Why help refugees when Canadians are homeless?

Syrian RefugeesDiscussion of the Syrian refugee crisis was common around family dinner tables over the holiday season. With the new Canadian Government working quickly to fulfill their election pledge, communities across Canada are beginning to receive their first government sponsored refugees. I have decided to make my New Year’s resolution this year to raise $2500 for settlement of Syrian refugees in London. To many this seems counter-intuitive given my role as Chair of the London Homeless Coalition, as their lead argument is ‘why help refugees when Canadians are homeless?’

Although this seems like a straight-forward either/or question, there are several factors to consider. Firstly, should Canada even take refugees? In my mind, there are two key reasons why we should. 1) Canada’s position of respect in the world is largely based on our stance as being a multi-cultural nation with borders open to all peoples of the world. Both my father, and my grandfather on my mother’s side, are immigrants to Canada, just two of the people who bring mix to our diverse society, so I’m particularly thankful for their journey to this country. As Canadians, we have a long history of accepting refugees from conflict situations, and I have had the privilege of serving as a nurse with some of these families. 2) From a pragmatic position, Canada depends on immigration to maintain an economically important level of population growth. Closed borders would equate to stagnant or declining populations, which are catastrophic for GDP-increasing economic activity (take a look at Detroit on Google Maps satellite view to see impact of population decline). We need to keep the borders open to grow our communities especially as our population ages.

Secondly, in my mind the various activities government take part in, such as public safety, infrastructure, health, education, immigration, and homelessness, are not mutually exclusive. That is, accepting refugees does not mean we can’t continue to do better on homelessness. And we are doing better. In particular, we are getting better at helping people move from homeless to housed. This is crucial to me, as when I worked as a nurse with people experiencing homelessness I was eternally frustrated that I could assist people with their health needs yet they remained homeless. With new models of Housing First we are doing better at the back end of the system, helping people exit homelessness, though I do wonder about the front end (ie. the number of new people becoming homeless). We can end homelessness and help integrate new Canadians from Syria at the same time.

Which brings me to my third point, these are new Canadians. The very question of ‘why help Syrian refugees when Canadians are homeless’ ignores the fact that these are individuals becoming Canadian. So it’s like asking, ‘why help new Canadians when Canadians who have been here longer are homeless’, which certainly seems tinged in xenophobia to me rather than sincere concern.

Which leads to my next point: a general skepticism that those making these remarks are truly invested in assisting people who are experiencing homelessness. Are individuals expressing this concern subsequently lobbying the government to invest more in homeless services? Are they volunteering time with or donating to homeless-serving agencies? Are they voting for governments that will expand the social safety net to prevent and reduce homelessness? Or are they tapping into a nationalism that actually ends at the tip of their own nose? I ask, because it seems that some of the same individuals complaining about Syrian refugees and suddenly seemingly being concerned about the homeless, have in the past complained about homeless services as being a waste of money.

My final thought on the issue is that it is truly up to us as a community to determine how much of a benefit this migration is to our city. If we accept people, if we welcome them, if we grant them opportunities, and if we extend the same neighbourly support that we, or our parents, or grandparents, or great-grandparents received on coming to Canada, then we will gain exponentially back as Londoners.

If you want to be a part of this welcome, please consider being 1 of 50 people donating $50 to support settlement of Syrian refugees in London.

Photo: Derek Ruttan, London Free Press – http://www.lfpress.com/2016/01/04/more-than-800-government-assisted-syrian-refugees-expected-to-arrive-in-london-by-the-end-of-february

Letter to Council

In light of the current multi-year budgeting process at City Hall, I drafted this letter on behalf of the London Homeless Coalition:

Dear Mayor Brown and esteemed members of London City Council,

On Thursday, October 8th the London Homeless Coalition hosted activities for World Homeless Action day. These activities served to highlight that homelessness is still a significant concern in our community, yet we are in the process of solving homelessness together in London.

As London City Council considers new spending priorities for multi-year budgeting, we as the London Homeless Coalition wanted to take a moment to write to you about our vision for doing better around homelessness. The Coalition exists to advise, shape, and coordinate community responses to homelessness in London, including what we can do as a municipality.

At the poverty conversation on October 17 (thank you to several of you for attending), Sister Sue Wilson shared with us that because poverty is human–made, it can also be undone. We would echo this same comment for homelessness. At the same forum, Deputy Premiere Deb Matthews shared that it was because of feedback received in consultations in London that the Government of Ontario has included the goal of ending homelessness in their Poverty Reduction Strategy.

We, as those most invested in the homeless sector in London, believe that homelessness is a solvable problem.

So what does this mean for us as a community and you as a Council? This means that we need to use our current resources wisely, and invest new resources in solution-oriented activities. The recent announcement by the Salvation Army of their move away from emergency shelter to housing solutions is reflective of a shift in using current resources wisely. Our latest shelter statistics show us that in fact the number of unique users of emergency shelter is on the decline. Similarly, in spite of a reduction in emergency shelter beds, shelter occupancy continues on average at less than 90%. We believe that this is reflective of the impact of Housing First programs now being delivered by CMHA Middlesex, London CAReS, Homes 4 Women, and others, as well as a housing focus across all agencies in London. We are having impact in the lives of people experiencing homelessness. In particular, we are helping people find home. With money freed up from emergency shelters you are now investing in a massive service collaboration to house street-level women at risk. This is a shift from band-aid responses to permanent solutions, and we laud this shift.

So what about new money and new opportunities? We believe that new money is still required in the homeless prevention system. Although shifts in service delivery will lead to savings in this sector as well as others, sometimes these shifts require investment of new resources. Housing supplements are a good example of this need. Housing supplements are an important piece of the puzzle for Housing First solutions. However, although agencies often have the staff and skills to delivering Housing First, the need for actual supplements remains high. This is an important investment in housing solutions, in solving homelessness.

London has a Homeless Prevention System Implementation Plan. As highlighted above, we are making excellent progress on this plan. So much so that London is beginning to be recognized as a leader in solving homelessness. However, there are a number of components of this plan that are still in process or being developed. A strategy for youth is a good example of this. Youth are the fastest growing demographic accessing emergency shelter. The plan in development will include key ideas for us as a community to solve youth homelessness, and will require some resourcing. This is money well spent.

Solving homelessness is not simply an administrative requirement, a responsibility of the municipality. Solving homelessness together is about community building, and is as important a community building task as the London Plan, transit strategy, and river development. You, as City Council, have an incredible opportunity to lead in this plan by making new investments in the sector. This will set our community up to leverage provincial opportunities given our alignment with their goal of ending homelessness. We believe that this is wise stewardship of municipal dollars, and we look forward to being a partner on coordinating the community to make the best use of these dollars driven by clear outcomes.

We remain available at all times to discuss budgeting or implementation components of solving homelessness together in London. Thank you for your interest in our work.


Don’t Criminalize Homelessness; Do Criminalize Low Standards

205736624_153dbd3d20_bThe criminalization of homelessness is a scourge of societies across the globe. The general thought behind it goes something like this: People and/or their behaviours are anti-social and/or bad for our neighbourhood(s), therefore we will make criminal certain acts that we deem to be unwanted. This at face value makes sense, as it aligns with some of the core tenants of a justice system (ie. to get along as a society we need to enforce certain standards of behaviour and interaction), but let’s take a quick look at how this plays out in practice.

1) Making Survival Criminal

The overwhelming majority of people experiencing homelessness live in abject poverty, for example in Ontario most surviving on Ontario Works receive approximately $7,600 per year. With insufficient income to meet the most basic of needs, people turn to alternative means to supplement their income. This can include such activities as survival sex work or panhandling. Making these behaviours illegal then becomes a downstream response that does not alter the root issue of insufficient income. The punishment of these activities, such as ticketing those panhandling, rather adds layers of marginalization, making it more difficult for people to subsequently exit poverty and homelessness.

“Solutions” to panhandling such as this one out of Albuquerque http://www.koat.com/news/311-not-a-247-solution-to-panhandling-problems/34627678 are only band-aids or worse unless they address the root issue of inadequate income.

2) Punished for Basic Functions

People need to go to the bathroom, shower, and be intimate. Those who are without a home often have nowhere else to perform these functions but in the public sphere. This article from New York states it well, “unforgiving policies against low-level violations pushes people into the criminal justice system” http://www.cbc.ca/news/world/new-york-public-urination-debate-tests-broken-windows-theory-of-crime-1.3170821. Citing someone for public nudity or public urination who is trying their best to relieve themselves out of sight, but who has no other option, is nothing other than cruel.

3) Chased Away

The cruelest and most insidious of policies are those that are simply intended to drive away certain people from certain communities. This can be as basic as removing benches from public spaces, to laws that criminalize such things as lying down on a sidewalk (see: Tampa and Honolulu http://thinkprogress.org/economy/2014/07/16/3460553/homeless-criminalization-report/). Fort Lauderdale makes it really awfully obvious what they are going for in making it illegal to have personal possessions on public property. If you want to get really angry, read this article about NYPD police taking pictures of “quality-of-life offenses” like being homeless in public http://nypost.com/2015/08/10/cops-are-taking-pictures-of-bums-and-posting-them-online/.

These particular laws are the most cruel as they are based on nothing other than protecting the public from seeing someone in poverty. There is no harm being committed, and the result is absolutely nothing other than perhaps forcing people to move elsewhere. Unfortunately, this is exactly the goal. It is completely dehumanizing, heartless, and short-sighted.

However, with all that said, I would like to go out on a limb and suggest that I do support some homelessness-related laws that have been deemed by others as anti-homeless.

There has been much discussion about laws around providing food to people experiencing homelessness. This article from Mother Jones subtly highlights that there are differences in laws around public food sharing: http://www.motherjones.com/politics/2014/11/90-year-old-florida-veteran-arrested-feeding-homeless-bans. Some laws are explicit about not providing food to to anyone in any way in public, whereas others stipulate criteria around food sharing safety. Most Canadian cities, with a strong public health system, fall under the latter. I believe that just because people are experiencing homelessness, it does not mean they should be provided with food that does not meet public food safety criteria. Now, I would note that this is said in the Canadian context where we don’t have individuals actually starving to death. My own research has shown that there is actually not a food access issue in London around poverty, but rather a food quality issue (as long as one is not facing mobility issues).

So, I believe that there should be laws against public sharing of food that does not meet food preparation and sharing safety criteria. If people are truly passionate about providing food to those experiencing poverty, then they can follow the simple criteria required to do so safely, or volunteer with an organization already doing so. Ignoring these standards is actually in itself dehumanizing.

I would make the same assertion around housing standards. Whenever there is a crisis in London that leads to people being very publicly de-housed, I see suggestions of solutions like tiny homes, tent cities, or shipping containers. When someone dies in a fire in substandard housing, some say that at least this housing is better than shelters or the street. Again, I believe that this perspective is based on the flawed logic that the housing standards that are good for me are perhaps too good for others. Instead, I believe that we have the resources in Canada to provide safe and adequate housing to all. We DO NOT want to return to the days of the slums and say that this is good enough for us (or for others, as the case may be). Rather, we need the political will to put the resources we have to work in order to provide adequate housing that is: safe, affordable, permanent, supported as needed, and of the individual’s choice.

This leads to the current, and possibly most controversial, concern: urban camping.

2929117132_8de2395d05_bAbbotsford, BC is in the midst of a court case where the B.C./Yukon Association of Drug War Survivors or fighting for the right of people experiencing homelessness to camp in public spaces. In this article http://news.nationalpost.com/full-comment/tim-richter-fights-for-the-right-to-camp-will-harm-more-than-help-homeless-need-a-home-not-a-tent Tim Richter of the Canadian Alliance to End Homelessness captures well the tension of the issue. When it comes to the goal of ending homelessness, meaning helping people find home, a tent meets little to none of the criteria for home. In fact, a tent might be a dangerous, even harmful place for someone to live, even temporarily.

Now, this issue is a little more complex because unlike the food issue, the lack of housing alternatives is more of an immediate crisis with many people having simply no other option in the moment. However, I would again highlight that we should not settle for inadequate because our system is currently poorly funded and/or designed. Rather, we should create a context where no one has to choose urban camping as an option. I don’t believe that we should fine homeless people in the interim, but neither should we surrender to unsafe housing alternatives.

To summarize, I don’t think that we should criminalize people experiencing homelessness for their homelessness. However, I do think we should criminalize low standards that would put people who are homeless at risk. Those experiencing homelessness deserve the same right to safety as those with a home. I suspect that we surrender standards when we lose the vision and belief that we can end homelessness for all.

Quality Housing for All

Oxford StI was asked to give comment regarding a number of residential facilities being re-classed as care homes, which has financial implications for the managers of these facilities. Here are my thoughts:

As Chair of the London Homeless Coalition I was acutely impacted by the fire occurring on Oxford St that claimed the life of David McPherson. David was known to many of our member agencies, as were several of the other 30 residents living in accommodations meant for 12 people. This scenario shed light on a situation of which many of us were aware, but had taken limited action on: That many people exiting homelessness end up living in substandard accommodations. Through the London Housing Advisory Committee we have requested that the City consider these types of accommodations, low income housing aimed to assist persons with disabilities, in their current by-law review.

One of the considerations I often hear is that housing of any kind that is affordable is better than the alternative of street or shelter. With an adult on Ontario Works only receiving $376 per month of shelter, regular market rent housing is obviously out of the picture. This is further complicated in situations where individuals require some degree of support, in the case of Oxford St, some food was provided. From this perspective, additional by-laws and regulations that increase the cost of housing put housing further out of reach. However, it has long been my stance to resist this sort of logic.

It is my fundamental belief that all people who are homeless deserve to have housing that is safe, affordable, supported, quality, and permanent. I highlight the principles of safe and quality. I believe that in a Canadian context we have the resources and the skills to provide people with a minimum standard of housing regardless of their income limitations. Therefore, if standards of safety and quality increase the cost of housing, so to should assistance be increased to cover these costs.

Because of this stance, myself and the Coalition have supported landlord licensing, and support better by-law protection around care homes. We understand that this increases pressures and costs of those managing the homes, but with safety and quality as the priority, I would hope that our community could lobby together to address the increased costs.

I will not support moving people into substandard housing for the expediency of getting them off the street or out of shelter. Similarly, as many individuals who are homeless experience physical, mental, and developmental challenges, I support the rigorous creation and enforcement of high standards of care. To balance this, I would be a willing partner with our fellow community agencies in lobbying for the resources to make these standards realistic for all individuals, regardless of income source.

Our Humanity

A Tim Hortons worker pours water on a sleeping homeless man in the middle of winter.

A London Free Press reader in the comments suggests killing refugees being screened for Ebola.

My students speak of nurses suggesting patients with conditions contracted through intravenous drug use be left to die.

A man murders three neighbours over a parking dispute (and possibly motivated by hate).

How readily we forget how tentative is our own humanity. In de-humanizing others, we surrender our own humanity. I recently read “Beloved” by Toni Morrison. In a story of an escaped slave who murders her daughter rather than having that daughter returned to slavery, I was struck by the true story on which it was based. Margaret Garner was not initially charged with murder of her child as the law that allowed her and her daughter to be taken back into slavery as possessions, prevented a conviction of murder. Yet slavery, in defining African Americans as less than human, made us all inhumane. In the words of Booker T. Washington: “You can’t hold a person down without staying down with them.”

Those experiencing homelessness are fully human, fully valuable, and fully deserve our respect and kindness. Any time we choose to take away from this, we are giving away a portion of our own humanity, value, and right to be respected and treated kindly.


Ontario’s Poverty Reduction Strategy: The Good, the Bad, and the Beautiful

OPRSToday, the Government of Ontario released the 2014-2019 Ontario Poverty Reduction Strategy. This follows up on the 2008-2013 Strategy, which I evaluated here and here. The previous strategy was focused on child poverty, and although the target of a 25% reduction in child poverty in Ontario was not achieved, 47,000 children and their families exited poverty. This new strategy takes a broader view on poverty and begins to address adult poverty as well. Here is my assessment of the strategy:

The Good

  1. The previous strategy was notable for its refined measurement tools and metrics that allowed easy tracking of progress on the strategy. This strategy promises to both do the same, and get even better at it.
  2. The $16M focused funding on supportive housing around mental health and addictions will have real, practical impact.
  3. The $50M Poverty Reduction Fund could be good, although we don’t know local allocation levels or much about how the fund will be accessed and used. Seeing the investment re-announced is good, we await with interest more details.

The Bad

  1. There aren’t actually a whole lot of new resources on the table here. The $42M increase to CHPI was already previously announced, and is great, but still doesn’t fully replace what was lost from CSUMB. The continuation of IAH and the Long-term Affordable Housing Strategy are good, but I consider the continuation of programs to be taken-for-granted in a majority government.
  2. There is no mention of an increase to social assistance rates. This has the most promise of changing the measure of vulnerable populations under the Low Income Measure (LIM). Although it has increased over recent years, or is announced to increase, by $50, this is still short of the SARC recommendation of a $100 increase.

The Beautiful

  1. The Government of Ontario with this Strategy has aligned itself with many Canadian municipalities as well as the Government of Canada in setting a goal of ending homelessness. This goal is possible, and having all orders of government focused on it will be incredibly helpful.
  2. A number of the components in the previous strategy have now been permanently entrenched in the budget process. In particular, child benefits and minimum wage will now inflate automatically on an annual basis. This will mean keeping ahead in the future.

Housing First – Mental Health

At Home Chez SoiHousing First was always in a way designed with people experiencing mental health challenges in mind. This is because the model was originally focused on ending chronic homelessness, and both chronic homelessness and homelessness in general occur most often in the context of mental health challenges. Although statistics vary from study to study, on average 2/3 of people experiencing homelessness also have an active mental health challenge. This rate goes as high as 100% in studies of those considered chronically homeless. There is a bit of a chicken/egg debate to be had about mental illness causing homelessness or homelessness causing mental illness, but regardless, the two are intertwined, and it’s likely a case of both/and. As Housing First was designed by those within the sector, it is grounded in research and practice with those with mental health challenges.

So, it comes as no surprise that both historical and recent research is demonstrating that Housing First works with this sub-population. This is also the sub-population for whom we have the most established best practices to draw upon, which is why I wanted to cover it first in this series.

The At Home/Chez Soi project represents one of the largest and most comprehensive reviews of Housing First programs, and it was focused on 2000 homeless Canadians experiencing mental health challenges. Half of the participants continued to receive the usual mental health and housing services available in their community, while the other half received a variety of targeted Housing First interventions through either Assertive Community Treatment (ACT) or Intensive Case Management (ICM).

The Results

It’s hard to argue with the effectiveness of the program based on the results. “Those who received Housing First were, after two years, stably housed 80 per cent of the time, compared to 54 per cent of those who had treatment as usual.” (1)

screenshot-by-nimbus (16)

Additionally, participants showed a rapid decline in shelter use that persisted over time. This coincided with less hospital use, drop-in centre use, and fewer arrests for drug-related offences. (2)  This equated to significant cost savings for the system as a whole, in particular for the 10% of those with highest service needs: “Over the two-year period following study entry, every $10 invested in Housing First services resulted in an average savings of $21.72.” Most importantly, from a perspective of the individual, those in the intervention experienced both better community functioning and improved quality of life, and were overwhelmingly more positive about their life course.

Best Practices for Housing First for Those with Mental Health Challenges

So here is what we can learn about Housing First for this sub-population of people experiencing homelessness:

  1. Housing First is effective across various demographics such as urban/rural, various ethnocultural communities, medium or large cities, and communities with differing existing services.
  2. Services are an essential component of Housing First, particularly for those experiencing a mental health challenge. These services need to be mobile, community-based, not institutional.
  3. Housing provides the foundation for other changes in peoples’ lives, but we can’t be too demanding that those changes happen too quickly if our programs truly have no requirement for being ‘treatment-ready’.
  4. Although there is some room to flex in terms of congregate living or live-in support is communities demand, this is highly discouraged as the best outcomes were seen with those programs that stayed truest to Housing First principles.
  5. The health care system needs to be at the table, if not the lead, in providing Housing First with this population. Because the supports are essential and include either ACT or ICM, health providers are going to be involved.
  6. Services are best de-linked from housing, in that they follow the individual to wherever they choose to reside, not being attached to just one apartment or building.
  7. Self-determination is essential as it goes hand-in-hand with the recovery-oriented approach of mental health care.

I’ll end with a final graph, that tells strongly of the importance of reconfiguring how our system responds to those with housing needs:

screenshot-by-nimbus (17)

Housing First Series

In my previous post I started to unpack some of the intricacies of housing first. What I hope this highlighted was that although housing first is an overall effective model, there is still some work to do in terms of refining what it means for sub-populations of people experiencing homelessness. So, over the next several weeks I want to start to unpack what we know and what we don’t know about Housing First for the following populations:

  1. Those with mental health challenges;
  2. Youth;
  3. The chronically homeless;
  4. Those with addictions;
  5. Aboriginal peoples;
  6. Older adults;
  7. Those leaving the justice system;
  8. Families;
  9. Women.

I have purposely ordered these in terms of those populations where we have the most work to guide us to date, to those where we have the least. In each post I will explore what we already know in terms of best practices for housing first, and what we need to know more about.

Housing First

Cell Phones for the Homeless?

This very well written, thoughtful, and detailed article on Mashable about homelessness and connectivity is well worth the read. It makes a number of valuable points about homelessness and smart phone connectivity with which I agree:

  1. Experiences of homelessness are often quite complexed, with housing status and where one is sleeping changing from night to night, defying simple definitions of what it means to be homeless.
  2. Phones can be tools by which people access resources to improve their status.
  3. The public can be uncomfortable with a homeless person having a phone, which is still considered a luxury by many.
  4. Having a phone can help one feel ‘normal’.
  5. One can still have a strong sense of self in spite of currently being unhoused.

This article raises the question for those of us who work in the sector of whether providing smart phones is indeed the intervention to help end homelessness? We sought to answer this question in a study of 212 individuals currently experiencing homelessness.

Here’s an interesting graph to start, that helps frame the discussion of why I am actually not holding much hope for this is an intervention:

Internet Use

1) The first thing that we noted is that there is a drastic divide between users and non-users of the internet. The majority either use it daily or not at all, with far fewer being intermittent users.

2) The second thing we heard is that for those who want access, getting it isn’t that difficult. Whether it’s free wifi downtown, in coffee shops, or at agencies, or computer access within agencies, or the most common, computer access in public libraries, people are able to get online when they want to. The only significant barrier to this was those living in social housing with physical limitations.

3) The third thing we heard is that in terms of accessing services, there is always an in-person alternative. So social agencies aren’t setting up programs that are only available online, you can always go and see a worker for assistance.

4) The fourth thing we heard is that internet access can actually make things worse for some individuals. In particular, youth talked about negative social capital, the fact that their social networks often were a detriment to their well-being, rather than helped them do better. All that internet access provided was more frequent and thorough access to this negative social capital. Youth talked about deleting their social media accounts as part of a process of exiting the street.

5) Our overall finding was that there was no statistically significant causal relationship between accessing the internet more and doing better physically, mentally, or socially. This means that although for some individuals, like the man in the story, their cell phone is their lifeline, giving all people experiencing homelessness cell phones and data plans might not be the best use of resources for ending homelessness.

7 Tough Questions for Housing First

London-20111028-00029Housing First has now been lauded far and wide as the most effective solution to homelessness in developed nations. This model focuses on rapidly moving people into independent and permanent housing regardless of where they are in their own personal journey. This in contrast with past models that required people to be at a certain phase of recovery, be accessing treatment for mental health challenges, or move through a step-wise process of increased independence. Research has now demonstrated that the best outcomes are grounded in access to housing. However, there are a number of tough questions that have been raised in this model that I would like to address in this post.

1) Does Housing First put women second?

Last year ‘Homes 4 Women’ released a critical white paper titled “Housing First, Women Second?” The paper highlights the lack of a gendered approach taken at the national level of implementing Housing First priority for project funding. With this there is a risk that best practices around women’s homelessness, particularly that take into consideration the ubiquitousness of violence in women’s experiences, will be lost. We know that women’s and men’s experiences are not the same, and this paper highlights important differences such as the more hidden nature of women’s chronic homelessness.

So does Housing First put women second? I would suggest that only if we let it. The core principal of housing as the most important foundation for ending homelessness holds true across gender lines. However, where this will play out is within program implementation. The needs of women will be secondary if the programs themselves do not include the decades worth of best practices already developed. It is important to note that Housing First is inclusive of different types of housing, with the concept of ‘independent’ living being more fluidly defined. Secondly, it is housing with support, and these supports can vary as well. Therefore, Housing First won’t inherently put the unique needs of homeless women second as long as we continue to bring those needs to the forefront.

2) Isn’t independent housing dangerous for women recently leaving a violent partner?

This question builds closely on the previous one of women’s needs. If all Housing First programs mean a rapid move to a single, private residence, this will indeed put women leaving violence at risk. There are high rates of ex-partners finding women who have left violence, which makes the safety planning that comes with congregate living much more effective. However, Professor Stephen Gaetz highlights that there is no need to abandon transitional models that have proven effective with certain sub-populations, such as women. Indeed, researchers and leaders in the women’s movement note the lack of “Third Stage” housing, which is essentially permanent housing with supports. A Housing First model would mean maintaining second stage housing where effective, but not forgetting that third stage housing is the ultimate goal. Again, this comes down to a matter of proper implementation.

3) Why are there so many deaths in Housing First programs?

I am part of a research team evaluating the health outcomes of the first group of individuals enrolled into London CAReS. All of these individuals are those identified as chronically homeless, and the vast majority have experienced chronic addiction. In this case, when I speak of chronic addiction, I mean persistent and high use of substances, including mouth-wash addiction and significant IV drug use. We have seen a noticeable number of deaths of participants enrolled in the program. This has also been noted by workers in the sector, and raised some questions about Housing First programs in general and risk to participants.

Some of the deaths seen are those that would already be anticipated with this particular sub-population of significant substance users. However, I would hypothesize that there is another phenomenon at play as well. Many of these individuals overdose on a consistent basis during their homelessness, but this occurs in the context of an agency where other residents or staff are present. They are then taken to hospital and revived. Moving an individual who continues to use high levels of substances into a more independent living arrangement puts them at higher risk of overdosing undetected. The difficult bind is that this independent living, permanent affordable housing, is the desire of the individual. Therefore, we don’t want to deny them that, we absolutely don’t want to force people to stay in shelter long-term, but we also have to be aware of, and make the resident aware of, the risk that comes with using substances privately.

4) Isn’t the Foyer Model a better one for homeless youth?

The Foyer Model of transitional housing for homeless youth is popular in Europe, and has seen some implementation in Canada. In essence, this model is a more long-term model of transitional housing, rejecting the common 364 day limitation, that incorporates wrap-around services inclusive of education, employment, and life skills development. Arguing the Foyer Model against Housing First is where we get into the semantics of these models. If the Foyer Model is implemented with no move out date, then it is indeed permanent, independent, affordable housing with supports; it’s just a particular degree of support. If a move out date, for example 3 years, is indeed enforced, then a conversation needs to be had about rethinking programs and services to entail truly permanent housing. However, this doesn’t mean we through out the great best practices that have been developed in Europe, but rather we can work to integrate them with Housing First.

5) Sure Housing First is great, but what if there is no housing?

To either divert people from shelter or rapidly move them out of shelter requires affordable housing on hand. In communities across Ontario we face 2-20 year wait lists for social housing, and many communities have vacancy rates below 2%, disincentivizing the market to add more such housing. However, local examples show that there are innovative ways to increasing the housing stock. The first way is to take advantage of private sector housing in communities where vacancy rates mean rentals are available. In London this means a rent subsidy of approximately $200 to move an individual from the OW housing allowance of approximately $375 to $575, which puts them into average market rent. Although this investment in housing means no capital increase for the Housing Division that you would get from a new build, the $200 cost is far less than the municipality pays to keep an indvidual in shelter (approx. $1230 per month).

A second way to look at increasing affordable housing stock is innovative ways to boost the overall available stock through new builds. Also in London right now we are in the process of developing a Housing Development Corporation (HDC). This HDC will increase projected new affordable housing units from 450 to 1000 over next 10 years, without necessarily requiring further municipal investment. This is done by leveraging funding across all government levels hand-in-hand with both charitable and investment funds from the private sector. This is a sign that ambitious targets for new affordable housing are obtainable while still investing in immediate short-term solutions, such as rent supplements.

6) Can individuals with chronic addictions really stay permanently housed?

When London CAReS started enrolling the most chronically homeless in our community for permanent, independent housing, many within the sector were sceptical to say the least. These were individuals that they had tried to re-house many times, but had seen them cycle back time and again to shelter. How could London CAReS do any better? Well, time has been the test, and the majority of individuals rostered with CAReS have maintained their housing against the odds. This is proving that those with chronic addictions can remain housed, but is requires the right supports. In this case the right supports includes intensive case management, one worker per ten participants, which is costly in terms of operations, but pays big dividends across both health and social systems, and of course in terms of outcomes for the individual. Anyone who wants to be housed can be housed. (And research of 200 homeless individuals with mental health challenges in London showed that 100% desired housing.)

7) How come individuals in Housing First programs still access high levels of other services?

In anticipating the benefits of Housing First, there is a predicted decrease in use of health, social, emergency, and corrections services. The decreases have been seen in health, emergency, and corrections services, but individuals enrolled in Housing First programs still frequently use high levels of social services. For example, they may still access drop-in services and food programs on a daily basis. This continues to strain limited resources in the social service sector, but is not necessarily a bad thing. Recall that Housing First means housing with supports. What is happening here is individuals are defining what their supports are, and these are most often the services they are familiar with through their period of homelessness. If these services are working for the individual, then they are still of great value.

However, ultimately the goal would be that people would integrate into communities. In my mind this is the current fore-front of work on ending homelessness. We have been able to move people from shelter into housing, and keep them housed, but we have seen limited results in terms of then integrating people socially, and recreationally. Although having a social network of other street-involved individuals is better than an alternative of social isolation, best long-term outcomes are seen when people have a sense of belonging where they live, and have more diverse social networks. So until we are better at helping people integrate socially, we should continue to anticipate (and allow) high use of homeless services by people who are now housed.