Excellent op-ed in the Winnipeg Free Press by Sam Tsemberis and Vicky Stergiopoulos
In Canada, we conducted the largest randomized controlled trial of its kind in the world on homelessness by comparing housing-first to services as usual (the At Home/Chez Soi study) involving 2,255 participants who were homeless across five Canadian cities (Moncton, Montreal, Toronto, Winnipeg and Vancouver). The one-year results, recently reported by the Mental Health Commission of Canada, indicate HF is significantly more effective than services as usual in providing stable housing for people who had been homeless for years and who have complex clinical needs.
Also compelling was the finding that for every two government dollars invested in the HF program, $1 was saved. Savings were even greater for those who used services the most, with $3 saved for every $2 spent.
It’s no wonder the federal government supports housing-first: It is highly effective and can save money.
So Canada is on the right track. We have both funds and evidence-based policy for moving forward on homelessness. However, we still face two major hurdles in order to successfully meet a housing-first model.
First, the majority of programs currently funded across the country can be described as providing services for people who are homeless. Shelters, drop-in centres, and especially transitional or short-term housing programs must be helped to shift resources to programs that end homelessness instead. We will need to invest in providing training and consultation services to communities so they will obtain the guidance and support, timelines, and performance indicators necessary to move the system toward this new, much-needed direction.
The second hurdle concerns implementing housing-first programs so they are consistent with the basic principles of the model that achieved the outstanding outcomes in the At Home/Chez Soi study. Housing-first moves people rapidly from shelters or the streets into stable housing and provides evidence-based clinical and social supports to address social, mental-health, health, addiction, educational, employment issues and others. By providing services using a team approach and co-ordinating housing, clinical and social supports, this model reduces problems associated with fragmentation of services and improves inter-sectoral collaboration that usually plagues individuals and families seeking treatment.
In other words, housing-first, if implemented properly will transform public services across the country as we know them, and to do this effectively, teams will need adequate support and guidance to do so.