What Is The Issue?
Vancouver’s Downtown Eastside is well known for its chronic homelessness and widespread substance use. Yet while this neighbourhood appears to characterize Vancouver’s homelessness problem, it does not represent the true scope of the issue. Homelessness in Vancouver extends well beyond the Downtown Eastside—and in many cases, people who are considered homeless actually spend as little as five per cent of their time on the streets, instead cycling through various institutions that are often not able to adequately meet their mental health needs.
What Are We Doing?
Through referral sources that included emergency shelters and street outreach programs, the Vancouver At Home/Chez Soi project recruited nearly 500 participants. Although the project did not specifically target people with concurrent disorders (i.e., having both mental health and substance abuse issues), the majority of participants were found to be dependent on drugs or alcohol, and nearly a quarter were using drugs on a daily basis.
Leveraging multiple models of housing support
Implementing a Housing First strategy in Vancouver required a significant focus on chronic homelessness and concurrent disorders. However, the project also needed to include those who have less complex needs but are trapped in a cycle of intermittent stays in substandard housing, shelters, hospitals and correctional facilities—all of which provide little in the way of mental health services and supports.
To best serve this population, the Vancouver team took a two-tiered approach. Under the “dispersed housing” model, participants were provided with access to housing across 22 neighbourhoods throughout the city and were supported by either an Assertive Community Treatment team through RainCity Housing (for people with more complex needs) or an Intensive Case Management team through the Coast Foundation Society (for people with moderate needs). Housing was supported through the housing team at MPA Society. Another group of people were provided housing and support through the “congregate site” model by the Portland Hotel Society. Housed at a single site at the Bosman Hotel, these people were given access to a range of on-site mental health and addictions services to meet their needs. The research team at Simon Fraser University and the University of British Columbia led the research to explore the impacts of homelessness on participants from both the “dispersed housing” model and at the “congregate site” model.
Collaborating with community partners
The Vancouver At Home/Chez Soi project worked extensively with community partners to share knowledge and ensure the initiative’s success. These partners include Vancouver Coastal Health, the City of Vancouver, the Vancouver Police Department, universities, not-for-profit organizations and provincial government departments
Spreading the word on Housing First
Both a skill-building tool and a way to raise awareness of the Housing First approach, the At Home/Chez Soi Vancouver Speakers Bureau gave study participants the opportunity to openly discuss their experiences of homelessness and the impact Housing First has had on their lives. The Speakers Bureau now includes 13 core members who have participated in more than 30 speaking engagements throughout Vancouver, sharing their stories and fighting the stigma surrounding homelessness and mental health.
Similarly, the National Film Board’s Here at Home, a web documentary following the lives of At Home/Chez Soi participants, has brought to life the stories and experiences of Vancouver’s homeless population in a powerful way.
What We've Learned
Participants who received housing and support had fewer emergency hospital visits and were convicted of offences less often than participants who did not receive the same level of support. Perhaps more importantly, they also reported a renewed sense of belonging in the communities they now call home.
People with complex needs experiencing homelessness—particularly those with concurrent mental health and substance use issues—have traditionally been unable to consistently access the type of care that is vital for recovery. Vancouver’s At Home/Chez Soi study has shown that a Housing First approach can significantly improve the lives of the city’s homeless population, including those living in the Downtown Eastside. Final findings of the Vancouver site present a strong case that people can maintain housing and reach other important goals with the right support.