Can Housing First Help Mental Health Issues?

Homelessness is a problem that affects thousands of American men, women, and children. The Department of Housing and Urban Development’s (HUD) 2018 Annual Point-In-Time Count found that on any given night, approximately 552,830 people experienced homelessness. The same study found that 67% of these people are individuals, while 33% are people in families with children. Additionally, youth under the age of 25 account for 7% of America’s homeless population.

Unfortunately, many of these people are unable to access housing due to regulations requiring people who apply for affordable or subsidized living arrangements to be on medication or entirely drug-free. These requirements often present further issues.

For example, a recent report by the Los Angeles Times found that of the more than 60,000 homeless people living in Los Angeles County, 67% were suffering from mental illness or substance abuse. That number is significantly higher than the Los Angeles Homeless Services Authority’s (LAHSA) tally which said that only 29% of LA’s homeless were mentally ill or abusing drugs.

According to the Los Angeles Times, the LAHSA tally achieved lower rates by leaving out certain questions. One of those omitted questions was: “What do you think are some of the main reasons or conditions that led to your loss of housing?”

Mental health issues were one of the multiple-choice answers, but those responses were only accepted if the survey taker answered “yes” to a follow-up question, which asked if their medical condition was long-term or permanent. This omission alone reduced the rate of mental illness by 11.4%.

Homelessness, mental health problems, and substance use disorder (SUD) are often linked, but only housing people after they are reviewed or “better” allows many of those in greatest need to fall through the cracks. Housing First hopes to change that.

What Is Housing First?

Housing First is an approach to addressing homelessness that prioritizes permanent housing over treatment for substance use, getting a job, or budgeting properly. The underlying belief is that people need to have their basic necessities met (ie: food and shelter) before they can pursue personal goals and improve their overall quality of life.

Simply stated, Housing First views housing as the foundation for life improvement. There are no prerequisites such as participating in behavioral health programs or stopping substance use altogether.

Does Housing First work?

Since 2016, a growing number of major metropolitan areas, both in the United States and elsewhere, have implemented Housing First programs, but there’s been little research on their long-term effectiveness. That’s starting to change, however, thanks to a six-year study conducted by The Center for Addiction and Mental Health (CAMH) in Canada who sponsored a randomized control study conducted in five Canadian cities titled The At Home/Chez Soi and published in peer-reviewed medical journal Lancet Psychiatry.

The study recruited 575 homeless people between 2009-2011 and tracked their progress for an average of six years. Though all genders were included in the study, 70% of the participants were male. Ultimately, researchers found that of those with serious mental health needs, 42% had greater housing stability under the Housing First program compared to other usual services for the homeless. This means that researchers saw a significant decline in people who returned to the streets while they participated in the program.

Is Housing First cost-effective?

Homelessness takes a financial toll on the individuals experiencing it as well as society as a whole. In fact, studies estimate that the cost of homelessness is $161,000 per-person, per-year, a number that includes medical fees, jail time, shelter costs, and police resources.

Homes First, a Toronto-based program, found that their Housing First services averaged a total cost of $1,545 per month, or $18,615 for an entire year of housing, which is nearly eight and a half times more affordable than the cost of allowing people to remain on the streets. In addition, CAMH found that for a client with moderate needs, Housing First only costs an average of $67 a day.

What does this research mean for the future of Housing First?

The At Home/Chez Soi randomized control study is the first of its kind, but the data provided is incredibly exciting. Patricia Mueller, society chief executive officer of Homes First in Toronto, noted that “Studies like this … [they] influence decision makers.”

With evidence-based proof that Housing First programs work, researchers and homelessness advocates are hopeful these programs will receive more funding.

How does Housing First promote whole person care?

By providing affordable housing to the mentally ill and those suffering from SUD, metropolitan areas can significantly reduce costs without exhausting government resources. If someone has a safe, comfortable home to return to, they’re much less likely to be hospitalized or arrested for being on the street. According to Patricia Mueller, Housing First is much more than just a program to provide shelter, it’s “saving lives.”


Housing First

State of Homelessness

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