health network scrambles with ‘ band-aid’ in milton park — for a crisis that is  ‘everywhere’

more than five years after the pandemic exacerbated the homelessness crisis, quebec’s health and social services network is still cobbling together a patchwork response in montreal.critics say the unco-ordinated response on the frontline has left holes in the care for people experiencing homelessness, substance abuse and mental health problems, and services aren’t reaching everyone they should.“they created those gaps and now they’re stopgapping them in the weirdest way possible,” a health network employee, who spoke on condition of anonymity, said of regional health and social services centres. there are five centres intégrés universitaires de santé et de services sociaux (ciusss) on the island of montreal. each ciusss is responsible for managing hospitals, clscs, long-term care residences and other public care facilities on its territory, and each one devises its own projects and programs in response to the humanitarian crisis on the streets, the employee said.homelessness “was an issue before covid,” the person said. “but it went to a completely different level when the pandemic hit. so it is fair to say that everything has been cobbled together in the last five years and i think we’re still dealing with the aftermath of covid.”the visible unhoused population nearly doubled across the province from the 2018 head count to the count in 2022. nearly half of the 10,000 unhoused people tallied in 2022 were in montreal. apartment evictions were the principal cause of homelessness at the time.the latest head count, in april 2025, now shows over 12,000 people experiencing visible homelessness in quebec, 5,789 of whom are in montreal.the ciusss du centre-sud-de-l’Île-de-montréal, or south-central ciusss, is the provincially designated co-ordinator of services for the unhoused across montreal. its role is to distribute quebec funding to individual projects developed by ciussses and private organizations. sam watts, the ceo of welcome hall mission, contends that “much of what is currently funded today amounts to downstream band-aids.”the problem is upstream, he said, as the unhoused population keeps growing. the programs are often a “drop in the bucket.”“if the inflow is greater than the outflow, the system breaks down,” watts said. drug and alcohol use go along with life on the street, he added, because “you’re going to do things that ease the pain.”

pierre obendrauf / montreal gazette

the gazette reported last week on one montreal neighbourhood — milton park — which intervention workers say is the most visible manifestation of the overlapping emergencies of homelessness, mental illness and substance addiction. but the workers warn that what they are witnessing there is occurring in other neighbourhoods as well.“we could speak solely of milton park, but everything that is in milton park applies everywhere,” said ashanti rosado, the director of programs and services for the native friendship centre of montreal. “we’re just seeing it more, confronting it more in milton park.” in montreal, a person with mental health issues is evaluated rapidly but has to wait around six months to begin treatment. the current wait time to enter a public, inpatient drug treatment program is a couple of months. and for people who need addiction treatment in english, including people from northern quebec and first nations communities, the only option in the montreal area was folded into a francophone centre this spring.james hughes, president and ceo of old brewery mission, said numerous initiatives have been launched to deal with the humanitarian crisis across montreal, most of it funded by the province. “to say nothing has been done is not true,” he said. “but to say not enough has been done is absolutely the case. … i would also say that we need far more than we’ve done.”hughes said “transformational investments” are needed, particularly social housing construction and support services for vulnerable people. it’s much cheaper to support people in housing than in shelters, he added.“we need far better measures in preventing homelessness than we have today,” hughes said. “we also need to take care of people who are living on the street who have incredible distances to cover to get to medical services.”on top of the wait lists for clinical treatment, support programs have developed haphazardly in the past five years. a promising service launched by one ciusss on the island doesn't become mandatory for the others. adopting best practices is voluntary.the old brewery mission and the centre hospitalier de l'université de montréal (chum) launched a program in 2013 to help unhoused adults with symptoms of psychotic disorders stabilize their conditions while at the shelter and help them transition into housing. prism, the mental health homelessness reaffiliation program, offers a team that includes a psychiatrist, nurse and professional specialized in drug addiction and mental health.the ciusss du centre-ouest-de-l’Île-de-montréal, or west-central ciusss, which covers milton park, established a prism program with welcome hall mission in 2017.there are now seven prism programs in the province, hughes said, adding that lionel carmant, the quebec cabinet minister responsible for social services and homelessness, recently made it a priority to expand prism across the province. but an equivalent program combining substance addiction treatment and re-housing is lacking, hughes said.as the gazette reported this week, unhoused people who detox in a hospital are being bused back to shelters because there’s no place to wait for an inpatient rehab centre. and even after a drug rehab program, vulnerable people return to a shelter or the same neighbourhood where they fell in with drugs or alcohol, and they repeat the cycle of addiction.“a shelter is not the best place for someone who has done very intensive work on themselves and expect them to come out on the other side,” the native friendship centre’s rosado said. “actually, it’s terrifying for many of them. it’s traumatic and discouraging because they go back to what they don’t want to go back to.”

dave sidaway / montreal gazette

the west-central ciusss implemented a walk-in service in 2024 for people seeking help with their substance use. the rapid access addiction clinic (card) requires the person to visit clsc métro at guy métro station, two kilometres from milton park. however, the ciusss says its connexion outreach team can accompany a person to the clsc. the clsc also provides clean syringes on an anonymous basis.the ciusss says it sends the connexion team of social workers, nurses and an addiction specialist to milton park a few times a week. the team visits other neighbourhoods as well. “the card program is not a direct admission program for detoxification or rehabilitation,” west-central ciusss spokesperson barry morgan said. it is designed to provide immediate medical and psychosocial assessment, without an appointment, to refer individuals to services and ensure a smooth transition while waiting, he said.“same-day admissions have occurred, but they remain exceptional and are neither a guarantee nor the primary objective of the (card) program,” morgan said. there are “structural delays” in admission to rehab related to capacity and clinical criteria, he said.however, watts questions the utility of a program like card. like hughes, he sees a need for programs to be married with the goal of re-housing people.“if a service like this is disconnected from a pathway back into permanent housing — in other words, if all you’re doing is providing a local service because of somebody who’s right in front of you — then are you really helping?” he asked. welcome hall mission accompanied 378 people into housing in the past year.“all we end up doing in those kinds of situations is helping people remain in a situation that we all agree is sub-optimal.”meanwhile, rosado said she’d like to see public concern turn toward tackling systemic changes, including going after the predators who target indigenous women.the native friendship centre launched the first indigenous street patrol in montreal, ka’wáhse, nearly 20 years ago.rosado said ka’wáhse worked with the city’s Émmis outreach team on mediation and cohabitation resolution in milton park in 2023 and 2024. but ka’wáhse has had to move away from mediation to focus on interventions with the unhoused indigenous population because the need is so great right now, she said.“it’s very intense, so at some point we had to prioritize the community,” she said. ka’wáhse patrollers are carrying life-saving naloxone, medication that counters the effects of an opioid overdose, even outside of work hours for fear of not being able to help someone in need, she said. “now you have an increase in gangs. these individuals are trafficking women, drugs. that criminal element is present in more places in montreal.”a decade ago, viger square was the flashpoint for the humanitarian crisis in montreal. it was the most visible of gathering places for unhoused people doing drugs, one of the workers said. the police removed the encampment there in 2015 when the city decided to renovate the square to reduce the presence of homeless people. “they didn’t get rid of the problem,” the worker said. “they just moved the people.”