The Toronto Board of Health quietly made a choice this week that tells us something about where the city thinks it’s winning—and where it’s still figuring things out.
They voted Monday to stretch the Downtown CORE pilot program another 18 months. That’s the initiative pairing public health nurses with Toronto police to reach people sleeping rough around Yonge and Dundas. It started in December 2024, aimed at connecting folks dealing with homelessness, mental health struggles, and substance use to actual city services.
Dr. Michelle Murti, Toronto’s medical officer of health, laid out the case. The program is helping people get into housing. It’s linking them to addiction support. Nurses are handing out wound care, naloxone kits, even immunizations. In one year, they logged over 8,400 interactions across 568 shifts. They reversed 12 overdoses and got 20 people emergency transport to hospital.
Those are real lives touched. But Murti also said the program needs work. She wants broader scope for the nurses, better referral pipelines, and tighter coordination between public health and police. Translation: it’s doing some good, but it’s not a silver bullet.
Here’s the harder truth buried in her presentation. Toronto counted 11,094 people experiencing homelessness at the end of January alone. Indigenous people, racialized communities, Black residents, and 2SLGBTQ+ folks are showing up in those numbers way beyond their share of the population. Acute drug toxicity killed 55 percent of unhoused people who died in the city last year. And roughly 300 babies are born each year to mothers with no fixed address, based on pre-pandemic birth records and data from Young Parents of No Fixed Address.
That context matters because it frames what this pilot really is: a triage measure in a much larger crisis.
Pauline Larsen, who runs the Downtown Yonge Business Improvement Area, sent a letter backing the extension. She said the program has made a real difference not just in connecting people to services, but in how the broader community feels about safety and care downtown. That’s the political sweet spot the city wants—visible action that reassures both vulnerable residents and business owners.
But not everyone is buying the approach. Diana Chan McNally, a community worker, took aim at the police presence specifically. She argues that having officers on the team scares people off, especially those worried about being criminalized rather than helped. Her pitch? Replace the cops with community workers if the city genuinely wants people to engage.
The Board of Health says police are there for safety reasons. That’s the official line. But Chan McNally’s point cuts to something deeper: trust. If you’ve been pushed out of public spaces, arrested for sleeping outside, or had your belongings cleared during an encampment sweep, a police uniform doesn’t signal help. It signals risk.
This tension isn’t new in Canadian cities. Vancouver’s tried different models. Montreal’s debated the role of police in social services. Calgary and Edmonton have experimented with community safety teams that don’t include armed officers. Toronto’s choice to keep police embedded in CORE reflects a political calculation about who needs reassuring most—and who might be left wary as a result.
The nurses themselves are doing frontline work that goes well beyond what most people imagine. Between mid-January 2025 and mid-January 2026, they handed out nearly 2,500 harm reduction supplies, close to 460 naloxone kits, almost 1,400 pieces of clothing, and nearly 6,000 snacks or meals. They managed 265 case files, helping people access emergency shelter, primary care, ID services, income support, and accompanying them to appointments.
That’s not just outreach. It’s navigating a maze of bureaucracy on behalf of people who often can’t do it alone. It’s showing up in the cold, in the middle of mental health crises, during overdoses. Ninety percent of those interactions were initiated by staff, not by the people they were helping. That tells you something about how hard it is to reach folks who’ve learned not to expect much from the system.
Murti told the board they’ll report back in the third quarter of 2027 with final recommendations. That’s two and a half years from now. In the meantime, this extended pilot becomes the status quo. The city gets credit for trying something. The program staff get more time to prove it works. And the people sleeping outside? They get another couple of winters to see if this version of help actually helps.
The bigger question hovering over all this is whether Toronto—or any Canadian city—can pilot its way out of a housing and addiction crisis that demands structural change. Programs like CORE can ease individual suffering. They can prevent deaths. They can rebuild trust one interaction at a time. But they can’t replace the affordable housing units that don’t exist, the mental health beds that were cut decades ago, or the income supports that might keep people housed in the first place.
Ottawa knows this. Queen’s Park knows this. City Hall knows this. But building those systems takes years, billions of dollars, and political will that extends beyond one council term. Pilots are faster, cheaper, and easier to message. They let officials point to something concrete while the harder work stalls.
What makes this extension worth watching is whether the city actually strengthens the program or just keeps it limping along. Murti flagged specific gaps: nurse scope, referral pathways, collaboration protocols. If those get fixed, CORE could become a model other cities adapt. If they don’t, it becomes another well-meaning initiative that never quite scales.
Chan McNally’s critique about police involvement isn’t going away either. There’s a broader conversation happening across Canada about who should respond to social crises. Some municipalities are testing civilian-led teams. Others are training officers in crisis intervention. Toronto’s sticking with the hybrid model for now, but the pressure to rethink that choice will grow if people keep avoiding the very team meant to help them.
For the nurses and case workers on the ground, the extension probably feels like both a win and a burden. Recognition that their work matters, sure. But also another 18 months of managing impossible caseloads in a system that still hasn’t caught up to the scale of need.
And for the 11,000-plus people experiencing homelessness in Toronto right now? The vote means the city isn’t giving up on them. But it also means they’re still waiting for solutions that match the size of the problem.
