Putting Housing First with Dr. Stephen Hwang, George Da Silva, and Kefa Omori Mogoncho
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What does the Housing First program reveal about ending homelessness in Canada— and what challenges remain? In this episode, we explore how the Housing First program fits into the bigger picture, why long-term stability goes beyond shelter, and what comprehensive supports are needed to address the root causes of homelessness.
TRANSCRIPT
Misty Pratt
In 2024 it was estimated that nearly 60,000 people across 74 communities in Canada experienced homelessness. The approach used to address homelessness has traditionally focused on individual factors such as improving mental health, income, or addressing substance use. A groundbreaking program called Housing First flips the script on homelessness. Instead of asking people to fix their lives before getting a roof over their heads, Housing First starts with what everyone deserves- a safe, stable home. But how effective is the program when it comes to participants’ health and longevity?
Welcome to In Our VoICES, the podcast that brings you the health data without the drama. I’m your host, Misty Pratt, and today I’m joined by three guests who will share their expertise and first hand experience on what it means to build a future where housing and health comes first. Dr. Stephen Hwang is Director of St. Michael’s hospital’s MAP Centre for Urban Health Solutions, Canada’s largest research centre focused on health equity and social determinants of health. He is also an ICES scientist. Kefa Omori Mogoncho is a dedicated peer researcher who leverages his knowledge and lived experience to inform research, advocacy, and program design aimed at addressing homelessness. And George Da Silva is a peer research associate and an advocate and volunteer who supports others living with HIV by sharing his life experiences. Welcome everyone to In Our VoICES.
Stephen Hwang
Thanks for having us.
Misty Pratt
Stephen, I’ll start with you. What is Housing First, as I mentioned in the introduction, and how does it differ from other homelessness interventions?
Stephen Hwang
As you’ve very clearly described in your introduction, Housing First posits that we should start with the provision of housing, rather than requiring that people jump through hoops before they are deemed worthy of receiving housing. Housing First, simply put, is a combination of immediate access to housing, typically in scattered site apartment units, together with mental health and other supports will allow the person to make a successful transition out of homelessness and into stable housing.
Misty Pratt
And so what were people asked to do before Housing First came on the scene? What was the typical way of addressing homelessness then?
Stephen Hwang
Well, the typical approach was to say to people “before you can be considered for housing if you’re living on the street, you’re going to need to move into a shelter, a more supervised environment. You’re also going to need to get treatment for your mental illness if you have it, and you’re also going to need to stop using any substances that you might be using”, and once the person achieved abstinence and treatment, then they could be considered for transitional housing, and if they did well in transitional housing, then they could be considered for permanent housing. So, this is what’s called the stair step model. The idea is that you have to climb one step after another to get to the final goal of permanent, stable housing. And not surprisingly, a lot of people, especially those who are chronically homeless, never made it to stable housing and thus remained homeless.
Misty Pratt
It’s really focused on individual behaviors, saying, you know, you must do this, that, the other thing before you can access something that seems to be very much a human right, of a home?
Stephen Hwang
Yes, absolutely. And really goes contrary to the idea that housing is a critical determinant of health, and without stable housing, how can we expect people to improve their well being?
Misty Pratt
So, what does the data then say about the Housing First program and its effectiveness, then for addressing homelessness?
Stephen Hwang
So randomized, controlled trials that we’ve done and that others have done have consistently demonstrated that Housing First is very effective at permanently ending homelessness for about 85% of people, and that the housing that they achieve is essentially permanent. Long term studies that we’ve done up to seven years show that people retain their housing at very high levels.
Misty Pratt
And some people think of housing more as a social issue rather than a health issue. So why is homelessness a risk factor for poor health outcomes and premature deaths?
Stephen Hwang
Well, there is a complex interplay in that people with significant physical and mental health conditions are at higher risk of becoming homeless. That, in and of itself, doesn’t explain homelessness as a phenomenon in our community, but certainly they are risk factors. And so, people who are have these conditions, when they become homeless, they almost always those conditions worsen, and just examples of why that happens are first of all, being homeless greatly impairs one’s ability to access appropriate health care. It also puts the person at obvious, immediate risk from things like exposure to extreme cold or extreme heat, perhaps less obviously, it puts people in a social environment, whether it’s in a shelter or on the street, that greatly increases their risk of becoming victims of violence, of being exposed to substances, the availability of substances that might lead to or worsen substance use disorders. And there’s also the whole dimension of stigma and discrimination that people face when they are living in poverty or homelessness.
Misty Pratt
And what were the main outcomes of the Housing First study?
Stephen Hwang
First of all, as I mentioned, that it was extremely successful in ending homelessness and having people achieve stable housing over a seven year follow up period, we also found, using data from individual provinces, that the utilization of acute care services such as hospitals and emergency departments went down among people who received the intervention, especially among people who were very high users of health care before they were randomized in the study.
Misty Pratt
And George, I’d like to bring you into the conversation here too, because you have had some experience with the Housing First trial. So, I’d love for you to tell us a little bit about yourself and how you were involved in the trial.
George Da Silva
So, for me, as somebody living with HIV, I became homeless because of personal my own story, which is a different story. And then when I found housing and found supports with friends and everything else, one of my friends said, “well, this why not get into HIV research and support?” And then this opportunity came up with Stephen’s team to look at homelessness, and since I was somebody dealing with homelessness, that I felt that having sort of that peer experience of being somebody living with HIV, being homeless, being on the street, having to go through various support networks and how to get those support networks, I felt that my life story would be best told by hearing other people’s life story and helping and supporting other people in their journey too. That this is not a journey that ends with just one person’s story. It continues on going forward, and research is the key to that.
And one of the things that I observed is when we house people in one building, and sort of getting to what Stephen’s comments were, is the likelihood of success rate of that person being able to move on or live on their own, was really impacted by the substance use and other factors, and because of that, the people weren’t being supported in the way that they should be. Caseworkers were also being regenerated all the time, new caseworkers. So, there was a lack of trust between the tenants and the housing piece, so they felt a little disjointed in “how am I being supported in my journey?” And they really wanted someone there to be. I can’t stress enough about that trust with the caseworker and the person experiencing homelessness is really a key factor in their success rate to be able to progress into back into the communal living, into society, into getting what they need, medications, social services, mental health supports, all those different things that they needed, which are always unique to the each individual. So, each individual has their own personal story to tell their own challenge will cause them to be homeless. That story is unique to each individual person. So, it’s hard to model one big program for everybody, when everybody has their own unique criteria.
Misty Pratt
Okay, so there was this benefit of that, we can see that it did lead to permanent housing. But then, as you became involved, you saw, okay, yes, but there are these issues, these ongoing issues that are because we’re sort of creating this one big program that’s not individualized, is that right?
George Da Silva
In a sense, yes. So housing was one of the key factors that they needed, but if they didn’t get other supports, I’ll use cleaning their unit, cooking, simple every day to day, functionalities that they’re not used to because they were on the streets, or they were given box meals or anything else, so they didn’t understand how to transition into that day to day living aspect. Then their likelihood, and then compounded on top of that, if they did have an underlying condition mental health or drug addiction, if that addiction support wasn’t there because there was a dealer in the building or something else that was going on, then it meant that their success rate wasn’t going to be as high as we think it should be.
Misty Pratt
And Kefa, like George, you have another story. You’re a peer researcher as well, but with a different lived experience than George. So, can you tell us a little bit about yourself?
Kefa Omori Mogoncho
This is a discussion that is revolving around what I’ve personally experienced as a new immigrant to Canada. I went through such homelessness in my life. Something that made me fell sick at some point, and as I almost gave up, I came to realize that I am not alone and had several people who are going through the same. And this was around September, when we are finishing summer to fall, and the weather was not that conducive outside there, and I realized that there is much to be done in terms of looking into why people are suffering in terms of homelessness, and this is why I found myself digging deep to understand and see how possible, as a person, I can be able to contribute towards positive change and also help in coming up with the knowledge that I have from the ground to help someone else also get help.
So that’s why I found myself and Dr. Steve, with the research that we are doing is given, giving me an opportunity to contribute more, and now we can be able to come up with solutions based on where the homelessness and the effects and how it can be tackled to at least, to make people have a better place to go. Having said so, we understand that we have challenges that are accompanied when somebody doesn’t have a stable housing. This comes when, like, I’m an immigrant, I need some services that maybe, if I don’t have a place where I’m housed, I lacked stability, and I cannot be able to focus on looking for more, I mean, good services that I need. And even when it comes to sickness, at some point when I don’t know where to and would to go, and I don’t have the source that I can entirely, I mean depend on, it becomes very difficult. But since I found myself a place, I can see there is a tremendous change. And if all I pray is that if we work together as a team that can also help somebody else who has gone through that.
Misty Pratt
And you touched on this a little bit there about the barriers, like, what are the barriers that people experiencing homelessness in particular, you mentioned immigrants, new immigrants. What are they facing when they’re trying to you know, they want to be healthy, everyone wants to be healthy- so what are the barriers to accessing getting to the hospital, getting to the doctor?
Kefa Omori Mogoncho
Again, there are so many barriers that comes along with getting access to help and support. Number one, I remember when I was looking for medical attention I was not able to get at that particular time. Sometimes it’s very hectic if you have an emergency as an individual and they don’t know how to navigate around. Those are some of the things that becomes a barrier for somebody to get immediate attention, and can lead even to death. Because I remember I had my sugars shoot because I stayed in the street for almost three weeks without any way I can, I can find warmth, and even, I mean, get good shelter. And due to that, I got traumatized, and also I was not able to get good food. So, my sugar level went up and I was not, I’ve never been diabetic before. I didn’t know how to go about it, so my body weakened in a way, and I tried to go to the hospital, I was able to be attended after about eight hours, because it’s a long queue. And there is also some things like paperwork I was not able to get my medical cover and such like so that is one barrier.
And then there’s also access to the medical facility. In terms of transportation, new people like myself, I got so many challenges to access. If you are weak, maybe you are not able to walk or go by yourself, it becomes a challenge. And also knowing where to get the resources that can help you. It’s also a challenge because not everybody can give you accurate information. So those are some of the barriers, and also the language, if you are not able to speak, I mean, and also understand the language that is being used, it’s also a big challenge that I personally went through.
Misty Pratt
Because even if you could get into the hospital communicating what is wrong, and being able to have that back and forth with the doctor may not be happening.
Kefa Omori Mogoncho
Yeah.
Misty Pratt
George, I wonder if you had any thoughts there too, on barriers that people are experiencing when it comes to health and health care access?
Misty Pratt
And that trust, as you said, takes time, right? And with the healthcare system under so much pressure as it is right now, that I think that time is lacking. So, Stephen, I wonder if you have any thoughts from the system perspective of the challenges there?
Stephen Hwang
Well, I think that, as we know, the healthcare system is under a lot of stress, and I think that when people are acting in time pressured situations, they tend to take both, they tend to take mental shortcuts, and perhaps are more likely to, we know, they’re more likely to make snap judgments about the people that come into their path. So, I think that it creates an environment where potentially, there’s more risk for bias to take hold. And then, certainly, what we do want to be mindful of is the fact that there are some people who have legitimate, very real needs, but they’re not fundamentally health care needs, but they’re coming to the hospital or to the health care system because those fundamental needs aren’t being met. I mean, a great example of that would be, you know, someone who goes to their family doctor not feeling well, but the real problem is that they can’t afford a healthy diet, and that’s what’s making them unwell. And so, I think it’s important that we realize that to alleviate the stress to the healthcare systems, and we have to look at the fundamental social determinants of health that are at play in our communities.
George Da Silva
And it gets also to what Stephen mentioned before, stigma and discrimination. So, I mean, I’m open with my HIV status because I’m an advocate for it, but not everybody is, and I was also intravenous drug user at the time. So, it’s understanding what were my limitations, and how can I communicate that when I go to a doctor and feeling that, what should I be disclosing? How do I disclose? How will I be judged? And if you’re living on the streets, then there’s also that other factor that gets weighed on your feelings of what you want to disclose and how are you going to be treated? All those factors come into play until you meet personally, this is my experience, until you meet that one person who’s like, “come here, sit down, let’s have a talk.” And once you’re able to do that and that trust, and like I mentioned before, that trust and that openness, then the discrimination and the stigma can be eased to that point, because we all feel internalized stigma at some point. Do I want to go to a doctor? Do I want to go and tell the doctor I’m homeless? Do I want to go and tell the doctor I need medications? Do I want to tell the doctor all these questions? Those are all big factors, and then when you do get housing, all of that seems to- for me, was lifted up and it was lifted away that now I’m happy to say who I am. I’m happy to tell a doctor about my conditions. I’m happy to tell people who are willing to listen about my lived experience, because that then helps me build a stronger person in myself.
Misty Pratt
And George, I’ll start with you here, but what’s been the most meaningful part of this research work that you’re doing?
George Da Silva
Well, for me, it’s building and listening to those stories that other people tell me about their life experience, and being able to share my life story with them too, and saying, “okay, this is how I navigated the system. This is how I was able to move along.” And I can see where people who are experiencing homelessness, who’s gotten housing, they want the next step, what’s going to be their next step? They want to start planning for the future, because they have dealt with so many barriers before. Now they can see, sort of like that light at the end of the tunnel, and how can they keep moving forward? And that, to me, is very rewarding, is that they want to move forward. They don’t want to go back. They want to be able to be a productive person in society. They want to be lifted above themselves. They recognize their challenges. They recognized what life has thrown at them, but now they want to move one one more foot ahead in their life.
Misty Pratt
And Kefa, what about you? What’s been the most meaningful part of your work?
Kefa Omori Mogoncho
Like what George has just shared, I’m getting empowered every day when I listen to what people are saying, having gone through the experience, I now have the knowledge on how I can lift the spirits of those who are going through this experience, and also get to know more how I can support them at individual level, and also how I can raise I mean, I can become the voice on behalf of them, so that it can get help that they are looking for. To add on that, I’m also able to share with them as they share their story. I’m also trying to share the story to the right place, like now what we are doing with MAP, and we we are trying to share the information and see if this support and help these people are looking for can be achieved from this end, and I am committed and passionate that I will go extra mile to reach out to those that maybe are not been able to be reached out to see what they can talk there are so many things that happens that so many people that are there and keeping quiet struggling with life, and I’ve realized that so many of them, it is all coming back to mental challenge, because once somebody is not comfortable and is not having what he needs, it is affecting the mental, I mean, the mental status of a person. And with that, I know, together with Dr. Steve and the team and George, we are going to come up with a with a good solution to that.
Misty Pratt
Those are fantastic perspectives on being part of this work. I wonder too, if there’s any challenges? I have heard from other peer researchers that there sometimes are challenges trying to work with scientists and doctors and things like that. So maybe Kefa, I’ll start with you. Has there been anything a little bit challenging about this work?
Kefa Omori Mogoncho
I don’t think I have any challenge so far I can speak because since it’s almost now eight months to one year that I’ve been through working with the team, and I cannot say that I have faced so many challenges. I haven’t, because I’m doing this passionately, because I have been through the experience, and I feel Like I have what it takes to raise my voice on behalf of those that are going through the same and that is why I have been able to be the one of the founders of the street soccer. The street soccer team, football, or soccer, is one of the initiatives that brings homeless people together. This is one of the events that we normally do on a weekly basis, where we come together, we play soccer and also socialize. Because I realized this is something that can also impact somebody’s life positively. So, it is something that is empowering. So far, I can’t say the only challenge maybe I have for now, it’s getting the materials for these people, especially like now soccer, sometimes I miss to get them something to do, like balls to play, and also some sneakers and such like those are the challenges that we are still hoping that something will come soon, and somebody, and maybe any other organization will come and support assist. It is not related to anything to do with Dr. Steve and the team. This is part of what I am doing personally.
Misty Pratt
Yes, a challenge across the board, and hopefully someone’s listening today that could maybe hear your call for some more resources. So, thank you. George, what about you? Maybe challenge isn’t the right word. Maybe it’s just, you know, working together as a team, there’s always things that you can improve on too.
George Da Silva
Well I think challenges is the word because I think Stephen realized that there was a challenge with his team, and we created the CEG, which is the Community Experts Group, which is a group of people with lived experience. And I chaired that group. And we meet with Stephen’s team when they’re doing research work, and we kind of get the first chance to vet it. What the project what questions are being asked, and how they’re going to approach the research side of it. So, we give sort of that input to them of, okay, here’s the questions you’re asking. Are these the right questions that resonate with the person dealing with homelessness? Are you asking them in the right way, how would you address them? And then fundamental to all that was Stephen’s team building in that peer piece to it, having peers go out and help to facilitate in the research work, which is not challenging, but it helps build that trust component that I keep speaking about. And I think that shows that if scientists realize that data is just numbers or stats or information, there’s a human element. And that’s what the CEG and that’s what the challenge to overcome allows us to do, is bring in that human element.
Also, we tend to in the CEG, look at soup to nuts. So, if you’re going to do the project and you’re going to start the product, and then what’s the end result? How is that end result going to change for the better? What factors can be done with that end result? So, I think having the CEG with St. Mike’s and MAP centre really helps us be pivotal in helping scientists learn more about what it’s really like with someone dealing with homelessness. What are the factors that they should really look at? And I think, from my experience, I’ve been there Stephen, I think what five years, over five years now, running the group that I can see when the scientists come to us and say, “oh, yeah, that’s right, you did say that before.” Or “yeah, you know, we should have done this before” or so, they’re in their educational period too, learning from us as to what we’ve gone through. So it’s a win, win on both sides.
Misty Pratt
It really sounds reciprocal of learning on both sides. Stephen, would you agree with that, too? Is there anything you wanted to add?
Stephen Hwang
You said it exactly that it is a reciprocal learning relationship. We learn from people with lived and living experience on the community expert group. They learn from us about how we think as researchers, and the kinds of questions we’re thinking about, and we we have a relationship, and we discuss things, we work out areas where we agree and disagree, and it helps shape how we do the work together better. And it really is very meaningful. I think that the real word to emphasize here is that it’s about a relationship. It’s not like I’m just going to check off the box of having someone on an advisory committee so that, you know, I can say that I’ve done it, but it’s really based on a long term commitment to the work and to the mission that we’re trying to achieve.
Misty Pratt
Yeah, avoiding that tokenism of just having somebody there because you need to for your grant. Or…
Stephen Hwang
Yes, exactly.
Misty Pratt
Yeah, it’s a much longer term relationship building, as you said. So, at risk of going to inside baseball here. But I do want to just address the fact that the most recent study you had come out Stephen used a pretty novel design to analyze the outcomes of the housing first RCT, the randomized controlled trial. So, you linked the randomized controlled trial data with health administrative data, and that for people listening is just a fancy word for routine data collected every time you go to the healthcare system and use it. So, what’s the benefit of applying this kind of a design to look at something like Housing First?
Stephen Hwang
This study was actually conducted in five cities in five different provinces. It was conducted in Vancouver, Winnipeg, Toronto, Montreal and Moncton, and so in each city where the study was done, it was possible to link the participants to their health administrative data and look at their healthcare utilization before and after they were randomized to either Housing First or usual care. But the challenge that presented itself to us was that we were unable to take that administrative data and combine it all into one single data set, and this is because, for those who may not be familiar with it, when we link data, health administrative data that’s highly confidential Information, that’s things like, did this participant get hospitalized? Did this participant have a mental health problem? Did this person get treated for a substance use condition, or did they have Hepatitis C or something like that?
So, these for obvious reasons, each province holds that data in a highly secure environment, and you can’t take that individual level of data out. So, what we were faced with was a challenge in that we wanted to know if the Housing First intervention affected the risk of mortality, did it increase or decrease the risk of death? And so, we needed the entire sample to give us the power to answer that question. So what we had to do, essentially, was conduct five separate studies, one in each province, by linking the people in that province to the administrative data on mortality in that province, and then take those results out and then combine them all together outside of the data centers in each province, and this is a process that some of the listeners will recognize as essentially a meta analysis. But unlike a traditional meta analysis, where you’re taking five different studies conducted by five different research teams, this was essentially one study in five provinces, and we were combining the data from all five provinces.
Misty Pratt
So just to that piece about the mortality then, the outcome that you found was that, you know, there wasn’t a huge difference significantly between the Housing First and the and the control group For mortality, but you did find, and I think George spoke to this earlier when he talked about some of the challenges with the Housing First trial was that there needed, perhaps to be more supports there for folks when it came to their health.
Stephen Hwang
Yeah, so the bottom line was that our study found that Housing First did not significantly affect the risk of mortality. It did not make it go up or down significantly. And this was might strike people as perhaps a bit of a surprising finding, because I think intuitively, people think well, being homeless is bad for your health, providing people with housing must improve their health and therefore reduce their risk of death, and so that’s why we do randomized trials. The power of them is that they provide us with a really high degree of reliability or trustworthiness, the answer to a very important question, and it’s a bit of a surprising result, but I think that there’s a couple of reasons that actually make it not entirely that surprising. So first of all, there is the fact that moving into housing does improve one’s health in certain ways, and almost certainly access to care, but it is a transition in a person’s life, and as George has mentioned, it does create other new challenges to a person. And just to give a very specific example, it might put someone in a situation where they might perhaps be more inclined to use substances alone in their home, rather than in a congregate setting like a shelter or in a park, where there might be people to help them if they should overdose, for example. So, there is that potential risk.
The other thing that I think we have to realize is that, as you mentioned, we have to combine these interventions with really aggressive connection to care and housing is a necessary first step to health, but I don’t think that housing alone is going to result in full improvements that can be achieved. We need health care and community integration and all the things that everyone needs to be healthy and thrive. And then lastly, the other consideration is that so in our study, many of the participants were people who had been homeless for a very long time. They had almost all of them suffered from great material deprivation for years, if not decades, and that has an adverse impact on people’s health, not all of which may be reversible by the fact that they’re now housed. And so, I think this is a third possibility that does point to the importance of preventing homelessness. So, in addition to saying we should house people that have been homeless for many years, we should be focusing as a society on how to prevent homelessness and the adverse long term effects that accumulate over time.
Misty Pratt
And I know this study is very recent, but you know, since the all of the studies came up on Housing First, have you seen a policy change or shift in approach to homelessness?
Stephen Hwang
Well, I have to say, we’ve seen some steps forward and we’ve seen some steps backward. The good news is that the research that we and others on our team have done have really indisputably demonstrated the effectiveness of Housing First, and the fact that is essentially the gold standard for ending chronic homelessness. I think that we’ve had some successes in convincing governments to enact Housing First approaches, but I think that where we have had some steps backward is the fact that Housing First is a program that can end homelessness for individuals, but it’s not a panacea or a golden bullet, and if you think about it, what really drives homelessness is housing policy and no program, no matter how wonderful or effective, is going to be able to completely overcome the broad societal effects of a lack of affordable housing, which we know is a problem across Canada right now. So, I think that it’s important to realize that it has had policy impact. We continue to try to spread the good news that it can be applied and adapted to the challenges we face today to end homelessness, and we’ve had some great progress in that area. Just yesterday, I was talking to someone from the province of Manitoba, where they’re making really substantial efforts using a Housing First approach to end homelessness there, but we have a long way to go still.
Misty Pratt
So, George, if you had a policy person here on the podcast with us, what would you want them to do as a next step?
George Da Silva
One of the adoptions I’d like to see is, instead of housing everybody in one common building, in my circumstance, I actually was able to get into a co-op, and I’m strongly for co-ops, because that allowed me to reintegrate back into community, being social, being active. If you put them into one building, the stigma, the discrimination, the knowledge that who lives in that building is there, whereas if you disperse people throughout different avenues, different buildings, different communities, I think their chances are much higher of a success rate than being housed all in one building. It would also alleviate the hopefully, the drug dealing that goes on and everything else the criminal factors that are present with the building, or anything else, it allows the person to be themselves. I can now decide who I want to tell about my circumstance or I don’t tell whereas, if I’m in a building, everybody then knows why I’m in the building.
Misty Pratt
Yeah, that makes a lot of sense. If you had somebody here who was a decision maker, somebody in government, what would you tell them is the next step they should be taking to address homelessness?
Kefa Omori Mogoncho
Talk of the impact of the policy change at the moment, if today, I am given that opportunity, as I’m talking to say something is to request the full implementation of the policy in place, and also work the integration of the information at hand that will help enhance towards the capping the homelessness that we are talking about at the moment. Much has been discussed around the same and there is still much to be discussed about it, until there is full implementation of what is supposed to be done. At my level, I may not be able to speak out more about it, but I believe, from where Dr. Steve sits, and the team who are ahead of me are able to speak more about it and also try to voice it out better, so that we can get the result that we are looking on to all of us.
Misty Pratt
You all sound like a wonderful team working so well together. Stephen, for you on the research side, what do you see as the next step?
Stephen Hwang
Well, actually, before I talk about research, I’ll just say that, you know, I think that when you see wonderful partners on our team like George and Kefa, that the importance of understanding the voice and the expertise of people for whom this is not a research exercise. This is about life and just that, it’s incredibly important. I think that the other thing to realize is just how when we address homelessness, we enable people to thrive in ways that we just sometimes cannot even imagine. We think that sometimes things can change, but I think that every day, you know, in the work that we do, we see that people’s lives can change dramatically for the better, and that they can thrive and contribute to the greater good of all of us. I think that, you know, if I were able to speak to a policymaker, I would say a few things.
One is that in addition to the human benefits of ending homelessness, there is a tremendous cost to doing things the way we do now. There is tremendous stress put on the system, and there’s system capacity in the healthcare system and in other social service systems that could be made available if we just address the problem of homelessness, there would be those resources could then be used in other ways that would be so much more beneficial and for for us as a society. And then the other thing is that I think that it’s, it’s just incredible to think about the societal cost to our own, to everyone’s well being, to allow homelessness, to, you know, to fester and grow in our in our communities. It really is, it just has a tremendous adverse impact on our communities, and it’s something that we can do something about as a very affluent society.
I think that you know in terms of where should we go next with research, there’s a couple of things that I think are really important. One is that we know that Housing First works, but we also know that the world has changed over the last several years, and certainly since Covid We’ve seen a rise in homelessness, and in particular, people on the street and in encampments. And I think that in addition, we’ve seen a increasingly toxic drug supply causing substance use disorders to become particularly severe beyond what they were in previous years. And so, I think that we need to adapt Housing First models and then test them and evaluate them to see how effective they can be in addressing the visible homelessness that we see in our communities today. I’m confident that it can, that it is up to the task of solving the problem of visible homelessness, but we do need to adapt and evaluate its effectiveness. And then I guess the other thing I would just say is that we also need to have interventions that focus on in addition to helping people get housed, helping them to access the health care that they need and integrate into community. And I think both, both George and Kefa have really spoken very eloquently about the need to have community friends, activities that bring us together. These are things that we, every one of us as a human being, needs to be a thriving part of our society, and so it’s just something that we need to actually do research on.
Misty Pratt
Well, thank you so much to all of you for being here. I know I started the podcast talking about numbers, but you know, I really feel in in how this conversation has gone, that it’s clear there are stories behind these numbers. It’s not just you know that we hear 60,000 people, it’s that every single person has a lived experience that’s important to hear, and I feel like the stories you’ve shared today are making that known and elevating that conversation. So, I appreciate you being here.
Stephen Hwang
Thank you for having us.
George Da Silva
It’s been a pleasure.
Kefa Omori Mogoncho
Thank you so much for having us.
Misty Pratt
Thanks for joining me for this episode of In Our VoICES. Check out the show notes, for links to research and any other information that we’ve referenced in this episode. A reminder that the opinions expressed in this podcast are not necessarily those of ICES. Please be sure to follow and rate us on your favorite podcast app. If you have feedback or questions about anything you’ve heard on In Our VoICES, please email us at [email protected] and we will get back to you. All of us at ICES wish you strong data and good health.
