According to the 2013 Street Needs Assessment, there are over 5000 people who are homeless on a given night in Toronto. A high prevalence of both physical illness and mental illness exists in the homeless population. Despite their high needs, homeless people frequently experience difficulties in accessing the medical care that they require. Many are not in possession of Ontario Health Cards, do not have the means to travel to medical appointments and may have experienced negative attitudes from health care professionals. Homeless individuals often rely on emergency department visits or inpatient hospitalization stays to meet their health needs.
In 2005, a small group of physicians working with the population came together with the support of the Ontario Ministry of Health and Long-Term Care to form Inner City Health Associates (ICHA). Dr. Vicky Stergiopoulos was ICHA’s first medical director. ICHA is made up of family physicians, psychiatrists, and other specialists to provide outreach and clinical care to the homeless in Toronto. ICHA physicians provide direct and indirect care and also work closely with clients’ community workers and case managers. In addition to the medical needs of clients, the social needs such as housing and income support are also addressed. ICHA’s focus is the provision of short-term transitional care with the ultimate goal of linking clients to permanent services and support. ICHA also focuses on developing partnerships with existing community services and agencies, thereby supporting a more coordinated approach to the care of the homeless. Finally, ICHA educates medical students and residents, and supports research on homeless health care. All physicians are credentialed by St. Michael’s Hospital.
In the early years, ICHA quickly expanded in physician numbers and clinic operations. Primary care and mental health care was provided in settings as shelters, drop-in centres and mobile outreach teams. The majority of the clinics are located in downtown Toronto but there are also clinics in Eobicoke, North York and Scarborough.
The day-to-day operations are facilitated by the ICHA Executive. The ICHA Executive consists of the Medical Director, the Outreach Coordinator, the Mental Health Lead, the Primary Care Lead, and the Population Health Lead. Also reporting to the ICHA Medical Director is the Education Lead.
With ICHA’s growth, the organization decided to formally incorporate. The Board of Directors officially formed and met in 2011. The Board of Directors is made up of ICHA members with a broad representation across sites and disciplines. It is responsible for the overall strategic direction of the organization.
ICHA has supported a number of recent initiatives including helping to build the Inner City Family Health Team (serving clients of Seaton House), increasing its advocacy efforts, and creating a virtual office consisting of ancillary staff to support the clinical activities.