Impact of a Housing First intervention on homeless Veterans with mental illness: a Canadian multisite randomized controlled trial

Abstract

Introduction: A large proportion of homeless Veterans live with severe mental health problems. We examine the impact of a Housing First program that included recovery-oriented initiatives (assertive community treatment or intensive case management) among those homeless Veterans who participated in a multisite demonstration project on homelessness and mental health. Methods: The data come from a Canadian multisite randomized trial (ISRCTN42520374), At Home/Chez Soi, with a volunteer sample of 2,285 homeless or precariously housed individuals living with mental health problems. Of this sample, 98 individuals reported being Veterans, of whom 57 were randomized to the intervention group and 41 to the control group. The data come from self-reported measures administered at baseline and after 6, 12, 18, and 24 months from Fall 2009 to Spring 2013. Data were analyzed by fitting a mixed model for each outcome variable, and special attention was given to the event × treatment × Veteran status interaction term. Results: The Housing First approach was effective in improving housing stability, social functioning, and quality of life in homeless Veterans with mental health problems. These results are consistent with the intervention’s effectiveness with other homeless Canadians with mental health problems. Discussion: These results are consistent with those of previous US studies and suggest that a Housing First approach that includes recovery-oriented support would effectively contribute to reducing homelessness in the Canadian Veteran population.

Climate change and its impact on the mental health well‐being of Indigenous women in Western cities, Canada

“…Climate change has emerged as a critical issue with far‐reaching consequences and its impact on Indigenous women's mental health and well‐being in Western cities in Canada (Bourque et al, 2015; Hrabok et al, 2020). Indigenous communities such as the Cree, Métis, and First Nations in Western Canada possess rich cultural traditions deeply intertwined with the land (Wesley‐Esquimaux & Calliou, 2010).…”

“…As climate change accelerates, bringing about disruptions such as altered weather patterns, loss of traditional lands, and threats to natural resources, Indigenous women face many challenges that intertwine with their mental health (Lawrance et al, 2022). The critical connection between Indigenous peoples and the environment means that climate‐induced changes can trigger emotional distress, anxiety, and a sense of loss as the very fabric of their cultural heritage is threatened (Bourque et al, 2015; Hrabok et al, 2020). Therefore, recognizing and understanding the mental health implications is crucial for designing effective strategies that address the holistic well‐being of Indigenous women, acknowledging the intricate interplay between environmental, cultural, and mental health factors (Okpalauwaekwe et al, 2022; Wexler, 2015).…”

“…The findings shed light on the complex relationships between environmental degradation, ongoing colonial impacts on traditional practices, and the mental well-being of Indigenous women. Concluding with implications for policy and community-led Climate change has emerged as a critical issue with far-reaching consequences and its impact on Indigenous women's mental health and well-being in Western cities in Canada (Bourque et al, 2015;Hrabok et al, 2020). Indigenous communities such as the Cree, Métis, and First Nations in Western Canada possess rich cultural traditions deeply intertwined with the land (Wesley-Esquimaux & Calliou, 2010).…”

Housing, homelessness and mental health: towards systems change

“…The At Home/Chez Soi study found that both the treatment as usual group and intervention groups showed improvement in all outcomes over time. However, the HF intervention group experienced more significant and persistent improvement in all outcomes at both 12 months and program completion (Bourque et al 2015).…”

Working Together in Montréal to Improve Veterans’ Well-Being: A Canadian Perspective

“…In Montréal, 6% of the homeless population was estimated to be composed of military veterans in 2015 (Latimer, McGregor, Méthot, & Smith, 2015, p. 7). These homeless counts have been accompanied by a recent spike in Canadian policy-facing homelessness literature (Bourque et al, 2015;Forchuk, 2016;Forchuk, Richardson, & Atyeo, 2016;Goering et al, 2014;Kerr, 2016;Segaert & Bauer, 2015). Other signs of trouble in veterans affairs have included a 2014 class action lawsuit against the Government of Canada's claw back of veterans benefits, a 2016 class action lawsuit pertaining to military sexual trauma, reports about convoluted and slow service delivery by VAC (e.g., Office of the Auditor General of Canada, 2014), and research attesting to our limited knowledge about veteran homelessness (e.g., Ray & Forchuk, 2011).…”