In this post, we share key insights from our recently published article on the long-term effects of Housing First (rent supplements and mental health support services) for people experiencing homelessness and mental illness. Housing First (HF) provides individuals experiencing homelessness and mental illness immediate access to housing without preconditions of psychiatric treatment or sobriety in conjunction with mental health supportive services through Intensive Case Management (ICM) or Assertive Community Treatment (ACT). Canada, the US, and European countries have implemented HF programs as a strategy to end chronic homelessness. However, there are few studies that provide evidence on the long-term impacts (2 years or more) of this approach on housing stability, quality of life, community functioning, and substance use outcomes for this population. Our study looked at the long-term effects of Housing First among participants in the Toronto site of the At Home/Chez Soi randomized study from 2009 to 2017.
The research team, led by Stephen Hwang, Patricia O’Campo, and Vicky Stergiopoulos, recently analyzed the main results of the effectiveness of HF on housing stability, health, and well-being outcomes. We followed and compared a group of 301 adult participants who received HF with ACT or ICM and rent supplement with a group of 274 adult participants who had access to the usual social, health and housing support services available in Toronto. The main outcomes that we examined were:
- Percentage of days spent stably housed,
- Quality of life,
- Community functioning, and
- Substance use severity
What did we find in our study?
- HF with ACT or ICM mental health support services combined with rent supplements is an effective strategy that helps people experiencing homelessness and mental illness become stably housed over the long term (up to six years). We found particularly that participants who received HF spent more days stably housed than participants who did not receive HF but had access to the usual services in the community.
- Homeless adults with a high need for mental health services benefit the most from HF. In the final year of follow up, 6 years after study entry, high needs individuals who received HF with ACT support spent 85% of days stably housed, compared with 60% for individuals who received treatment as usual.
- We found no differences between the HF and treatment as usual groups in quality of life, community functioning, and substance use severity. The lack of effect of HF on these outcomes might be due to the complex and multidimensional needs faced by individuals experiencing homelessness and mental illness. Therefore, additional services are probably needed to further support improvements in these outcomes.
What are our conclusions?
Housing First is an effective strategy for ending homelessness in Canada, with significant benefits in housing stability that last for more than 6 years. However, further research is needed to identify additional services to better address the needs of this population group and improve other important outcomes such as recovery, health status, social participation and long-term economic independence.