Housing First was the big idea in the late-2000s when it came to solving the problems of homelessness, addictions and mental illness sparked by the closures early in the decade of mental institutions like Riverview. Photo by NICK PROCAYLO /PNG
Daphne Bramham: The solution to homelessness, DTES chaos and disorder has been known for years
Opinion: It’s hard not to think that our governments are throwing good money after bad when policy-makers ignore both the evidence and the experts
By Daphne Bramham, The Vancouver Sun, January 28, 2021
VANCOUVER, In 2008 — the same year that Vancouver Mayor Gregor Robertson pledged to end homelessness by 2015 — a five-year, $110 million, federally funded trial called At Home/Chez Soi began in Vancouver, Winnipeg, Montreal and Moncton, N.B.
For the trial, 300 participants were identified in Vancouver, which was described as “distinct” from the other cities because of the geographic concentration in the Downtown Eastside and the high rates of substance use.
Of the 300 participants, 200 were the control group, left to lead their usual chaotic lives, and 100 were given homes.
“The trial was doing what we knew was the most effective intervention,” said Julian Somers, now a distinguished professor at Simon Fraser University. “It was proof of the concept that to a large extent long-term homelessness was the result of neglected mental-health and addictions issues.
“And there was a possibility that we would be able to achieve an alternative that eventually the provinces and territories would take on.”
In spring 2014, the results were released:
The At Home/Chez Soi report provided evidence that not only is it more humane and compassionate to move people off the streets and into housing, their lives also become measurably better and — better still — it costs taxpayers measurably less.
On average, the study found that it cost $28,282 annually to support high-needs participants.
In Vancouver, these were 100 people who had been homeless for most of the previous 10 years, had addictions, mental illnesses and multiple contacts with police.
Once their lives were stabilized, those lucky 100 used an average of $24,190 less per year in services such as hospitals, shelters and jails.
It meant that for every $10 invested, there was an average savings of $8.55 in avoided use of social services.
(Because inflation is low, the 2020 dollar figures are only about 10 per cent higher than the numbers in the report.)
Ambulance paramedics help a man suffering a drug overdose on Columbia Street in Vancouver, BC’s Downtown Eastside Saturday, May 2, 2020. After being injected with Naloxone by the paramedics the man woke up and walked away. Photo by Jason Payne /PNG
It was a revelation that echoes what had already been done in Portugal but largely gone unnoticed because most media coverage focused on that country’s decision to decriminalize personal possession of drugs at the same time as it massively invested in social services for the homeless and addicted.
Somers said other experts told them it wouldn’t work that “people weren’t ready to go from the street to housing, they needed to go through a kind of car wash — detox, sobering, transitioning through shelters until they ‘graduated’ to independent housing.”
But in the trial, the homeless, addicted, mentally ill and traumatized people weren’t left to find their own way to those ‘car-washing’ services and work their way up.
There were people assigned to help them get what they needed close to their new homes.
Those lucky 100 were given choices from the moment they were identified.
Among them was which neighbourhood they wanted to live in. Some chose the DTES, but others chose Marpole and the West End.
They lived in rental apartments where no more than 20 per cent of the residents were in the trial.
They were asked what help they needed or wanted.
Their lists included food, dental care, bank accounts, addictions treatment, counselling and, yes, friends.
Housing First was never just roofs over heads, Somers said.
Just as he insists that the other big idea embedded in the trial — distilled to the catchphrase harm reduction — was always intended to be more than needle exchanges, supervised consumption sites and substituting pharmaceuticals for street drugs.
“The language in the At Home report was for recovery-oriented housing,” he said.
“What has emerged from the outcomes of the trials bears no resemblance to what we did in the trials. None.”
The crucial issue isn’t finding spaces to house people.
It’s finding and training staff to work there and will have to deal with people who likely haven’t had roofs over their heads for a long time, have addictions, brain injuries and other mental illnesses.
It seems the provincial government has learned from its recent experiences, both good and bad.
The bad was during the pandemic it moved homeless people into vacant hotel rooms to ensure social distancing, but didn’t initially provide staff to deal with their unique issues.
The good was with the Oppenheimer Park campers. Eby said close to 90 per cent of those who went into government housing are still housed.
The ones who aren’t are mainly those who have complex care needs and have frequent contact with police.
It’s also not moving a few people at a time and risking the kind of “endless backfill” that happened at Oppenheimer.
There, when a few small groups were moved out, they were quickly replaced by others coming from doorways, shelters and friends’ couches who believed that the route to a roof over their heads was some time under canvas in the park.
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Meantime, we have an ever-worsening crisis despite more money than ever before being spent in response to the global COVID-19 pandemic and as opioid overdose deaths hit a new high.
It’s a crisis that Somers has offered to help out with by sharing research. But he said his overtures are almost always rebuffed.
He’s a psychologist in the sea of public health officials, medical doctors, former HIV/AIDs researchers, grieving families and drug-users who are driving most of the policy direction and don’t share his views about addiction.
If people’s experience with addiction has mainly been in the DTES and whose training is steeped in pharmaceutical solutions, Somers said it may be understandable that they see its treatment as a kind of palliative care or maintenance.
“Many (of them) are actually of the view that you can’t treat it, that it’s like diabetes,” he said “That’s really crazy. People can’t quit diabetes, but people quit addictions all the time.”
In 2014, my colleagues Pete McMartin and Lori Culbert did the last tally of spending in the DTES. They catalogued the service-providers and then looked at their budgets. They determined that providing services for an estimated 6,500 people in 2013 cost at least $360 million — a million dollars a day.
Nobody in government seems to know exactly how much money is now being spent. But whatever it is, it’s a lot more than in 2013.
And, it’s hard not to think that our governments are throwing good money after bad when policy-makers ignore both the evidence and the experts whose views don’t fully align with theirs.
Calling on our Star Brothers and Sisters,
the Halion Engineers, Healers of Tralana,
the Hathors and Ascended Masters for help
with homelessness and addiction issues
in North America.
And Archangel Michael:
Today, what is the expression
of my Infinite Potential?
With assistance
from our Star Brothers and Sisters,
and the Divine,
there is no situation,
there is no challenge
that cannot be transmuted,
reconstructed with Love.
The Universal Law of Transmutation
THE SCALES OF JUSTICE, OF WORTH AND OF THE UNIVERSE, IN BALANCE
