Photo by Susan Madden Lankford
In doing so, the MHCC was demonstrating, evaluating and sharing knowledge about the effectiveness of the “housing first” (HF) approach, where people are provided with a place to live and then offered recovery-oriented services and supports that best meet their individual needs. Officially launched in 2009, At Home/Chez Soi sought to learn whether the housing first approach works—and, if so, for whom and at what cost. To gather the most comprehensive data, projects were established in five cities, each with a particular area of focus:
- Vancouver (people also experiencing problematic substance use)
- Winnipeg (urban Aboriginal population)
- Toronto (ethno-racialized populations, including new immigrants who do not speak English)
- Montréal (includes a vocational study)
- Moncton (services in smaller communities)
During the project, 1,158 Canadian from the streets and shelters received the housing first intervention.The National At Home/Chez Soi Final Report, released in 2014, demonstrated that housing first works to rapidly end homelessness for people experiencing mental illness, and can be effectively implemented in cities of different size and different cultural contexts. It also proved that HF is a sound investment, with every $10 invested in Housing First services resulting in an average savings of $9.60 for participants with high needs and $3.42 for participants with moderate needs.
The study demonstrated that housing first can be effectively adapted according to local needs, including rural and smaller city settings such as Moncton and communities with diverse mixes of people (e.g., Aboriginal or immigrant populations) like Winnipeg or Toronto.
The study also revealed more about the small group (about 13%) for whom housing first as currently delivered did not result in stable housing in the first year. This group tended to have longer histories of homelessness, lower educational levels, more connection to street-based social networks, more serious mental health conditions and some indication of greater cognitive impairment.
For some participants, involvement in the program likely resulted in the identification of unmet needs for more acute or rehabilitative levels of care in the short term.
The report stated:
Living in shelters and on the streets requires that enormous energy be put into basic survival. The circumstances are not conducive to participating in treatment and managing health issues. On average, participants had been homeless in their lifetime for just less than five years when they enrolled in the study, and many had a history of poverty and disadvantage reaching back to early childhood. For some, the road to recovery after housing can be rapid, but for most it is more gradual, and setbacks are to be expected.
Across all sites in the qualitative interviews, 61% of the housing first participants described a positive life course since the study began, and in general, the study documented clear and immediate improvements, followed by more modest continuing ones for the remainder of the study period. The study revealed measurable improvements in participants’ mental health and substance-related problems.
Key findings included:
1) Housing first can be effectively implemented in Canadian cities of different
size and different ethno-racial and cultural composition. The HF approach was successfully adapted to serve Aboriginal, immigrant and other ethno-racial groups in a culturally sensitive manner.
2) Housing first rapidly ends homelessness. Across all cities, HF participants in At Home/Chez Soi rapidly obtained housing and retained their housing at a much higher rate than the treatment-as-usual group.
3) Housing first is a sound investment. The economic analysis found some cost
savings and cost offsets.
4) It is Housing First, but not Housing Only. The support and treatment services
offered by the HF programs contributed to appropriate shifts away from many types of crisis, acute and institutional services towards more consistent community and outreach-based services. This shift supports and encourages more appropriate use of health and shelter services.
5) Having a place to live and the right supports can lead to other positive
outcomes above and beyond those provided by existing services. Housing first
participants also demonstrated somewhat better quality of life and community
functioning outcomes than those receiving existing housing and health services
in each city.
6 There are many ways in which Housing First can change lives. These groups,
on average, improved more and described fewer negative experiences than others. Understanding the reasons for differences of this kind will help to
tailor future approaches, including understanding the small group for whom housing first did not result in stable housing.
7 Getting Housing first right is essential to optimizing outcomes. Housing stability, quality of life and community functioning outcomes were all more positive for programs that operated most closely to the standards created initially by Pathways Housing First in the United States.
