Episode 10: Housing First & Complex Care
Hi, I'm Jessica Samuels. Welcome to A Way Forward presented by Bean Credit Union. I'd like to acknowledge this podcast takes place on the ancestral traditional and unceded lands of the Okanagan Selix people. Our topic today is supportive housing. And CMHA Kelowna CEO Mike Golick and I are going to specifically dig into housing first and complex care.
Jessica Samuels:These are two terms that are in high rotation right now. And so we are going to really take a look at what they are and what it is that they really do. Mike, maybe we can start this one with you just giving us a little bit about your background in the mental health sector and how it pertains to supportive housing and housing.
Mike Gawiuk:Yeah. So I've been at this for a number of years, and I got my start working frontline with young people, and in particular young people who are at risk of and some that were experiencing homelessness. So that's where it started. I've been involved ever since. Through my career, I've had opportunity to build new and different programs.
Mike Gawiuk:Many years ago, I was helping to build the youth shelter here in Kelowna and then start a little youth housing program. And so really got a sense of what it looked like for young people and the specific issues that they were facing as it pertained to the potential experience of being unhoused. And then I came over to CMHA. And again one of the things that stood out for me is that I saw a lot of familiar faces that I had seen as young people and some of them weren't doing particularly well. So, I mean, certainly that led and brought a lot of passion around how can we do things different.
Mike Gawiuk:And so since that day, the opportunity to be involved in developing supportive housing. Since I've been here, there's been four buildings that we've opened. Launching a Housing First and a Housing First for Youth program, along with our scattered site housing program, where we lease units in the private sector and support people to live in community and taking on that housing first perspective. I've had a lot of experience, have been connected to some work that has taken place nationally around youth homelessness. I'd say the time we're in right now is pretty interesting when it comes to the issue of people who are unhoused and the approaches that are being undertaken to help them.
Mike Gawiuk:And I know we're going to talk a little bit about Housing First today. And I know that's one that's pretty controversial. I'll certainly try to do my best to sort of explain the realities, what it is and what it isn't.
Jessica Samuels:Yeah. Okay. Yeah. And part of the reason why we're talking about it, you know, before on this podcast, we've talked about social determinants of health. And we've we we know that housing is a social determinant of health.
Jessica Samuels:What was interesting to me is this specific components about housing or homes that allows it to be that or kind of qualifies it, and allows folks to excel in their well-being and their mental health, or at least have stability in those areas when they have safe housing. Can you share a little bit more about that, maybe even just starting off with that understanding when we say a social determinant of health, what does that even mean? And why does it keep coming up in this space? Folks, I want to start there so that we can really set the foundation, which will get us to where you mentioned.
Mike Gawiuk:Yeah. I mean, social determinants of health are identified as non medical factors that influence health outcomes. There's a number of different social determinants of health, like income, poverty. Money is a social determinant of health. Those that are in poverty are more likely to struggle with health issues, mental health concerns, those pieces.
Mike Gawiuk:Having a home is not just about, again, as we talked before, the four walls and the ceiling and protecting you from the elements, but home means something different for everybody, whether that's safety, whether that's family, whatever that looks like. Having access to food, nutritious food that you can afford. Without that, your physical health is not going to be very good. So all of these factors, again, non medical factors, societal and systemic that impact and have an impact on our health and well-being.
Jessica Samuels:All right. Okay. And thank you for that. So when we go back to talking about, housing and having a home, a social determinant of health, it was also long since been declared by, the UN as a basic human right. I think that was in the late 40s and '48.
Jessica Samuels:Canada said, yes, we agree. They declared it as well in 1976. And then they kind of underscored that in 2019, when they passed the Housing Strategy Act. Can you tell us just a little bit about that act and why it was significant?
Mike Gawiuk:Well, think, I mean, is, again, it reinforced or tried to enshrine housing as a human right. How we're doing around protecting that human right looks a whole lot different. In the context of this conversation, again, as it applies to people who are unhoused, homelessness, and the issue of resourcing. What was also part of that act was funding for a program called Reaching Home. And Reaching Home really is one of the federal government's approaches to supporting communities to address preventing and ending homelessness.
Mike Gawiuk:Kelowna happens to be a designated community through reaching home, which means money comes from the federal government directly to the community.
Jessica Samuels:Can I just pause you there? I just realized that you just said something there. So Kelowna is a designated community. If it's the Canadian housing strategy, does that mean that not all communities are a designated community?
Mike Gawiuk:Under the reaching home umbrella, not every community across the country is. So Kelowna is, West Kelowna isn't. And so that creates for interesting challenges because if you're funded through reaching home, there can be, again, if you're in a larger area, geographical barriers where you can provide service and you're not able to provide service. But that's been the federal government's go directly to communities to address this issue of homelessness. It ties into housing first for a few reasons.
Jessica Samuels:Okay. So Kelowna has been one of these communities. CMHA Kelowna has been a recipient. So tie that all together, how it supported the housing program through this organization, through the community and further.
Mike Gawiuk:Yeah. And I don't want to be long winded on this. I want to try to explain it as simply as possible and then get into housing first. CMHA has received funding through Reaching Home for different programs. One of those programs was the Housing First program that we launched in 2016.
Mike Gawiuk:And I remember back in the day here at CMHA, we had a gazebo in the back parking lot and then there was someone that was unhoused and they were sleeping in the gazebo. When we got that funding, I was like, that's going to be our first housing first client. And we were able to work with him to rapidly move into housing. So we've benefited there. We've also benefited from reaching home funding to help support some of our youth homelessness initiatives like Bright Minds.
Mike Gawiuk:It's also provided us support for Rent Bank as well. So we've been fortunate to get some of those funds to be able to implement programs and move some new things forward. Okay. And then there's a catch. And then there's housing first and where this fits into it.
Mike Gawiuk:And I can talk a little bit about it. There's the because housing first was the thing for a while, right?
Jessica Samuels:Yeah.
Mike Gawiuk:And the history of Housing First as it goes is there's a Sam Semberes is his name. Pathways to Housing is the organization, and he's in New York City, and he's actually a psychologist from Montreal. And in the early 90s, he was working in hospitals in New York and dealing with a lot of people with serious mental illness. And what he was seeing was on his way home after work, he'd see people that had been in the hospital, that they had gotten, stabilized on medication, this kind of thing, and here they were sleeping outside. Sort of this counterintuitive approach came in and he said, If this is homelessness, what if we give people homes and try that out?
Mike Gawiuk:And so that's what he did. But in addition to that, with Housing First, also brought along a comprehensive and fully supported a number of wraparound services. So that included psychiatric care, primary care, mental health, substance use, other things. And the idea of taking someone from the streets, housing them first, and then working to address those issues was counterintuitive. It showed a level of success for a period of time.
Mike Gawiuk:And then it really took off in Canada in 02/2009, I believe it was. There was a study that was commissioned by the Mental Health Commission of Canada called At Home Chezsois. And it was a $110,000,000 research study that looked at housing first versus treatment as usual. So it was a randomized control trial in five cities across the country: Vancouver, Winnipeg, Montreal, Toronto, and Moncton. That research project demonstrated was that housing first, when done correctly, this is the catch, significant positive impact for people.
Mike Gawiuk:It's not going to be the thing that works for everyone. But in terms of housing stability, the scores versus treatment as usual, was significant. The money that was saved, you know, again, for every $10 that were spent, dollars 21 were saved in cost offsets to hospitals and police and those kinds of things. Of course, what happened is those cost offsets didn't get reinvested into housing and homelessness, so it created challenges. But that study really was the benchmark study in this country that took a look at housing first and and showed that it could be successful when done correctly.
Jessica Samuels:This is the foreshadowing there. So, you know, my next question is, does it seem to be getting a bad rap and is really where that when done correctly comes into play? Because now I feel like there's a pushback like you like housing first is almost a dirty word.
Mike Gawiuk:Yeah. I mean, it's become that, I think so. I think there's a few things that have happened. So the impact of at home chaiseuil in terms of funding and the reaching home funding we talked about, it influenced it. It influenced to the point where the federal government said that 50% of reaching home funds must go towards housing first programs.
Mike Gawiuk:Now, here's the catch. At that time, the amount of money that came into Kelowna, specifically through Reaching Home, was about $500,000 a year. 50% of $500,000 is $250,000 to do a Housing First program. It was super challenging. The only way that we were able to move it forward was through partnerships with BC Housing, who provided rent supplements, and Interior Health at that time was launching an assertive community treatment team.
Mike Gawiuk:And those robust supports are part of what's necessary to make housing first, housing first. So the government moved on making this again a policy approach, funded it for pennies on the dollar, right? Compared to what went into Shaysois. And because it was the thing that was getting funded, all of a sudden, was doing housing first.
Jessica Samuels:Because people want the thing. Fair enough, it's human nature. We've got some wicked, wicked problems out there in our community and just give us the thing to do to fix it.
Mike Gawiuk:Yeah. And we're looking for the silver bullet. And when we started the project, we actually had Sam Semberes come to town to do some training with our staff, to also talk to the community about Housing First, what it was, what it wasn't. And that's when I was introduced to the term that it's housing first, not housing only. Part of the challenge is housing first is a very specific model.
Mike Gawiuk:It's called a fidelity model and it's kind of like a recipe. There's principles. If you follow those principles, you ultimately demonstrate success. When you don't, what you have is people that get put in places, left to their own devices, damage happens to apartments and people end up back out on the streets. And so what I would say in our experience, we've attempted to follow a fidelity model of housing first.
Mike Gawiuk:And when you do that again, it doesn't necessarily work for everyone. But in our adult program, we're at just over 80% of people who we house sustain their housing. And we were just part of a similar study, a baby at home with our youth program, and looked at young people, our Housing First for Youth program, plus integrated services through Foundry. We were one site and there were three sites in Toronto. Because we had access to Foundry, the clinical supports and services that exist there, and we had our housing first case workers, we've seen a ninety percent success rate in people who have found housing and maintain their housing.
Jessica Samuels:Okay.
Mike Gawiuk:But I can tell you again, when housing first is the thing, everybody becomes a housing first provider and it doesn't look like the original idea, doesn't follow the model, things tend to break down. And the other part is that where there's been a hit as far as Housing First goes is because we're seeing increases in unhoused people, again, across the country, Housing First must be a failure. While Housing First is a philosophy, Housing First is a program model, Housing First was never designed to address broader systemic issues like housing affordability. So when we first started in Kelowna, you could find an apartment and you might be able to pay $750 8 hundred dollars a month. And for those that we supported with a rent supplement, it was actually affordable.
Mike Gawiuk:Well, things have changed dramatically on the housing front in terms of affordability and availability across the board. Obviously, housing affordability is an issue that we're struggling with across the country. And so that dynamic changes what you can do. The other thing that changed along the way, and I would say really has had an impact on things, is the drug poisoning crisis. And so we were starting before that became a thing.
Mike Gawiuk:And as we're seeing now, along the way, that's had a really significant impact on communities, on people in our communities, and certainly in terms of the people that are struggling, some of the challenges with brain injury and those elements, the needs and the supports that are required look different. That leans a little bit into this notion of complex care.
Jessica Samuels:And that was the next part of that. So we're talking about housing first, not housing only, wraparound, the support services and the demonstrated success that if for many, not for everyone, that if you follow this fidelity model, it's going to achieve those results, those successes, but then introduce things like what you just talked about in complex care. So let's pivot to that a little bit. So then would complex care be a form of housing first?
Mike Gawiuk:So in order to address these issues, again, there's no one solution that's going to work. And, you know, again, the diversity of people who are unhoused can look quite different. Not everybody who is unhoused has an acquired brain injury and this and this, But certainly some of the people that are the most visible and have the most impact in society certainly are. And so complex care was created by the provincial government just a few years ago. And the idea behind it was in some ways closer to housing first from the standpoint of the amount of and types of resources that were made available to individuals who were really struggling.
Mike Gawiuk:So access to clinical supports, again, be that psychiatry or a doctor or substance use counseling or any other clinical supports for individuals who are struggling. Because, again, we were finding people in our community who were having tons of challenges and had been through multiple systems and it hadn't been successful. So this was, is and continues to be one attempt to address that. How it's looked across the province is different. So complex care in the context of Kelowna, how it's operated and how it was chosen was to be more smaller congregate care settings.
Mike Gawiuk:So there's a four bedroom home and there's a 12 bedroom home where people reside. They're provided with 20 fourseven supports and Interior Health attaches themselves to that. And that is for some people who are, again, really struggling with multiple complex issues. Where the difference between the principles of Housing First and Complex Care differ a little bit. Housing First was based on people's right to choose, autonomy and the belief that once housed and supported, they would make the choices to access different clinical services.
Mike Gawiuk:Complex care provides a lot of the supports, provides a place to stay, and it's nuanced. But the autonomy piece that Housing First entailed is not quite the same. Right? And it speaks to something else. Right.
Mike Gawiuk:And it speaks to the challenge that we have in our communities, feeling helpless to be able to do anything. It's an interesting progression, right? You look at an approach that's got more of a voluntary nature to it, shows some success. But due to the fact that it's not appropriately funded, it's not delivered according to the plan, You throw the whole thing out and you go to a place where and this is a scenario we find ourselves in now and the struggle that we have around the notion of people are really ill. And so that notion of choice starts to get challenged and we get to a place where we move from choice and autonomy to compassionate, involuntary care.
Mike Gawiuk:And those things kind of bump up against each other. Right? And it's not to suggest that there aren't people in the community that require a high level of support. However, if there's a belief that exists that there are some people that can't make decisions for themselves and we need to move forward with compassionate care that's involuntary, that's going to run counter to the model that we've had. And so that also then impacts the perception of Housing First and success that it may or may not have had.
Mike Gawiuk:We're grappling with an issue and we're grappling with challenges that, again, there's no one answer for. There's multiple answers that are required in order to meet the needs of a very diverse population. And that's from prevention all the way to high need support through complex care. And in an environment where we're looking for that silver bullet, one of the terms that's been used is that we need a silver buckshot. It needs to spray a little bit all over the place, and we need more than just one approach.
Mike Gawiuk:And so, yeah, we're in a really interesting and challenging place as it applies to addressing these issues.
Jessica Samuels:Wow. I mean, the impacts or the implications or lack thereof are so broad. And just there's two questions I want to ask you just as we prepare to wrap up here. One, you were talking about complex care relatively in the scheme of supportive housing, housing new, And providing supports for people who have really complex problems. So then it it got me thinking, if we didn't have these resources and we didn't have these things in place before, can I make the assertion hypothesis then that the folks who are currently unhoused in our community, again, not to speak about all of them, these are individuals who have complex needs?
Jessica Samuels:So what I was saying is that if the resources weren't there before to house them or have been limited there, then we wouldn't have the ability to successfully house them. So therefore, they would be unhoused. This is kind of the thinking that I'm going. Or is that oversimplifying?
Mike Gawiuk:I say some people.
Jessica Samuels:Some people.
Mike Gawiuk:It's not a blanket statement. No. Because, you know, not everybody who's in that situation requires that level of complex intervention. Right.
Jessica Samuels:Yeah. Okay. Thank you for that. The other thing we talk about, you use the term success and sustain housing. And I think what's important to mention when we talk about supportive housing, complex care, housing first, is how is success defined?
Jessica Samuels:Because I think also, again, another one of my hypotheses is that part of the reason sometimes when we're talking about supportive housing or this type of program, broadly speaking, success looks like, and you moved out and you're fine and you're market housing and you have a job and, you know, everything's hunky dory. And that may be the case. But success, if I'm understanding correctly, is not necessarily defined that way in these contexts.
Mike Gawiuk:I would I would say success definitely looks different based on the individual. For those that have the capacity to do those things and get to that place, that's great. There are going to be people who have complex challenges that are going to require a level of significant support for a long period of time, and some may need that for their entire life. So again, no two people who are unhoused are necessarily the same. And so the TV movie of the week, feel good story, there's some of that.
Mike Gawiuk:But on the other side of the coin, there are some people that are really, really impacted and need a level of support that they may require for, like I say, a good portion of their life. They may stabilize or in some cases, it's a longer term approach that they may need for the rest of their lives.
Jessica Samuels:Mike, thanks for digging into this with us today. Huge topic.
Mike Gawiuk:Yeah, it is. I did joke earlier, but there's one thing that I did want to add because, again, Housing First has taken a bit of a hit. There's no doubt about that. But there are places actually where it is showing success. So I joked earlier about Finland.
Jessica Samuels:Finland
Mike Gawiuk:has done an amazing job in terms of addressing the issue of homelessness in their country. Now, they take a housing first approach, but what they also do and what government there has done is invested significantly in social housing and the affordability factor that goes with that. So the availability, the supply of housing that people can afford has made a huge difference for them. The success rates that they've seen have been quite incredible. And so what that shows again is that it's necessary to look at both things.
Mike Gawiuk:We've talked about before housing is healthcare. It is. It may not certainly again be the only thing required. For some people, that's enough. For other people, it's housing plus those wraparound supports that's going to be the thing that makes the difference.
Mike Gawiuk:Finland showing us that it can be ultimately done. They're taking an approach that's working. So at least that gives some hope and optimism that, you know, things can ultimately change.
Jessica Samuels:Mike, thank you so much for this discussion. Okay, so we know that was a huge topic, and we are going to include some of the links to the history, the social determinants of health, and some of the information about complex care and housing first, of course, on our A Way Forward podcast page presented by Beam Credit Union, and that is on the cmhacolona.org website. As well, you can always email us at awayforwardcmhacolona dot org if you have questions or comments about this topic or any topic. And again, as always, please do take good care. Beam Credit Union supports mental health initiatives across British Columbia because caring for each other builds stronger, more connected communities.
Jessica Samuels:United has won. Beam's founding credit unions now serve 190,000 members across BC.
