How to End Homelessness

Gregor Robertson will become mayor of Vancouver this Monday afternoon. He won the job in large part because he promised to end street homelessness by 2015.

His critics scoff. They either don't believe he can do it, or they don't believe it can be done by a mayor who must use his dwindling property tax dollars to fund police protection, garbage collection and other essential services.

His enemies swoon. They are quick to note that outgoing Mayor Sam Sullivan was tossed to the curb after he failed to deliver on a homelessness pledge -- and that Sullivan merely promised to cut the city's homeless count in half.

But homeless and mental health professionals believe Robertson will beat homelessness if he can persuade the province to throw its weight behind two bold but simple ideas: Housing First and Treatment on Demand.

And they warn that while senior government support is critical, Robertson must not limit his crusade to Victoria and Ottawa. They say Robertson will have to inspire nothing less than a movement to end homelessness -- one that engages a diverse coalition of governments, corporations, not-for-profit societies, faith-based groups and ordinary citizens.

This article explores the two policies. Tomorrow's proposes a list of specific projects to explore.

A goal that saves lives and money

The Tyee put the following question to nine local experts on the issue of homelessness: If you were mayor, what would you do?

Some of these professionals work for the city, some work for the province, and others receive government funding. All are concerned about becoming caught in future political crossfire between Victoria and Vancouver. So in order to free them to present completely candid and utterly unvarnished advice, The Tyee has provided anonymity to all.

All nine agreed that street homelessness could be ended by 2015. And each said that regardless of how one feels about the homeless, getting bodies off the street is sound city policy. Here's why:

1. It's the law. In the wake of the B.C. Supreme Court ruling allowing homeless camping in Victoria, cities may soon be required by law to either provide shelter or allow homeless camps. Since makeshift camps can deteriorate into magnets for crime and violence, providing shelter is the only reasonable course of public action.

2. It saves money. Taxpayers now spend an estimated $85 million a year providing emergency services to Vancouver's homeless. Vancouver property owners pay the lion's share of that, in the form of police and ambulance calls. Cut the number of street homeless, and you cut the cost to taxpayers.

3. It shifts the tax burden. Not only does it cost half as much to house the homeless as it does to service them on the streets, but the province pays the roughly $28,000 a year to house them while the city pays most of the estimated $55,000 a year to service them on the streets.

"We're headed into a recession," one longtime housing advocate said. "Taxpayers can no longer afford to subsidize these failed experiments in laissez-faire housing and deinstitutionalization."

Policy #1: Housing First

"Housing First" is an American term to describe a policy that treats basic housing as a right rather than a privilege.

Under a Housing First bylaw, the city would work with the province to provide basic housing -- such as a room in a residential hotel -- to everyone, without time limits or other conditions. Housing First prioritizes homes over shelters, and takes a harm reduction approach toward drug and alcohol use.

The evidence supporting this approach is overwhelming. Residents who live in Housing First housing are healthier and more law-abiding than those who live in shelters or on the street. Housing First residents are more likely to enter treatment for addiction or mental illness, and once enrolled they succeed in higher numbers.

"They don't become model citizens overnight," noted one local expert. "But most do become better citizens in a remarkably short period of time."

Enacting a Housing First policy will be easy. Enforcing it will require unprecedented commitment and more than a little political wrangling in the face of tremendous resistance.

For example, a true Housing First bylaw would make it illegal for an institution to discharge clients to "no fixed address," as federal prisons and provincial hospitals routinely do.

(An aside: A frequent objection to Housing First arises from the mistaken assumption that homeless would flock to Vancouver for the free housing. In fact, by halting the release of ex-cons to the city, Vancouver would plug a route by which many B.C. residents wind up homeless in the Lower Mainland.)

Thus, by adopting a Housing First policy, Vancouver would be asking senior governments to arrange housing for every discharged prisoner and hospital patient.

In all likelihood, the city would have to take the federal government to court in order to collect fines for any infractions. Several who spoke to The Tyee for this article believe that after years of polite but fruitless lobbying in Ottawa, the time has come to take such a confrontational stance in an effort to drag the federal government back into meaningful discussions about the funding of homeless housing.

Policy #2: Treatment on Demand

Gregor Robertson's bid to end homelessness will fail without a massive commitment to addiction and mental health treatment. On this point, the experts who spoke to The Tyee were unequivocal.

How big? The view among several of the experts who spoke to The Tyee is that Vancouver currently needs up to 1,000 additional treatment slots.

It can be done. Here are but two of many examples of creative and aggressive approaches that could quickly provide treatment to the homeless:

There are hundreds of additional addiction treatment beds scattered across the Lower Mainland in the form of "recovery houses," but because Vancouver Coastal Health clings to a narrow medical model of treatment, it refuses to fund them. With funding and much-needed oversight, these private facilities could begin receiving homeless addicts within weeks.

Likewise, if the province were to throw out the residential treatment stereotype altogether and embrace an in-situ approach, hundreds more could be treated where they live by visiting professionals. The old-fashioned house calls approach could prove particularly beneficial for those who are both addicted and mentally ill, and therefore do not fit easily into residential facilities designed for one group or the other.

But there's no way the City of Vancouver can provide treatment. It has neither the mandate nor the money.

And so it is that Mayor Gregor Robertson, a former NDP lawmaker who has staked his career on ending homelessness in Vancouver, has placed his political fate in the hands of Premier Gordon Campbell, who is leading his BC Liberal Party into a May election.

Robertson needs Campbell to bring the same creative zeal to addiction treatment that he has recently brought to social housing.

"I can't say this strongly enough," one knowledgeable source told The Tyee. "Unless there are rapid and radical changes at the top of Vancouver Coastal Health, Mayor Robertson's plan to end homelessness will fail -- and fail spectacularly -- just as Mayor Sullivan's effort failed because he did not recognize that treatment is the master key without which this puzzle will not be solved."

Tomorrow: 50 ways to help the homeless

There are other hurdles to ending street homelessness in Vancouver, of course. Tomorrow's list of "50 ways to help the homeless" will address finding enough homes, creating places for pets, and involving surrounding communities.

But most of those wind up being tactical challenges that ultimately can succeed only in the context of Housing First and Treatment on Demand.

"We already know that it's cheaper to house the homeless than to leave them on the streets," said a veteran of the Downtown Eastside. "My guess is that in the same vein, it's cheaper to provide treatment than to keep building more housing... It costs $200,000 to build a new unit of social housing. If Coastal Health were to spend even $100,000 treating an addict, and that addict ultimately cleans up and returns to market housing, then it seems to me that BC Housing just saved $100,000. But our politicians aren't thinking like that... and the two agencies aren't working together."

Another longtime social worker summed it up this way: "If everyone who wants a home were given one, and if everyone who wants treatment could get it, there'd be like a dozen people left on the streets of Vancouver."

Related Tyee stories:

• Up to 15,500 Homeless: Report
  Tally of BC homeless by health profs far higher than housing minister's.
• More Homeless than Athletes in 2010
  Can Vancouver's Olympic pride be saved? First in a series.
• Vancouver plays Whack-a-Mole with homeless campers