Everyone seems to be jumping on the ‘Housing First’ (HF) bandwagon. Since it was first introduced in the early 1990s by Dr. Sam Tsemberis with the Pathways to Housing Program in New York City, HF initiatives have been successfully implemented across Europe, the United States, and Canada. The philosophy behind HF is quite simple: provide chronically homeless individuals with housing first, and provide wraparound services and supports to clients after. Although this approach seems fairly straightforward (why wouldn’t we want to provide housing to people living on the streets?), it contradicts the traditional strategy that has been taken with chronically homeless people. Prior to the introduction of the HF philosophy, most homelessness programs required individuals to access treatment and attain a period of sobriety before they could access long-term housing. This traditional approach developed, at least partially, out of the stigmatization of homeless people and the corresponding view that in order to be ‘worthy’ of supports and services, ‘poor’ behaviors had to be challenged and changed.
Homelessness is a serious public policy issue affecting thousands of Canadians every year; however, HF is not the solution for everyone. Many homeless people are able to find housing alternatives on their own – often with little support. However, about 15 per cent of the Canada’s homeless (between 4,000 and 8,000 individuals) can be considered ‘chronically’ (long term) or ‘episodically’ – moving on and off the streets -homeless. This high-needs population experiences homelessness frequently and typically have concurrent mental health and addiction issues. Although the chronically and episodically homeless make up less than 15 per cent of the total homeless population, they are the most expensive group, consuming more than half the resources in the Canadian social housing system.
In 2008, the Mental Health Commission of Canada decided to take a closer look at the application of HF in a Canadian context by commissioning and funding a national, five-year study called At Home/Chez Soi (AT/CS). AT/CS compared HF initiatives to conventional homelessness programs in five cities across Canada. HF participants were aided in accessing and staying in housing, and were subsequently provided with varying levels of support ranging from case management to comprehensive community-based treatments. In order to cover the costs of housing, HF participants were provided with rent supplements or housed in pre-existing affordable housing units. AT/CS found impressive results that highlighted HF as an effective response to address chronic homelessness. Compared to treatment in the conventional strategy group, HF participants obtained and retained housing at higher rates, experienced greater improvements in quality of life, and spent fewer nights in hospital emergency rooms, jails, and shelters.
Moreover, AT/CS demonstrated the significant financial savings that can result simply from giving a homeless person a permanent residence. According to the report, for every $10 invested in HF, an average reduction in costs of other services of $9.60 was seen for the highest needs participants while a reduction of $3.42 was observed for individuals with moderate needs. These results demonstrate that the most significant economic savings were realized for the most high needs clients, the chronically homeless. This is due to the fact that before the HF intervention, the highest need individuals are constantly in contact with the health, justice, and social systems and are ‘costing the system money.’
It has also been noted in the literature and further supported through AT/CS findings that high needs clients are best served by Assertive Community Treatment (ACT) teams. These teams consist of a comprehensive collective of health care providers, including psychiatrists, nurses, mental health workers, and addictions counselors. ACT teams are very different from the more traditional Intensive Case Management (ICM) approach, in which clients are provided with only one case manager who connects the individual to services in the community and provides general support. ICM teams tend to be better suited to individuals with moderate needs.
So why does this all matter?
In 2014, as a response to the AH/CS findings, the Federal government made important changes to their Homelessness Partnering Strategy (HPS), a funding strategy for communities to address homelessness. The new and improved HPS had an important catch: 70 per cent of the nearly $600 million investment in the initiative was to be used for solely HF programs.
On the surface, this sounded like a great thing for local programs and municipalities ready to tackle homelessness. But after further examination, it has become apparent that the government’s decisions were quite misleading and the new HPS only pays lip service to the serious challenges of the chronic homeless. There are two central reasons for this.
First, the HPS mandate stipulates that only programs using an ICM model of service providers, rather than an ACT model, will be eligible for funding, (Remember, the ACT models provides more in-depth and comprehensive supports to high needs clients, while ICM models work better with low and moderate needs clients by connecting them to existing services). Now, if the federal government’s goal is to use HF strategies as a cost-saving mechanism by housing the highest needs chronically homeless, it has made the wrong decision. We have already noted that in order to achieve the highest cost savings, HF programs should serve those with the highest needs and those with the highest needs require the holistic supports afforded by an ACT team. By funding only programs that utilize an ICM model, the government is turning a blind eye to our society’s most vulnerable, and even more importantly, they are ignoring the highest-cost homeless population.
Second, without a more significant investment in creating affordable housing, HF programs cannot be successful because funding for HF is not used for the creation of new brick-and-mortar housing units. Instead, HF programs must make use of affordable housing in communities, or rent subsidies funded by the various levels of government. Federal investment in affordable housing has been declining, and as another hint towards the lack of commitment to this issue from the feds, it can be noted that addressing housing and homelessness for low income people has hardly been mentioned in the platforms of the main federal parties during this election period.
Where does this leave us?
The federal government’s decision to focus funding on HF at first glance seems like a promising move away from the traditional methods for ‘dealing’ with the chronically homeless. But after taking a closer look at the stipulations of the HPS, and noticing the absence of a complementary federal affordable housing strategy, it becomes apparent that, at this rate, we are not yet on track to end homelessness in Canada.
Emma Helfand-Green is a 2016 Master of Public Policy candidate at the School of Public Policy and Governance, University of Toronto. She holds a Bachelor of Arts in Psychology and Political Science from the University of Guelph. Her main areas of policy interests include social and health policy.