Psychiatric patients often have problems beyond their core psychiatric issues. For people with severe, persistent mental illness, homelessness may be among them.

This week’s Reading focuses on a Utah public-policy initiative to address chronic homelessness; the author notes that the chronically homeless are almost all suffering from mental illness and/or addiction.

The article begins by discussing the “the standard approach” to homelessness in the past – that is, “to try to make homeless people ‘housing ready’: first, you got people into shelters or halfway houses and put them into treatment; only when they made progress could they get a chance at permanent housing.” Utah, under a conservative Republican governor, decided to try something new: “a different strategy, called Housing First: it started by just giving the homeless homes.”

The Utah initiative has since drawn bipartisan interest south of the 49th parallel.

The piece doesn’t touch on Housing First efforts in Canada, but they are active in cities like Toronto and Calgary. You may have seen The Globe and Mail article on this topic in the spring which commented on the cost-effectiveness of Housing First. In some ways, that result is surprising; in some ways, it makes sense. At the recent Canadian Psychiatric Association meeting, for example, Ontario data was presented on the top 40 mentally ill users of Emergency Departments for a LHIN outside of Toronto; among these patients, about half lacked stable housing. The homeless are frequent visitors to our EDs – and have contact with the health-care system in other ways, too (as well as the prison system).

My thought: in these past decades, so much has changed in our treatment of the mentally ill in terms of medications and therapies – and good work is also being done to address seemingly refractory social problems as well. Hope.

The Globe and Mail piece can be found here:

Reading of the Week. Every week I pick a reading — often an article or a paper — from the world of Psychiatry.