isrctn.org Identifier: ISRCTN42520374.

A n estimated 35 000 Canadians are homeless on any given night, and over 235 000 experience homelessness over the course of a year. 1 In some jurisdictions, the discussion has shifted toward how homelessness can be ended rather than on how to manage it.1,2 Ending homelessness will require resources in the form of targeted prevention interventions, 2 development of affordable housing and a variety of housing and support programs such as Housing First, in which homeless people are offered immediate access to permanent housing together with long-term, individualized support.3 Arguments for additional government expenditures on programs to end homelessness can be better framed if the costs of maintaining the status quo are well understood. To this end, estimates of the costs of homelessness are needed.Limited information is available on the economic costs that homeless people engender in Canada. Based on a sample of 10 people, in 1998-1999, service and shelter costs of Background: Limited evidence on the costs of homelessness in Canada is available. We estimated the average annual costs, in total and by cost category, that homeless people with mental illness engender from the perspective of society. We also identified individual characteristics associated with higher costs.

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Individual placement and support (IPS) has not been tested experimentally among people recently housed with a scattered-site Housing First program. Ninety recently housed people were randomized to IPS or usual services. Regression models estimated via GEE were used to compare employment outcomes. Over 8 months of follow-up with good fidelity, fifteen (34 %) people in the IPS group versus nine (22 %) in the control group found competitive employment (p = 0.16). Adjusted odds of obtaining competitive employment were greater in the IPS group (OR 2.42, 95 %CI 1.13-5.16). Other employment outcomes were not significantly different between groups. Satisfaction with services was greater in the group receiving IPS. In this study, IPS was a modestly useful adjunct to scattered-site Housing First for people with mental illness who have been homeless.

Key Points Question Is a Housing First intervention with Intensive Case Management for homeless people with mental illness cost-effective compared with treatment as usual? Findings In this economic evaluation study of data from the At Home/Chez Soi randomized clinical trial with 1198 initially homeless participants, the incremental cost-effectiveness ratio was $56.08 per additional day of stable housing. At $67 per day of stable housing, there was an 80% chance that the Housing First intervention with Intensive Case Management was cost-effective compared with treatment as usual. Meaning Expanding access to Housing First with Intensive Case Management appears to be warranted from an economic point of view.