The best way to deal with homelessness? How about giving people homes.

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Here in KW, there is a man who everyone involved in the service sector seems to know. He used to tend to gravitate toward the downtown area, and was often the target of verbal and physical violence. People would call the ambulance or police for him regularly, sometimes several times a day for mental health or other reasons. Over a long period of time, people began to realize that contacting emergency services on such a regular basis was not helpful to this individual, and was also enormously expensive for being so ineffective.

hand and key

In the dominant model of dealing with homelessness, the person described above would be expected to get cleaned up and healthy before accessing housing and other supports. This model is often called the ‘treatment first’ model, under which people who are homeless spend time in emergency services accessing treatment before they are deemed suitable for their own independent housing. There is an alternative model though, which even exists here in KW, called the housing first model. It’s exactly what it sounds like—first get people dealing with homelessness a home of their own, and then support them in accessing support for issues such as mental health, addictions, employment (whether paid or volunteer), or social engagement.

According to the Homeless Hub, the central tenets of the housing first model include that there are no housing readiness requirements, the individual receiving housing has choice in terms of what kind of housing they receive, in addition to housing they receive individualized support services, social and community integration  is central, and the housing is centred around harm reduction. What is harm reduction exactly? The Homeless Hub says the following:

“Harm reduction aims to reduce the risks and harmful effects associated with substance use and addictive behaviours for the individual, the community and society as a whole, without requiring abstinence. In Housing First, this means that absolute sobriety is not required (though as part of the spectrum of choices, people may choose ‘abstinence only’ housing) and a tenant cannot lose housing because of substance use” (source).

Does it work? The At Home/Chez soi project is a large scale study which just finished in Canada, and it may answer that question. The project originated in 2008, when the Canadian government granted the Mental Health Commission of Canada $110 million to “carry out a radical experiment in social engineering. The driving question is: is there a better way to address chronic homelessness?” (Source) Based on a housing first model, the four-year Canada-wide experiment sought to give homes to people who are experiencing homelessness and mental health issues first, and then focus on treatment and other supports once they had their own place. The project went to five cities across Canada (Vancouver, Winnipeg, Toronto, Montreal, and Moncton) and recruited just over 2000 participants experiencing homelessness. Approximately half of the participants (1,265 people) received a home where the rent was geared to their income (so they were paying approximately one third of their income to rent), while a control group of 970 did not receive a home but continued to have access to other supports.

The final results of the study are not yet in—the study finished on March 31st of this year—but the interim report released in March and the early findings reports do have some interesting statistics. They found, for example, that housing first did increase housing stability drastically. During the project, they found that people in the housing first group spent an average of 73% of their time in stable housing. In contrast, the group undergoing treatment as usual only spent an average of 30% of their time in stable housing. The costs savings were significant as well: for every dollar invested in the housing first approach, $1.54 was saved elsewhere in the system. Researchers believe the reason for this is that when people have stable housing they are (far) less likely to be forced to use expensive services like the emergency room, police detention, and hospitals. At a personal level, having housing has been important for many participants to thrive in other areas of their lives. One report states:

“Many At Home/ Chez Soi Participants are re-connecting with their families and friends, building skills and confidence and discovering new interests. Through their art and sharing their stories, by finding jobs and going back to school or volunteering, participants are finding new meaning in their lives, new ways to contribute to their communities – and are helping to change the way people think about homelessness.”

In sum, “once housed many are beginning to take advantage of the safer places and the opportunities that are created to make better life choices – including pursuing opportunities to engage in part or full-time employment.”

These are hugely important findings because they indicate that not only is the housing first approach far better for the health and well-being of Canadians who are homeless, but it is better for everyone in Canada because it saves scarce tax dollars elsewhere in our social systems and taps into skills that would otherwise go unused. Simply put, this project has the potential to revolutionize how we approach mental health and homelessness in Canada, or anywhere in the world. What stands out to me about the housing first model is that it is based on trust. It far more effective to give someone a home and trust that they will do what they need in order to thrive in their community, than to withhold housing in order to motivate them to take steps towards health.

Here in Waterloo Region, there are many organizations already pioneering the housing first model. At House of Friendship, we have Eby and Charles Village, both supportive residential buildings. There’s also Supportive Housing Waterloo Region (SHOW), profiled here, Lincoln Road with the YWCA, as well as Waterloo Region’s program STEP Home (Supports to End Persistent Homelessness). STEP Home was the 2012 winner for the Canadian Urban Institute’s Leadership Award in the Innovation category. These existing programs are demonstrating that as people have a stable place to live they have a foundation from which to make improvements in their lives and access further supports as they seek them out.

If you are interested in following the stories of people involved in the At Home/Chez soi study, there is a really cool interactive web documentary where you can watch video stories and read about the project. It’s called Here at Home. To read about the origins of the housing first model, read this great blog by the founder, Sam Tsemberis.

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