To meet COVID-19 precautions, homelessness sector services in Toronto, Canada, closed their doors and lowered occupancy levels. Many people deprived of housing moved into tent communities and makeshift structures (encampments) in public spaces. The government response was to evict people from encampments. Many people died, unable to meet their basic needs in the context of worsening housing affordability and the toxic drug supply. The community-led response involved volunteer groups forming, and existing services (e.g., overdose prevention sites) adapting, to provide outreach supports to encampment residents to meet their basic needs (e.g., food, shelter, harm reduction).

Our study is a multi-stakeholder community-based evaluation to assess and contextualize how well outreach supports during the COVID-19 pandemic met encampment residents’ needs. Many of the outreach groups interviewed included harm reduction workers. We analysed survey data descriptively, and qualitative interviews using reflexive thematic analysis.

We conducted 127 surveys and 23 interviews with encampment residents, and 16 interviews with workers and volunteers, in Spring/Summer 2021. 82% of residents used substances that were not prescribed to them. Residents said overdose deaths were less likely to occur in an encampment compared to shelter settings because they mutually supported each other and outreach provided harm reduction support. Residents most valued when outreach supports were frequent and consistent, flexible and responsive to feedback, and provided social support. Community-based workers and volunteers acted in solidarity by building relationships and centering resident autonomy to provide the support that was needed most. However, some outreach workers were limited by the inability of large institutions to adapt to crisis, especially to provide adequate housing.

Community-based outreach met encampment residents ‘where they were’ by providing basic survival and social support, including to address overdose risk. However, a major increase in permanent housing that breaks the cycle of being unhoused is urgently needed.