Consumer choice is central to the Housing First model and guides both housing and service delivery. Housing First is a specific program approach, but it can also be looked at as a philosophy of service, and as a systems approach for addressing homelessness.
View a TED talk from Dr. Sam Tsemberis about the goal and origins of Housing First/Pathways to Housing.
It is estimated that 200,000 Canadians will be homeless over the course of a year.7 The prevalence of mental health issues is significantly higher for Canadians who are homeless, compared with the general population. The Mental Health Commission of Canada estimates that there are approximately half a million people diagnosed with a mental illness in Canada who are inadequately housed, with more than 100,000 of those individuals being homeless.8 Studies suggest that between one-quarter and one-third of Canadians who are homeless experience serious mental illness.9
Housing should be guided by the principle of consumer choice and self-determination. Participants should be able to have some choice about unit type (scattered site, congregate) and neighbourhood preference, although choices will, in many cases, be contingent on the conditions of the local housing market. Additionally, participants should not make up more than 20 per cent of renters in a specific unit and should not pay more than 30 per cent of their income towards rent.
A Housing Team assists participants in selecting housing of their choice. Responsibilities of the Housing Team include:
- Helping participant search for and identify appropriate housing
- Building and maintaining relationships with landlords, including mediating during times of conflict
- Applying for and managing housing allowances
- Assistance in setting up apartment
- Independent living skills development
A Clinical Team provides a range of recovery-oriented, client-driven supports. Supports range from ICM, where support is coordinated by a case manager, to ACT, where support is coordinated by a multidisciplinary team. These supports address health, mental health, social care, and other needs. Effective assessments at enrolment are important for matching the right participants with the right supports. These supports are aimed at promoting community integration and improving quality of life and independent living. These supports may include:
- Life skills for maintaining housing, establishing and maintaining relationships and engaging in meaningful activities.
- Income support
- Vocational assistance, such as enrolling in school, finding employment, or volunteering
- Managing addictions
- Community engagement
Upon learning about Housing First, many service providers will say that they have already been doing Housing First. While many housing and support programs for people who are homeless operate from a basis of recovery, individualized and consumer-directed services, and a focus on community integration, supportive housing programs are less likely to adhere to two important components of Housing First: housing choice and structure and the separation of housing and support services. In this table, we clearly delineate the key elements of these two components to show where potential differences may lie across programs and initiatives. The second column provides items from a Housing First fidelity scale based on the Pathways to Housing program;15 the third column is based on a literature review on supported Housing First;16 the fourth column is from a recent, widely distributed book on Housing First in Canada;17 and the last column contains key elements from the federal Homelessness Partnering Strategyâ€™s (HPS) position on Housing First.18
Click here for more information on HPS and Housing First.
From this table, we can see that the recent book on Housing First in Canada and the HPS position on Housing First overlap to a large extent with the Pathways to Housing program and the literature. However, there are some divergences as well. Scattered site housing with housing subsidies and standard landlord-tenant leases are emphasized, but they are seen as not necessary for Housing First. As well, the two Canadian sources are silent on whether support services must be provided outside of the housing site and whether separate agencies must operate housing and support. To be clear, in this toolkit, we are emphasizing adherence to the original Pathways to Housing model, on which numerous applications in the U.S.19 and in Canada and Europe20 are based.