The Biggest 'Housing First' Trial | Dr. Eric Latimer

In our first three episodes on the Cost of Homelessness, we explored how housing the homeless can often cost less than leaving them in the emergency system. But that's not always the case for every person, program, or place. And saving money isn't the main goal—ending homelessness is about improving lives.

In this episode, we speak with Dr. Eric Latimer, Professor of Psychiatry at McGill University and lead economist on Canada’s landmark At Home / Chez Soi Housing First study. He helps us look carefully at the evidence: Housing First dramatically improved housing stability and life outcomes, and over 50% of the program's cost was offset by reductions in emergency service use.

While in this study Housing First didn’t fully "pay for itself", we discuss some fascinating reasons for that, and we explore why we shouldn't always expect cost-neutrality for programs that successfully reduce homelessness.

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Guest: Dr. Eric Latimer is a Professor in the Department of Psychiatry at McGill University and Research Scientist at the Douglas Mental Health University Institute. He was lead investigator for the Montreal site of the At Home / Chez So research and demonstration study on homelessness and mental illness and was its lead economist nationally.

Topics Covered:

• The results of Canada’s At Home / Chez Soi study, the largest Housing First trial ever conducted
• How most of the program's cost was offset, and why it didn't quite “pay for itself”, at least in the short term
• Key reasons for variation across "cost of homelessness" studies: connecting people to health care and income supports, inclusion of low- or moderate-need participants, and “regression to the mean”
• Comparisons with U.S., French, and Finnish studies and programs
• Why cost savings aren’t the real goal—ending homelessness is about dignity, health, and equity

Studies referenced:

• Effect of Scattered-Site Housing Using Rent Supplements and Intensive Case Management on Housing Stability Among Homeless Adults With Mental Illness: A Randomized Trial (2015)
• Housing First Impact on Costs and Associated Cost Offsets: A Review of the Literature (2015)
• Costs of services for homeless people with mental illness in 5 Canadian cities: a large prospective follow-up study (2017)
• Cost-effectiveness of Housing First Intervention With Intensive Case Management Compared With Treatment as Usual for Homeless Adults With Mental Illness Secondary Analysis of a Randomized Clinical Trial (2019)
• Cost-Effectiveness of Housing First With Assertive Community Treatment: Results From the Canadian At Home/Chez Soi Trial (2020)
• A Tale of Two Countries: A Comparison of Multi-Site Randomised Controlled Trials of Pathways Housing First Conducted in Canada and France (2021)

Production:

• Producers: Tristan Markle, Lina Moskaleva, and CJ Tremblay
• Sound and original music: Matthew Hayter, matthewhaytermusic.com
• This podcast is a project of The Publication Cooperative
• If you have thoughts, feedback, or ideas, email us at [email protected]