How an Ottawa Valley county solved its homelessness problem — and saved Bill Wilson

Bill Wilson stands in his furnished, one-bedroom apartment in downtown Renfrew less than one year removed from living in a pitched tent near some railway tracks.

“I don’t have to worry about surviving no more,” he announces. “Now I’m living.”

Wilson, 55, spent two years in a tent on the margins of Pembroke, pushing his belongings around in a shopping cart for fear of being robbed. On the worst nights, he slept inside a bank machine kiosk or in a protected doorway.

His best friend froze to death beside him in his tent. He saw others succumb to fentanyl overdoses.

Suffering from depression and anxiety, reliant on marijuana and cocaine, Wilson found it hard to imagine a different life, much less to navigate towards one.

He needed medical attention for a persistent leg infection, and last spring, he finally decided to visit a drop-in centre where he was looked at by a couple of paramedics.

Then everything changed.

The story of how Wilson overcame his homelessness is part of a larger narrative about Renfrew County and how its paramedic service spearheaded a broad-based effort to address the twin crises of homelessness and drug abuse in the Ottawa Valley.

It’s called the Mesa program, and it’s a success story in a field of endeavour starved for them.

***

Mike Nolan, Renfrew County’s chief paramedic and director of emergency services, was confronted with some troubling statistics in 2023.

That year, Renfrew County lost 41 people to suspected drug overdoses. With a population of 107,000, the county had one of the highest per capita overdose death rates in Ontario.

At the same time, Nolan, like everyone else, could also see more people sleeping rough, particularly around Pembroke, where a makeshift tent city had taken shape. It was estimated that about 80 people were homeless at any one time in Renfrew County, with many more couch-surfing.

A former deputy paramedic chief in Ottawa, Nolan had taken over Renfrew’s service in 2004. He quickly established himself as an innovator.

In 2006, he introduced community paramedicine, a system that uses paramedics to identify and assist people who frequently end up in emergency departments because of chronic illness or infirmity. By making regular house calls to the county’s sickest patients and by monitoring their health status remotely, the program significantly reduced 911 call volumes.

In March 2020, faced with a regional shortage of family doctors and the emergence of COVID-19, Nolan helped put together the Virtual Treatment and Assessment Centre (VTAC).

Using a dedicated number, Renfrew County residents can reach a medical receptionist who arranges appointments with the most appropriate health-care provider. Patients can be referred to a virtual assessment with a family doctor, a hybrid assessment with a paramedic and a virtual physician, an assessment by a paramedic in a clinic or home, or an in-person appointment with a family doctor.

Still in operation, VTAC offers anyone without a family doctor a doorway into the health-care system and has helped reduce the pressure on the region’s hospitals.

Nolan’s track record meant local officials were ready to listen when he began to discuss the need for a new approach to the region’s homelessness, addiction and mental-health crises. He consulted a wide range of experts looking for a model to emulate, but couldn’t find the right fit for Renfrew County.

“People were addressing issues of homelessness, people were addressing issues of mental health, addressing issues of addiction,” he says, “but we didn’t really have a best practice in terms of who brought those three elements together and had a plan to address all three simultaneously. That’s really what the Mesa program represents.”

Mesa is an “escalator model” designed to transition homeless people off the streets, out of addiction and into stable housing, where their mental health problems can be better addressed.

Mesa — it draws inspiration from the Spanish word for “table” — brings together Renfrew County’s paramedic service, its community services department and its development and property department along with outside agencies such as Mackay Manor, a residential addiction-treatment centre, and local hospitals.

The program was launched in May 2024.

Paramedics are on the frontline of the Mesa program, shepherding the homeless and other vulnerable people toward its services.

If paramedics respond to an overdose resuscitation at a homeless encampment, for instance, they’ll arrange a follow-up visit by the Mesa team.

Two dedicated Mesa teams operate 12 hours a day, seven days a week. Each team is made up of a community paramedic, a community mental health professional from Pembroke Regional Hospital and an addictions specialist from Renfrew Victoria Hospital or MacKay Manor. Eight paramedics are committed members of the program.

Mesa teams address patients’ immediate health needs, seek to understand their situations and arrange for follow-up visits. The idea is to build enough trust that Mesa team members can then discuss addiction treatment and housing options with their patients.

“At the end of the day, they need to trust you more than they trust their drug dealer,” Nolan says. “The goal is to get them stabilized as quickly as possible and then get them into supportive housing and into treatment.”

***

After growing up in Chalk River, Bill Wilson moved to the Greater Toronto Area, where he worked in a car factory and launched a small painting business.

Wilson suffered anxiety and depression, but managed them until his mother fell ill with cancer. He cared for her until her death, but lost his business during that crisis. In the meantime, his rent skyrocketed, his mental health deteriorated and he medicated them with marijuana and cocaine.

“I lost everything,” he says.

Wilson ended up in a tent in Pembroke. He spent his days pushing his tent and other belongings around town in a shopping cart, plotting ways to find his next meal, stay warm and avoid trouble.

In May 2024, he met some Mesa paramedics at The Grind, a drop-in centre and community kitchen in Pembroke. They treated him for his leg infection, talked to him about his housing situation and arranged for a follow-up visit.

Wilson gave the paramedics his cell phone number. He was one of the few people in the homeless community with a working phone, and he became a key contact when paramedics wanted to warn people about a bad batch of drugs or to find a client who needed follow-up.

Wilson sometimes asked the paramedics to check on people he was worried about. They even helped him find some dog food when he was left looking after a friend’s animal.

That summer, a contaminated supply of purple fentanyl hit Pembroke streets. The drugs deepened the chaos in the homeless community and led to a spike in overdoses and violence.

Wilson decided he couldn’t take it anymore: He phoned the Mesa team and asked for help. He said he wanted to get off the street and to rebuild his life.

“I wanted a second chance,” he says.

Wilson signed a social contract with Mesa and took the next step: He moved into a motel where the county had booked 10 rooms.

He was connected to mental health and addiction services, received dental care and treatment for a heart issue. Within months, he stopped using drugs and became, in his words, “a lot more stable.”

***

Those who work with street-involved people will tell you this is where the rubber meets the road.

Many programs aimed at addressing homelessness and addiction fail because they can’t offer addiction treatment when an individual is ready. Others fail because they can’t offer supportive housing to someone who successfully completes addiction treatment. (Many will relapse if forced to again confront homelessness.)

Renfrew County officials overcame those pitfalls by working together to build access to residential addiction-treatment beds along with short- and long-term housing options.

They optimized existing programs. For instance, the county receives money from the province under something called the Homelessness Prevention Program; it was used to rent motel rooms on an ad hoc basis to address emergency situations experienced by homeless individuals, such as illness.

By blocking out 10 rooms year-round at the same motel, however, county officials cut the nightly rate in half while doubling the number of nights available for short-term housing. It was one of many bureaucratic victories that resulted in more housing options.

A 24-hour-a-day, year-round Mesa warming centre in Pembroke opened in December to serve the homeless community. Then, in January, the province announced Pembroke would be the site of a Homelessness and Addiction Recovery (HART) hub that will offer health care, mental-health services, addiction treatment beds and more transitional housing.

MacKay Manor, the addiction-treatment centre, agreed to fast-track treatment for homeless people who enter the Mesa program. The facility has 17 local residential treatment beds for men.

“We really kind of threw out the old rule book and created a system that works with our clients where they’re at and gets them to where they need to be,” says MacKay Manor executive director Liana Sullivan.

Each person who enters the Mesa program signs a “social contract” to obey the law and not to negatively affect others in the program in return for addiction treatment, housing, medical and social supports.

Nolan says a Mesa team “will literally give a person a ride to an addictions treatment program” if that’s what it takes for them to succeed.

Research shows that substance abuse can be both the cause and effect of homelessness, which can in turn compound mental-health issues. It means, Nolan argues, that one problem can’t be treated in isolation from the others.

“You have to hit on all three to have success,” he insists. “It’s rare that you have an addiction issue without an underlying mental health issue. And, if that mental health is driving your addiction, it can lead you to homelessness.”

So how do you pull someone out of that spiral?

“You make it easy,” he says. “You have to find the path of least resistance.”

***

The success of the Mesa program has not escaped the attention of Michael Tibollo, Ontario’s former associate minister of mental health and addictions.

In a recent interview, before he moved to a new cabinet position, Tibollo pointed to the program as one that could be emulated across Ontario as the province closes safe consumption sites and opens HART hubs as part of an emphasis on “exit strategies” for those trapped on the carousel of homelessness and addiction.

“I’d love to have that model (Mesa) everywhere,” he said.

Already, Tibollo said, similar programs have been established in other regions of Ontario, including Barrie, Lambton County and Thunder Bay. Like Mesa, those programs rely on paramedics teamed with crisis-response workers to engage homeless people, to treat their immediate health needs and to lead them toward off-ramps that include addiction treatment, housing and social supports.

The model, he said, has many benefits: It replaces the policing model for homelessness with one emphasizing compassionate care, alleviating pressure on emergency rooms and offering long-term returns for government.

“When you look at all the costs that are being saved by helping that individual get back on track,” Tibollo said, “the savings far outweigh the expense of helping someone get through that.”

The Mesa program costs Renfrew County taxpayers $1.6 million a year.

According to data collected by the county, the Mesa program put in place care plans for 980 people during its first nine months. Almost all of them were enrolled in the community paramedics program, giving them access to primary health care.

The Mesa teams concentrated their focus on 160 clients with complex mental-health and addiction problems, many of them homeless. That cohort had 3,320 encounters with Mesa team members, the data shows.

More than 100 Mesa clients entered residential treatment programs during the program’s first nine months, and 46 formerly homeless people now live independently with ongoing support from the Mesa team. Another 50 people are in short-term accommodations.

“We’ve been able to eliminate homelessness in Renfrew County,” Nolan says. “Everybody has a roof over their head right now.”

Only about six people on average — people who are experiencing episodic bouts of homelessness — use the regional warming centre, he says. The number of overdose deaths also fell to 27 in 2024, compared to 41 deaths the previous year.

Renfrew County Warden Peter Emon says the Mesa program has been successful because it’s both nimble and responsive to an individual’s needs.

“It certainly has had a very positive impact,” Emon says. “I think we have eliminated homelessness in our community at this point … It is a very remarkable accomplishment, and I think it could translate well to other rural municipalities across Ontario.”

Deirdre Freiheit, former president and CEO of the Shepherds of Good Hope in Ottawa, says the key to Mesa’s success is its ability to offer people the right housing at the right time. Replicating that experience in Ottawa would be difficult, she says, because there are simply not enough available housing options.

The housing problem in Ottawa is compounded, she says, by the fact that the capital attracts homeless people from surrounding communities and provinces.

“People come here and then they don’t go back,” she says, “because they might get greater support here than in a smaller community. So the issues here have gotten greater.”

What can be replicated in Ottawa, she argues, is Mesa’s commitment to building relationships and trust with homeless people and its collaborative approach to the problems of homelessness and addiction.

Says Freiheit: “What I think is so brilliant about Mesa is that it’s a whole-of-community solution.”

***

Five months ago, Bill Wilson moved into an apartment in downtown Renfrew with furniture donated by the county’s politicians. His rent, $1,100 a month, comes from his Ontario Disability Support Program payments and a housing subsidy provided through Mackay Manor.

It leaves him with $450 a month to pay for his phone, groceries and the cost of renting his fridge and stove. The Mesa team helped find him a bicycle and a baby carrier so he can transport his groceries.

Wilson says he could not have conceived a year ago that such a life was possible. He didn’t know then how to take the first step out of his predicament.

“Everybody, everybody could do it,” he says. “They just have to believe.”

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