I'm personally both a supporter but also a detractor of Housing First. I guess my concern about Housing First is it doesn't necessarily get us upstream on housing and homelessness, sort of a reactive intervention. Why I'm supportive of Housing First is that I do like that it's framed in the right to housing. And I think that's what I'd like to sort of focus on here, when I talk about or think about the right to housing and in relation to Housing First, for me, the sort of the foundational framing around housing and supportive housing, is that housing is itself supportive. So then when we talk about health, housing as a determinant of health, I'm not sure if there is a better way of saying it than that housing is also health. It's not a clinical intervention. It's not a health intervention, but it is a health intervention. If you look at all of the all the data, all the evidence, if you look at what people who are experiencing homelessness say in Toronto Street Needs Assessment, their recent surveys done of people living outdoors and encampments, during the pandemic, you talk to Houselink and Mainstay's own clients, what they say is that their main issue is access to the housing itself is it's an affordability issue for the vast majority. And then we know and Housing First evidence also confirms this, that people's trajectories change once they have the housing. So I'd really like us to sort of hone in even more on the concept of housing as not the concept, but the fact of housing as a right and how we, how we help achieve that reality. And the concept that housing is in and of itself supportive. So how we make Housing First happen, I guess, in a more broad, universal way. And then as we work to achieve that, how we wrap services around people in the housing, as the right to housing is realized.
Stephen Hwang, MAP 4:11
You're raising a really interesting point about to what extent should we be trying to create - do we need to focus on affordable housing in general for people? And to what extent do we have an unmet need for permanent supportive housing?
Gautam Mukherjee, Mainstay 4:25
That's right. And, you know, one of the things I think about a lot is really, what is supportive housing, but also what is what are the characteristics of housing, housing is characterized, I, you know, the way I understand it, that people have control over their lives, they can come and go as they please. They have security of tenure. These are really important concepts. And then, you know, supportive housing. You know, when you talk about some of the, I guess, higher order kinds of services that can be provided. It doesn't always come with that characteristic of control over over your housing, of security of tenure. The ability to come and go as as you like. And then the ability, which is in the recommendation to have choice around the services that you access and that you that you use. So I like to sort of zoom out and say, okay, like, let's start with this right to housing concept. And then, you know, maybe there's some other interventions that are more clinical. But you know, it is really a small minority of people, both those experiencing homelessness and in the general population, who need that kind of significantly higher orders, sort of supportive interventions. Now, you know, the majority of people when we talk about supportive housing again, like it's not to say they don't require support, like it's, it's obviously mission mission critical for my organization, the work that we do. But what I mean to say is that most people, really they need access to support that it's there when they need it. But they don't necessarily need that higher, more assertive type of support, where there's things like 24/7, supervision and medication support, and someone making your food for you and providing housekeeping and so on and so forth.
Stephen Hwang, MAP 6:05
So, for those people who do need those kinds of supports that Mainstay provides, what are the barriers to creating a adequate supply of permanent supportive housing?
Gautam Mukherjee, Mainstay 6:16
Well, you know, I mean, I think there are obvious barriers around the availability and cost of land, the availability of funding, the availability of grants, like so there's some really obvious barriers. I think, again, what I sort of have been thinking about a fair amount lately is that at the structural level, there are some other barriers that we need to untangle as well, that certainly in my organization, we're trying to do, right? So one is really meaningfully as Canadians meaningfully believing and accepting that housing is a right, it's a right even for people with mental health and addiction issues. You know, on the flip side, you've got some structural and some sort of ideological pieces in our society, right. So one is even as much as we sort of think that we're, and we are advancing around stigma against around mental health. But at the same time, there is still this belief that some people have overtly and some still sort of hold less overtly that mental health and addictions are the reason why are the cause of homelessness. So, you know, I think, to sort of really start to realize the right to housing, we really need to ideologically sort of flip that around that, you know, absence of housing is the cause of homelessness. And in the current system, I think for some individuals, their own mental health or addiction issues, at the individual level may be the reason they wind up homeless, but again, like, if we're going to get upstream, I think we really need to interrupt that sort of that sort of thinking. And then the other one is also the extent to which ownership of property ownership of land is seen as this, you know, great Canadian good or Canadian way. And what happens then is that more and more individually, it sort of individualizes us and, you know, for people who own property, their own sort of wealth and well being gets tied up in the property. And then you, you know, you sort of see that introducing supportive and affordable housing nearby becomes sort of an individual threat. And then we don't realize that as a community, we're all impoverished by the consequences of that kind of thinking, which is homelessness, and more acute mental health and physical health and addictions issues and other and other kinds of consequences.
Stephen Hwang, MAP 8:45
I think that you know, puts always has struck me is the fact that the way in which housing is created, and how the financial and economic aspects of how it is an investment or a wealth generator, has created huge inequities in our society and the COVID pandemic has really just brought those inequities to even more stark contrast. So I wonder if it's such a big issue that it addresses not just the availability of housing for certain people, but the way we think about something that's fundamental to our existence, which is where we live? How do we go about changing the way that we think about housing and the way that we think about how government needs to intervene, not on behalf of just those who are in greatest need, but on behalf of our society as a whole?
Gautam Mukherjee, Mainstay 9:41
Yeah, I mean, I think maybe one of my large achilles heels is how, how I'm an optimist, but also in my own job, do my best to to make, you know, make a difference with with the folks that I work with in this in this organization. But you know, so with that caveat, having been made I think one reason for optimism is that in terms of recognition around the need to do something around the housing crisis is is growing. It's certainly I think, growing among the public. And you see, increasingly, I think governments turning their attention to it at all three at all three levels of government. So I'm optimistic. I don't think it's fast enough. I mean, I think, you know, we talked about the incremental realization of rights, in Canada. And I think, with housing something so fundamental, just like health care, I think that we should we should work to get action sooner. But I mean, I think on the flip side, Stephen, is that in housing, and in some other aspects, today, we're just talking about housing. But essentially, I think since you know, the late 90s, we've allowed things to get so acute and dire in the housing system in Canada, that, you know, it doesn't take much to make things a little bit better for a lot of people. I think that's sort of the place that we're at in early 2022. So I I'm optimistic, I think we have to turn the taps up, we have to turn turn the volume up around programs for affordable housing.
Stephen Hwang, MAP 11:11
Absolutely. I think that has to be a high priority. I actually have a question on a slightly different note, as you know, I'm a physician and I take care of patients within the healthcare system. And there is this huge need for health care and housing, to work together rather than in silos. And I'm wondering, in your experience, have you seen the siloing effect affect the people that are housed by Mainstay? And do you think that we need to work together more?
Gautam Mukherjee, Mainstay 11:44
Yeah, although, again, you know, I don't, I'm not sure that this that the siloing in, in housing, and healthcare is the biggest issue that our population deals with, you know, we work very hard to connect our tenants to primary care in particular. And, you know, during the pandemic, the impact has been very severe for our tenants in terms of the retraction of in person services. But we do see a lot of people who come to live with us, you know, not having had access to health care for a long, long time. And so you get this real buildup of unaddressed both mental and physical health issues as a result. So if you want to talk about siloing, around housing and health care, and you know, on the good side of some of the work during the pandemic, there's been some work done around this. But again, how do we get upstream and get better mental health and, and primary health services to people when they're experiencing homelessness, although, you know, again, with the caveat that we shouldn't accept that people are homeless, but you know, as long as they are, I think, you know, when people come to Mainstay seven years without having seen a doctor, there is a significant silo issue there that we should address before they before they come to Houselink and Mainstay. And one of the things that, you know, I think we envision doing something about in our, in our work in housing, is the fact that mental health services at least and I think substance use services, as well, have become quite atomized or individualized, where, you know, you've got individualized relationships between, say, mental health workers and organizations and clients. We call, you know, it's this, like community mental health approach, right? So, you know, one of the things we'd like to do is, think about how can we create places where the siloing can be sort of broken down in a geographical sense, right? So you've got, you got one place, and there's, you know, sort of enough people there, that we can sort of build in things like clinics and having on site clinical services, while at the same time it's like a normal place to live, right. It's not this like, institutional place where just people with particular challenges live. So like that vision of, of a of an inclusive community where people can access the services that they need, all kinds of people can access the services they need, is the role we say we see us playing and in addressing what you know, what you describe as, as the, as the silos in housing and health.
Stephen Hwang, MAP 14:18
Yeah, well, you know, you've really laid out the kind of the approach so well, I think that it really rings true that the often there are significant health needs that have been neglected and housing is the first step to health. It's not sufficient by itself, but it's necessary. And I think that making those connections is really important. But you've also made a comment, which I think really rings true, which is that the need for people to have community and inclusion in a setting that is not an institution or some kind of treatment facility. It's really it's their home, right and that is just so important to create ways have that community?
Gautam Mukherjee, Mainstay 15:01
Yeah, absolutely. I don't know the numbers. But you know, I was saying earlier, I mean, the evidence also speaks to the fact that a lot of people who are experiencing homelessness or housing precarity, or those who are sort of on lists for supportive housing, describe affordability as their as their biggest issue. And then, you know, once you get in, whether it's supportive housing or just sort of broadly speaking, affordable housing, I think sort of, there's two sides to the coin around affordability. Right. So one side is how much rent to pay. And then the other side is how much money how much money do you have, and where you know, where the rent is very low, people without means without a lot of money. You know, I've sort of described that they can be held hostage to the apartment, right. And then, you know, when we create communities, like, you know, the only communities that we offer and supportive housing that we own in Houselink and Mainstay. All the units are affordable, all the units are targeted to people who are eligible in terms of having mental health challenges. And, you know, even those people who feel like, hey, you know, I'd like to, I'd like to live in that building over there, where somebody who, you know, even $60-$70,000 a year is they don't have that choice, because they just can't afford it, you know, they have to stay where the rent is low. There, we do have a lot of tenants who, like knowing that everybody in the building may have had some similar sort of challenges, is them but also a lot, who if they could find affordability and, and live in a in a more inclusive community or a more diverse community, we would do that. So you know, we're working to provide those kinds of options.
Stephen Hwang, MAP 16:43
So what do you think will help open doors the most both at a societal level, and then also at a at the programmatic level?
Gautam Mukherjee, Mainstay 16:52
I mean, I think if there was one lever that that could be pulled, again, quickly, this is back to the housing first thing, but more broadly, it is to do better on the income side for all, you know, for all Canadians, right? Are we just talking about Ontario, I think the some of the big barriers, and some of the big drivers of homelessness are things like the amount people get to pay the rent, those who are on on social assistance is for disability is under 500 bucks a month. So that's one, one piece where I think there's a lever that can be pulled pretty quickly. I think the other barrier is really, for us to produce more housing that I'm concerned about it is just that just the availability of funding to support us to construct new housing.
Stephen Hwang, MAP 17:42
I'm always struck by the fact that there's a tremendous cost to doing things the way we do it. Now. I mean, we just have to look around and see, you know, homeless people on the street riding the TTC at night to keep from freezing to death, enormous amounts of money being spent to rent hotels to provide temporary solutions to homelessness. And after all, that money is spent, all these people are still homeless rather than permanently housed. And so there's an enormous cost to our society, to our city to doing things this way. And yet, if we want to make the argument that it's more cost effective, or you know, would save certain costs, if we were to house everyone, is that a dangerous path to go down? Because at one level, it's true that it's an incredibly inefficient, you know, approach that we're taking now. But if we start talking about, oh, this will save us money. Are we somehow compromising on the principle that it doesn't matter if it costs us money or saves us money? It's the right thing to do. We don't have conversations about well, will sending our children to school, save money or cost money? We know it's the right thing to send our kids to school? So should we talk about housing and supportive housing in that way or not?
Gautam Mukherjee, Mainstay 19:05
I mean, I think it can have its place but that is exactly the reason why like your question is exactly the reason why I talk instead about how homelessness impoverishes us and I talk about the right to housing. And I also talk about housing as a you know, as a determinant of health. But you know, when you think about the idea of homelessness, impoverishing us, it does sort of talk about, you know, the relative costs to society to government on the budget of homelessness, which is significant. But also, there was a moral cost to us as a society to accepting this to stepping over people to having people you know, freeze outside in the winter, like there is a cost on all of us, that I think impoverishes us on a moral level. People we know people who are dealing with mental health challenges people who are dealing with addictions issues People who are experiencing homelessness, they have things to contribute to society. And as long as they're subject to being homeless, that contribution as a society, we're missing out on those.
Stephen Hwang, MAP 20:12
So I'm wondering what would someone listening to this podcast, who is your average member of the general public, who's not someone who builds housing and is not a political leader, what can they do to help make this happen?
Gautam Mukherjee, Mainstay 20:27
Talk to your friends, talk to your family, about stigma about reversing the view, reversing the conversation around any sort of blame, being assigned around homelessness, and changing the conversation to the recognition that, you know, homelessness doesn't does impoverish all of us. And, of course, you know, the impact on people who go through it have some compassion and, and desire to change the conversation and to and to change that reality to make it not not occur anymore. I think like that's what the average person can do. And then I think those of us who are sort of politically engaged, you know, concerned about concerned about politics. One thing that we've sort of, I don't know, if deliberately, like assiduously avoided talking about it. But one of the things I would kind of observation I would I would offer too, is that like, as Canadians in the political system, we get sort of really hung up about which jurisdiction is responsible for an issue, is this a federal government fault or provincial government ball? And Ontario is unique in the whole world where social housing is funded by municipalities. So this happens nowhere else in the world. So we're really into the thick of jurisdictional, you know, shenanigans here. So I think for listeners who are involved in politics, you know, I would say, we can sort of talk about that about who's responsible for this, I think all, you know, all levels of government should do more. I think the next generation, I'm in my mid 40s. So to talk about, say millennials, and maybe less concerned about that, and more just like, we have a problem. And I don't really care about, you know, which jurisdiction is responsible, I just want to solve it. But you know, I think, you know, we need to sort of take it to people involved in politics at all three levels of government to say, I don't want to hear about this is this is a provincial matter, this is a federal matter. I just want a solution. So that's what there's a couple things. I think that those listening who aren't involved directly involved in the system like we are, you know, and encourage them to start doing.
Stephen Hwang, MAP 22:40
Yes, and I absolutely want to echo your comment that homelessness and the lack of affordable housing, impoverishes everyone, it is really something that has incredible negative effect on our society. And if we can create more affordable housing for everyone, we would all be richer for that. Absolutely. So Gautam, I have three final questions that we like to ask all our guests on MAPmaking. I wonder, Gautam, on your very best days at work, when you come home, feeling grateful that you get to do what you do? What do you look back and think about those days? What makes those days? The good ones?
Gautam Mukherjee, Mainstay 23:17
That's a good question. I'm looking forward to the day that, you know, this is not any day so far to be like, you know, in the, in the, in the time that I've been with house like a Mainstay anyways, I look forward to the day that I can break some glass on the side of a brand new building that we've just, you know, we've just opened. And, you know, the sort of good days are the days where we do sort of advance the ball toward toward that goal, which, you know, I think at our organization, anyways, we're making good progress. The other one that might be more relatable in a way but less concrete in a sense to is just like the days where you impact the conversation and the ways that we're talking about helping people understand that mental health and addiction issues are not the fault of faults of individuals. And this this sort of vision around really realizing the right to housing for all and the impact that that would make on individuals in our in our society. Those are those are great days. You know, when when that energy around that, that that vision is spread one person further are the other really exciting days for me.
Stephen Hwang, MAP 24:25
So on your toughest days at work, what gives you hope and motivates you to continue on?
Gautam Mukherjee, Mainstay 24:31
Yeah, as I said, I mean, I'm an optimist. So I think we're making progress. The you know, what makes it a tough day is just the fact that as we've said, this is ongoing, the place that we're at right now as a country, we've been in this place for too long. So that's what makes it I think, makes it tough. And we you know, we see that homelessness is not not getting better in our city. That's what makes it tough. Where I get hope is the fact that I you know, I think increasingly there is a recognition, you see, like there's a housing commissioner at the City of Toronto. Now, the city's putting more and more resources into housing. I just see like housing is like the number one issue for more and more Canadians like right across the country. And more and more governments are seeing they need to do something in terms of policy around it. So I know that we're heading to a better place. I would like us to get there much faster. So I get hope when you know, we get some energy around pushing to get there.
Stephen Hwang, MAP 25:32
Yeah, I absolutely agree with you that, you know, now is a moment of opportunity like never before, I've never seen people talking about the need for affordable housing, and the problem issue of homelessness than then we are seeing right now. And I've never seen young people so engaged in the issue previously.
Gautam Mukherjee, Mainstay 25:53
Yeah, it's unacceptable and people see it. So now we got to gotta mobilize more.
Stephen Hwang, MAP 25:58
I'm wondering, how would you finish complete the sentence? Thriving is...
Gautam Mukherjee, Mainstay 26:03
Yeah, thriving for our country, I think is realizing the right to housing, it's housing for all. That's how we thrive. I'm biased because I'm in housing.
Stephen Hwang, MAP 26:13
Well, we know that you're doing great work in Houselink and Mainstay are really part of that solution and making a difference every day. So we were just thankful that you and everyone at your organization are doing such great work.
Gautam Mukherjee, Mainstay 26:29
Thank you, Stephen. And yeah, I agree. And we have to we have to do this work.
Stephen Hwang, MAP 26:34
Gautam Mukherjee, thank you so much for joining us today.
Gautam Mukherjee, Mainstay 26:37
Thank you. Yeah, we should, we should do more of these.
Stephen Hwang, MAP 26:42
You've been listening to MAPmaking. MAP is a St. Michael's Hospital research centre dedicated to creating a healthier future for all. We partner with communities and researchers across Canada to understand inequities from the inside out and from the ground up. Based on what we learn, we develop programs and solutions to address inequities, and help make sure everyone has the opportunity to thrive. We work with government leaders to help improve policies and bring our programs to more people across Canada. Learn more at maphealth.ca. I want to acknowledge the sacred land on which MAP and St. Michael's Hospital operate. This land is the territory of the Huron-Wendat and Petun First Nations, the Seneca and most recently, the Mississauga of the Credit First Nation. We are grateful to have the opportunity to work in the community on this territory. We are also mindful of broken covenants, and the need to strive to make right with all our relations. This podcast is produced by Emily Holton with associate producer Samira Prasad. Technical production is provided by David Grein of the Acme Podcasting Company. I want to acknowledge and thank the St. Michael's Foundation and our incredible donors as well as Staples Canada for their support and commitment to MAP's work. We partnered with the team at Staples to create Even the Odds, an initiative to raise awareness of inequity in Canada and to help build vibrant healthy communities. You can learn more at staples.ca/eventheodds. I'm Stephen Hwang. Thank you for listening. Take good care, and we'll see you next time.