On any given night, more than 12,000 people in Toronto (Canada) experience homelessness, with about three-quarters of these individuals facing mental health challenges. Alarmingly, many find themselves stuck in what’s known as the “Revolving Door”–cycling between the criminal justice system, temporary housing, medical institutions, homeless shelters, and the streets.

Homelessness is associated with high levels of stress and survival needs can lead people to resort to criminal activity, like shoplifting. In other instances, homeless individuals may be at increased risk for engaging in behaviors considered illegal, like sleeping in parks, loitering in buildings, or using public restrooms for personal care. Consequently, these behaviors lead to higher arrests and conviction rates.

After facing incarceration, these individuals are often subjected to unrealistic bail conditions, and placed in institutions that lack proper mental health services. Upon release, they face many challenges, such as limited access to employment and housing, which only entrenches them into a cycle of homelessness, criminality, and institutionalization.

Government policies often address homelessness without tackling its root causes, offering only temporary band-aid solutions for large wounds in the system. This is where social workers and activists are focusing on an innovative approach called Housing First—an intervention that offers stable housing to homeless individuals without strings attached.

In western countries, there is an increase in efforts to divert people with severe mental illness away from the criminal justice system and toward mainstream mental health care, such as psychiatric facilities and court-mandated rehabilitation programs. Despite these growing efforts, the number of homeless individuals with severe mental illness within the criminal justice system continues to rise.

Additionally, homelessness support programs tend to place barriers, often requiring individuals to engage in treatment before they can access stable housing. But should people be expected to fully recover from substance use and treat their mental health challenges while battling homelessness?

Vicky Stergiopolous, a scientist at the Center for Addiction and Mental Health (CAMH), University of Toronto, and a lead researcher on the Housing First approach, describes the intervention as client-centered and recovery-oriented. “Housing First offers immediate access to stable community-based housing, coupled with intensive, community-driven mental health support that does not require abstaining from substances or acceptance of psychiatric care.”  

Many individuals have expressed how much Housing First has helped them. One such individual was Damion, who after the death of his wife, fell into a deep depression and was left homeless. Boston’s Housing First Initiative provided him with a home and a chance to reclaim his life. He says, “[Housing First] makes sure I maintain my mental health and my work/life balance. It’s so much more than just housing.”

A study published in 2022 found that homeless individuals with severe mental illness who had been placed in stable housing were more likely to be independent and housed after four years compared to those who received alternative treatments. By decreasing the barriers needed to access housing, individuals struggling with finding their footing can use unconditional housing as a foundation to get their lives back on track.

The benefits of providing housing are also economic. A study from 2021 found that this approach can significantly reduce costs. Over 14 years, the Housing First program proved to be more cost-effective, when considering social service usage, incarceration, rehabilitation services, and medical care, compared to those receiving traditional treatments.

Despite these benefits, concerns have been raised about the program. The cost of assertive and intensive care often associated with Housing First were more expensive compared to usual treatment at the beginning of the study, and after a 2-year follow-up. Also, its lack of focus on rehabilitation means that many individuals continue to struggle with substance abuse.

Studies conducted in Vancouver and Toronto showed no difference in substance use between Housing First and traditional treatments. In fact, one study found higher alcohol consumption among individuals within the Housing First intervention.

Research shows that despite these concerns, the Housing First program has been successful in supporting many unhoused people with mental health challenges. This shift toward fulfilling basic necessities like housing, food, and water before focusing on treating more complex issues like substance use and severe mental illness may be a viable solution.

Stergiopolous says, “Housing is health.” By providing stable, unconditional shelter, individuals can focus less on survival needs and treatment has a greater likelihood of being more effective.

– Adrian Parham, Contributing Writer

Image Credits:

Feature: Nick Fewings at Unsplash, Creative Commons

First: Mart Production at Pexels, Creative Commons

Second: Ev at Unsplash, Creative Commons