What Is The Issue?
Despite our social security system, homelessness is a serious problem in Canada. An estimated 150,000 to 300,000 people are homeless across the country, costing Canadians $1.4 billion each year in healthcare, justice and social services costs. While many factors can lead to homelessness, mental health plays a significant role—an estimated 25 to 50 per cent of homeless people live with a mental health disorder. Solving this social crisis will require new ways of helping these critically vulnerable Canadians.
We know that the social determinants of health often make the difference between being able to live healthy, productive lives and being chronically ill and disadvantaged. Decent affordable housing is one of the essential building blocks for health and wellbeing. Without it, we all are more likely to become or stay ill and our efforts to take care of ourselves and our families can be seriously hampered.
Recovery begins with a place to call home
For people living with mental illness who are homeless, recovery can’t happen without adequate housing. Not only do people experiencing homelessness face significant physical health risks—homelessness can reduce a person's life expectancy by 20 years—existing mental health problems can also be exacerbated. Without a home to provide an element of stability and control—a safe place to call their own—facing the daily challenges of life is nearly impossible.
Shifting the mental health and housing paradigm
The provision of housing has traditionally come after a person has achieved a certain level of recovery. That is, housing was not provided until the person could demonstrate certain life skills often tied to treatment, such as sobriety. Moreover, the housing provided to individuals meeting these conditions is not the kind most people would choose as it is often of low quality and concentrated in a small number of neighbourhoods.
A 'housing first' approach represents a shift in the traditional paradigm—and is showing significant promise in helping people who are homeless and living with mental health issues. Programs using this approach provide housing to the people who need it most, and then provide them with the treatments and supports of their choosing. The housing first orientation to recovery is beginning to be applied in some jurisdictions and has yielded positive results thus far—but more such programs are needed.
What Are We Doing?
The MHCC’s Mental Health Strategy for Canada recommends increased access to housing for people living with mental health problems—and specifically, the expansion of programs that take a 'housing first' approach to homelessness.
Supportive housing is also a critical component of a high-performing mental health system and the former Service Systems Advisory Committee therefore completed work in this area.
Assessing the need for housing
Looking at the housing needs of Canadians living with mental health disorders, the past Service Systems Advisory Committee produced Turning the Key: Assessing Housing and Related Supports for Persons Living with Mental Health Problems and Illnesses. This report found that as many as 520,700 people living with mental illness are inadequately housed, including up to 119,800 who are homeless. Only 25,000 supportive housing units are currently available across Canada; the Turning the Key report recommends the development of 100,000 housing units over the next decade.
Implementing a housing first approach
Launched in November 2009 and ending in March 2013, the At Home/Chez Soi project is actively addressing the housing need by offering ‘housing first’ programs to people with mental illness who are experiencing homelessness in five cities: Vancouver, Winnipeg, Toronto, Montreal and Moncton. This project aims to provide evidence on what services could best help people who are homeless and living with mental health problems. In total, At Home/Chez Soi has provided more than 1,000 Canadians with housing; early findings reports were released in April 2011, January 2012 and Fall 2012. An interim report was also released in the fall of 2012 detailing one year findings.
Shedding light on homelessness and mental health
Working with the MHCC, the National Film Board has produced Here at Home, a web documentary following the lives of At Home/Chez Soi participants—giving voice to Canadians who have experienced homelessness while highlighting the initiative’s challenges and successes.
Meanwhile, the Focusing the Frame pilot program supplied participants of Winnipeg’s At Home/Chez Soi project with a camera and photography lessons to help share their experiences. Many of the pictures taken were displayed at an art exhibition in 2012.
What We've Learned
Mental illness does not inherently lead to homelessness—the issue is more a matter of affordable and available housing. The fact is that people with mental health problems who have experienced homelessness can maintain housing with recovery oriented supports.. In addition, providing housing and related supports is actually a more cost-effective way to help many people living with mental illness who are homeless.
Housing is a worthwhile investment
There is promising evidence that the 'housing first' model can reduce homelessness and help people recover from mental health problems. In March 2011, homelessness decreased in Vancouver, with the MHCC’s At Home/Chez Soi project cited as one of the reasons. In Calgary, a homeless shelter announced it was closing beds because of reduced demand—an outcome attributed to that city’s investments in a housing first program.
The success of At Home/Chez Soi and the housing first approach has also attracted international attention, with the program being replicated in France and ongoing interest from other countries.
Supportive housing programs can also reduce the costs associated with healthcare and the justice system. One study found that investing in supportive housing costs $13,000 to $18,000 per year; in comparison, traditional institutional responses like prisons and psychiatric hospitals cost $66,000 to $120,000 per year.
More than just a house
Through the provision of quality housing and recovery-oriented services, people see improvements in other areas of their lives. With a focus on social change and building supportive communities, housing first programs allow people to work on their goals, whether it’s reconnecting with family, accessing treatment or returning to work or school.