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What Is The Issue?

According to l’Agence de la santé et des services sociaux de Montréal, in 2010–2011 there were more than 57,000 admissions to the city’s three largest men’s homeless shelters and nearly 5,700 admissions to the main women’s shelters—an increase of six per cent and 34 per cent, respectively, compared to just two years earlier.

The most recent survey of homelessness in Montréal, conducted in 1996–1997, found that almost 13,000 people had been homeless at some point during the previous year. What’s more, 40 per cent of these people were experiencing severe mental illness and nearly half were having substance abuse problems. That survey, however, didn’t account for those who chose not to access any type of services or may have been hospitalized or incarcerated at the time. As such, it is difficult to know exactly how many people are homeless in Montréal, but some estimates have put the number as high as 30,000.

What Are We Doing?

The Montréal At Home/Chez Soi project recruited 469 participants for its study, all of whom were experiencing some degree of mental illness. While many participants were recruited from shelters and hospitals, about six per cent were people who had experienced chronic homelessness who were not receiving any type of support.

Several teams contributed to the implementation of Housing First in Montréal including CSSS Jeanne-Mance (Intensive Case Management, Assertive Community Treatment), Diogene (Intensive Case Management), Institut universitaire en santé mentale douglas (Douglas Mental Health University Institute) (housing and support services), and Douglas Hospital Research Centre (research).

Helping people who have experienced homelessness find employment
One of the objectives of the Montréal At Home/Chez Soi project was to investigate the capability of people receiving housing and intensive case management to re-enter the labour market.

As the Individual Placement and Support (IPS) model has proven successful at helping people with mental health problems find and maintain competitive employment, the Montréal team aimed to study its applicability to the homeless population. Consistent with the IPS model, participants who expressed interest in finding a job were provided with a range of personalized employment supports, from assistance writing résumés to being introduced to potential employers and preparing for job interviews. Program staff also worked directly with employers to find appropriate job opportunities for participants and to educate them on how to support their new employees.

Watch a video to see five participants’ experiences reintegrating into the job market.

Giving people who are homeless the power of choice
To many community groups in Montréal, the answer to the city’s homelessness problem is to provide more social/congregate housing. However, due to limited availability of social housing sites across Montréal, the At Home/Chez Soi team was forced to take a broader approach. Rather than randomly assigning participants to either social housing (to the extent it could be found) or subsidized, private-market apartments, it was decided to give all participants the ability to choose the type of housing in which they wanted to live. In the end, fewer than five per cent of participants elected to be placed in social housing. Regardless of which option they chose, all participants were visited by program staff regularly and given access to the same kinds of services, including health care and life skills coaching.

What We’ve Learned

Final results of the Montréal At Home/Chez Soi study show that the Housing First approach is feasible, effective and cost-effective. After being provided with housing, study participants were found to spend less time in shelters, jails and hospitals—and at a cost per person that is not much more than traditional interventions.

Providing employment services to people who have experienced homelessness with moderate mental health needs has also been effective. However, the IPS model has proven more difficult to apply to the homeless population than to the general population for a number of reasons including: substance abuse problems, criminal records and issues with motivation that can make it difficult to hold down a job. Still, the team’s work in this area is providing important findings into what works and what doesn’t for this specific population, which will lead to more effective vocational support programs in the future.