Predictors of housing instability and stability among Housing First participants: A 24-month study

ABSTRACT

This study examined the characteristics of people who experienced housing instability and stability after 24 months of being enrolled in Housing First (HF). A companion study addresses the same objective using qualitative methods. A sequential logistic regression was conducted to determine predictors of unstable and stable housing at 24 months of enrollment in HF in a randomized trial. We applied the Gelberg-Andersen. Behavioral Model for Vulnerable Populations to identify and group predictor variables. Thirty-one percent of the HF participants (N = 302/977) met the study criteria for housing instability (i.e. stably housed for less than 90% of last six months). Residence in Winnipeg, longer accumulated lifetime homelessness, and higher levels of substance use predicted unstable housing. Residence in Toronto and Montreal, older age, being in an ethno-racial minority group (other than Indigenous), higher income, higher perceived housing quality, and having a family physician predicted stable housing. The findings of the study have implications for strengthening HF supports to better address the needs of HF participants who may be at risk of housing instability.

KEYWORDS:

• Housing First
• mental illness
• homelessness
• housing stability
• community mental health

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This research was made possible through a financial contribution from Health Canada. The authors thank Jayne Barker, Cameron Keller, Catharine Hume, and the late Paula Goering, formerly the Mental Health Commission of Canada’s At Home / Chez Soi national project leaders; the site coordinators; the numerous service and housing providers; and the persons with lived experience who contributed to this project and the research. The views expressed are those of the authors. The authors report no financial relationships with commercial interests regarding this research.

Notes on contributors

Maryann Roebuck

Maryann Roebuck, Ph.D., is a Postdoctoral Researcher at the University of Ottawa and the Ottawa Branch of the Canadian Mental Health Association. Her research focuses on community mental health and homelessness.

Ayda Agha

Ayda Agha is a Ph.D., Student in Community Psychology at the Centre for Research on Educational and Community Services (CRECS) at the University of Ottawa. She holds a Master of Science in Community Health with a specialization in Addictions and Mental Health from the Dalla Lana School of Public Health, University of Toronto.

Geoffrey Nelson

Geoffrey Nelson, Ph.D., is Professor Emeritus of Psychology at Wilfrid Laurier University. His research has examined housing for people with lived experience of mental illness and/or homelessness.

Jino Distasio

Jino Distasio, Ph.D., Vice President, Research and Innovation, Director of the Institute of Urban Studies, and Professor of Geography, at University of Winnipeg. His research agenda includes housing market analysis, mental health and homelessness, Indigenous urban issues, and broad urban policy.

John Ecker

John Ecker, Ph.D., is a Research Manager at MAP Centre for Urban Health Solutions, Unity Health Toronto and the Director of Research & Evaluation at the Canadian Observatory on Homelessness, York University.

Stephen W. Hwang

Stephen W. Hwang, MD, MPH, is a Research Scientist and Director at the MAP Centre for Urban Health Solutions, Unity Health Toronto, and Professor of Medicine at the University of Toronto. His research focuses on homelessness, housing and health.

Eric Latimer

Eric Latimer, Ph.D., is a Research Scientist at the Douglas Mental Health University Institute and Professor in the Department of Psychiatry, McGill University. His research interests focus on community-based supports for people with severe mental illness, particularly their economic aspects.

Sarah Purcell

Sarah Purcell has a B.A. in Psychology and B.Sc. in Biology from the University of New Brunswick, Fredericton. She is in the graduating class of 2024 in Dalhousie Medicine, Saint John, New Brunswick.

Julian M. Somers

Julian M. Somers, Ph.D., is a Full Professor in the Faculty of Health Sciences at Simon Fraser University. Dr. Somers works to improve clinical practices and public policies related to addiction and mental health.

Sam Tsemberis

Sam Tsemberis, Ph.D., is Chief Executive Officer for Pathways Housing First Institute and Associate Professor, Department of Psychiatry at UCLA. His research has focused on homelessness, mental illness and recovery.

Tim Aubry

Tim Aubry, Ph.D., is a Professor in the School of Psychology at the University of Ottawa. His research examines community mental health, housing, and homelessness.