Pan-Canadian Project on Mental Health and Homelessness

Tim AubryNational Research Team Member

& Co-lead of Moncton Site

Homelessness in Canada

• There are no accurate estimates of homelessness in Canada; but Canada’s National Secretariat on Homelessness suggests around 150,000 Canadians are homeless; other reports suggest it could be as high as 300,0001

• Serious mental illness, substance abuse and suicidal behaviours are more common among the homeless than the general population

• People who are homeless use more government services; British Columbia found costs for health, criminal justice and social services is 33% higher for people who are homeless than for people with housing

• Many people experiencing homelessness and mental health issues face marginalization and isolation

At Home/Chez Soi

• Announced in Federal budget February 2008

• $ 110M over 5 years

• Vancouver, Winnipeg, Toronto, Montreal, Moncton

• Early developmentBuilding on what existsCommunity collaboration

• RFA process that included research and services

Principles

•People with lived experience are central

•Build on existing work

•Support knowledge exchange

•Foster collaboration and partnerships

•Work with communities to ensure lasting results and buy-in

•Address fragmentation through improved system integration

•Plan for sustainability

“Housing First”

•Recovery oriented -- client choice at the centre•Clients pay < 30% of their income for housing. •Housing in self-contained units, mostly private sector and

scattered site•Treatment and support services are voluntary,

individualized, culturally appropriate, portable •No conditions on housing readiness. Tenancy not tied to

engagement in treatment.•Requirements: rent paid directly to the landlord, once a

week visits by support team or case manager for pre-determined period.

•Evaluated and found to be a cost-effective approach for retaining clients in housing in New York City

Design and Questions

• Pragmatic, multi-site, randomized, mixed methods field trial

• Effectiveness and cost-effectiveness of Housing First (+ supports) model in Canadian contexts

• Model being tested at two levels of intensity (high needs = ACT) moderate (ICM) vs. usual care

• Being extended to include primary care, vocational supports, and special populations

Target Population

•Adults (age 18 (19 in Vancouver))

•Homeless (absolutely or precariously housed)

•Presence of a serious mental health issue

•Targeted # of project participants of over 2000

•Over 1300 are targeted to receive housing and other supports

Recovery-related Outcomes

• Outcomes focusing upon quality of life, community integration and recovery• Consumers have vetted all measures and proposed new measures (e.g. food security)• Fidelity to recovery-promoting principles will be measured at the program level• Consumers are involved in training RAs

At Home/Chez Soi:Vancouver

• Outcomes of individuals with serious addictions e.g. injection drug use• Intervention third arm includes comparison to a congregate setting• Unique aspect is impact on media messages

At Home/Chez Soi:Winnipeg

• Focus is on aboriginal homeless population• Participatory action research• Intervention incl. traditional healing e.g. medicine wheel, spiritual approaches• Measures include trauma, residential school history

At Home/Chez Soi:Toronto

• Focus is on needs of diverse ethnocultural groups• Intervention includes modifications for different ethnic groups• Also focus on chronic physical illnesses and access to primary care• Consumers have been very involved

At Home/Chez Soi:Montreal

• Testing of HF approach in a mental health system in transition • Intervention includes ISP vocational approaches• Team has contributed to fully bilingual data collection system

At Home/Chez Soi:Moncton

• Intervention will blend high and moderate need services in one - “flexible supports”• Focus is on models for smaller cities• Also testing Housing First approach in rural areas

Milestones To Date

• RFA –Nov. 2008/Awards Feb. 2009

• Site Development work began April 1, 2009

• 5 local research/service teams in 5 cities

• Each city contributes to core research questions but has also has own questions

• First participants 2nd week of October, 2009. Currently at about 50% of target enrollment

Acknowledgements

“The At Home/Chez Soi Project Team includes: Jayne Barker, Ph.D., Director of Research and Policy, Mental Health Commission of Canada, and Project Lead for the study at the national level; Paula Goering, RN Ph.D., Centre for Addiction and Mental Health and University of Toronto, Research Lead at the national level; and approximately 40 investigators from across Canada and the U.S. In addition there are 5 site coordinators (one for each city where the study is carried out) and numerous lead service and housing providers as well as persons with lived experience.”