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Supportive Housing for Individuals

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Vanessa Corpuz

on 16 March 2016

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Transcript of Supportive Housing for Individuals

By: Vanessa Corpuz, Elisa Kantor, Jennifer Manning, Robin Schulman & Sarah Snow
What is Supportive Housing?
What Are Concurrent Disorders?
Rationale Cont'd
(Homeless Hub, 2015; Concurrent Disorders: Substance Use in Canada, 2009)
(Homeless Hub, 2015)
Over
235,000
Canadians experience homelessness in a year
50,000 are provisionally accommodated (prisons, couch surfing, hospital, motels, etc.)
Homelessness costs the economy
$7 Billion
each year


Housing is a basic human need, especially for vulnerable populations
=
Maslow's Hierarchy
of Needs
Housing Models
Housing models for people with serious mental illness have evolved over time.
Custodial Approach (initial stages of deinstitutionalization)
Supportive Housing Approach (1980s- 1990s)
Supported Housing Approach (2000s)

Research indicates that both supportive and supported housing are favoured over the custodial approach with a preference for supported housing on the rise.
Ontario
Canada
Toronto
Currently, Canada does not have a National Housing Strategy
.
The Trudeau Liberal Government on Housing:
Policy Resolution 162 - Affordable National Housing Strategy
Policy Resolution 51 - National Framework for Mental Health


Relevant Federal Investment
Homelessness Partnering Strategy (HPS): Housing First approach to reduce/prevent homelessness and promote stable housing
Eligible organizations receive funding to coordinate/carry out projects based on Housing Firs model; “Community-based approach”
Economic Action Plan 2013:
$600 million (total) investment in HPS over five years (2014-2019)


Housing in Canada: The Federal Context
Overview of Supportive Housing in Ontario
1999-2000 the responsibility shifted to a municipal role
Non-profit housing (including supportive housing) is run by city owned and community organizations
2000 - The Social Housing Reform Act: transferred housing to the Service Managers of each district/municipality
2011 - The Housing Services Act: replaced the former act
2011 – Long Term Affordable Housing Strategy (LTAHS)
Responsibility for supportive housing was transferred from the Ministry of Housing and Municipal Affairs to the Ministry of Health and Long Term Care and Ministry of Community and Social Services.
Since 2006 Ontario’s 14 Local Health Integration Networks (LHIN’s) play a vital role in supportive housing in terms of administration and funding.
(Ontario Non-Profit Housing Association, 2013)
Ontario's Poverty Reduction Strategy
10 year plan to end homelessness
Addresses some issues related to mental illness and addictions

At Home/Chez Soi:
federal investment project that provided stable housing to homeless people with complex mental health and addiction issues

In 2013 the Ontario government invested $4 million to this program to provide 240 people with units in Toronto with rent supplements and support services.
Phase 2 of the Comprehensive Mental Health and Addiction Strategy (2014-2015) is supposed to be expanding on housing supports for people with Mental illness and addictions.
The Ontario government plans to invest $16 million over 3 years to create 1,000 new supportive housing spaces.
The strategy suggests more collaboration between the municipalities and LHIN’s
(Ontario, 2012)
Homelessness in Toronto
Approx. 32, 000 individuals use Toronto emergency shelters annually
On average, 6,500 people are considered homeless on any given night.
66% of the city’s homeless have been diagnosed with a severe mental health disorder, 66% with substance abuse issues, and 86% have been diagnosed with concurrent disorders
Contributing factors:
Deinstitutionalization
Healthcare and Welfare policy changes
Lack of community supports and affordable rents
(Mental Health Commission of Canada [MHCC], 2014b)
(MHCC, 2014b)
(Hwang, Stergiopoulos, O'Campo & Gozdizik, 2012)
(Riordan, 2014)
Current Resources in Toronto
Housing Connections
Toronto Community
Housing Corporation
Mental Health &
Addiction Supports
(hospital or community based)
(Housing Connections, n.d.)
The Access Point
NGO Supportive
Housing Providers
Assertive Community
Treatment Team
Intensive Case Management
Applicants access
housing through NGO
internal waitlists
(Permanent or transitional)
(The Access Point, 2015a)
The Issue: Lack of Services = Long Waitlists!
Wait times vary and depend on unit size and preferred location, as well as types of mental health services required

Housing Connections
Over 170, 000 applicants on the waitlist
5-15 year wait for housing

TheAccessPoint
5 – 7 year wait for supportive housing
In Toronto, wait-list for supportive housing increased from 8,900 to 10,100 between 2014 and 2015

8- > 12 months for case management or ACTT

Community Mental Health and Addiction Supports
Median wait time for residential supports: 62 days

Supportive Housing is Cost Effective!
Providing housing for individuals with mental health and addiction issues reduces the use of emergency and institutional services such as:
Emergency Rooms
Psychiatric hospitals
Emergency Shelters
Jail
Return on Investment

In Canada:
Psychiatric hospital bed: $330 to $681 per day
Hospital acute care bed: $720 to $1115 per day
Ambulance: $690 to $785 per use
Emergency room visit: $212 to $820
Incarceration: $143 to $457 per day
HOSPITAL
"Doing Nothing is Not Free"
US Department of Housing and Urban Development's Strategies for Reducing Chronic Street Homelessness (2004)
(MHCC, 2013)

Housing First:
Cost: $22,257 per person per year on average for a high need individuals receiving assertive community treatment.
$14,177 per person per year for a moderate needs individual receiving intensive case management.
Results found by comparing the differences in costs of the treatment as usual group and the participants in housing first group both at baseline
and after housing first intervention.
Average reduction of $21,375 in the costs of other services being used by high needs participants.
Average reduction of $4,849 in costs of other services being used by moderate needs individuals.
Every $10 invested in Housing First resulted in an average reduction in costs of other services of $9.60 for high needs participants and $3.42 for moderate needs participants.
At Home/ Chez Soi Findings
(MHCC, 2013)
(Adapted from Pomeroy, 2005)
Issues with Supportive Housing for
Individuals with Concurrent Disorders

Housing that supports individuals with mental illness and addiction through onsite access to a range of psychosocial services and assistance with activities of daily living

Common services include:
Case management, individual/family counselling, life skills training, employment assistance & community supports

(CAMH, 2012)
(Centre for Addiction and Mental Health [CAMH], 2012)
Historical Context
1950’s Deinstitutionalization
Shifted the locus of care from a specific place (asylum/institution) to the community
Lack of housing for those affected by mental illness upon discharge.
Deinstitutionalization was not accompanied by the development of community supports.
Housing and supports for the mentally ill is an ongoing social problem that needs to be addressed
This includes individuals with concurrent disorders

The Issue
The lack of supportive housing programs in Toronto has resulted in very long wait times for necessary acommodation & services for individuals living with concurrent disorders
Concurrent disorders occur when an individual is living with both mental illness and substance use issues.

Prevalence:
"The Canadian Centre on Substance Abuse (2009) suggests that over 50% of people seeking treatment for an addiction also suffer from a mental health disorder and that 15-20% of people with mental disorders have substance use problems."

People with concurrent disorders are highly associated with:
Poverty
Homelessness
Unstable housing
Shorter life expectancy
More frequent admissions to psychiatric hospitals
More time in hospital per admission

(CAMH, 2012)
(Regher & Glancy, 2014)
(Kirkpatrick, 2009, p.68)
(Aubry, Ecker, & Jette, 2014)
(Aubry, Ecker, & Jette, 2014; Forchuk, Nelson & Hall, 2006; Kirkpatrick, 2009; Nelson, 2010).
(Liberal Party of Canada, 2015a)
(Liberal Party of Canada, 2015b)
(Government of Canada, n.d.)
(para.3)
(Kwan, 2014)
(Ontario Council of Agencies Serving Immigrants [CASI], 2015)
(S. Lurie, personal communication, December 1, 2015)
(The Access Point, 2015)
(Canadian Institute for Health Information [CIHI], 2012)
(The Access Point, 2015b)
Relative Cost of Emergency/Institutional
versus Supportive Options
Recommendations & Evaluation
Encourage continued investment by federal, provincial and municipal governments in housing first initiatives


Advocate for commitment from federal government to create a national financial strategy and dedicated budget specific to funding supportive housing initiatives
Investments and
Financial Planning
Reallocate Funding
Recommendations: 10-Year Plan
Recommendations:
Cost Differential
Recommendations:
Develop transitional supports to help individuals relocate from supportive housing to other types of housing when they are ready.
(S. Lurie, personal communication, December 1, 2015)
Advocate for and support national, provincial and local education strategies regarding mental health and addictions.
Recommendations:
Assisting in transitioning will enable people who no longer need the supports to go forward which will free up space for individuals on the waiting list.
The more informed people are the better they will understand the benefits and importance of developing and maintaining supportive housing for people with mental health and addictions issues.
Key Indicators of Success
Reduction in Homelessness in Toronto
Within mental health and addictions populations
Within general municipal population

Reduction in wait times for housing and community support services for mental health and addictions

Decrease in frequent hospitalization for addiction and mental
health related crises

Increased use of community agencies for addiction and mental
health supports
Methods of Evaluation
Methods of Evaluation
On a
municipal

level:
Comparing statistics of annual studies from the following sources:

Street Needs Assessment
# of homeless individuals in Toronto
Prevalence of mental health and addiction issues within homeless population
# of applicants on supportive housing waitlist
% of those who had interaction with criminal justice system

Ongoing observation of supportive housing waitlist in Toronto
changes of # of people on waitlist
changes in wait times
(City of Toronto, 2013; Shepherd, 2013)
Ongoing research regarding hospitalization and homelessness in Toronto
i.e., Centre for Research and Inner City Health
ED and ICU usage among patients with not fixed address
Healthcare costs of hospitalization for patients with no fixed address
Information provided by yearly reports from Housing Connections and Access Point
On a
federal
and
provincial
level:
Create a national research initiative to evaluate improvements of supportive housing within Canada and individual provinces after recommendations have been implemented.
References
References
References
Aubry, T., Ecker, J., & Jette, J. (2014). Supported housing as a promising housing first approach for
people with severe and persistent mental illness. In M. Guirguis-Younger, R. McNeil, & S.W. Hwang (Eds.),
Homelessness & health in canada
(pp. 154-185). Canada: University of Ottawa Press.

Burt, M. R., & United States. (2004).
Strategies for reducing chronic street homelessness: Final report
. Washington,
DC: U.S. Dept. of Housing and Urban Development, Office of Policy Development and Research. Retrieved from: http://www.huduser.gov/Publications/PDF/ChronicStrtHomeless.pdf

Canadian Institute for Health Information [CIHI] (2012).
Healthcare in Canada, 2012: A focus on
wait times
. Retrieved on November 28th, 2015 from https://www.cihi.ca/en/HCIC2012_CH4_EN.pdf

Centre for Addiction and Mental Health (CAMH). (2012).
Road to recovery: Client experiences in supportive housing.

Toronto, ON: CAMH.

Centre for Health Services and Policy Research. (n.d.).
Evidence and perspectives on funding
healthcare in Canada: Current funding
. Retrieved from http://healthcarefunding.ca/key-issues/current-funding/

City of Toronto, (2013).
Street needs assessment, 2013
. Retrieved on November 28th, 2015 from
http://www.toronto.ca/legdocs/mmis/2013/cd/bgrd/backgroundfile- 61365.pdf

Concurrent Disorders: Substance Use in Canada. (2009).
Précis
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http://www.ccsa.ca/Resource%20Library/ccsa-011811-2010.pdf

Forchuk, C., Nelson, G., & Hall, G. B. (2006). "It's important to be proud of the place you live in":
Housing problems and preferences of psychiatric survivors.
Perspectives in Psychiatric Care, 42(1),
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Goering, P., Veldhuizen, S., Watson, A., Adair, C., Kopp, B., Latimer, E., . . . Aubry, T. (2014). 
National at
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Government of Canada. (n.d.).
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initiative/homelessness-partnering-strategy

Government of Canada. (2013).
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www.housingconnections.ca/Provider.Net/AboutProviders.aspx
Hwang, S. W., Stergiopoulos, V., O'Campo, P., & Gozdzik, A. (2012). Ending homelessness among people
with mental illness: The at Home/Chez soi randomized trial of a housing first intervention in Toronto.
BMC Public Health, 12
, 787

Kirkpatrick, H., & Byrne, C. (2009). A narrative inquiry: Moving on from homelessness for individuals with
a major mental illness.
Journal of Psychiatric and Mental Health Nursing, 16(1)
, 68-75. doi:10.1111/j.1365-2850.2008.01331.x

Kwan, A. (2014, October 17).
Toronto's affordable housing crisis sparks growth of illegal rooming houses
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Globe and Mail. Retrieved from http://www.theglobeandmail.com/news/toronto/torontos-affordable- housing-shortage-sparks-growth-of-illegal-suburban-rooming- houses/article21153160/

Liberal Party of Canada. (2015a).
Policy resolution 162
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resolutions/162-affordable-national-housing- strategy/

Liberal Party of Canada. (2015b).
Policy resolution 51
. Retrieved from: https://www.liberal.ca/policy-
resolutions/51-priority-resolution-national-framework-mental-health/

Mental Health Commission of Canada. (2013),
Turning the key: Assessing housing and related supports for
persons living with mental health problems and illness
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Mental Health Commission of Canada. (2014a). April 8, 2014 – Ground-breaking research shows that
‘housing first’ approach working to end homelessness. Retrieved from: http://www.mentalhealthcommission.ca/English/article/24696/april-8-2014- ground-breaking-research-shows-%E2%80%98housing-first%E2%80%99- approach-working-end-homel

Mental Health Commission of Canada. [MHCC] (2014b).
Initiatives: Toronto
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2015. Retrieved from http://www.mentalhealthcommission.ca/English/initiatives-and- projects/home/toronto

Nelson, G. (2010). Housing for people with serious mental illness: Approaches, evidence and
transformative change.
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Ontario Council of Agencies Serving Immigrants [OCASI]. (2015, September 4). How long do I have to wait
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Ontario Ministry of Finance. (2014).
Correctional services program - VOTE 2605
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Ontario Non-Profit Housing Association. (2015).
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Pomeroy, Stephen. (2005),
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cities
. Retrieved from: http://www.raincityhousing.org/docs/CostofHomelsssness- FourCitiesMarch2005FINALREVISEDMAR29.pdf

Regehr, C., & Glancy, G. (2014).
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Roberts, G., & Grimes, K. (2011).
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Shepherd, L. (2013, October 22). Research finds small group of homeless people are extremely high users of
Emergency Departments. St. Michael's Hospital Newsroom. Retrieved from http://www.stmichaelshospital.com/media/detail.php?source=hospital_new s/2013/20131022b_hn

The Access Point. (2015a).
FAQ
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The Access Point. (2015b).
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( Goering et al., 2014)
( Goering et al., 2014)
(Roberts & Grimes, 2011)
Potential Barriers of Implementing
Recommendations
Cost/incurring debt during initiation of changes

Political will
References
The Institute for Competitiveness & Prosperity. (2014).
Building better healthcare: Policy opportunities for
Ontario
. Retrieved from http://www.competeprosper.ca/uploads/WP20_BetterHealthCare_FINAL.pdf
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