Studying Work Experiences and Mental Health Among Homeless Service Providers during the COVID-19 Pandemic in Canada

Background/Purpose: Research on homeless service programs often overlooks the work life of service providers. Nevertheless, mental and occupational health issues among providers may undermine the effectiveness of essential services. Given that researchers often rely on service providers for making and maintaining connections with people experiencing homelessness (PEH), service providers deserve greater attention. This paper demonstrates how the COVID-19 pandemic affected not only providers’ mental health, but also their capacity to serve their clients. Finally, this paper explores methodological and policy implications related to mixed-methods research conducted during the pandemic.

Methods: Recruitment began in November 2020, with an online search of community organizations and networks serving PEH across Canada. An online survey was emailed to over 300 agencies. Participation was open to providers working in homeless, supportive housing, or harm reduction service sectors who directly served people with histories of homelessness. A total of 701 participants completed the quantitative survey during Canada’s second wave of the pandemic. Qualitative semi-structured interviews were then completed virtually with a purposive sample of 30 of these providers to learn more about their work experiences during the pandemic. An additional 10 providers in senior leadership positions were also recruited.

Results: Response rate to the survey was higher than anticipated, and the pandemic actually made it easier to talk with providers beyond the researchers’ locale. Virtual conferencing software was widely available on participants’ computers, including at home, allowing for greater connection to more providers than would have otherwise been possible.

Nearly 80% of providers experienced a decline in their mental health during the pandemic, with younger workers and those who spent all or most of their time in direct contact with service users facing the greatest risk. Greater exposure to chronic stressors during the pandemic was significantly associated with more posttraumatic stress symptoms and psychological distress. Qualitative findings showed increased stress from pandemic-related anxieties about workplace health and safety, as well as from “systems dumping” (taking on individuals who have been under-supported or discharged from other sectors). Overall, the findings highlight a vulnerable workforce that has encountered increased pressures during the pandemic and is in need of more occupational supports.

Conclusion/Implications: Based on these findings and the consequences of the pandemic, this paper offers recommendations for improving the working conditions of service providers. These include expanding employment-based access to mental health supports for those working with PEH and task rotation strategies to equip service providers with opportunities for respite from the emotional demands of direct service delivery. Furthermore, the findings of this study support the implementation of the Quadruple Aim as an accountability and evaluative tool for homeless services. The Quadruple Aim is a policy framework for optimizing health system performance that recognizes the centrality of the work life of service providers for effective program implementation. The impact of COVID-19 on homeless services and the mental health of service providers emphasizes the need for policies that attend not only to the psychosocial needs of service users but also the needs of providers on the frontline.