Marcus sits slumped over in the waiting room chair. After a night spent on the streets, waking every few hours to seek shelter in a cafe to warm up, he is exhausted.

For years, Marcus (whose name and details have been changed for privacy) has struggled with hearing voices and paranoia around people, and often feels too afraid to spend time in a shelter. With the impending winter, overcrowding has become worse, but he is desperate for a bed and agrees to let us help him find a shelter for tonight.

We sit down together to call. At every place, the answer is the same: “We’re sorry, there are no beds.” Discouraged, Marcus gathers his belongings, ready for another cold night on the streets.

Marcus’ story is one that plays out many times across the city each day. As front-line clinicians working with people experiencing homelessness, we see first-hand the physical and mental health impacts of our city’s desperate lack of shelter beds.

This fall, shelters remained full, with more than 5,000 people accessing shelters each night and many more precariously housed or on the streets. Shelter occupancy rates have been between 95 and 99 per cent – well beyond the city’s own target of 90 per cent. In these conditions, clients endure challenges related to overcrowding, including lice, infectious disease outbreaks, poor sleep and violence.

On Tuesday, Dec. 5, two important motions will be presented to Toronto city council. One calls for the declaration of an emergency in the shelter system, and for the federal government to open the Fort York and Moss Park armouries for shelter. The second calls for the city to create 1,000 new shelter beds. These motions by concerned councillors add urgency to the work being done now by city staff and community agencies to add more shelters.

Our shelter system is broken. Without a bed, people like Marcus must choose either a night on the street, or to sleep on a mat in a drop-in or an Out of the Cold (OOTC) program. With a chronic shortage of beds, the city increasingly relies on faith-based OOTC to provide respite over the winter months. More recently, we have seen the addition of 24-hour cold weather drop-ins to accommodate the growing number of people who are unable to access a shelter bed.

Since Nov. 24, the Out of the Cold programs and drop-in centres have hosted an average of 380 people each night. While these are important stop-gap measures, neither meets basic shelter standards.

The most fortunate people sleep on a thin mat, inches from their neighbours, while others sleep in chairs or on the bare floor. There are often no showers, few bathrooms, little privacy, and no safe place to store belongings. For people struggling with mental illness or physical impairment, these conditions, and the chronic stress related to poverty and homelessness, both cause and worsen health.

The answer to this crisis is a rapid expansion of subsidized, rent-geared-to-income housing. The recent announcement of Canada’s first national housing strategy, after many years of community advocacy, aims to cut chronic homelessness in half over the next 10 years, and promises investment in the construction of 100,000 new affordable housing units across the country. While a step in the right direction, even the very first of these new homes are years from being built and growing demand will still outpace new construction for many years.

In Toronto, there are estimated to be 181,000 people on the housing waitlist. This crisis cannot be solved overnight. As we debate the solution to our affordable housing woes, life-saving emergency measures must be taken to address the daily crises faced by those who are homeless. At least 230,000 people will experience homelessness each year in Canada. That’s a staggering number and it has staggering consequences.

In the first eight months of this year alone, according to Toronto Public Health, over 70 homeless people have died, a number that is likely an underestimate but which exceeds the city’s murder rate. Homelessness is among the leading causes of avoidable loss of life. More than half of those who have died in Toronto this year were younger than 48, a shocking reflection of the adversity faced by people without a home.

As healthcare providers, we have seen too much suffering, trauma and death. The time to declare an emergency is now. The opening of interim spaces with adequate space, showers and cots would provide necessary respite to those currently sleeping on floors and mats and streets.

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Beyond that, what is urgently needed is 1,000 new shelter beds across the city. Marcus, and others in his situation, cannot wait.

Dr. Michaela Beder is a psychiatrist and Madeleine Ritts is a social worker in Toronto. Both work with people experiencing homelessness and are members of Health Providers Against Poverty.