How did a Housing First intervention improve health and social outcomes among homeless adults with mental illness in Toronto? Two-year outcomes from a randomised trial.
We studied the impact of a Housing First (HF) intervention on housing, contact with the justice system, healthcare usage and health outcomes among At Home/Chez Soi randomised trial participants in Toronto, a city with an extensive service network for social and health services for individuals who are experiencing homelessness and mental illness.



Participants identified as high needs were randomised to receive either the intervention which provided them with housing and supports by an assertive community treatment team (HF+ACT) or treatment as usual (TAU). Participants (N=197) had in-person interviews every 3 months for 2 years.



The HF+ACT group spent more time stably housed compared to the TAU group with the mean difference between the groups of 45.8% (95% CI 37.1% to 54.4%, p<0.0001). Accounting for baseline differences, HF+ACT group showed significant improvements over TAU group for community functioning, selected quality-of-life subscales and arrests at some time points during follow-up. No differences between HF+ACT and TAU groups over the follow-up were observed for health service usage, community integration and substance use.



HF for individuals with high levels of need increased housing stability and selected health and justice outcomes over 2 years in a city with many social and health services.



ISRCTN42520374.
Centre for Research on Inner City Health, St Michael's Hospital, Toronto, Ontario, Canada Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
Patricia
P
O'Campo
Centre for Research on Inner City Health, St Michael's Hospital, Toronto, Ontario, Canada Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
Vicky
V
Stergiopoulos
Cota, Toronto, Ontario, Canada.
Pam
P
Nir
Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
Matthew
M
Levy
Centre for Research on Inner City Health, St Michael's Hospital, Toronto, Ontario, Canada.
Vachan
V
Misir
Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, London, UK.
Antony
A
Chum
Cota, Toronto, Ontario, Canada.
Bouchra
B
Arbach
Centre for Research on Inner City Health, St Michael's Hospital, Toronto, Ontario, Canada Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
Rosane
R
Nisenbaum
Centre for Research on Inner City Health, St Michael's Hospital, Toronto, Ontario, Canada.
Matthew J
MJ
To
Centre for Research on Inner City Health, St Michael's Hospital, Toronto, Ontario, Canada Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Stephen W
SW
Hwang
D000328:Adult; D002170:Canada; D003156:Community Mental Health Services / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006703:Ill-Housed Persons / Q000523:psychology* / Q000706:statistics & numerical data; D006798:Housing / Q000706:statistics & numerical data*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D001523:Mental Disorders / Q000150:complications* / Q000523:psychology; D015397:Program Evaluation / Q000379:methods*; D012947:Social Work; D014505:Urban Population / Q000706:statistics & numerical data
Health services utilization; Homelessness; Housing First; Housing Stability; Mental Illness