Appendix A - Housing First: Case Studies

New York City

A 1992 study in New York City provided apartments to 242 chronically homeless individuals with no questions asked. Participants were not required to be sober and were permitted to continue living in the apartments as long as they didn’t hurt anyone or bother their neighbours. Medical care and drug and alcohol rehabilitation detox services were offered to participants if they chose to use them. After five years, 88 percent of the participants were still in their apartments, and the cost of caring for them in their own homes was less than it would have been to take care of them on the street. A later study of 4,679 New York City homeless with severe mental illness found that each person cost an average of $40,449 a year in emergency room, shelter, and other expenses, and that getting those individuals in supportive housing saved an average of $16,282.

Toronto, Ontario

Toronto has Canada’s largest and most developed Housing First program. The Streets to Homes (S2H) program started in 2005 with an annual budget of $4 million. S2H’s mission is to provide the chronically homelessness with permanent housing without preconditions. S2H’s mandate is to house people who are spending most nights outside and who are not already receiving housing services. It takes an average of 16 days for the program to find housing for participants after intake. After participants are offered housing, they are given support such as counselling, income support, furniture, clothing and other life supports for one year. Individuals who still require support after one year can then be transitioned to other services.

The S2H program is unique in that it is run by the City instead of community agencies, the more common model for Housing First programs. Observers report that this gives S2H more influence in the housing system and the ability to get things done more efficiently. The S2H program is considered a success and about 600 people have been housed every year since the program started. Of those given housing under the S2H program, 87% remain housed, 70% reported improvements in their health and 72% reported improvements in their personal safety. As well, use of expensive emergency services by participants decreased with 40% fewer hospital emergency room visits and 68% less time in jail.

Medicine Hat, Alberta

Medicine Hat implemented a Housing First program as part of a broader strategy by the Alberta government in 2008 to end homelessness in the province’s seven largest cities. Between April 2009 and September 2013, 703 people received housing, including 243 children. Participants in the Housing First program had 51% fewer days in hospital, 48% fewer days in jail, and 7% more court appearances. 72% of participants stayed in the housing provided. By May 2015, the mayor reported that no one in the city spent more than 10 days in a shelter or on the street, because after that point, the city provided housing. The mayor also reported that the cost to give a person housing under the Housing First program was $20,000 a year while it could cost up to $100,000 to support someone living on the street. These estimates are consistent with findings by the Mental Health Commission of Canada.