At Home / Chez Soi — Housing First
Mental Health Commission of Canada · Vancouver, Winnipeg, Toronto, Montréal, Moncton, Canada · 2009
Summary
At Home/Chez Soi is the largest Housing First RCT ever conducted. The standard model of homeless services required people to demonstrate sobriety and treatment compliance before receiving permanent housing ('treatment first'). Housing First reverses this: provide housing immediately, then offer (but don't require) supports. The experiment showed dramatically higher housing stability with Housing First, improved quality of life, and comparable mental health outcomes. The cost per housed day was substantially lower than continued shelter system use. Housing First is now the evidence-backed standard of care for chronic homelessness in Canada, most of Europe, and increasingly the US.
Research question
"Does Housing First (immediate permanent housing with supports, no treatment prerequisites) outperform standard care for chronically homeless people with mental illness?"
Methodology
Intervention
Immediate placement in independent housing plus community mental health support (Housing First) vs. treatment-as-usual (shelter progression model)
Assignment
Randomized controlled trial (individual)
Sample size
2,148 participants across 5 Canadian cities
Primary outcome
Housing stability; quality of life; community functioning; mental health
Effect estimate
Housing stability: 73% of time housed (HF) vs. 32% (control) at 24 months; quality of life significantly improved; community functioning improved; mental health symptoms not significantly different; cost per additional day housed much lower than shelter system
Decision
Housing First adopted as official policy by federal government and multiple provinces; replicated in US, UK, France, Ireland, and Denmark with consistent results
Result
Positive
Housing stability: 73% of time housed (HF) vs. 32% (control) at 24 months; quality of life significantly improved; community functioning improved; mental health symptoms not significantly different; cost per additional day housed much lower than shelter system
Evidence strength
Strong
Randomized trial, replicated across multiple sites or studies.
Replication status
Replicated
Institution
Mental Health Commission of Canada
Location
Vancouver, Winnipeg, Toronto, Montréal, Moncton, Canada
Year
2009
Policy area
Housing
Mechanism
Housing