Over al., 2016). In 1980 a shift

Over the past two decades, homelessness has become the worst man-made disaster in the world, it is estimated that 100 million people across the world are homeless. Currently, there is a major struggle to answer the questions of why do people become homeless? and why do people stay homeless? Specifically, individuals who are homeless are unable to maintain safe and secure housing long-term. While there is a lot of interest in learning about the causes of homelessness, there is very little data available to accomplish this. Currently, homelessness affects individuals across all economic levels and circumstances, but certain citizens are increasingly more prone to homelessness than others. There is a great deal of support in the idea that homelessness has a significant correlation to poverty and mental illness. In fact, individuals who are affected by homelessness are likely to exacerbate or develop a mental illness that would otherwise be controlled. Housing First is a model that has been recently embraced as being very effective in reducing homelessness. Housing First emphasizes a client-centered approach to services and immediate housing placement without requirements for sobriety or treatment participation. This model seeks to address the problem of a disproportionately high number of homeless people with a serious mental illness. These individuals represent a subgroup who tend to stay homeless for long periods of time and who are considered “difficult to house”. To effectively address homelessness and mental illness, an effective federal housing intuitive needs to be implemented. This paper will explore how equipping individuals with a stable housing environment through community support can lead to a decrease in adverse health outcomes and a greater initiative in self-care.
Dating all the way back to the 1980s poverty in Canada is a lot more widespread that many individuals living in Canada realize (Gaetz et al., 2016). In 1980 a shift in disinvestment in affordable housing and spending reductions in social support programs saw an rapid increase in the number of homeless individuals. According to a 2016 report on homelessness in Canada 235 000 individuals experience homelessness that year and averaging of about 35 000 every night (Gaetz et al., 2016). The government of Canada spends about $3-6 billion to support homelessness across the country (Graham, 2010). Beginning in the 1980s and accelerating into the 1990s, the homeless problem increased from afflicting a small number of single males to a “crisis” affecting a diverse population (Gaetz, 2010). The rapid increase of homeless individual had led homelessness to become a full blown outbreak by 2017. Now more then ever citizens are unable to afford homes, with many turning to homeless shelters that are already underfunded and understaffed. 
Before 1980 Canada has a relatively good housing policy which saw implantation of the idea the homeless individuals need to be rehoused. It was at this time that a major shift took place that saw a demand for less government intervention, lower taxes across the board, and  privatization of important government services,(Gaetz, 2010). Simultaneously, the government also roll back large amounts of social spending which further increased the homeless problem. The dismantling of Canada’s national housing strategy had the most extreme impact on homelessness. The Federal government created a strategy where there was not only to shift in housing policy towards home ownership but also drastic cuts to spending in order to balance the budget (Gaetz, 2010). Fast-forwarding to present day the housing problem has to an extent has gotten out off hand. While many politicians thought that increasing the number of rental properties would solve the housing problem that has not been the case. The exact opposite effect has actually taken place, rental properties are being torn down and replaced by condominiums. This becomes a problem, because while there has been an increase in wealth in the past decade, most of it has gone to the richest individuals (Statistics Canada). This leaves lower income individuals systemically poor and unable to afford the current housing prices on the market. This is directly represented in the increases statistic of the current homelessness problem, showing us that this has become a major catastrophe. 
While statistics on homelessness are calculated every year, in reality it is hard to measure homelessness and the figures presented are never 100% accurate. This is because homelessness is very difficult to define as many individuals experience homelessness in different ways. therefore, for the purpose of this paper the United Nations definition of homelessness will be used. This criteria includes; people with no homes, including natural disasters and people who’s homes do not meet the criteria for basic living standards, including adequate protection from elements and access to safe drinking water/sanitation (McLaughin, 1986). Many social and economical factors led to the increase of homelessness in Canada, with majority of homeless individuals being segregated to city centres stricken with poverty. Mental health and health problems, as well as addictions, created challenges for people who lacked the necessary income and access to appropriate services (Gaetz, 2010). 
Homelessness has a direct association with mental health and addiction, individuals who are homeless and suffer from mental illness have an increased need for social services. Despite this knowledge mental health and addiction services available to homeless individuals is adequate at best (Gallagher et al., 1997). One of the first and most famous studies conducted by Appleby and Desai (1985) concluded that populations who were homeless and possessed a mental illness had lower hospital admissions than this who had permanent housing and where mental ill. Furthermore, homeless individuals often left hospitals against the doctors wishes and where rarely referred to long-term care facilities. Similarly a study conducted in Montreal and Quebec City, determined that 60% of people using resources for the homeless reported mental disorders at some point in their lifetime (Bonin, 2007). Specifically 72% of the sample population had experienced serious disorders within the past year (Bonin, 2007). However, 56% of the sample stated that they had not received any mental health services in the past year, despite having access to the Canadian health care system (Bonin, 2007).
Both of these studies show that the use of mental health services in homeless populations is very poor. In fact, homelessness actually increases the negative affect on mental illness, essentially making the problem worse (Hwang, 2002). There are several key factors as to why homelessness is such a prevalence among individuals with mental health. The inability of the public health sector to to deliver coordinated health services required to meet the vast needs to homeless people has been identified as massive contributing factor (Kuno, et al., 2000). Stress and coping is another factor that severely affects the population. Current research suggests that homeless individual implement strategies that distance them from stress, instead of actively trying to solve it. In Kitchener?Waterloo, Ontario, a study found that street youth were
more likely to engage in substance use and self?harm as a means of coping (Ayerst, 1999). Furthermore, social support is very important in a persons life, meaningful relationships and social networks provide emotional support in difficult situations. Individuals who are homeless often do not have access to sufficient support in their lives. Often this is because they have no permanent home address and therefore move around a lot making it hard to develop relationships. Many individuals are also dealing with strenuous family lives, meaning they do not have family members that they can turn too. A study conducted in Ottawa found that 15% of adults living on the street reported receiving no social support (Farrell et al., 2001). 
Psychiatric related complication also pose a barrier for individuals to hold down permanent housing. In Toronto, Ontario, 67% of shelter users in the Pathways into Homelessness Project reported a lifetime diagnosis of mental illness (Goering et al., 2002). The prevalence of mental illness in the population creates a strain on interventions that address this problem. Despite the fact that mental health programs exist and are available free to all Canadian citizens, many homeless individuals do not use them. In fact, the homeless are more likely to use temporary emergency care instead of long-term facilities. Data from the Canadian Institute for Health Information indicates that mental health and behavioural disorders account for a larger share of emergency department visits and hospital stays among the homeless population than among the general population (Canadian Institute for Health Information, 2007). This data shows that mental illness and homelessness is directly linked and you can not attempt to fix one without addressing the other. In the past decade their has been strategies put forth that can prove to be affective in addressing both issues. In 2013, the government of Canada renewed the Homelessness Partnering Strategy (HPS) for another 5 years (Gaetz, et al., 2016). The renewal project consisted of adding another $119 million into the Housing First model (Gaetz, et al., 2016). In recent years housing programs that focus on mental health and addiction have demonstrated affective solutions to a leading problem in homelessness (Gaetz, 2010).     
The Housing First model first appeared in New York City in 1992 where it founded on the belief that housing is a human right (“Pathways Housing First”, 2017). Dr. Sam Tsemberis provided a consumer-driven evidence-based Housing First model that provides mental ill and addicted individuals with immediate permanent housing (“Pathways Housing First”, 2017). Research suggests that while chronically homeless constitutes only a minority of the homeless population, these individuals can account for over half of all public shelter stays (Stefancic and Tsemberis, 2007). In addition, they also increasingly consume costly acute care services, such as emergency medical, substance use, and psychiatric care, often seeking out these services as a temporary respite from homelessness (Stefancic and Tsemberis, 2007). The Housing First provides permanent, independent housing without prerequisites for sobriety and treatment, therefore removing significant barriers to housing entry (Stefancic and Tsemberis, 2007).
Housing First is a direct contrast to existing housing programs that often see housing as a privilege that you have to earn. Other programs have a tendency to not be affective because of the model that they employ. Individuals tend to remain chronically homeless because they are reluctant to seek psychiatric treatment. This means that they are often disqualified from receiving housing through these treatment-first type programs. The reality is that anyone who is actively using alcohol or drugs, or has a history of behavioural problems and/or criminal activity are labeled as “not housing ready” by traditional programs (Stefancic and Tsemberis, 2007). In addition, those who are excepted into the program are often kicked out due to relapse, violations of program rules, and preference for self-determination and independent living (Stefancic and Tsemberis, 2007).There are only two program requirements: tenants must pay 30% of their income toward the rent by participating in a money management program, and tenants must meet with a staff member a minimum of twice a month (Tsemberis, Gulcur and Nakae, 2011). Even with these restriction the staff is very flexible and the needs of the participant come first. One of the key reasons that Housing First is so affective is because it operates in such a manners as to address the consumers primary need first, which is housing (Stefancic and Tsemberis, 2007). Encompassing this notion the following sections of the paper will explore why the Housing First model is so affective.  
Firstly, Housing First does not require sobriety or participation in treatment to be part of the program. Housing First encourages participants to define their own needs and goals and, if the participant so wishes, immediately provides an apartment of the consumers own choosing (Tsemberis, Gulcur and Nakae, 2011). In addition to an apartment, participants are offered treatment, support, and other services by the program’s Assertive Community Treatment team (Tsemberis, Gulcur and Nakae, 2011). This proves to be affective because it allows the participants to decide their own treatment. They are not pushed into treatment before they are ready and therefore when they do decide to go into treatment it tends to be more affective. Housing First tends to rely on a harm-reduction approach in its clinical services to address alcohol abuse, drug abuse, and psychiatric symptoms or crises (Tsemberis, Gulcur and Nakae, 2011). This approach recognizes that patients can be at different stages in their lives and have different outlooks on affectedness of interventions. Having permanent housing without the condition of sobriety allows for them to have the availability of long-term support. When ever they are ready help will be there for them and treatment will be tailored to their specific needs. This is shown through the fact that Housing First participants show larger gains in social skills and in behaviours associated with medication compliance, and cooperation with treatment providers (Aubry et al., 2015).
Secondly, Housing First allows the participant to have control over their lives and where they want to live. A study published in 2011 on consumer choice in Housing First concluded that  
tenants at Housing First experience significantly higher levels of control and autonomy in the program (Tsemberis, Gulcur and Nakae, 2011). This experience may be the reason that Housing First has such a high retention rate. A study conducted in 2014 that compared Housing First to traditional housing programs concluded that 73% of Housing First participants still resided in stable housing compared to 31% in traditional programs (Aubry et al., 2015). These findings suggested that after one year Housing First participants are more likely to remain in stable housing. The study also concluded that participation in  Housing First produced improvements in overall quality of life and in the quality of specific aspects of life related to housing, safety, and leisure activities (Aubry et al., 2015). These outcomes are directly related to the patient first mentality that Housing First had. When individuals have the choice to decide what they want for themselves, the outcomes interventions are usually much higher. Since the burden of having housing is not a conditional offer at this program participants often find that they become board, therefore they begin to focus more time on improving they overall life. Opportunities for social and cultural engagement are supported through employment, vocational and recreational activities (Gaetz et al., 2016). 
Lastly, Housing First provides affective treatment for mental illness and addiction. Community involvement is a big aspect of the Housing First model and because of this participants feel like they have somewhere to turn to. In fact participants of housing First show greater improvements in community functioning (Aubry et al., 2015). In most communities struggling to deal with homelessness,  priority is often given to high-needs clients who may have more trouble obtaining and maintaining housing on their own (Gaetz et al., 2016). This includes families, chronically homeless individuals and those with mental health and addiction challenges (Gaetz et al., 2016). Housing First provides patient based care thought a sector titled “Assertive Community Treatment” (ACT). ACT is an integrated team based approach designed to provide comprehensive community-based supports to help participants remain in stable housing (Gaetz et al., 2016). The corse goals of ACT include; clinical/medical staff  (psychiatrist, doctor, nurse, substance abuse specialists), peer support workers; and generalist case managers who may have varied professional/experiential qualifications (Gaetz et al., 2016). All of these opportunities five participants the most affective treatment that can sustain their sobriety long term.         
In Canada Housing First dates back all the way to the 1970s with Houslink, based in Toronto at the time, the program developed an approach to working with individuals who suffered from mental health and/or addictions issues where providing housing was considered a priority (Gaetz et al., 2016). The first large scale application of a Housing First model was the “Streets to Homes Program” which was developed and implemented by the City of Toronto in 2005(Gaetz et al., 2016). Most recently Housing First has successfully been implanted as a $110 million pilot project in Moncton, Montréal, Toronto, Winnipeg and Vancouver (Gaetz et al., 2016). Funding has also be prioritized for At Home/Chez Soi the world’s largest and most in-depth evidence-based exploration of the effectiveness of Housing First (Gaetz et al., 2016). Exactly 2149 people participated in the study, 81.5% of whom were absolutely homeless at the time. The results indicated that over 900 individuals from shelters and on streets benefited form the Housing First model with 86% of participants remain in their first or second unit (as of August 2012) (Gaetz et al., 2016). These statistics show the benefit of Housing First and its ability to tackle homelessness affectively.   
While the Housing First model is affective in combating homelessness, especially in terms of mental illness and addiction. It is still aa fairly new concept that is currently being evaluated to address all of the flaws if the program. Housing First heavily relies to rent availability within cities. This creates a problem because the availability of affordable renting currently in Canada is not the best. Meaning that there might be shortage of available homes compared to the number of homeless individuals. Even if the model was to rely on social housing from the government there is currently a 2-20 year wait lists in some areas. In addition, there may be unintentional segregation of homeless individuals to less desirable areas known as ghettos because landlords do not want to rent out to homeless individuals from fear of property destruction. Landlords also prefer to lease to long-term renters, which is a huge gamble with homeless individuals as some of them may return to the streets. Lastly, The programs ability to give freedom of choice to its participants is great but it can also hinder them. For example some individuals strive of structure and discipline, they simple can not get clean on their own. This in turn creates a cycle of individuals who a rehoused several times but it never sticks. This cost the government more money and is ineffective in the long run. Addressing how to deal with these types of individuals is a problem in itself that will need to be figured out if the government truly wants to end homelessness. 
The Housing First model is an affective step in the right direction to fight homelessness. Current studies show that it is a lot more efficient that the model that was previously popular. While more research needs to be done on the model, so far its retention rate has been very high. Therefore Housing First should be taken into implementation in a Canada wide scale. Its core principles have made the program very popular among researchers and politicians alike. Examples like The Transitions to Home program in Hamilton, Ontario, shows how Housing First works affectively in all areas even a mid-size city (Gaetz et al., 2016). The goal now is to address what happens in  five or ten years if a client has another crisis. Researchers will need to determine how people will maintain their supports to prevent future experiences of homelessness (Gaetz et al., 2016). 


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