The At Home/Chez Soi project part two - 2014 to 2015

The At Home Chez Soi (AHCS) project is a pan-Canadian study on homelessness and mental illness. This $110 million pragmatic randomized controlled trial was funded by the Mental Health Commission of Canada (MHCC) and began recruiting participants in October 2009 simultaneously in five Canadian cities: Vancouver, Winnipeg, Toronto, Montréal, and Moncton.

The AHCS project aimed to provide access to housing to homeless individuals experiencing mental illness under the Housing First (HF) model — a particular approach to developed in New York City by the organization Pathways to Housing.

Housing First – Ending homelessness

The HF model, as implemented in the AHCS project, involved offering people who were homeless and living with a mental illness immediate access to a subsidized apartment of their choice, combined with clinical services. A rental supplement allows participants to live in a decent apartment for 25% or 30% of their income (depending on rent including heating or not). The intensity of clinical support is tailored according to the needs of participants: “high need” participants received Assertive Community Treatment (ACT), while “moderate” need participants received Intensive Case Management (ICM). Services and rental supplements were offered with no conditions, other than agreeing to the visit of a staff person from the program at least once per week.

The project aimed to evaluate the effectiveness and cost-effectiveness of the HF model. Effectiveness was conceived of first and foremost in terms of housing stability, but also in terms of quality of life, mental and physical health status, community functioning, community integration, etc. Recruitment and research follow ups of the participants began in October 2009, with recruitment completed in May 2011, while research follow ups ended in April 2013.

Studies carried out in the United States have found that HF programs significantly increase housing stability, while the costs of the intervention are largely, if not completely, offset by a reduction in spending on acute health care services, shelters, and justice and correctional services.

The At Home/Chez Soi project in Montréal

In Montréal, 469 participants were recruited between October 2009 and May 2011, and assigned to different groups depending on their level of need, either high need (HN) or moderate need (MN). HN participants were randomly assigned either to HF with an Assertive community treatment (ACT) team (N=81), or they were assigned to treatment as usual (TAU, N=82). Participants with moderate needs were randomly assigned to one of the two Intensive Case Management (ICM) teams (N=204) or to TAU (N=102). Participants in TAU formed the control group, and did not receive an HF intervention nor a subsidized housing from the project: they continued to use services already available to them within the community. Over a 24-month period, participants met with researchers every three months in order to complete a research interview. The Montreal site achieved exceptional follow-up rates of 91% overall, which increases the reliability of its findings.

Socio-demographic portrait of participants at baseline

  • 44.1 years old: average age of participants;
  • 32.3% of them are women;
  • 78.4% had worked for at least one consecutive year in the past;
  • 29 months: average longest uninterrupted homelessness period;
  • 52 months: average time spent homeless during lifetime;
  • 35 years old: average age during first homelessness episode;
  • 21% have at least one child;
  • 40% have been hospitalized more than 2 times within a single year for a mental illness in the past 5 years;
  • 29% were involved with the judiciary system during the past 6 months;
  • 33% are at moderate or high risk of suicide.

Housing the participants

Participants assigned to HF were quickly offered help in accessing an apartment of their choice (in terms of neighbourhood, type of building, etc.), with a rent subsidy set so that they only had to pay 25 per cent or 30 per cent of their income (the latter if the rent included heat) for the rent. In Montréal, the rent subsidy averaged $375 per month. Participants were able to remain housed after the end of study period, March 31st 2013, thanks to rent supplements from the MHCC and the Société d’habitation du Québec (SHQ).

The teams

Several institutions in Montréal partnered to implement the AHCS project: the CSSS Jeanne-Mance established and managed the ACT team as well as one of the two ICM teams; the Centre Hospitalier de l’Université de Montréal (CHUM) provided the service of psychiatrists and, later, a coordinator for the ACT team; Diogène, a community organization, provided the remaining ICM team; and the Douglas Institute established and coordinated the housing team as well as the research team. While the housing team maintained its own office, the research team was located in the same offices as the CSSS Jeanne-Mance teams in order to facilitate interviews. A community-based organization that includes a large men’s shelter but provides a variety of other services as well, Welcome Hall Mission, also managed the (partial) rent payments to landlords by HF participants who had consented to have their share of the rent paid directly to their landlord from their account.

Contact

For all questions related to the At Home / Chez Soi project, please contact:

Eric Latimer, Ph. D.
Lead investigator, Montreal At Home project
eric_dot_latimer_At_mcgill_dot_ca