Housing and Stress: Examining the Physical and Mental Health Differences between Homeless and Formerly Homeless Individuals

By Desjarlais-de Klerk, Kristen A. | Canadian Review of Social Policy, Fall 2016 | Go to article overview

Housing and Stress: Examining the Physical and Mental Health Differences between Homeless and Formerly Homeless Individuals


Desjarlais-de Klerk, Kristen A., Canadian Review of Social Policy


Introduction

Housing policy influences the lives of individuals under its purview by dictating who is entitled to social housing, how entitlement changes over the course of their lifetime, and the extent to which social housing is supported in a community (Bramley, 1988; Miron, 1988; Niner 1989; Bacher, 1993). Housing First1 is a specific approach to housing policy that has gained momentum in the last ten years (Tsemberis and Eisenberg, 2000; Tsemberis, Gulcur, and Nakae, 2004). Housing First is based on the view that in order to prevent homeless individuals from experiencing the deleterious effects of homelessness, and to counter chronic homelessness, individuals should be placed into housing before any of their other personal issues are addressed. Housing First advocates housing as a means to improve overall health for homeless individuals, thereby reducing the reliance of homeless people on emergency services and decreasing costs to health care. This model differs from other housing policies where individuals must first prove their merit or ability to maintain housing before being able to transition from homeless shelters (meant to address temporary homelessness) to social housing (Dordick, 2002).

This paper2 seeks to examine whether those in housing fare better than those living in homeless shelters by analyzing data from Alberta's Homelessness Management Information System (HMIS). If the assumptions surrounding Housing First policy are correct, and housing enhances the lives and improves the health of formerly homeless individuals, then those in housing should be in better health than those in homeless shelters. This paper is not intended to be an in-depth analysis of the situation in Alberta and the findings here cannot be generalized across Canada. Instead, this paper attempts to understand differences across shelter and housed statuses and to highlight some of the issues associated with assessing different types of housing policies.

A Brief History of Housing Policy in Canada

In the last twenty years, housing policy in Canada has undergone major shifts, including, in particular, the adoption of the Housing First model. These shifts seem to coincide with changes in governmental rhetoric around homelessness and its causes (Hulchanski, 2004). Policies that primarily address individual causes of homelessness focus on personal merit or worthiness as a basis for determining which homeless individuals can access social housing, while policies that focus on the structural causes of homelessness take account of systemic issues such as the availability of housing or unemployment rates in determining accessibility (Peressini, 2009; Watts and Grimshaw, 2009; Sealy, 2012). Different perceived causes to homelessness by the Canadian government have thus resulted in different proposed policy solutions.

Past Canadian housing policy has often been credited as the cause of the relatively steady rise in homelessness since the 1960s, at the time when a policy of deinstitutionalization began (Anucha, 2006; Peressini, 2009; Sealy, 2012). Deinstitutionalization involved returning psychiatric inpatients to the community, often without adequately addressing their housing needs. As deinstitutionalization progressed, and more people found themselves in need of housing, the federal government moved away from social housing. Social housing had begun as a public good to meet the needs of Great Depression victims and WWII veterans. By the 1960s, however, the CMHC (Canadian Mortgage and Housing Corporation) had changed its role, becoming a regulator of mortgages rather than a lender and provider of social housing (Miron, 1988). This shift led to governmental conflict around social housing and its provision by the state. Primary responses to poverty and the need for a centralized social housing policy developed through partnerships between the federal government and municipalities (Bacher, 1993; Miron, 1988; Rose, 1980). …

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