MONTREAL — As Ottawa budgeted new funds to provide housing for mentally ill homeless people, Quebec has quietly made plans to dismantle the At Home/Chez Soi program in Montreal.
Several sources say Quebec is abandoning the five-year, $18.4-million “housing first” federal project because health falls under provincial jurisdiction, and the province had no say in how this project was set up or run.
Quebec health officials, however, maintain it is not being disbanded. Participants will continue to get a monthly supplement toward their rent for one year. Also, there will be no break in services as the Montreal Health and Social “Services Agency is now handling the transition from Chez Soi’s specialized mental health teams to regular service provided by existing programs in CSSS community health clinics.
But advocates who work with the homeless say problems have already started. Anxious participants began deserting their apartments this fall as rumours circulated on the street about the project’s end.
Chez Soi housed and was caring for about 230 clients in July, down to 210 in September. By last week, it dropped sharply to 160 clients.
Some people returned to shelters, while a few found low-cost lodging. Others are in prison, hospitals or back on the street.
“We’re losing them every day,” said one former Chez Soi worker who asked that her name not be published because she’s not authorized to speak to the media. “They’re not maintaining services. They’re providing a transition to usual services that didn’t work that well in the first place.”
The Mental Health Commission of Canada’s $110-million At Home, a five-year study on housing for hard-core itinerants with drug addictions, chronic diseases and mental illness, ended on March 31. It was based on the success of similar programs in the United States over the past two decades in addressing chronic homelessness with a “housing first” approach, coupled with services geared to the needs of the homeless, from roving health teams that include nurses, social workers, psychologists and street workers.
Montreal recruited 280 homeless people. Researchers in Moncton, Toronto, Winnipeg and Vancouver enrolled another 2,285 people in a project some have called one of Canada’s largest social experiments.
The project was complicated politically since the beginning because Quebec was never on board, said Daniel Latulippe, director of RACOR, a coalition of 100 mental health advocacy and community groups. Housing first is not the only approach to homelessness, and it’s not suitable for all the homeless, he said, but it would be a shame for Montreal to lose current gains.
Uncertainty led participants to feel abandoned, he said. The sentiment is: “ ‘I know I’m losing it in a year. I’m going back — at least I know what to expect on the street,’ ” he said.
Ontario announced it is continuing the entire program while federal and provincial officials “have developed plans for a transition year to ensure that people can continue to access housing and supports throughout the year and beyond” in Vancouver, Winnipeg and Moncton, according to the commission.
Quebec is the only province that is scrapping the “housing first” approach. Its specialized care teams have been cut to less than half, to nine people from 23.
It was a research project that ended as originally planned “with the complete withdrawal of federal funding that accompanied it,” explained Laurie Comtois, press attaché to Véronique Hivon, the minister responsible for youth protection and social services.
Quebec wasn’t consulted on the project, but now finds itself responsible for bearing the consequences, Comtois said, yet so far there’s been no more than the promise of money to fund the transition for a year.
“Discussions to finalize an agreement are ongoing,” she said. “Obviously, ethically and in solidarity with the participants in this project, we will ensure the continuity of services and housing supplements.”
However, researchers and clinicians counted on the provincial government to maintain the program and are now all the more disappointed given the renewed federal funding in the last budget for homelessness with a focus on “housing first.”
Marc Boutin, coordinator of mental health services at the Montreal agency, said the first meeting about the handover to existing services was held mid-February with now former Chez Soi workers to identify participants that benefit from heavy support, often daily, and services that maintain their autonomy off the streets.
The agency already provides mental health and social services to 2,500 itinerants through CSSS Jeanne-Mance, Centre hospitalier de l’Université de Montréal and Diogène, among others, so the expertise is in place, he said.
“Our goal is to make sure that no one ends up on the street because of the end of Chez Soi,” he said.
However, the effect of scrapping the program was almost immediate, says one landlord who has 18 Chez Soi tenants in her buildings.
For example, three people didn’t pay their rent because workers that helped clients manage their money were no longer there, said Valéry Couture: “It’s very sad. Support ended March 31. What will it be like in two months?”
This is a fragile population with severe addiction and mental health problems that landed them on the street in the first place, Couture said, and it’s obvious that usual services aren’t enough.
“One woman told me she sniffed the rent money up her nose. I offered to help her manage her (welfare) cheque, but I can’t do it for everyone,” she said. “They had all this structure in place and now they’re left on their own. They will be back on the street within months,” Couture said. “I can’t believe it, how can we destroy in just a few days what we built up in three years?”
Health economist and lead investigator for the Montreal site, Eric Latimer, said he hopes that positive results of the project will help convince decision-makers to eventually re-establish housing-first teams.
“It’s the way of the future,” said Latimer, associate professor of psychiatry at McGill University and a research scientist at the Douglas Mental Health University Institute. “More and more countries are implementing this approach because it works. There are U.S. cities that are showing a 30-per-cent drop in homeless from widespread use of this approach.”
It’s heralded in Canada as well. Under Alberta’s 10-year plan to end homelessness by 2019, the province invested $47.5 million during 2011/2012 fiscal year in a “housing first” approach.
Studies show it can cost upward of $100,000 per year in health, emergency and justice system services to support a chronically homeless person. Under “housing first,” it costs about $35,000 per year, on average, to provide permanent housing and the supports needed to break the cycle of homelessness.
Program costs vary depending on the complex needs of individuals and on housing markets, with the highest rates found in Toronto and the lowest in Moncton, Latimer said. In Montreal, costs ranged on average between $42,000 to $63,000, for moderate to high needs individuals, and these figures include their welfare cheques.
The approach makes economic sense, Latimer said. One homeless person had cost the system $300,000 a year in ambulance, hospitalization, arrests and court appearances. The study also included recruits who essentially cost the system nothing, like a man who lived under a park tree, who was not accessing any health or social services.
“This benefit for the homeless is achieved at little or no net cost to society because the more comprehensive care significantly reduces the use of shelters, ambulance transports, hospitalization and detox, court appearances and social housing,” said Latimer, whose final report is expected by the end of the year.
But even with “housing first” there are setbacks. Housing the chronically homeless often requires several attempts because it’s not simply a matter of providing a roof.
Results show Chez Soi stabilized up to 80 per cent of participants, similar to the U.S. experience, Latimer said. Lonely or uncomfortable, some spent a few nights at shelters even though they had apartments, other were hospitalized or arrested. And some were evicted and returned to the streets.
That was the case of Farshad Mohammadi, a mentally ill man who had been evicted from his apartment for disturbing the peace with his nightmarish screams at night. Chez Soi staff were looking for a more suitable apartment for Mohammadi when he was shot and killed by police in January 2012 after he attacked an officer with a knife.
As homelessness continues to grow, officials from Montreal’s largest shelters say they were concerned about the project’s viability from the start, and especially worried that participants would be left on their own, said France Desjardins, director of Maison du Père.
“We have lobbied the government as much as we could … forget the politics. We want everyone to focus on helping these people,” Desjardins said. “We don’t need more shelters. And we don’t want more people living in more shelters. We want them to live on their own.”
The supplement for rent will continue during the transition year, but the teams are no longer providing psychosocial support, a key ingredient of the housing-first approach, said Matthew Pearce, director of the Old Brewery Mission: “We should have had a plan for those individuals so they wouldn’t find the rug pulled from underneath them, literally, just because project ended.”
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