National study the largest randomized trial of its kind in the world, puts ‘Housing First’
A version of this commentary appeared in the Vancouver Province, Huffington Post and Winnipeg Free Press
At this moment, Canada has an opportunity to take action and reduce homelessness dramatically by expanding strategies we already know can work.
The federal government launched the National Homelessness Initiative in 1999, after a significant rise in homelessness. This initiative allocated more than $1 billion to funding solutions such as community programs and beds in shelters. Programs such as these play an important role, but have not measurably reduced the number of homeless people country-wide. For that reason, the current government has sought evidence on the cost-effectiveness of alternative options, such as ‘Housing First.’
‘Housing First’ is based on the principle of providing housing to those in need before they’re deemed ‘ready’ to re-enter society. To qualify for housing, individuals don’t need a job or a stable lifestyle, and they don’t need to enter rehab, though once they get a home, many of them will accomplish all of these things and more.
Canada will soon finish the largest randomized trial of its kind on Housing First in the world. Overseen by the Mental Health Commission of Canada with funding from Health Canada, At Home/Chez Soi has housed about 1000 people with mental illness in five cities across Canada. Each participant was given a choice of apartments to live in, a rent subsidy and an assigned case worker for support.
The study randomly assigned 990 participants to a control group of people who only received the services already available in their cities.
About 85 per cent of participants who were housed are still in the first or second apartment they chose. Not only that — many of them are thriving. Many are volunteering and enrolling in school. Many participants have accepted professional help for their mental illnesses.
Results from this study will help governments invest cost effectively in the reduction of chronic homelessness and in doing so will radically improve people’s lives.
For every two dollars spent on Housing First, the system saved a dollar by reducing the costs of police detentions, hospital services and shelters. For those who used services the most, those savings were even greater, with three dollars saved for every two dollars spent.
Homelessness is more than a social issue, it’s a health issue. The participants in At Home/Chez Soi all live with mental illness and they are at a much higher risk of physical illness than most Canadians. Getting appropriate health care is just one of the things that community support teams help participants with.
A chronic lack of affordable housing and stable employment opportunities that pay a living wage for low-skilled workers are often the reason people end up homeless in the first place. It’s a game of musical chairs, and when the music stops, often those who need support the most are left standing outside the circle. But once they have a decent place to live, they can begin to reconnect with friends and rejoin the community.
The At Home/Chez Soi model is a wise investment in addressing the inequalities faced by those with complex illness.
This is ground-breaking research with the potential to help governments drastically improve Canada’s approach to homelessness, social policy and our entire health care system. Continued support for At Home/Chez Soi and similar Housing First programs will help ensure we don’t lose the crucial ground we’ve gained in improving the lives of Canadians.
Paula Goering at the Centre for Mental Health and Addiction and Stephen Hwang at the Centre of Research on Inner City Health, St. Michael’s Hospital, are experts advisors with EvidenceNetwork.ca and investigators with the At Home/Chez Soi study. They are both researchers at the University of Toronto.
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