In the summer of 1998, a group of managers who operated programs for the chronically unhoused came together. They shared similar concerns about a sub-group within the population who showed complex health needs, and despite frequent use of health services, were not well cared for. Though there was no clear solution at hand there was a strong sense that, as a community, our care could be more effective if we knew more about this population, communicated better and worked together. This was the beginning of what eventually became Ottawa Inner City Health, Inc.

During this time, there was interest in palliative care due to the increasing number of people living with HIV and Hepatitis. Additionally, many unhoused persons were simply refused access to palliative services. Unless they died in hospitals, basic palliative support like home care were not accessible. There was an identified need not only to provide access to care, but to change the culture of the unhoused community to better handle death and dying. The Mission established an interest in developing an expertise in palliative care on behalf of the community. This eventually led to a major fundraising effort to build a Hospice for the homeless.

The Ottawa Mission Hospice

Alongside palliative care, there was also a need for a safer place to care for homeless people who were ill or leaving the hospital, as it was identified that homeless persons stayed an average of four days longer in hospitals than housed individuals. The Salvation Army Booth Centre set aside 10 beds for people who were vulnerable in the shelter, where they could receive extra support. They were enthusiastic about the opportunity to add nursing, physician, personal care and home care services. Eventually, this became the Special Care Unit program, which received tremendous support from the hospital and home care sectors, who saw an opportunity to facilitate timely discharge from hospital and the provision of home care services.

At this time, chronically homeless individuals with concurrent alcohol use disorders were consistently identified as the most challenging to care for. Thus, the Shepherds of Good Hope aimed to develop a structured harm reduction program where controlled drinking would be permitted. A relationship was established with a similar program at the Seaton House Annex in Toronto, who provided support, advice and staff training. Development of the Managed Alcohol Program challenged the community to consider a new approach to substance use health care.

In February 2005, Ottawa Inner City Health Project incorporated as a nonprofit organization becoming Ottawa Inner City Health, Inc. and a short time later was granted charitable status. The Ontario Ministry of Health and Long-Term Care committed to ongoing funding, and as of March 31, 2007 OICH, Inc became part of the Local Integrate Health Network. The founding Board of Directors engaged in a strategic planning process to guide future development of programs and services.

Prior to 2005, primary health care was the one service people in shelters could access fairly easily, with nursing services provided by community health centers or Ottawa Public Health. However, as demand for primary care grew and the provincial government failed to invest, people experiencing homelessness struggled to access care outside the shelter system. In 2006, the Ottawa Mission Board, in celebration of its 100th anniversary, chose to fund a clinic for homeless individuals. This funding allowed Inner City Health to hire nurse practitioners and renovate the Hospice, creating space for a primary care clinic.

Recognizing a significant gap in services, we identified an urgent need to provide specialized care for women. While a dedicated unit existed for men, there was no equivalent program addressing the unique challenges faced by women. It became clear that women's needs differed greatly, with a stronger emphasis on trauma, mental health, and substance use concerns, rather than physical health issues. An OICH Mental Health Nurse and a psychiatrist from the Royal Ottawa Health Care Group worked tirelessly to develop a trauma-informed care model specifically suited to our setting at the Shepherds of Good Hope.

The idea for a new housing model arose from clients in the Managed Alcohol Program at Shepherds of Good Hope who no longer wanted to live in a shelter. Long-term residents were stable in terms of alcohol use, mental health, and physical health, but expressed frustration with the disruption and limitations of shelter life. Through discussions at their resident meetings, the idea for a new model of supportive housing began to take shape. Finding a location large enough to house 55 people, accommodate a Managed Alcohol Program, and fit into a welcoming neighborhood proved challenging. Eventually, Shepherds of Good Hope purchased a former apartment hotel, turning the vision for the Oaks program into reality.

Another population not well served by mainstream services were senior women. The leadership team at Cornerstone (a women’s-only shelter) were frustrated by the lack of housing options for elderly women with severe mental illness. They were deemed unsuitable for retirement homes and often denied home care services because of their behavior, leading them to remain in shelters, sometimes until the end of their lives. The Cornerstone vision of a mixed-age, women’s-only supportive housing program was so different from existing models that it took years to secure funding and a location, but eventually Booth House opened its doors. Inner City Health’s role in supporting the women focused on personal, medical, and mental health care.

The peer program began as a six-week pilot in preparation for the TED program's launch. Given the unique complexities of OICH, we needed a custom-designed approach. Our six-week pilot program was built collaboratively with engagement from all partner organizations. It was essential to define how peers would interact with key agencies, including Ottawa Police and Ottawa Paramedics. The pilot's success led to its extension from six weeks to six months and ultimately to its establishment as a permanent program. At the time, we faced widespread misconceptions about peer workers. The peer program’s success demonstrated that peers are capable, professional, and fundamental contributors to compassionate and effective care.

The collaboration with partners like the Royal, paramedics, police, CMHA, Shepherds of Good Hope, and OICH made the TED program possible. This program was designed to divert individuals who are homeless from the emergency room. Initially, there was skepticism about the program’s impact—many believed clients would end up in the hospital regardless. However, the data told a different story: only 4% of cases required hospital visits. This level of diversion was far more significant than anyone anticipated. What truly set TED apart was the tailored support it provided. Clients received the help they actually needed, rather than the standardized care offered in a traditional emergency room.

John Howard Society of Ottawa partnered with OICH in opening the Rita Thompson Residence. At the time, the project was considered so innovative that it garnered visitors worldwide wanting to learn from its success. Although most people who use drugs do not need the intensity of support and care that this model of housing provides, for those living with complex health needs and active substance use, it offers a high quality of life as well as reducing shelter, criminal justice and health care costs. Although at the beginning, the program only housed men, in time it shifted to include all genders, creating a more balanced and calmer living experience.

In 2017, there was a significant shift in the unregulated drug supply, and we needed to deploy teams 24/7 to respond to multiple overdoses in and around our shelter programs. We applied for a federal exemption to open a supervised consumption site. Our application was granted and we opened in a renovated construction trailer in November 2017. In September of 2020, we moved into a permanent space inside the basement of the Shepherd’s of Good Hope.

This site represents the next iteration of the John Howard Society and OICH’s Enhanced Supportive Housing program, offering individuals safe accommodation and intensive on-site supports to help achieve life goals and improve overall health and well-being. The program aims to reduce the number of individuals in homeless shelters or living on the streets. Located in Mechanicsville, the 36-unit apartment building serves individuals who have been chronically homeless for an extended period. It provides semi-independent accommodation and intensive support to individuals of any gender aged 18 and up.

Developed in partnership with Shepherds of Good Hope, this building was created in response to an urgent need for more supportive housing, specifically for clients in MAP and also, women. Many women had been staying in shelters for up to two years without access to appropriate housing options due to a severe lack of specialized accommodations. This program was built with the goal of providing housing solutions tailored to individuals requiring complex support, including mental health services, substance use support, and other individualized care. By prioritizing these needs, the program aims to break the cycle of shelter dependency and create pathways to long-term stability.

We knew that individuals who were homeless were a vulnerable group when the COVID pandemic hit and that there was a real risk of overwhelming the hospital system if we did not figure out a way to manage outbreaks in the community. At the beginning of the pandemic, the Covid Isolation Unit was opened rapidly to help support the overall Covid strategy for the Ottawa shelter systems. With the support of the city and The Ottawa Hospital, this program was opened in a City of Ottawa recreational centre building and turned into a shelter outbreak unit for clients who were pending and/or tested positive for COVID-19. It was designed to incorporate as many harm reduction methods as possible. This unit shut down in early 2023.

Merivale Road was another push for supportive housing for individuals who have complex mental health and substance use needs. Using lessons learned from other housing units, this unit was intended for moderate to high acuity individuals coming from shelter. It was a challenging building to open as many of the residents were new to OICH, which meant it took longer to build rapport, and engage in treatment planning health. This building has intensive support for substance use, mental health, and physical health needs.