Nowhere to Go: Understanding the health impacts of service restrictions in Hamilton’s shelter system

A community-based study led by McMaster University researchers reveals how shelter policies and practices affect health outcomes for people experiencing homelessness in Hamilton, Ontario.

The findings, published in BMJ Public Health, explore how service restrictions affect the health and well-being of people experiencing homelessness.

“Service restriction refers to the temporary denial of shelter access due to behaviours deemed harmful to staff, other clients, or the community,” says Claire Bodkin, assistant clinical professor in McMaster’s Department of Family Medicine and the project lead.

“While intended to maintain safety, these restrictions often push people into unsheltered homelessness, separating them from their belongings, support networks, and access to essential health and social services,” added Bodkin.

Researchers conducted interviews with 20 individuals with experience of service restriction and reviewed their electronic medical records to understand their health care usage and health outcomes. The research team included people with lived experience of homelessness, shelter staff, and health care providers.

“Despite its widespread practice in the emergency shelter sector in Canada, service restriction remains minimally researched. This study gives us important insight into how those who are service restricted access and use health care services, as well as their overall health status,” says Bodkin.

The study found that participants averaged 17 primary care visits, 11 emergency department visits, and four hospital admissions over four years. Common reasons for visits included infections, injuries, and substance use-related concerns. Many participants reported feeling dehumanised, stigmatized and criminalised in both shelter and health care settings, which contributed to poor health outcomes, avoiding care, and difficulties accessing essential services.

Despite these challenges, the study highlighted the resilience and solidarity among those affected. Participants described strong peer networks and community-led harm reduction efforts, such as distributing sterile drug supplies and supporting one another through crises.

The study findings can help inform shelter and service restriction policies in Hamilton and beyond. Participants called for pragmatic, harm-reduction approaches in shelters and emphasized the need for transparent service restriction policies. Since this research was conducted, the City of Hamilton has updated their emergency shelter policy, including their service restriction policy, and some of the changes reflect our findings. For Bodkin, the big question is–how this has translated into practice?

“I hope this research can shed light on the need for transparency and a transformation in the procedures regarding shelter restrictions. There is a need to end the use of unnecessary restrictions and recognize the danger that this causes among the shelter community,” says Jammy Pierre, a peer investigator on the study.

The research was funded by the Hamilton Community Foundation Education & Research Fund 2021-2022.

Learn more about the study and its findings in the report.