In 2008, the Government of Canada allocated $110 million to the MHCC to undertake a research demonstration project on mental health and homelessness. The result? At Home/Chez Soi, a four-year project in five cities that aimed to provide practical, meaningful support to Canadians experiencing homelessness and mental health problems.
In doing so, the MHCC is demonstrating, evaluating and sharing knowledge about the effectiveness of the "housing first" approach, where people are provided with a place to live and then offered recovery-oriented services and supports that best meet their individual needs.
A cross-Canada approach
Officially launched in 2009 and with the research officially ending in March 2013, At Home/Chez Soi seeks to determine whether the housing first approach works—and, if so, for whom and at what cost. To gather the most comprehensive data, projects were established in five cities, each with a particular area of focus:
- Vancouver (people also experiencing problematic substance use)
- Winnipeg (urban Aboriginal population)
- Toronto (ethno-racialized populations, including new immigrants who do not speak English)
- Montréal (includes a vocational study)
- Moncton (services in smaller communities)
Meeting objectives, conducting research, sharing findings
Since the end of the recruitment phase in June 2011, At Home/Chez Soi has provided housing to more than 1,000 homeless Canadians. And to make a more meaningful contribution to the evidence being collected, researchers have also been gathering input from a control group of 900+ participants who are not receiving At Home/Chez Soi support but are accessing the usual services available in their communities.
Published in January 2012, Early Findings Report, Volume 2 includes a number of statistics about the study population. For example, in addition to living with a mental illness, more than 90 per cent of participants have at least one chronic physical health problem, ranging from back pain to hepatitis.
The Early Findings Report, Volume 3, published in late 2012, shows that housing is only the first step and once people have secure, quality housing it is often a catalyst for people to achieve other goals. “Housing First” improves the lives of people with histories of homelessness and mental health issues, and also has a positive impact on service systems and communities.
In addition, the At Home/Chez Soi Interim Report released in September 2012 showed that “Housing First” makes better use of public dollars—especially for those who are high service users. To solve chronic homelessness, a cross-ministry approach that combines health, housing, social services with non-profit and private sector partners is required, and implies new relationships and new ways of working together.
Released in April 2014, the National At Home/Chez Soi Final Report demonstrates that Housing First works to rapidly end homelessness for people experiencing mental illness, and can be effectively implemented in cities of different size and different cultural contexts. It also proves that Housing First is a sound investment, with every $10 invested in Housing First services resulting in an average savings of $9.60 for participants with high needs and $3.42 for participants with moderate needs.
The MHCC website will be the central vehicle for the dissemination of research reports and summaries, withdditional reports related to cost effectiveness, Housing First implementation findings, qualitative analysis and other topics to be released in the next 24 months.
Another effective way to share information about participants in the project has been through the telling of stories. At Home/Chez Soi participants have generously shared their life stories—including their successes and failures—with both mainstream media and with members of the National Film Board of Canada (NFB). Through a partnership between the NFB and the MHCC, it is possible to watch a video documentary called ‘Here At Home’, which includes individual stories and thoughts from participants and project staff.
Involving people with lived experience
Key to the successful implementation of participant choice and self-determination in all aspects of the program has been peer involvement, that is, involvement by people with lived experience in homelessness and/or mental illness. From 2009-2012, the National Consumer Panel (NCP) provided a national perspective on behalf of people with such lived experience. NCP members provided significant input in the development of some of the project’s documents and procedures, as well as proactive guidance to optimize the use of peer knowledge within the project. For example, a Discussion Paper on Stigma and Discrimination was produced.
In addition, the Peer Support Communities of Practice that developed over the course of the project, comprised of peer support representatives from each of the sites, was another national mechanism for peer engagement. The Communities of Practice developed a Peer Support Discipline Summary as an important step to defining peer support and synthesizing their collective experience and reflections.