Hope for the homeless lies in housing first, treatment later

A year-long academic study on the crisis of homelessness suggests the answer to the complicated question of how best to help those in need is simple: provide safe, affordable housing first, then offer treatment second.

The “Housing First” model—designed to quickly find permanent shelter for people experiencing long-term or multiple occurrences of homelessness—is cheaper and more effective, researchers from McMaster and St. Michael’s Hospital found after interviewing and following the lives of dozens of men who had spent more than 30 days in an emergency shelter.

They also interviewed case-management teams, senior social services workers and analyzed reams of data.

Specifically, the team examined the effectiveness of Hamilton’s Transitions to Home (T2H), a program offering affordable, stable housing with no conditions attached, run through Wesley Urban Ministries.

“Housing before all else, should be seen as a basic human right,” explained Julia Woodhall-Melnik, author of the report and a post-doctoral fellow at McMaster and the Centre for Research on Inner City Health of St. Michael’s Hospital in Toronto.

“It shouldn’t depend on mental health or whether or not an individual commits to addiction counseling,” she said.

To that end, researchers found most T2H participants spent fewer nights in emergency shelters, were more likely to remain in affordable rental housing if they stayed in the program, and services offered—such as therapeutic recreation, addictions counseling and housing support—improved their general well-being.

The findings address the oft-debated issue of whether to follow this model or provide “treatment first,” where programs require individuals to access services for addictions and mental illness, among other issues.

Under the “treatment first” model, housing is then dependent on clients participating in treatment programs, but critics argue it’s unproductive because it forces individuals to prove they deserve their housing.  If they fail to meet conditions, they are back in the shelters and on the streets.

“The housing first model is gaining traction in Canada,” said Jim Dunn, co-author of the report, an associate professor of Health, Aging & Society at McMaster and research scientist at the Centre for Research on Inner City Health of St. Michael’s Hospital.

“With housing in place first, people can better cope with and then resolve mental health and addiction issues and work towards achieving other personal goals,” he said.

The model was first introduced in New York City in 1990s by Sam Tsemberis and his team, who developed Pathways to Housing and is widely considered to be an evidence-based approach to addressing homelessness.

Researchers also found many of the men they interviewed had a long term history of trauma.  Some had been exposed to parental addictions or poverty as children, while others spent time in juvenile detention.  Still others suffered had mental health issues as children or had left high school.

“We found that most of the men we interviewed had experienced some form of trauma earlier in life,” explained Woodhall-Melnik. “This points to a need for better counseling services and good prevention strategies to support low-income and at-risk families and children.”

The study also revealed an overall need for:

• More affordable and social housing in Hamilton that is clean, in good repair and pest free
• Housing allowances and rent supplements
• Better collaboration between agencies which help the homeless
• Creative solutions to engage with the homeless.

The full report can be found here.