By Omar I. Hassan

Graphic design by Vicky Lin

As a liberal democracy that is shaped by social democratic values, Canada carries the duty to safeguard not only the rights of its citizens but also uphold the dignity of its most marginalized. In the face of rising homelessness,¹ addiction,² and overrepresentation of racialized individuals in the criminal-legal system,³ Canada is losing ground in upholding its own values. These issues signal major systemic failures. It is precisely in this context that researchers focused on inequities intersecting with social determinants of health become critical. Dr. Matheson, a sociologist and the Endowed Chair in Homelessness, Housing, and Health at Unity Health Toronto, recounted her experiences growing up in Prince Edward Island in a small village where there was “a lot of differentiation based on income status.” Her experience inspired her to determine the origins of these disparities. With a vested interest in addressing societal inequity, Dr. Matheson combines academic rigor and community collaboration to uncover the drivers of these systemic failures and develop innovative interventions.

Dr. Matheson provides novel and compelling new perspectives to examine inequities. She has developed a career centred around community-engagement in research that bolsters academic inquiry through lived-experiences. Instead of imposing research questions in a top-down manner, Dr. Matheson engages in dialogue with local organizations such as homeless shelters and advocacy groups to orient her research. This strategy allows her to uncover the hidden causes of marginalization. Her significant collaborations with the Good Shepherd Ministries resulted in the first Canadian shelter-based study tying gambling to housing instability.⁴ The later development of the Problem Gambling App (SPRinG app) showed a novel method to extend gambling supports digitally to those without stable housing. Furthermore, Dr. Matheson has found brain injury (BI) rates to be a hidden, yet determining factor, in criminal-legal involvement–pushing for policy implementation and greater accommodation. These initiatives exemplify the strengths of Dr. Matheson’s work, which is not only scientifically rigorous but also vertically integrated in community needs.

In 2013, Dr. Matheson launched a landmark research project in collaboration with the Good Shepherd Ministries men’s shelter in Toronto. Her project revealed a troubling gap: despite a focus on services for substance use, mental health, and housing, gambling remained an unrecognized driver of homelessness.  Acting on this concern, Dr. Matheson and her team conducted the first shelter-based prevalence study in Canada. Of the 264 clients interviewed, 35% reported problems with gambling, compared to just 4% in the general population.⁵ The nine-fold difference suggests that gambling is likely a strong contributor to housing instability. Acting on these results, Dr. Matheson and her team supported the establishment of the Gambling Addiction Program (GAP) by the Good Shepherd Ministries. Funded by the Local Poverty Reduction Fund, the three-year GAP intervention offered case management, cognitive behavioural therapy, and support from Gamblers Anonymous (a standalone self-help group).⁴ Dr. Matheson recalled fondly that “clients showed great enthusiasm and described GAP as uniquely supportive and understanding of their environments and experiences.” Despite these positive responses, this program was discontinued due to a lack of funding, a recurring theme that exposes the fragility of our current program-based government models. Dr. Matheson’s work bolsters community driven priorities but is constrained by short-term policy cycles.

Building on her shelter-based research, Dr. Matheson increased outreach through digital innovation, reaching marginalized populations on a larger scale. The SPRinG (Supporting People Recovering from Gambling) app was designed by Dr. Matheson and her team to provide “flexible, accessible support for individuals experiencing problem gambling, particularly those who did not have stable housing or found themselves underserved by traditional [in-person] treatment programs,” she said. The app used evidence-based tools derived from cognitive behavioural therapy and provided easier access to educational resources and support/crisis networks.⁴ The design reflected a curious insight from Dr. Matheson’s work: while homelessness is often associated with disconnection, many unhoused individuals use smartphones, allowing for digital equity interventions. The SPRinG app extended care beyond the shelter walls, and provided useful resources for unstably housed individuals, mitigating risk of homelessness. Like the Good Shepherd initiative, the program was discontinued when funding expired. Dr. Matheson explained that, despite promising results, “The SPRinG app has sprung; we had to decommission the app as we could not find additional funding to keep it going. We built it with our community partners and people with lived experience. We tried to get funding through the [gambling] industry and through Government options; we even participated in the University of Toronto Early-Stage Technology (UTEST) program.” Despite promising feedback, the program was cut short due to a lack of long-term funding sources. Dr. Matheson’s approaches are innovative and provide community-informed solutions to directly address service gaps but remain vulnerable to structural issues. 

Alongside her work on gambling, Dr. Matheson has pushed frontiers in inequity research within the criminal-legal system. By documenting BIs in people who are incarcerated, she and colleagues found that young adults with a history of traumatic BI (those caused by external blows to the head) were over 2.5 times as likely to experience incarceration than those without, and the trend impacts both men and women.⁶ Further, her research found that the prevalence of these injuries increased the risk of a serious disciplinary charge by 39%.⁷ BI limits individuals’ abilities to navigate the criminal-legal system, from police questioning to hearings, and increases the chance of cyclical incarceration. Despite these findings, Dr. Matheson noted that “we have very few brain injury services available in Ontario with long wait lists and many of them require a formal diagnosis of brain injury to access care.” She also remarked the difficulty in getting such diagnoses, “leaving many people without access to care.” Despite this, Dr. Matheson remains hopeful. She said that with more “funding and training we can see improvement.” She continues her research in the hopes of her advocacy shaping structural change. Dr. Matheson’s findings have informed policy discussions in Ontario with calls to include BI screening in with correctional health records. This way, Dr. Matheson has ensured that her research uncovers more hidden inequities while seeking to mitigate system-level shortcomings to address such inequities.

Dr. Matheson’s work demonstrates the strengths and vulnerabilities of community-engaged health research in Canada. Whether through GAP, SPRinG, or BI screening, Dr. Matheson exemplifies a consistent pattern: her research is empirical, rigorous, community-focused, and promotes equity. These successes, however, are often dampened by program-based funding cycles. In the face of these challenges, Dr. Matheson remains determined to “keep plugging away at it” even if “our government has expanded the number of prisons rather than community healthcare.” Dr. Matheson has proved the value of her research through effective interventions, but the premature discontinuation of these programs underscores the urgent need for sustained structural investments in solutions for marginalized communities. Without such investments, Canada risks allowing further innovative and community-centred progress to wither.

References: 

1. Statistics Canada. Homelessness: How does it happen? (2023).

2. Miller J and Carberg C. Addiction Statistics Canada (2025).

3. Office of the Correctional Investigator. 2020-2021 Annual Report (2022).

4. Matheson FI, Hamilton-Wright S, Hahmann T, et al. Filling the GAP: Integrating a gambling addiction program into a shelter setting for people experiencing poverty and homelessness. PLOS ONE 2022.

5. Matheson FI, Devotta K, Wendaferew A, et al. Prevalence of gambling problems among the clients of a toronto homeless shelter. J Gambl Stud 2014. DOI: 10.1007/s10899-014-9452-7.

6. McIsaac KE, Moser A, Moineddin R, et al. Association between traumatic brain injury and incarceration: a population-based cohort study. CMAJ Open 2016. DOI: 10.9778/cmajo.20160072.

7. Matheson FI, McIsaac KE, Fung K, et al. Association between traumatic brain injury and prison charges: a population-based cohort study. Brain Injury 2020. DOI: 10.1080/02699052.2020.1753114.