New guidelines provide pathway to end homelessness, with housing as the foundation.
A collaborative approach is required to build healthcare pathways that will end homelessness in Canada. Clinicians can and must play a role by tailoring their interventions using a comprehensive new clinical guideline on homelessness published in CMAJ (Canadian Medical Association Journal).
The guidelines aim to inform clinicians, and encourage collaboration with community organizations and policy-makers, around priority steps and evidence-based interventions to treat homeless and precariously housed people at risk of homelessness.
“Homelessness has become a health emergency, not just a social issue. And we now know how to end it,” says Dr. Kevin Pottie, Bruyère Research Institute and the University of Ottawa, Ottawa, Ontario. “It is critical to bring more clinicians into the conversation about homelessness and vulnerably housed people.”
A network of clinicians, academics, governmental and nongovernmental stakeholders, called the Homeless Health Research Network, as well as five people with lived experience of homelessness, created the guideline. A steering committee with representatives from across Canada helped coordinate the process.
“Housing is medicine,” says Amanda DiFalco, fellow at the Institute of Global Homelessness, and who has experienced homelessness. “We need to integrate these guidelines into health policy and how we teach the next generation of clinicians.”
Clinicians can learn to adapt their clinical approach to meet a patient’s needs – both social and medical.
The guidelines recommend the following interventions to help patients who are homeless or vulnerably housed:
- Permanent supportive housing – connect homeless or vulnerable housing people to a local housing coordinator or case manager to provide links to housing options
- Income assistance – help people with income insecurity to find and access income-support resources
- Case management – ensure people with mental health and substance use disorders access local mental health programs and psychiatric services
- Opioid agonist therapy – provide access to opioid agonist therapy in primary care or referral to an addiction specialist
- Harm-reduction – for people with substance use issues, identify appropriate management or refer to local addiction and harm reduction services
The homeless population in Canada has changed considerably over the last 25 years, from a largely middle-aged urban male population to increasing numbers of women, youth, Indigenous people, older adults and even families. The estimated homeless population in 2014 was 235,000 of whom 27.3% were women, 18.7% were youth, 6% were recent immigrants or migrants and growing numbers of seniors.
“The successful implementation of the guideline starts with permanent supportive housing for all,” says Tim Aubry, University of Ottawa. “Then begins the work of tailoring our health interventions to guide people out of homelessness, a deadly and disabling condition.”
The Homeless Health Research Network will update the guideline every five years.Read the guidelines at the CMAJ.Media Contact: Eric Dicaire, Communications Coordinator, email@example.com
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