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The Globe and Mail

Place to live first - recovery will follow, mental health study suggests

Early results from the largest project in Canadian history to study the link between homelessness and mental health indicate a "housing first, recovery will follow" strategy is working.

The Mental Health Commission of Canada has placed 770 participants out of 1,877 in homes across five cities as part of its At Home project, designed to craft a national strategy. Dr. Jayne Barker, the executive lead, said they are showing positive signs of rehabilitation.

"I've met with one participant whose children had been taken away and put into foster care," Dr. Barker said. "But since joining the program - she was pregnant again - has stabilized and is taking her medication. And she is doing really well with her 10-month old baby. That's just one of the many examples we've seen."

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A total of 1,325 people in Toronto, Moncton, Winnipeg, Vancouver and Montreal will eventually be given a place to live and be provided social support services during the four-year study that launched last November. Participants are expected to contribute 30 per cent of their income - irrespective of whether it comes from a part-time job or welfare support - toward their rent.

Dr. Barker said the thinking behind the federally funded, $110-million study is that once a person is given a place to live, he or she can better concentrate on other personal issues.

"Normally to get housing you need to be stable, clean and sober," she said. "But if you don't know where your next meal is going to come from or where you are going to sleep, then it becomes that much harder to cope with your mental health issues. It becomes a vicious cycle."

The program faced some early criticism because it is essentially a scientific study dealing with some of the most vulnerable members of the population: For about every three people housed, another two are left without homes. Comparing the two test groups is a necessary part of ensuring the research's accuracy, said Dr. Vicky Stergiopolous, the principal lead investigator in Toronto.

"Some people did not like the randomization. They felt that all the homeless people in the study should get access to housing services because it has already been proven from American studies that this process works," she explained.

Yet Dr. Stergiopoulos, who also works as a psychiatrist at St. Michael's Hospital, said the randomization was necessary to test the effectiveness of health care delivery to homeless people living with mental illness in a "Canadian context."

Dr. Barker said while At Home aims to provide meaningful and practical support for hundreds of vulnerable people, the ultimate purpose of the study is to promote policy and best practices that will help people who are living with a mental illness and who are homeless.

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"I found it quite disturbing that some 40 percent of the homeless people in our study meet the criteria for diagnosis of a serious psychotic disorder," she said. "But the general population, less than 1 per cent would be diagnosed with that.

"It just goes to show that there is a serious problem here that we need to address."

Number of people successfully housed so far:

Moncton - 96 out of 180 participants

Montreal - 163 out of 404

Toronto - 175 out of 443

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Winnipeg - 119 out of 401

Vancouver - 220 out of 459

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