What happens if you house people who have no home? A knowledge exchange event on February 3 at Crossways in Common (222 Furby St, in the sanctuary) brought together advocates, researchers, and service providers to share new ideas on addressing the problem of homelessness in Canada, the progress, and the results. It also served as a celebration for the accomplishments that have been made to date.
There were discussions on the Mental Health Commission of Canada, the National At Home/Chez Soi Report, the Winnipeg At Home Chez Soi Report, suicide, medication adherence, involvement with the justice system, and the project as a whole.
Introduction and Background
Dr. Jino Distasio, Director of the Institute of Urban Studies and Associate Vice President of Research and Innovation at the University of Winnipeg, and his partner Dr. Sareen Jitender, Professor & Head of Psychiatry at the University of Manitoba, shared lots of information about the study.
Distasio, the Principal Investigator for the project, explained the project ended homelessness for more than 1,000 Canadians, who were previously on the streets or in shelters and struggling.
“This is a very unique program that provides individualized community supports,” said Distasio. “The program respects [that] each person has their own pathway. Homelessness has many faces. Outcomes are different for different people.”
The project, a novel idea at the time, was marketed to Canadians and policy makers in 2008.
“In 2015, we secured Homeless Partnering Strategy funds,” said Distasio. “It was in five cities and now is in 60+ Canadian cities.”
The researchers held events and workshops to engage landlords, created partnerships with private and public landlords, made negotiations, used rent subsidies, and provided landlords with encouragement and reassurance.
“In particular, in Winnipeg from 2009-2010, the city’s vacancy rate was less than one per cent,” said Distasio. “We had to convince landlords to take part to have apartments. It was easier in Moncton with a 5 to 6 percent vacancy rate.”
Mental Health Commission of Canada Report
Ed Mantier, Vice President of Programs & Priorities at the Mental Health Commission of Canada, welcomed and explained the project.
Mantier explained that sustainability after the experimental phase was complete was the largest issue. This experiment took place in five cities across Canada, but Winnipeg, in particular, had a sense of community. First Nations organizations in the city were welcoming, creating a sense of community to members. The cultural focus in Winnipeg influenced how the other sites took on this aspect.
Alden Wiebe, Chair of the Lived Experience Committee, agreed the research was well done, but asked about sustainability – one of the key factors that advocates, participants, and staff were concerned about during the study.
In the At Home/Chez Soi Winnipeg Report:
- 38% said as a child they did not have enough to eat, had to wear dirty clothes, and were not protected;
- 36% experienced domestic violence;
- 57% had lived with someone who had substance use problems; and
- 31% had a family member incarcerated.
National Study Focus
Dr. Geoff Nelson, Professor of Psychology at Wilfrid Laurier University, talked about sustaining housing in the National At Home/Chez Soi Project.
Nelson mentioned that participants were anxious about the project’s sustainability. In Toronto and Winnipeg, all the programs offered in the study provided to participants continued. He further explained that housing is ongoing, rent subsidies in Winnipeg were adapted to the needs of the participants, and training is available for new staff.
In the National At Home/Chez Soi Study, many participants maintained stable housing during the study period, as choosing where to live and having support from the service team helped.
Winnipeg Study Focus
Scott McCullough, Assistant Director, and Sarah Zell, Senior Research Associate from the University of Winnipeg Institute of Urban Studies, discussed sustaining At Home/Chez Soi in Winnipeg.
The Winnipeg At Home/Chez Soi Report described several partnerships with the service sector. Wiisocotatiwin at Mount Carmel Clinic supported participants with high needs using an Assertive Community Treatment model. Ni Apin, the Aboriginal Health and Wellness Centre of Winnipeg, supported moderate need Aboriginal participants using their existing “Medicine Wheel” model with elements of the Intensive Case Management model. Wichewin at Ma Mawi Wi Chi Itata Centre supported moderate need Aboriginal and non-Aboriginal persons using an Intensive Case Management model.
The research in the At Home/Chez Soi Winnipeg report and of McCullough and Zell both found many participants initially struggled with maintaining stable housing because they had to deal with challenges such as reintegration into housing, maintaining healthy relationships, and new responsibilities. Participants learned which types of housing, neighbourhoods, and personal spaces were needed to remain stably housed.
Josh Aquin, a graduate student from the University of Manitoba, asked whether Housing First decreased suicidal behaviour among homeless adults with mental health disorders.
Aquin found that the Housing First approach provided stability and that there were less emergency room visits. 55.4% of 2,000 participants had a lifetime of suicide attempts. 37.3% had ideation in the month interviewed. Mood disorders and PTSD were common; people who experienced short-term homelessness reported higher stress levels.
Over the course of the experiment, Aquin found both the treatment-as-usual group and the Housing First participants experienced a sense of purpose being followed by service staff. They felt someone cared.
This discussion emphasized the importance of knowing that suicide is a complex issue with many factors. Housing First, therapy, and supports are all needed.
In the National At Home/Chez Soi Study, around half reported having no one to confide in. 36% of participants were in high distress.
Harman Kalkat, a graduate student from the University of Manitoba, presented on whether Housing First increased self-reported medication adherence.
According to Kalkat, all the participants experienced mental health concerns. There were many reasons to miss taking prescription medications, such as finances, forgetfulness, side effects, medicine being stolen, having nowhere to store their medication, or other reasons.
Kalkat found the Housing First approach and intensive case management helped people be able to take their medications regularly. The participants with moderate needs had a baseline of four out of five on the scale of taking medications. This is proved in the At Home/Chez Soi National Study; social networks, sense of community, health, and quality of life improved with the Housing First group, whuile intensive case management helped them stay on track with taking their prescribed medications.
The report stated that recovery is a lifelong process in the cases of many participants, who have to work hard even after having housing and service team supports.
In the At Home/Chez Soi Winnipeg Report, 28% reported psychotic disorder, 86% reported non-psychotic disorder, 77% had substance-related problems, and 45% had post traumatic stress disorder.
Dr. Michael Weinrath, Professor in the Faculty of Criminal Justice at the University of Winnipeg, discussed Housing First and contact with the criminal justice system.
Weinrath explained people who are homeless are often victimized by others. 55% experienced trauma, 75% were mugged, and 57% experienced sexual violence. Men were more likely to be robbed and women were more likely to be sexually assaulted.
Weinrath found there was little to no significant changes in criminal activity for the majority of the participants, even if they were housed. The research data had outliers that affected the data of participants’ involvement in the justice system, whether they were involved in offences or victimized.
In the At Home/Chez Soi Winnipeg research, 36% of participants were involved with the criminal justice system in the six months prior to the study; this could be arrests, court appearances, or incarceration. 32% were mugged, 43% were threatened, and 37% were physically assaulted.
In the National At Home/Chez Soi Report, 89% had at least one interaction with police officers, one-third of participants were actually arrested during the study period, and there was no significant difference between the housed and treatment-as-usual groups.
However, the report stated that Housing First participants had fewer arrests for public nuisance offences and drug related offences over time. Treatment-as-usual participants didn’t see fewer arrests for these offences.
Weinrath warned that involvement with the justice system is complex. Some participants had warrants for arrest for offences before the study began.
The National At Home/Chez Soi Report found that the Housing First intervention caused fewer nights in shelters, fewer emergency room visits, fewer psychiatric and general hospitalizations, and fewer doctor’s office visits, but greater use of food banks.
The intensive case management team helped participants with social services, mental health supports, and help getting paid employment.
In the study, costs per participant per year were between $14,177 to $22,257 per year. These costs include salaries of all front-line staff and their supervisors, additional program expenses (such as travel, rent, utilities, etc.,) and rent supplements. These costs include one service provider for every 10 participants.
Overall, this resulted in average reductions of $21,375 in the cost of other services for high need participants and $4,849 in the cost of other services for moderate need participants. Every $10 invested in Housing First services resulted in an average reduction in costs of other services of $9.60 for high need participants and $3.42 for moderate need participants.
Before At Home/Chez Soi, participants had used services costing on average $225,000 per year, per person. Every $10 invested in a Housing First intervention resulted in $21.72 in avoided costs.
The conference was a great discussion of the project’s discoveries and policy influences. Not only did it give insight, but it also helped many Canadians change their lives. This event celebrated the victory of solutions that are helpful in ending homelessness in Canada, one person at a time.
We were appreciated by and, in turn, are grateful to Elder Velma Oris, who gave prayers, and the Southern Thunderbird Medicine Traditional Women Singers, who gave songs. We are thankful to Crossways in Common and Young United Church for the space and the caterers, Feast Café Bistro, who provided the lunch.
For more information on this research and an overview, visit the Mental Health Commission of Canada’s page on Housing and Homelessness.