Hamilton inspectors don't check if lodging homes meet mental-health needs of residents, inquest hears

In the final months of Attila Csanyi's life, staff at his lodging home had called police at least three times to report him for breaking the rules in an effort to get him kicked out, says one of the responding Hamilton police officers. 

Const. Rob Booker testified Thursday at the inquest into the death of Csanyi. 

Booker had responded to a 911 call from Sampaguita Lodge and Rest Home on March 2, 2020 — a week before Csanyi was improperly evicted, leaving him homeless, and two months before he was found dead from a drug overdose on the rooftop of Jackson Square.

Sampaguita personal support worker April Lay reported to Booker that Csyani had brought a friend over and was smoking in his room — both weren't allowed under house rules. She also said he'd become "increasingly disruptive" and staff wanted him gone, according to Booker's notes.

"She said they were going to be calling the police each time he acts out," Booker told the inquest. "There were no allegations of criminal activity or crime." 

One expert at the inquest, Prof. Rob Wilton with McMaster University, said there's little city oversight of homes like Sampaguita or assessment of whether staff are equipped to support people with mental health issues, despite these homes being a go-to for people with psychiatric disorders. 

Lay, the support worker, testified last week, accused Csanyi of hoarding, using intravenous drugs, not taking medications and threatening her with a knife. However she did not document these alleged incidents. 

When Booker was at Sampaguita, Csanyi and his friend had already left and Lay told the officer she felt safe and he moved on to his next call, Booker said. 

On March 11 — the same day the World Health Organization declared the COVID-19 pandemic — Csanyi was forced to leave despite the home not completing the formal eviction process. His family was never notified. 

City licenses 70 lodging homes

Wilton, a social geography professor who's done extensive research on barriers people with disabilities face finding housing and employment, said Thursday that people diagnosed with psychiatric disorders have lived in these kinds of lodging homes for decades.

He spoke at the inquest to help the five-person jury understand the current housing system in Hamilton for people with mental health challenges. The jury can make recommendations at the end. 

Lodging homes almost accidentally became a main form of housing rather than a "grand" government plan, Wilton said. 

Beginning in about the 1960s, there was a growing sense in North America that institutions were not the most appropriate place to treat people experiencing mental illness, Wilton said. Places like Hamilton Psychiatric Hospital (now St. Joe's West 5th Campus) gradually reduced the number of patients living there from 1,300 to 300 by the 1970s. 

Many of those patients required and found affordable housing in the many lodging homes in Hamilton's downtown core, where they rented a room and shared common areas. Other residents included low-income seniors and people with a range of disabilities.

The municipal government at the time recognized this trend and began licensing homes and providing funds to provide "minimal support" for people who needed assistance with daily living, Wilton said. Staff will provide meals, for example. 

About 70 of these homes currently exist in Hamilton, according to city data. 

They're a form of "custodial housing" that's run in a "standardized and routinized fashion" rather than to improve residents' independence or quality of life, said Wilton.

"The smooth operation of the facility outweighs the individual needs or desires of residents," he said. "It becomes about managing people rather than thinking about health or recovery-oriented goals." 

Wilton said for residents like Csanyi who may have had difficulty following the rules — such as not having guests over or not smoking inside — staff have the desire to "move people along" rather than finding creative ways to intervene and maintain housing.

This approach is different than the one taken by supportive housing providers like Indwell of Good Shepherd, which are focused on improving life for residents and providing wraparound supports.

Public Health doesn't ensure tenant needs are met

Jane Murrell, with the city's public health division, told the inquest earlier in the week that regular inspections are done of licensed lodging homes, focused on checking for pests, kitchen cleanliness and meals offered and that tenant paperwork is up-to-date. 

Inquest counsel Jai Dhar clarified, "What you're saying is that there's no city inspector that would come in and say … let's make sure that this facility is able to meet the needs [of the resident]? That doesn't happen?"

"We are not looking into what the medical or mental health issues of a resident are," said Murrell in response. 

It's up to the home to determine if they can meet the resident's needs when considering their application, she said, referring to the city's bylaw known as Section 20. 

But Wilton said Section 20 does allow for public health inspectors to do more extensive oversight to ensure homes are meeting the needs of residents. The city's medical officer of health also has the power under the bylaw to assess whether more staffing and services are required, he said. 

City funding for the homes comes through the province's Homeless Prevention Program, but the Ministry of Municipal Affairs and Housing doesn't oversee the homes or do inspections, said Dan Lawrence, a ministry director, at the inquest.

The city has to show the ministry it has standards for lodging homes, but the ministry doesn't evaluate if they're adequate, Lawrence said.

"They just have to exist," he said. 

The inquest is expected to wrap up in coming days. The jury will then determine what, if any, changes could be made to prevent the circumstances that led to Csanyi's death from happening again.