POLICY BREAKTHROUGH: HOUSE THE HOMELESS FIRST, THEN HELP THEM WITH
THEIR PROBLEMS

Until recently, social policy dictated that homelessness was best
dealt with through a graduated system: Homeless people would begin
their lives off the street in emergency shelters, and then progress to
transitional housing and ultimately to their own apartments.

While this seems a reasonable approach, it is fraught with
difficulties. For many people, it's a struggle to just to survive when
they're on the streets or in a shelter, and that means they have
little time or energy to devote to overcoming the problems that led to
their becoming homeless in the first place.

This is especially true for those struggling with mental illness or
substance abuse or -- as is usually the case -- both. Many housing
programs expect people to be stable and sober prior to entry, yet it's
next to impossible for mentally ill and addicted people to receive
adequate treatment while living on the street.

The result is a classic Catch 22 -- you can't get help to solve your
problems until you have a place to stay, and you can't get a place to
stay until you've already solved your problems.

As a result of this situation, a Canadian psychologist in New York
proposed a different model for ending homelessness in the early 1990s.
Committed to the belief that housing is a basic human right, Sam
Tsemberis founded Pathways to Housing, a group that popularized the
"housing first" approach -- which, as the name suggests, aims to find
people permanent housing first, and then offers them help for other
problems such as mental illness and addiction.

According to a recent study of Pathways to Housing, the program has
met with conspicuous success: Participants experienced fewer and
shorter psychiatric hospitalizations, a 35-per-cent decrease in the
need for medical and mental health services, and a 38 per cent
reduction in jail use.

In addition to benefiting program participants, Tsemberis emphasizes
how housing first programs benefit society: While Pathways to Housing
costs New York City $57 a day per participant, it costs $164 a day to
keep one person in jail, $519 for one emergency room visit, and $1,185
for a one-night stay in a psychiatric hospital.

Unfortunately, such programs are rare in Canada, and research on their
effects doesn't exist. In an attempt to remedy this problem, the
Mental Health Commission of Canada announced last week a four year,
$110- million project designed to see if housing first programs work
equally well in Canada.

The At Home/Chez Soi project will involve 2,225 homeless people living
with a mental illness in five cities across Canada.

A total of 1,325 participants will be provided with places to live as
well as access to various services, and will be expected to contribute
30 per cent of their rent.

The remaining participants will be offered access to services, but not
permanent homes.

While each of the five cities -- Moncton, Montreal, Toronto, Vancouver
and Winnipeg -- will focus on a specific subgroup of the mentally ill
homeless population, the Vancouver project will involve 500 people who
struggle with addictions in addition to mental illness.

The project is expected to wrap up in 2013, and will assess the
efficacy of the housing first approach in Canada, as well as what
services work best for the homeless populations in each of the subject
cities.

It will also look at the comparative costs to society of providing
people with housing or leaving them on the street.

While the project won't likely solve all homelessness problems, it is
certainly a start, and for that the Mental Health Commission is to be
commended.