Housing First

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Housing First is a policy that offers unconditional, permanent housing as quickly as possible to homeless people, and other supportive services afterward. It was first discussed in the 1990s, and in the following decades became government policy in certain locations within the Western world. [1] There is a substantial base of evidence showing that Housing First is both an effective solution to homelessness and a form of cost savings, as it also reduces the use of public services like hospitals, jails, and emergency shelters. [2] Cities like Helsinki and Vienna in Europe have seen dramatic reductions in homelessness due to the adaptation of Housing First policies, [3] [4] as have the North American cities Columbus, Ohio, Salt Lake City, Utah, and Medicine Hat, Alberta. [5] [6] [7] [8] [9] [10]

Contents

Housing First is an alternative to a system of emergency shelter/transitional housing progressions. Rather than moving homeless individuals through different "levels" of housing, whereby each level moves them closer to "independent housing" (for example: from the streets to a public shelter, and from a public shelter to a transitional housing program, and from there to their own apartment or house in the community), Housing First moves the homeless individual or household immediately from the streets or homeless shelters into their own accommodation.

Housing First approaches are based on the concept that a homeless individual or household's first and primary need is to obtain stable housing, and that other issues that may affect the household can and should be addressed once housing is obtained. In contrast, many other programs operate from a model of "housing readiness" — that is, that an individual or household must address other issues that may have led to the episode of homelessness prior to entering housing.

The Housing First strategy is a comprehensive solution incorporating support for homeless people in all aspects of their personal and social life. It does not intend to provide housing for the people in need and forget about them. [11] [12] [13] [14] The Housing First philosophy is a paradigm shift, where quick provision of stable accommodations is a precondition for any other treatment to reduce homelessness. Meanwhile, this approach relies on layers of collaborative support networks that promote stability and eliminate factors that cause or prolong homelessness. The support system addresses issues such as healthcare, education, family, children, employment, and social welfare. [15] [16]

General principles

Housing First is an approach that offers permanent, affordable housing as quickly as possible for individuals and families experiencing homelessness, and then provides the supportive services and connections to the community-based supports people need to keep their housing and avoid returning to homelessness. [17]

History

Temporary housing for those evicted from their apartments in Sornainen, Helsinki, Finland in 1924 Sornaisten rantatie 31 - Helsinki 1924 - N31881 - hkm.HKMS000005-km003otk.jpg
Temporary housing for those evicted from their apartments in Sörnäinen, Helsinki, Finland in 1924

In the late 19th century, Don Bosco pioneered both the concept that would later become known as Housing First in Italy[ citation needed ] as well as pioneering the concept that would provide Dorothy Day the basis for her Catholic Worker Movement House of Hospitality founded in 1933. Bosco himself was inspired by and created a need society based on the teachings of St. Francis de Sales, a 16th and 17th century clergyman who was also at the forefront of early movements insisting that basic needs of the people be met first without various rules and regulations.[ citation needed ][ improper synthesis? ]

The formal Housing First Model has its origins in "Supported Housing" implemented in North America during the 1990s. For many years, the conventional action taken in regard to people experiencing homelessness was that of psychiatric hospitalization, where doctors considered individuals diagnosed with severe mental illness incapable of functioning in all areas of life and that they required around-the-clock supervision and support. This also reflected the idea prevalent at the time that all or a vast majority of people experiencing homelessness were suffering from mental illnesses. However, by the 1980s, experts began to raise questions regarding the underlying assumptions of this approach. [18]

In response, a "staircase" approach began to be utilized. The staircase approach for people experiencing homelessness had three goals: training people to live in their own homes after being on the streets or in and out of hospitals; making sure someone was receiving treatment and medication for any ongoing mental health problems; and making sure someone was not involved in behavior that might put their health, well-being, and housing stability at risk, particularly that they were not utilizing drugs or alcohol. Housing was seen as the end goal of the program. [19]

This model had several flaws. Those served by the staircase model often became "stuck" in staircase services, because they could not always manage to complete all the tasks necessary to proceed. Participants were often evicted from housing due to failure to abstain from drugs and alcohol and refusing to undergo psychiatric treatment. Programs also had high levels of standards beyond those expected from a "typical citizen" - participants were expected to be the "perfect citizen" in order to continue. [20]

Supported housing services developed as an alternative to staircase services for psychiatric patients. In contrast to the staircase approach, former psychiatric patients were very quickly provided with ordinary housing and received flexible help and treatment from mobile support teams. Support was provided for as long as was needed. Importantly, supportive housing did not require individuals to abstain from drugs or alcohol and providers did not expect full engagement with treatment as a condition for being housed.

Building on the supported housing model, but applied to people experiencing homelessness, Housing First was developed by Dr. Sam Tsemberis, a faculty member of the Department of Psychiatry of the New York University School of Medicine. [21] Housing was provided ‘first' rather than, as in the staircase model, ‘last'. Housing First offered rapid access to a settled home in the community, combined with mobile support services that visited people in their own homes. There was no requirement to stop drinking or using drugs and no requirement to accept treatment in return for housing. Housing was not removed from someone if their drug or alcohol use did not stop, or if they refused to comply with treatment. If a person's behavior or support needs resulted in a loss of housing, Housing First would help them find another place to live and then continue to support them for as long as was needed. Dr. Tsemberis founded Pathways to Housing in New York City in 1992 to implement this model.

Research conducted in the late 1990s by pioneering American social researcher Dennis P. Culhane and others demonstrated that the housing first model was more effective at ending long-term homelessness than previous models of care. [22] The systemic use of comparative research demonstrated the model's effectiveness. [23]

Definition

Housing First for the chronically homeless is premised on the notion that housing is a basic human right, and so should not be denied to anyone, even if they are abusing alcohol or other substances. The Housing First model, thus, is philosophically in contrast to models that require the homeless to abjure substance-abuse and seek treatment in exchange for housing. [24]

Housing First, when supported by the United States Department of Housing and Urban Development, does not only provide housing. The model, used by nonprofit agencies throughout America, also provides wraparound case management services to the tenants. This case management provides stability for homeless individuals, which increases their success. It allows for accountability and promotes self-sufficiency. The housing provided through government supported Housing First programs is permanent and "affordable," meaning that tenants pay 30% of their income towards rent. Housing First, as pioneered by Pathways to Housing, targets individuals with disabilities. [25] This housing is supported through two HUD programs. They are the Supportive Housing Program and the Shelter Plus Care Program. [26]

Execution

The Housing First Model is executed through either a scattered-site or project-based implementation. A scattered-site Housing First program is a model in which residents are offered the opportunity of being housed in individual housing units throughout a community. [27] [28] This model integrates participants in a community as opposed to assembling multiple or all participants in one project or location. [29] In a project-based Housing First implementation, residents are offered units within a single housing project or site. This model congregates multiple or all participants in one locality. [30] In both the scattered-site and project-based Housing First programs, residents are given access to a wide variety of supportive health and rehabilitation services which they have the option, although not mandatory, to participate in and receive treatment. [25]

Weekly staff visits as well as a normal lease agreement are also a part of the program. Consumers have to pay 30 percent of their income every month as rent. [31] Rather than have a homeless person remain in an emergency homeless shelter, it was thought to be better to quickly get the person permanent housing of some sort and the necessary support services to sustain a new home. But there are many complications that must be dealt with to make such an initiative work successfully in the middle to long term. [32] [33]

Evidence and outcome

Australia

Some housing projects have been shown to produce similar results to the US Housing First model in terms of strong housing outcomes and reductions in intensity and frequency of service use relative to pre-intervention levels. [34]

Canada

In its Economic Action Plan 2013, the Federal Government of Canada proposed $119 million annually from March 2014 until March 2019—with $600 million in new funding—to renew its Homelessness Partnering Strategy (HPS). In dealing with homelessness in Canada, the focus is on the Housing First model. Thus, private or public organizations across Canada are eligible to receive HPS subsidies to implement Housing First programs. [35] In 2008, the Federal Government of Canada funded a five-year demonstration program, the At Home/Chez Soi project, aimed at providing evidence about what services and systems best help people experiencing serious mental illness and homelessness. Launched in November 2009 and ending in March 2013, the At Home/Chez Soi project was actively addressing the housing need by offering Housing First programs to people with mental illness who were experiencing homelessness in five cities: Vancouver, Winnipeg, Toronto, Montréal and Moncton. In total, At Home/Chez Soi has provided more than 1,000 Canadians with housing. [36]

Sue Fortune, Director of Alex Pathways to Housing in Calgary in her 2013 presentation entitled "Canadian Adaptations using Housing First: A Canadian Perspective" argued that less than 1% of existing clients return to shelters or rough sleeping; clients spend 76% fewer days in jail; clients have 35% decline in police interactions. [37] Fortune reported that the Housing First approach resulted in a 66 percent decline in days hospitalized (from one year prior to intake compared to one year in the program), a 38 percent decline in times in emergency room, a 41 percent decline in EMS events, a 79 percent decline in days in jail and a 30 percent decline in police interactions. [37]

Pathways to Housing Canada describes the Housing First as a "client-driven strategy that provides immediate access to an apartment without requiring initial participation in psychiatric treatment or treatment for sobriety." [37]

Following the development of several Housing First programs through the Home/Chez Soi research project, an initiative to provide Housing First training and technical assistance was created and has been shown to be useful in developing high fidelity programs. [38]

When comparing the effects of Housing First on homeless adults with lower or borderline intellectual functioning to homeless adults with normal intellectual functioning it has been shown that there is no significant difference. [39]

Czech Republic

In Czech Republic the first pilot Housing First project started in May 2016. 50 families were taken into municipal flats in Brno. NGO IQ Roma Servis supported them for next two years. More than 80% of the families were able to sustain in the flats. This project won SozialMarie - international prize for the best social innovation project. [40]

In 2017 another project started in Brno. This time the target people group was long term homeless singles and the project is run by the municipality. The program supports 65 tenants in municipal flats. [41]

In 2019 Czech government and EU supported 13 new Housing First projects across the country by European Social Fund. [42]

Denmark

In Denmark, Housing First is embedded in the national Homeless Strategy as the overall strategy. However, it has been shown that this intervention strategy is serving only a small number of people recorded to be homeless which is most likely due to barriers like shortage of affordable housing. [43]

Finland

The Kenttatie homeless shelter and a service center in Myllytulli, Oulu Nahkatehtaankatu 7 Oulu 20151212.JPG
The Kenttätie homeless shelter and a service center in Myllytulli, Oulu

In 2007 the centre-right government of Matti Vanhanen began a special program of four wise men to eliminate homelessness in Finland by 2015. [44] [45]

The programme to reduce long-term homelessness targets just some homeless people. Assessed on the basis of social, health and financial circumstances, this is the hard core of homelessness. The programme to reduce long-term homelessness focuses on the 10 biggest urban growth centres, where most of the homeless are to be found. The main priority, however, is the Helsinki Metropolitan Area, and especially Helsinki itself, where long-term homelessness is concentrated.

The programme is structured around the housing first principle. Solutions to social and health problems cannot be a condition for organising accommodation: on the contrary, accommodation is a requirement which also allows other problems of people who have been homeless to be solved. Having somewhere to live makes it possible to strengthen life management skills and is conducive to purposeful activity.

Because of all the reasons there are for long-term homelessness, if it is to be cut there need to be simultaneous measures at different levels, i.e. universal housing and social policy measures, the prevention of homelessness and targeted action to reduce long-term homelessness.

The programme's objectives are:[ needs update ]

Analysis of Housing First in Tampere, Finland found that it saved 250,000 in one year. [46]

A study of Finland's Housing First program found that giving a homeless person a home and support resulted in cost savings of at least 15,000 per person per year, with potentially even higher cost savings in the long term. [47]

France

The French government launched a Housing First-like program in 2010 in four major cities — Toulouse, Marseille, Lille and Paris — called "Un chez-Soi d'abord", focused on homeless people with mental illness or addictions. The plan is on a three-year basis for each individual, living in accommodation provided by an NGO. [48] Clients are given help with social issues and medical care. The first houses have been working in three cities since 2011 and a hundred apartments were planned in Paris starting in May 2012. [49] [ needs update ] Several NGOs provide rental management and social support for tenants. [50] Those NGOs are linked with scientists investigating the results. The lead team of "Un chez-soi d'abord" is expecting results to be published around 2017. [51] [ needs update ]

Japan

Though homeless support groups like non-profit organization Moyai, Bigissue, Médecins du Monde Japan have requested Housing First, Japanese government does not have a Housing First program yet. Traditionally, the government offers public housing (so-called Koei-jutaku) for low-income people by public housing law, run by local government. Rent fees are adjusted according to household income. Because applicants must be selected by lottery, low-income people are not guaranteed to be chosen to live in the housing, although they have an advantage. There are a couple of Housing First-like programs. [52] Some renovate discarded or empty homes and they rent the rooms to single mothers with financial and occupational support. [53]

United Kingdom

In 2017, the U.K. government announced plans for a Housing First pilot programme in the West Midlands, Liverpool, and Manchester, along with funding of £28m. [54] This followed publication of a report entitled Housing First by the Centre for Social Justice which cited the results from the Finnish application of Housing First. [55]

United States

In August 2007, the US Department of Housing and Urban Development reported that the number of chronically homeless individuals living on the streets or in shelters dropped by an unprecedented 30 percent, from 175,914 people in 2005 to 123,833 in 2007. This was credited in part to the "housing first" approach; Congress in 1999 directed that HUD spend 30% of its funding on the method. [56] In 2013, the estimated national public cost of chronic homelessness was between $3.7 and $4.7 billion according to the United States Interagency Council on Homelessness (USICH). Through Housing First programs, chronically homeless individuals are using fewer hospital resources, spending less time in costly incarceration and requiring fewer emergency room visits. The implementation of Housing First philosophy when working with homeless families and young adults has been shown to increase clients' enrollment in public assistance benefits, decrease involvement in the child welfare system, and have very few returning to homelessness. [57]

Research in Seattle, Washington, found that providing housing and support services for homeless alcoholics costs taxpayers less than leaving them on the street, where taxpayer money goes towards police and emergency health care. [24] [58] [59] This first US controlled assessment of the effectiveness of Housing First specifically targeting chronically homeless alcoholics showed that the program saved taxpayers more than $4 million over the first year of operation. During the first six months of a study of 95 residents in a Housing First program in downtown Seattle, even after considering the cost of administering the housing, the study reported an average cost-savings of 53 percent—nearly US$2,500 per month per person in health and social services, compared to the per month costs of a wait-list control group of 39 homeless people. Further, stable housing also results in reduced drinking among homeless alcoholics.

In Utah, there has been "a 72 percent decrease [in chronic homelessness] overall since enacting the plan in 2005" according to the Utah Division of Housing and Community Development. [60] There has been some success with Utah's housing first plan, reducing chronic homelessness by 91 percent over the first ten years. [61]

In September 2010, it was reported that the Housing First Initiative had significantly reduced the chronic homeless single person population in Boston, Massachusetts, although homeless families were still increasing in number. Some shelters were reducing the number of beds due to lowered numbers of homeless, and some emergency shelter facilities were closing, especially the emergency Boston Night Center. [62] By 2015, Boston Mayor Marty Walsh had announced a 3-year plan to end chronic homelessness, focusing on coordinating efforts among public agencies and nonprofit organizations providing services to homeless men and women. [63] [64]

A research study from the University of North Carolina at Charlotte also reported that a housing project for the chronically homeless called Moore Place had saved the county $2.4 million. [65]

When comparing the effects of Housing First on older and younger homeless adults, older homeless adults have shown significantly higher rates of improvement in areas like mental component summary scores, condition specific quality of life, mental health symptom severity, and percentage of days stably housed. [66]

Critics of the Housing First approach have argued that some of the most severely mentally ill or drug addicted cannot be served effectively by the approach. In San Francisco, home to over 4,000 people experiencing homelessness and mental illness or drug addiction, [67] a 2015 study found that 91% of those approached by the San Francisco homeless outreach team during sweeps refused the shelter offered to them, [68] often due to underlying drug addiction or mental illness. Even when such individuals do accept housing, there are serious issues: 16% of all overdoses in San Francisco occur in government-provided single room occupancy housing (SROs) [69] where there is insufficient infrastructure to prevent overdoses. Recent studies have suggested that institutionalization and compulsory drug rehab are ineffective in many cases, [70] which has led to a broader adoption of Housing First solutions, but in practice support for these individuals in need often ends the moment they are housed. As a result, many struggle to move on to more sustainable self sufficient living; residents of San Francisco's SROs are more than twice as likely to overdose or return to homelessness than they are to move into permanent housing. [69]

Endorsement

Housing First is currently endorsed by the United States Interagency Council on Homelessness (USICH) as a "best practice" for governments and service-agencies to use in their fight to end chronic homelessness in America. [71]

Post-2007 U.S. policy and legislation

The United States Congress appropriated $25 million in the McKinney-Vento Homeless Assistance Grants for 2008 to show the effectiveness of Rapid Re-Housing programs in reducing family homelessness. [72] [73] [74]

In February 2009, President Obama signed the American Recovery and Reinvestment Act of 2009, part of which addressed homelessness prevention, allocating $1.5 billion for a Homeless Prevention Fund. The funding for it was called the "Homelessness Prevention and Rapid Re-Housing Program" (HPRP), and was distributed using the formula for the Emergency Shelter Grants (ESG) program. [75]

On May 20, 2009, President Obama signed the Homeless Emergency Assistance and Rapid Transition to Housing (HEARTH) Act into Public Law (Public Law 111-22 or "PL 111-22"), reauthorizing HUD's Homeless Assistance programs. It was part of the Helping Families Save Their Homes Act of 2009. The HEARTH act allows for the prevention of homelessness, rapid re-housing, consolidation of housing programs, and new homeless categories. In the eighteen months after the bill's signing, HUD must make regulations implementing this new McKinney program. [76]

On June 11, 2014, the 100,000 Homes Campaign in the United States, launched in 2010 to "help communities around the country place 100,000 chronically homeless people into permanent supportive housing", announced that it reached its four-year goal of housing 100,000 chronically homeless people nearly two months before its July 29 deadline. [77]

New York Times journalist David Bornstein summarized key elements of the 100,000 Homes Campaign that campaign leaders attribute to its success. [77] This included learning individual homeless people's "name and need" by mobilizing volunteers to go very early in the morning to check on them, establishing a "vulnerability index" so they could prioritize certain homeless people and "bring housing advocates and agency representatives together to streamline the placement processes, and share ideas about how to cut through red tape." [77]

Miscellaneous

As part of the H2020 research project "HOME_EU: Reversing Homelessness in Europe" by the European Commission, approximately 5600 surveys have been conducted between March and December 2017 in France, Ireland, Italy, the Netherlands, Portugal, Spain, Poland, and Sweden in order to understand people's knowledge, attitudes, and practices about homelessness and how much support the general public has in regards to Housing First as a solution for homelessness in Europe. [78]

Criticism of Housing First

Limits of evidence based policy

In 2011, Professor Victoria Stanhope of New York University School of Social Work and Professor Kerry Dunn of University of New England School of Social Work, writing in the International Journal of Law and Psychiatry, [27] gave a critical overview of evidence-based policy, based on its reliance on positivist methods and technical approach to policy making, which used the Bush Administration's Housing First policy as a case study. According to Stanhope and Dunn, Housing First is "an example of research-driven policy making but also resulted in a progressive policy being promoted by a conservative administration". The paper argues that evidence-based policy fails to integrate evidence and values into policy deliberations, and concludes with alternative models of policy decision-making and their implications for research." [27]

Housing First has been criticized on its failure to address broader service outcomes, namely substance abuse (in one case, it was argued that the only reason substance abuse outcomes were no worse was that the residents were not severely addicted). [79] These criticisms have been rebutted on the grounds that Housing First is a program to end homelessness not to reduce substance abuse, though more recent research indicates it is more effective than traditional approaches in this regard as well. [80] This exchange highlights the way in which the selection of outcomes sets both the terms of the debate and the parameters of "what works." Embedded in that mantra are a priori decisions about what constitutes working and for whom; in this case it was stable housing for the chronic homeless. [27]

According to Stanhope, Housing First "is an anathema to neoliberal ideology" because it asserts a fundamental right to housing and therefore "challenges deeply held beliefs that have shaped US welfare from its inception: That no one has a right to a government benefit unless they have proved themselves to be deserving or worthy (e.g., "TANF"), or have earned it (e.g., social insurance).” [27] [81] Stanhope argues that the dissonance between the fundamental right to housing that Housing First entails and neoliberal ideology has not been considered during policymaking, especially because of the focus on the empirical outcomes of Housing First. [27]

In a rapid review and document analysis of Housing First scholarly literature in the U.S. and Canada, it has been shown that these literature are severely lacking in the implementation and explicit mention of harm reduction. [82]

Exceptions to Housing First

Emergency response

Hotels have historically been used to house the homeless population temporarily while further accommodations are made. [83] [ improper synthesis? ]

See also

Citations

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General references

Further reading

Related Research Articles

<span class="mw-page-title-main">Homelessness in Canada</span>

Homelessness in Canada was not a social problem until the 1980s. The Canadian government housing policies and programs in place throughout the 1970s were based on a concept of shelter as a basic need or requirement for survival and of the obligation of government and society to provide adequate housing for everyone. Public policies shifted away from rehousing in the 1980s in wealthy Western countries like Canada, which led to a de-housing of households that had previously been housed. By 1987, when the United Nations established the International Year of Shelter for the Homeless (IYSH), homelessness had become a serious social problem in Canada. The report of the major 1987 IYSH conference held in Ottawa said that housing was not a high priority for government, and this was a significant contributor to the homelessness problem. While there was a demand for adequate and affordable housing for low income Canadian families, government funding was not available. In the 1980s a "wider segment of the population" began to experience homelessness for the first time – evident through their use of emergency shelters and soup kitchens. Shelters began to experience overcrowding, and demand for services for the homeless was constantly increasing. A series of cuts were made to national housing programs by the federal government through the mid-1980s and in the 1990s. While Canada's economy was robust, the cuts continued and in some cases accelerated in the 1990s, including cuts to the 1973 national affordable housing program. The government solution for homelessness was to create more homeless shelters and to increase emergency services. In the larger metropolitan areas like Toronto the use of homeless shelters increased by 75% from 1988 to 1998. Urban centres such as Montreal, Laval, Vancouver, Edmonton, and Calgary all experienced increasing homelessness.

<span class="mw-page-title-main">Homelessness in the United States</span>

In the United States, the number of homeless people on a given night in January 2023 was more than 650,000 according to the Department of Housing and Urban Development. Homelessness has increased in recent years, in large part due to an increasingly severe housing shortage and rising home prices in the United States.

<span class="mw-page-title-main">Homeless shelter</span> Service agency that provides temporary residence for homeless people

Homeless shelters are a type of homeless service agency which provide temporary residence for homeless individuals and families. Shelters exist to provide residents with safety and protection from exposure to the weather while simultaneously reducing the environmental impact on the community. They are similar to, but distinguishable from, various types of emergency shelters, which are typically operated for specific circumstances and populations—fleeing natural disasters or abusive social circumstances. Extreme weather conditions create problems similar to disaster management scenarios, and are handled with warming centers, which typically operate for short durations during adverse weather.

Supportive housing is a combination of housing and services intended as a cost-effective way to help people live more stable, productive lives, and is an active "community services and funding" stream across the United States. It was developed by different professional academics and US governmental departments that supported housing. Supportive housing is widely believed to work well for those who face the most complex challenges—individuals and families confronted with homelessness and who also have very low incomes and/or serious, persistent issues that may include substance use disorders, mental health, HIV/AIDS, chronic illness, diverse disabilities or other serious challenges to stable housing.

<span class="mw-page-title-main">Homeless women in the United States</span>

Out of 10,000 female individuals 13 are homeless. Although studies reflect that there are many differences among women suffering homelessness and there is no universal experience, the average homeless woman is 35 years old, has children, is a member of a minority community, and has experienced homelessness more than once in their lifetime.

<span class="mw-page-title-main">Affordable housing</span> Housing affordable to those with a median household income

Affordable housing is housing which is deemed affordable to those with a household income at or below the median as rated by the national government or a local government by a recognized housing affordability index. Most of the literature on affordable housing refers to mortgages and a number of forms that exist along a continuum – from emergency homeless shelters, to transitional housing, to non-market rental, to formal and informal rental, indigenous housing, and ending with affordable home ownership.

Pathways to Housing is a not-for-profit organization founded in 1992 by Dr. Sam Tsemberis. It is the mission of Pathways to Housing to transform individual lives by ending homelessness and supporting recovery.

The Mental Health Commission of Canada (MHCC) is a national non-profit organization created by the Canadian government in 2007 in response to a senate committee tasked to study mental health, mental illness, and addiction. The committee appointed Michael J. L. Kirby as the first chairperson. The MHCC was endorsed by all the provinces and territories with exception to Quebec. The Commission is funded by Health Canada and has a ten-year mandate enforced through a sunset clause. On 21 April 2015, Minister of Finance Joe Oliver announced that the 2015 federal budget calls for the renewal of the MHCC for another ten-year mandate starting in 2017-2018.

<span class="mw-page-title-main">Housing</span> Living spaces

Housing, or more generally, living spaces, refers to the construction and assigned usage of houses or buildings individually or collectively, for the purpose of shelter. Housing is a basic human need, and it plays a critical role in shaping the quality of life for individuals, families, and communities.

<span class="mw-page-title-main">Homelessness</span> A condition of lacking stable, safe, and functional housing

Homelessness or houselessness – also known as a state of being unhoused or unsheltered – is the condition of lacking stable, safe, and functional housing. The general category includes disparate situations, such as living on the streets, moving between temporary accommodation such as family or friends, living in boarding houses with no security of tenure, and people who leave their domiciles because of civil conflict and are refugees within their country.

<span class="mw-page-title-main">Homelessness and mental health</span>

In a study in Western societies, homeless people have a higher prevalence of mental illness when compared to the general population. They also are more likely to suffer from alcoholism and drug dependency. It is estimated that 20–25% of homeless people, compared with 6% of the non-homeless, have severe mental illness. Others estimate that up to one-third of the homeless have a mental illness. In January 2015, the most extensive survey ever undertaken found 564,708 people were homeless on a given night in the United States. Depending on the age group in question and how homelessness is defined, the consensus estimate as of 2014 was that, at minimum, 25% of the American homeless—140,000 individuals—were seriously mentally ill at any given point in time. 45% percent of the homeless—250,000 individuals—had any mental illness. More would be labeled homeless if these were annual counts rather than point-in-time counts. Being chronically homeless also means that people with mental illnesses are more likely to experience catastrophic health crises requiring medical intervention or resulting in institutionalization within the criminal justice system. Majority of the homeless population do not have a mental illness. Although there is no correlation between homelessness and mental health, those who are dealing with homelessness are struggling with psychological and emotional distress. The Substance Abuse and Mental Health Services Administration conducted a study and found that in 2010, 26.2 percent of sheltered homeless people had a severe mental illness.

The Canadian Observatory on Homelessness (COH)—formerly named the Canadian Homelessness Research Network (CHRN)—is a Canadian non-profit, non-partisan research institute that works with researchers, service providers, policy makers, students and people who have experienced homelessness.

<span class="mw-page-title-main">Homelessness in the San Francisco Bay Area</span>

The San Francisco Bay Area comprises nine northern California counties and contains five of the ten most expensive counties in the United States. Strong economic growth has created hundreds of thousands of new jobs, but coupled with severe restrictions on building new housing units, it has resulted in an extreme housing shortage which has driven rents to extremely high levels. The Sacramento Bee notes that large cities like San Francisco and Los Angeles both attribute their recent increases in homeless people to the housing shortage, with the result that homelessness in California overall has increased by 15% from 2015 to 2017. In September 2019, the Council of Economic Advisers released a report in which they stated that deregulation of the housing markets would reduce homelessness in some of the most constrained markets by estimates of 54% in San Francisco, 40 percent in Los Angeles, and 38 percent in San Diego, because rents would fall by 55 percent, 41 percent, and 39 percent respectively. In San Francisco, a minimum wage worker would have to work approximately 4.7 full-time jobs to be able to spend less than 30% of their income on renting a two-bedroom apartment.

Homeless veterans are persons who have served in the armed forces who are homeless or living without access to secure and appropriate accommodation.

<span class="mw-page-title-main">Sam Tsemberis</span> Greek Canadian psychologist


Sam J. Tsemberis is a Greek Canadian clinical and community psychology practitioner, and the founder and executive director of Pathways to Housing, a Housing First program for individuals with serious mental illnesses, long histories of homelessness, and often co-occurring substance abuse. He is also an Associate Clinical Professor in Psychiatry and Biobehavioral Sciences at the University of Los Angeles California.

A managed alcohol program is a program meant to reduce harm for chronic alcoholics. The program involves providing a regular dose of alcohol to individuals with alcohol addiction, typically at a shelter-based harm reduction centre.

<span class="mw-page-title-main">Homelessness in Colorado</span> Summary and analysis of homelessness in the state of Colorado

Homelessness is a growing problem in Colorado and is considered the most important social determinants of health. Homelessness is very difficult for many Coloradoans to escape due to the continuous increase in costs for housing in Colorado, along with mental health treatments and other factors. When people are forced to live without stable shelter, they are then exposed to a number of risk factors that affect physical and mental health. Although it is difficult to pin point any one cause of homelessness, there is a complicated combination of societal and individual causes.

<span class="mw-page-title-main">Homelessness in California</span>

The United States Department of Housing and Urban Development estimated that more than 181,399 people were experiencing homelessness in California in January 2023. This represents more than 27% of the homeless population of the United States even though California has slightly less than 12% of the country's total population, and is one of the highest per capita rates in the nation, with 0.46% of residents being homeless. More than two-thirds of homeless people in California are unsheltered, which is the highest percentage of any state in the United States. 49% of the unsheltered homeless people in the United States live in California: about 123,423 people, which is eight times as many as the state with the second highest total. Even those who are sheltered are so insecurely, with 90% of homeless adults in California reporting that they spent at least one night unsheltered in the past six months.

Serious mental illness (SMI) is characterized as any mental health condition that impairs seriously or severely from one to several significant life activities, including day to day functioning. Four common examples of SMI include bipolar disorders, psychotic disorders, post-traumatic stress disorders, and major depressive disorders. People having SMI experience symptoms that prevent them from having experiences that contribute to a good quality of life, due to social, physical, and psychological limitations of their illnesses. In 2021, there was a 5.5% prevalence rate of U.S. adults diagnosed with SMI, with the highest percentage being in the 18 to 25 year-old group (11.4%). Also in the study, 65.4% of the 5.5% diagnosed adults with SMI received mental health care services.

The concept of street outreach to individuals that are experiencing homelessness is a classic example of a form of outreach. Those who experience homelessness have a variety of complex issues that incite the need for specific forms of care. As such, street outreach is challenging work. There are multiple governmental and non-governmental agencies that have sought to engage in this work because of the understanding that unhoused people tend to have increased barriers to access traditional services. Street outreach comes in different forms, from people walking around carrying supplies or offering resources, to mobile health clinics with teams of medical volunteers driving around and offering services. Regardless of its form, the essence of street outreach is the desire to meet people where they are at, build deep trust and connections, offer support, and reinforce the human dignity and respect that is deserving of all people. The core elements of effective street outreach include being systematic, coordinated, comprehensive, housing-focused, person-centered, trauma-informed, culturally responsive, as well as emphasizing safety and reducing harm.