From: Submission to the Select Committee on Mental Health and Addictions. Presented by Paul Garfinkel, June 3, 2009.
Ontario needs to invest in supported housing with an appropriate mix of housing types and levels of support.
Safe, secure and affordable housing is a key component to anyone’s mental health. For those who have more severe mental illness or addictions and who are struggling with crisis and treatment regimens, it is even more critical. Despite this need however, Ontario government spending on housing is low relative to other provinces. When municipal housing spending is included in the mix, Ontario just makes the provincial average (Wellesley Institute, 2008). The lack of affordable housing is even more problematic for particular groups such as Aboriginals, women, and racialized communities who experience greater health inequalities (United Nations, 2007).
In Ontario there are three general types of housing that target individuals with mental illness and addictions: custodial housing, supportive housing and supported housing (1). The need for housing and related supports exceeds the available supply and a significant amount of housing in Ontario does not follow best practices in housing for individuals with mental health or addictions. Not only is the supply inadequate, the type of housing that exists does not match the needs of individuals. Research has shown that there is an inappropriate balance of the housing available to meet the needs of individuals with mental health and addictions. For example, there are more congregate units than people require and there are too few independent housing units, such as apartments with related supports, to meet the need (CAMH, 2002; Sylvestre, George, Aubry, Durbin, Nelson, & Trainor, 2007
The importance of housing to individuals with mental health and addictions cannot be overestimated. Research has shown the benefits that stable housing has on clients’ quality of life, treatment outcomes and service utilization. Previous research on supportive housing has shown that hospitalization rates among those in the program were significantly reduced (McCarthy & Nelson, 1991). More recently, research on ‘housing first’ models have shown reduced health care costs and reduced alcohol use among chronically homeless individuals with severe alcohol problems (Larimer et al., 2009). As well, stable housing has an impact on the success of other mental health programs. One review found several studies that demonstrated better outcomes when housing was combined with case management programs than just the case management on its own (Nelson, Aubry & Lafrance, 2007).
Independent housing with appropriate supports is what most consumers have identified as their preference (Forchuk, Nelson & Hall, 2006; CAMH, 2002). Having this level of choice over housing and professional supports has been shown to improve clients’ quality of life and community functioning (Nelson et al, 2007). Experts agree that not only does Ontario need more housing for individuals with mental health and addictions, but that it matters what kind of housing. Evidence-based models of housing are central to improving clients’ quality of life and wellness. Increasing the availability of independent housing and the required support services is a critical element in a provincial mental health and addictions strategy (Sylvestre, George, Aubry, Durbin, Nelson & Trainor, 2007; CAMH, 2002).
(1) Custodial housing is generally for profit ‘room and board’ settings with little or no rehabilitation support. Supportive housing is congregate settings which include rehabilitation support. Supported housing is a strengths-based approach aimed at helping consumers get and keep independent housing in the community.
In Submission to the Select Committee on Mental Health and Addictions:
- Executive Summary
- The Centre for Addiction and Mental Health (CAMH)
- Mental Health and Addictions – Out of the Shadows
- Foundations of a Mental Health Strategy
- Key Components of an Integrated System
- Bringing it together