What it takes to solve chronic homelessness rather than manage it

In Canada, about 85,000 individuals are expected to be homeless on a given night. In a country that is considered to be one of the most progressive in the world, how have we failed these many people? How are so many individuals forced to spend a night cold on the streets, hungry, thirsty or sick while surrounded by abundance?

Canadian Definition of Homelessness

In Canada, homelessness is defined as “a situation of a person or a family without access to safe and permanent housing”.

Now, depending on the sub population in question, this definition could change. For instance, with youth, this could also refer to a person aged 13–24 who are living independent of a caregiver.

With respect to indigenous peoples, it could also mean the traumas imposed by colonialism that have led communities to feel as if they have no home or that their home has been taken away from them.

Homelessness can be caused by a lot of different things

One thing needs to be made abundantly clear. Oftentimes people think that a person experiencing homelessness can just pick themselves up off the street, go get a job, buy a house and revert back to their regular lives. That the reason they’ve yet to do this is because they are lazy, non committal or something else of the kind. That everything could be solved with a “pull yourself up by your bootstraps” kind of mentality.

The fact of the matter is that this is, in almost every case of homelessness, wrong. Homelessness is not caused by laziness but instead it is often caused by a combination of environmental factors that are mostly out of a person’s control. No one chooses to be homeless, and in this way, anyone can be homeless.

Take for instance, the case of mental illness. 46% of Americans experiencing homelessness have a severe diagnosable mental illness or substance use disorder. Chances are, you also know someone in your life who also has a diagnosable mental health illness. The only thing that determined that the homeless individual is homeless as opposed to your friend or family member is that the homeless person most likely suffered some combination of secondary factors — perhaps a lack of economic support, familial rejection, abuse, addiction or a whole host of other things.

And these secondary supports are so often out of our control.

Now, the reasons for which a person might be homeless are varied and often interconnected. Typically, they can be sorted into three groups.

First, structural factors which broadly mean the socioeconomic barriers which limit a person’s access to economic opportunity (jobs or loans, for instance). These structural factors could be things like racism, homophobia, lack of affordable housing, poverty…

Next, systems failures which are when the shortcomings in other systems force people to turn to the homeless system. For example, a young person aging out of the foster care system or a person being discharged from prison.

And then there are the individual and relational factors like abusive and violent households, addiction, mental illness, traumatic events…

For instance, let’s consider Ottawa (Canada’s capital) specifically. A 2018 study figured out some of the specific demographics of the city’s homeless which include (but are not limited to)

  • Structural Factors: 24% are of Indigenous heritage, only 8% list employment as a source of income.
  • Systems Failures: 27% of individuals are newcommers to the country, 24% were at some point involved in foster care.
  • Individual and relational factors: 50% struggle with addiction, 44% have an acute mental illness

You might say that part of our homeless system needs to be about getting rid of these factors — i.e ending systems failures, structural & individual factors. But, the scope of that problem is way too much for one system to handle alone.

So yes, while the homeless system should have a hand in ending these issues, they also need to be focused on solving the inevitable individual cases as they come up.

Right now, if you are homeless, you go to emergency shelters.

When someone becomes homeless, they can experience it in different ways. Most of the time, we think of the unsheltered homeless — the people who sleep on street corners, in alley ways, tents or anything else that is not suitable for long term use.

Then there are the sheltered homeless who are sleeping inside. Now automatically, we might think about the people who are sleeping inside at shelters, but there is a subset of this population called the hidden homeless who find temporary accommodations by sleeping at the houses of family members, friends or sometimes complete strangers.

These people are still considered homeless because wherever they might be at the moment is not permanent. And depending on where they are staying, a person might wind up as a victim of abuse, physical or sexual exploitation.

This population is the most difficult to assist because they’re hidden — it’s hard to identify who and where they are.

According to the Homeless Hub, of the 85,000 people experiencing homelessness on a given night in Canada,

  • 50,000 will be hidden
  • 14,400 will be in an emergency shelter
  • 7350 will be in a violence against womens shelter
  • 4464 will be in an institutional transitional housing center
  • 2880 will be unsheltered

Let’s consider someone who recently became homeless and is not unsheltered or hidden. Once the factor that was responsible for their homelessness became insurmountable and lost access to their house, they might choose to go to an emergency shelter or a violence against women’s shelter to get a meal and a place to stay — i.e. they enter the homeless system.

From there, they could access some of the programs which are available to them from that specific shelter. These could include

  • Hot meal program
  • Overnight shelter stay
  • Addictions counseling
  • Mental health counseling
  • Support groups

And most would continue this way until they are ready to return home or can support themselves. Depending on what shelter they have arrived at, they might be connected with institutional transitional housing and support (a more comprehensive program that gives people more autonomy but still a lot of economic support).

So, what’s the problem with this?

As a generalization, this way of doing things prolongs homelessness. It creates chronic homelessness.

Chronic homelessness is the condition of a person experiencing homelessness for a significant amount of time — specifically, a total of 6 months over the past year or 18 months over the past 3 years.

This is different than episodic homelessness which is when someone has 3 or more “episodes” of homelessness over the course of a year with each episode lasting at least 30 days before that person is back in stable shelter. It is also different from transitional homelessness where a person is homeless for a smaller period of time as they transition from one source of stable and permanent housing to another.

According to Everyone Counts, on a given night, 60% of homeless individuals are chronically, 8% are episodically and 32% are transitionally homeless.

So, besides this being bad because it extends a person’s suffering far beyond what it could be, we could also make the economic case.

According to the Wellesley Institute’s Blueprint, each month it costs $1,932 to keep someone in a shelter bed, $4,333 in a jail cell and $10,900 in a hospital bed. In comparison, rent for social housing in Toronto is $199.92 per month. Adding this up with costs of food and support, financing a chronically homeless person takes $134,642 each year.

Adding this into the fact that a chronically homeless probably isn’t a “productive” member of society — i.e. they don’t have a source of income and aren’t contributing to the economy, this becomes an even bigger burden for the government.

In Malcom Gladwell’s famous New Yorker Article Million Dollar Murray, we get a glimpse of the story of a chronically homeless man named Murray Bar who the government spend 1 million dollars on over the course of one year.

Homelessness is expensive. Chronic homeless is even more expensive.

A system which prioritizes painkillers over casts

Well, let’s say that you struggle with alcoholism. After a few years of this addiction progressively getting worse, you lose your job and consequently, your only source of income. Slowly, you begin losing contact with your friends and your sense of support begins to fade. So, when it comes time to pay your monthly rent, at some point, you just don’t have enough money to do it and you are evicted.

Because you have no one to turn to, you go to an emergency shelter and register for one of their addictions counseling programs. After a couple weeks of diligently following the program, sleeping at the shelter and eating it’s hot meals, you are connected with a rent supplement that will cover you for a few months. You are expected to get a job, start earning income, and overall return to the way things once were.

So, you return home. Makes sense.

But, a couple days into living on your own, you have a drink because there isn’t anyone else there to keep you and help you from doing otherwise. The cycle repeats, and you are now episodically homeless.

And, of course the cycle would repeat, because each time you go to that emergency shelter you are given a tremendous amount of support. But, every time you leave, you suddenly go to complete autonomy.

There is no middle ground. There is no smooth transition in which people give you the proper tools you need to overcome whatever challenge landed you in the situation in the first place and also give you time to learn how to use those tools independently.

Without this transition, you haven’t pulled your problem out at the roots, but have only learned to mask it. Your emergency shelter stay is prolonging this problem, thereby prolonging the amount of time you will spend homeless.

Let’s say chronic homelessness is like breaking your leg. Emergency homeless shelters are like the painkillers you would take upon arriving at the hospital — they numb the immediate pain, but they don’t actually fix the problem. For that, you would need a cast. Transitional housing is like the cast — it is what actually fixes the problem. However, this isn’t to say that you don’t need painkillers. Without them you’d be in incredible discomfort. You need both.

We need 2 things to solve this

So, chronic homelessness. It not only comes about by the generic causes of homelessness, but also because of the shortcomings in the homeless system itself. The main one being that it doesn’t actually in still the skills necessary for a person to develop stable autonomy.

This is because our homeless system currently looks like

when it needs to look like

In other words, that crucial continuum of autonomy — the slow gain of independence that gives people the skills to solve a problem is not present. We put way too much emphasis on the emergency phase which exists to stabilize a person and relieve their issue, but not solve it.

When it’s put like this, it seems like a pretty obvious thing to fix — we just need to create a more balanced system. But, the main reason it’s not being fixed can mostly be summarized by saying that the resources it would take to develop the transitional housing side are largely allocated to emergency shelters.

We can break this down into two reasons. First, we have governmental funding which tends to be allocated to emergency shelters. Why? Because the overwhelming mentality is that “once get through the current wave of homeless, then we can move onto long term solutions”. But, that’s simply not the case because unless those long term services are put in place, current homelessness will just be prolonged. The “wave” will not end.

Second, transitional housing is not nearly as “glamorous” as emergency shelters which leads to it getting less public support. Now, of course, emergency shelters are far from glamorous, but to a member of the public, they are pretty easy to understand. Their purpose is clear, you can volunteer at them, you can donate supplies to them, you see them when you are driving. Transitional facilities on the other hand are basically the opposite.

Regardless of the source of disparity, the imbalance leads there to be much more and larger emergency shelters, so more people access them, so they receive more funding…etc.

The second big issue with our current homelessness system is that it’s not collaborative. It’s not enough to just have well funded emergency and transitional shelters — we need them to actually be connected to each other and to other institutions.

So, for instance, if an individual experiencing homelessness turns up at an emergency shelter, they have full access to the services present at that shelter. But, what if the service they really need is at another shelter? Well, chances are they won’t get in touch with it because they are not at that shelter.

And when it comes time for a person to go to transitional housing? If transitional housing is only offered by a different organization, they most likely won’t be sent there and would just be expected to go back to independent living which we know is a problem. This would be alright for someone who is transitionally homeless and only needs an emergency shelter for a couple of days, but it’s also what prolongs chronic homelessness.

So, to compensate for this fact, homeless shelters often feel as though they have to offer every service under the sun and spread themselves too thinly so that each individual service isn’t that good. Or, they grow to almost become a corporate level homeless shelter, which although can help a lot of people, sort of loses that human element that should come when trying to help another human being through what could be the toughest days of their life.

Not to mention, there are so many services which a homeless system could leverage that are already done by external providers, but since cross sector communication is not a huge thing, the system doesn’t collaborate with those necessary services.

And institutions like prison and the hospital or even the foster care system which discharge people can discharge people into homelessness — a simple fact which could be relieved if someone at one of these institutions put their charge in contact with the homeless system.

The reason this problem persists is because homelessness has grown into a significant enough issue for it to have become a bureaucracy, and like in any bureaucracy, active communication is hard to integrate, not to mention master.

So, what will it take to solve homelessness?

Implementing a homeless system that solves homelessness rather than manages it.

The ideal homeless system has six things.

First, a community needs to understand who is homeless

This includes different demographics like race, profession, gender, sexual orientation and age as well as the reasons why those people are homeless like addiction, mental illness, lack of economic income…

This can help a community in general to determine if there are any specific trends at play which can help to better inform universal prevention strategies — i.e changes the community can make to discourage homelessness in general.

It can also help a community divide up sub populations and send them to specialized organizations based on their needs or their preferences so that they can be better helped.

For instance, if a community has a particularly high population of homeless women who were victims of sexual assault or human trafficking, they most likely have some overlapping needs which are different from the needs of men struggling with mental illness. In fact, each population would most likely be more comfortable if they were separated from one another.

But then, how do you figure out who the homeless are. The most popular way is to use something called a point in time count. This basically entails a bunch of community organizations getting together on one night and surveying all the homeless people in their city.

Second, we need outreach

Rather than just waiting for a person to show up at a shelter in great need of assistance, we can use mobile outreach teams to actively go out into the community and seek out these people. Of course, this wouldn’t necessarily mean that every person the workers talk to would be willing and enthusiastic to come back to the shelter — some people can’t handle the overwhelming social situation that implies.

But, it could definitely help a lot of people who are willing before their situation gets too bad and changes our approach from reactive to proactive.

Third, we need centralized intake

So, we’ve established that one of our big issues is that when a person shows up at one shelter, it doesn’t necessarily have the services that would be the best for them.

How do we match a person with the best services?

Using centralized intake. Some kind of way of evaluating a person to figure out their needs and extremity of their needs. For instance,

  • Supportive Housing Registry in BC ranks people on a scale of SL1 to SL4 based on their need so that they know what organization they should be sent to.
  • The SPDAT test figures out the acuity (specificity) of someone’s need
  • the Alex in Calgary does an interview and an evaluation with a psychiatrist and a psychologist to get similar results.

Any of these rankings would be done by one of the outreach workers mentioned in Step 2.

This information is then put into a centralized data bank called the Homeless Management Information System which is made available to all the organizations working to solve homelessness in a city.

The specific results of the outreach ranking is then used to figure out which emergency shelter and transitional housing program would be the best fit for them and they are sent to those places.

Centralized intake plays into the whole issue of connectivity by making collaboration possible across organizations and across sectors. It also enables each not for profit to specialize because instead of worrying about needing to satisfy the needs of an incredibly diverse population of homeless people, they can be assured that another organization in the community will cover other needs.

Together, everyone is able to address the range of concerns and each organization can do their part at a higher level.

Fourth, Emergency Shelters

Yes, the painkillers, we still need them. Emergency shelters are undeniably a crucial part of the homeless system. For the transitionally homeless, they might be all that is needed, and for the chronically, episodically homeless they’re there to stabilize them. To give them a place to sleep and a meal right after they can’t get those things themselves.

But, then (after a matter of days ideally), it’s time to move on. Definitely not the length weeks and months people currently spend in them.

Fifth, comes transitional housing.

Transitional housing is, as it sounds, the transition between the complete support of an emergency shelter and the complete autonomy of long term housing. It’s the intermediate location where people learn how to definitely deal with their problems.

Housing First

Housing first is a kind of transitional style housing which, in the past few years, has gained a lot of popularity due to its effectiveness in reducing chronic homelessness.

Housing first originally came about as a derivative of the Pathways to Housing Model which was used in New York.

The Pathways Model works like this

  1. Potential clients are identified in two streams: hospital discharge and street outreach
  2. Clients talk about what their preferences are in terms of housing and location as well as their needs.
  3. A team works with a private landlord in order to get a place for the person to stay that more or less fits their description.
  4. A person is matched with an team of clinical proffessionals depending on their level of acuity.

Alright, so that was a lot of jargon, but from this model, a more generalized set of guidelines was derived on five key principles

  1. Immediate access to permanent shelter without readiness requirements. This means that someone doesn’t have to be sober, healthy or anything else in order to access housing.
  2. The consumer has some say in shelter and supports. Treatment are non conditional meaning the person has some choice in the matter — they can choose to refuse any or all of the treatments.
  3. Focuses on recovery (solving the root cause of why they are homeless). The team of people assigned to a person helps them learn tools necessary to deal with their specific reasons for homelessness (addiction, mental illness, abusive relationships…)
  4. Managed on a case by case basis depending on the client
  5. Integrates people back into the community.

The last point, of integrating people back into the community is thought to be the most important aspect. Forming relationships with people who can be a person’s support network as they move on to long term housing.

Housing first can use a couple different kinds of distribution models

  • Scattered site housing: one person lives independently per area
  • Community housing: a group of clients live together in one building

The benefits of scattered site housing is that it is a bit more discreet, and so there is less stigma surrounding the whole affair. It also helps reinforce the client’s sense of independence and gives them more opportunity to get connected with the neighbourhood.

But sometimes, with clients with more acute needs where this added sense of independence is not beneficial, something like permanent supportive housing is better, which is typically done using community housing.

So once a person is identified for a housing first program and matched to a house, they are given access to supports: housing, clinical and complementary.

Housing supports usually consist of some kind of case manager helping a person

  • Finding housing
  • Maintain relationships with landlords
  • Learn skills for independent living
  • Subsidies
  • Setting up furniture

Really just all the things you need to know to keep your house in order. The point about maintaining relationships with landlords is perhaps the most important. The client’s relationship with the landlord should be as important as their relationship with the case manager because, well, the landlord is basically the gateway to their housing.

Keeping this relationship positive and consistent in order to prevent eviction can be done through a strategy called landlord-tenant mediation which basically means forming a set of clear agreements between the landlord and tenant. This can be done using the

  • Successful Tenancy Action Plan — a process completed at intake in order to determining the client’s needs as well as what their triggers and how they can best be managed
  • Working together agreement — a three way agreement between the landlord, client and organization laying out what the client can and can not do and what the landlord should be able to tolerate

Clinical supports really depend on the client’s needs — depending on what they struggle with, they should be matched with different supports.

There are three different kinds of teams which oversee these clinical supports

  • Rapid Rehousing — little to no clinical supports meant for people who don’t have acute needs
  • Integrated Case Management (ICM teams) which consist of a case manager who is available at least 12 hours a day each day of the week. The case manager helps the client find a job, manage income or do anything else they need so they usually cover housing supports as well.
  • Acute Care (ACT) teams are made up of a group of specialized people — sometimes a psychiatrist, a psychologist, employment counselor, landlord… This group will usually take on about 10 different clients and are collectively available 24/7. They come to the client’s house to meet regularly with them and with each other.

Some of the most successful housing first programs in Canada include the ones set up by the Calgary Homeless Foundation, VivianRain City, Transitions to Home in Hamilton and the City of Lethbridge Social Action.

Then, like what was said before, we need to collaborate across sectors.

Beyond just having centralized intake which allows organizations to specialize in certain populations and refer clients, we need to collaborate across sectors.

This means building relationships with police officers, clinics, support groups, employers, recreation activities… all those other organizations that provide crucial aspects of a person’s life that one housing first center could not possibly provide on their own.

The other benefit of doing things this way is that theoretically, when a person leaves transitional housing, they will still need to access programs like a support group, therapist or clinic regularly. If all of these programs are contained within the housing first organization, it’s difficult or impossible to access them after leaving.

But, if they are done through collaboration, when a person graduates out of the program, they can instead keep with their current sources of support.

Doing things this way also helps to reintegrate people back into the community while using housing first. It breaks the stigma surrounding homelessness.

One popular thing that cities like to do as part of their homelessness plan is increase the amount of affordable housing. Now, don’t get me wrong, affordable housing is a necessary part of any homelessness plan, but it’s not the entire plan. Subsidizing housing is not going to solve a person’s reason for being homeless most of the time.

Which is why it should be done as a collaboration with the homeless sector rather than being the entire homeless sector itself.

Finally, we need prevention.

Prevention takes place throughout the homeless system, it’s not a last step.

As it sounds prevention has to do with preventing a person from experiencing homelessness in the first place. Sometimes, housing first is considered a preventative measure, because it tries to get people housing immediately, but often it still means spending a few days in an emergency shelter.

The biggest kind of preventative measure we should be taking is to stop discharging people into homelessness. We have so many different public institutions which can effective at doing what they are meant to do, but are hopeless at transitioning people out of them.

Take a hospital for instance, once an operation or other clinical procedure is finished, a person is free to leave. But, what if that person has nowhere to go, the instant they leave the hospital, they have to deal with the harsh realities of homelessness.

And no, it’s not the hospital’s job to find a house for every patient, but for the patients that would be walking into homelessness, they should be connected with an organization that can get them a place to stay — i.e. the centralized in take. And this doesn’t just apply to hospitals, it also applies to prison/correctional facilities and even the foster care system. Our institutions need to be a continuum rather than a bunch of fragmented pieces.

Then of course, there are the programs meant which can help a person on the trajectory towards homeless before they actually make it there. These are the things like subsidized housing, economic opportunities, education. And, these things should be specifically targeted towards a community’s minority populations most at risk of being victims of the structural factors that cause homelessness.

Access to housing is considered a human right and one of the three essential things humans need to stay alive (along with food and water). But, there are so many people who are effectively shut out of housing and the personal stability that comes with it. Our homelessness system has existed in various forms for centuries, and despite its best intentions, never before has its weaknesses been more obvious.

We need a system capable of solving homelessness rather than one that just manages it. It’s time for change.

Activator at The Knowledge Society | A Sandwich or Two Founder

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