Homelessness is a sad fact in most cities in North America. In 2007, it was estimated that there were about 1,200 homeless people living in Greater Victoria (Victoria Cool Aid Society, 2007). Approximately 41% of those surveyed identified problems with alcohol and drug use as contributing factors to their current housing situation. Between 2008 and 2010, the High Risk Populations Study from the BC Alcohol and Other Drug Monitoring Project found that approximately 50% of adults who participated in the study and inject drugs were homeless as defined by living outside, in shelters or having no fixed address, and approximately 30% of youth interviewed identified as homeless (CARBC, 2010a). While there is continuing injection drug use, increased rates of crack use have been found among those who use injection drugs (VIHA, 2010). Approximately 23% of those who use injection drugs in the 2009 I-track survey were also homeless at the time of the survey. Although there are differences in sampling, this percentage is increased from previous I-track studies. Further, concerns related to housing and substance use were identified by VIHA in 2000 in a study of injection drug use in Victoria (Stajduhar, Poffenroth & Wong, 2000).
While substance use and increased rates of problematic substance use have been documented among those who are homeless, the increasing number of homeless people is a result of societal changes and years of social policy shifts that have limited the growth and, in some cases, reduced housing supply and available income for vulnerable men, women and youth (Shapcott, 2009). The traditional linear approach to services, where people ―progress through a series of congregate living arrangements with varying levels of on-site support before graduating to independent living arrangements‖ (Gulcur, Stefancic & Shinn, 2003, p. 172), is characterized by frequent moves and barriers to service, and is not meeting the needs of those requiring supports (Mayor‘s Task Force, 2007a).
A key recommendation of the City of Victoria Mayor‘s Task Force to End Homelessness was that ending homelessness will require a fundamentally different approach in the way homeless people are served and assisted. In particular, the Mayor's Task Force Expert Panel commended a series of leading practices that included the following (Mayor‘s Task Force, 2007b, p. 14-15).
- Client-centred approach. Services to homeless residents with mental illness and addictions are most effectively delivered in a context of services adapted to client needs—rather than organized around efficiencies or expertise in service delivery—and requires a client-centered approach, low barrier programs and a policy of harm reduction.
- Low barrier programs. Programs that do not require clients to be abstinent or in treatment for mental illness have been shown to be more likely to attract clients, motivate them to begin making changes, retain them in treatment, and minimize attrition and drop-out rates.
- Harm reduction. The reduction of risks and harmful effects associated with substance use and addictive behaviours not only assists the affected person, but has a positive impact on urban neighbourhoods where street-level substance use problems are concentrated. Examples of harm reduction programming include needle exchange services, substitution therapy, safe consumption sites, and law enforcement practices that attach a priority to enforcement of laws against trafficking while adopting a more a cautious approach toward drug use.
- ‘Housing First’. An approach to housing where homeless residents are provided immediate access to a place of their own without requiring treatment or sobriety as a precondition for housing. Residents are supported with treatment options for their recovery and integration into the community.
- Emphasis on choice. Client-centred strategies that cater to various subpopulations, each with its own unique needs and challenges, demonstrate higher success rates for recovery and community integration. A "one-size-fits-all" approach has proven to be unsuccessful.