Background and History
What Is Housing-First?
How Does Housing-First Differ From Traditional
Approaches?
Housing-first is an approach to homelessness that offers unconditional and stable housing as quickly as possible to individuals experiencing homelessness. Other supports are then offered afterwards. The philosophy is that individuals are better able to improve their situation, regardless of what that situation may be, if they are housed. Thus, individuals with addiction and/or mental health issues are better able to utilize available supports once housing is in place. Housing first asserts that housing is a human right, and a prerequisite for recovery (Aubry, T., et al., 2019; Gaetz, S. et al., 2013; Nelson, G. & Aubry, T., 2021).
A Brief History Of Housing-First In Canada
Housing-first is quite different from more traditional approaches to addressing homelessness, which typically offer support first, with housing possibly being made available at the end of the recovery process. In these models, individuals are often expected to address mental health or addiction concerns prior to receiving housing. Usually, this involves placing individuals experiencing homelessness in emergency services, and they are then transitioned to supportive living housing. Here, they may be able to access services for things like mental health or addictions, until they are deemed ready for to live independently. Only then may they have access to housing, if and when it becomes available (Aubry, T., et al., 2019; Gaetz, S. et al., 2013; Nelson, G. & Aubry, T., 2021).
In the 1980s, the number of people experiencing homelessness increased exponentially, due to a number of factors, such as reduced governmental spending on social housing. In the 1990s, the Canadian government provided 61 communities across Canada with funding to address homelessness. Spending was left to the discretion of the communities and was used for things like shelters, transitional programs, and street outreach. These approaches, however, did not end homelessness.
In 2008, funding ($110 000 000) was provided by the Canadian government for a housing-first project called At Home/Chez Soi. At Home/Chez Soi was trialed in five cities in Canada (Vancouver, Winnipeg, Toronto, Montreal, and Moncton), with over 2000 participants. The program was based upon housing first initiatives in the United States. There were two main premises. Firstly, clients were not to spend more than 30% of the income on rent, and thus participants were provided with rental supplements. Secondly, community-based supports were to be provided. Assertive Community Treatment (ACT) or Intensive Case Management (ICM) models were to be used, depending on need. Individuals with moderate need received housing-first with ICM, and those with high needs received housing-first with ACT.
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Two years after the program began, in 2010, 73% of housing-first participants had stable housing, compared to 32% of individuals who received traditional support.
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A literature review from 2012 regarding housing-first efficacy indicated the following positive outcomes from 66 peer-reviewed studies: “housing stability, satisfaction, choice versus coercion, changes in mental and physical health, issues of sobriety, reduced substance use and harm reduction, cost effectiveness, and quality of life” (Wagemakers-Schiff & Rook, 2012, p. 9). They further noted: "We can safely conclude that HF has been shown to be effective in housing and maintaining housing for single adults with mental illness and substance use issues in urban locations where there is ample rental housing stock (Wagemakers-Schiff & Rook, 2012, p. 17-18).
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In 2015, revisions were made to the federal government’s funding policy, such that 65% of funding for homelessness was allocated to housing-first approaches, for Canada’s 10 biggest cities. Forty per cent of funding for smaller communities was to be used for housing-first approaches.
Financially, in 2016, costs associated with housing-first approaches were about $20,000/year per participant, with an extra $14,500 for ICM-related fees. The return on investment was considered to be good, with marked reductions in healthcare, social services, and justice-related spending.
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In 2017, mandatory usage of federal funding to be used for housing-first was dropped, with Canada’s National Housing Strategy. Since then, individuals experiencing homelessness are less likely to live in stable housing, with an increase in those living in tent encampments, tiny homes, and congregate environments. This is despite the evidence for housing-first approaches, and the lack of evidence for positive outcomes regarding other approaches (Aubry, T., et al., 2019; Gaetz, S. et al., 2013; Nelson, G. & Aubry, T., 2021; Waegemakers Schiff, J., & Rook, J., 2012).