Lifetime criminal justice involvement is not a barrier to Housing First effectiveness and cost-effectiveness

ABSTRACT

Introduction: Because justice involvement of people experiencing homelessness and mental illness reduces residential stability and increases economic costs, patterns of criminal history may have an impact on the effectiveness and the cost-effectiveness of the Housing First intervention. Method. This study examined whether the effectiveness and cost-effectiveness of Housing First compared to usual services vary according to these profiles in participants recruited for the multi-site Canadian At Home/Chez Soi randomized controlled trial. Generalized linear models are used to examine the evolution of costs, days in stable housing, and net monetary benefit over two years. Results. The effectiveness or the cost-effectiveness of Housing First do not differ according to these profiles. All people who are experiencing homelessness and mental illness are likely to benefit from Housing First, regardless of criminal history. Discussion. This works provide further support for offering Housing First to all individuals expressing a desire for housing.

KEYWORDS:

• Homelessness
• economic evaluation
• program evaluation
• cost-effectiveness analysis
• Housing First

Acknowledgments

Marichelle C. Leclair would like to acknowledge that she conducted most of the work when affiliated to the Department of Epidemiology, Biostatistics and Occupational Health at McGill University and benefited from a scholarship by the FRQ-SC. Ashley J. Lemieux would like to acknowledge the FRQ-SC and the VISEV Team for doctoral research scholarships, as well as the McGill University Department of Psychiatry for a Graduate Excellence Fellowship in Mental Health Research. Laurence Roy would like to acknowledge the Fonds de recherche Québec – Santé (FRQ-S) for her Junior 2 Chercheurs-boursiers salary award. The authors declared no conflicts of interest.

Disclosure statement

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

Notes

1 Albeit not “dominant”, i.e. both more effective and less costly.

2 In this context, “needs” refers to criminogenic needs, which relate to dynamic risk factors of justice involvement.

Additional information

Funding

The At Home/Chez Soi project was been made possible through a financial contribution from Health Canada to the Mental Health Commission of Canada; Fonds de Recherche du Québec - Santé.

Notes on contributors

Marichelle C. Leclair

Marichelle C. Leclair is a professor at the Université du Québec en Outaouais and a research scientist at Institut national de psychiatrie légale Philippe-Pinel who specializes in developing strategies to enhance mental health services for people involved with the justice system to promote recovery and desistance.

Anne G. Crocker

Anne G. Crocker is director, Research & Academics at Institut national de psychiatrie légale Philippe-Pinel and Full professor, department of Psychiatry & Addictions and School of Criminology, Université de Montréal. She holds the SSHRC Canada Research Chair in Mental health, justice, and safety.

Ashley J. Lemieux

Ashley J. Lemieux is planning, programming and research officer at Institut national de psychiatrie légale Philippe-Pinel. She specializes in the implementation of responsive, person-centered care in forensic mental health.

Laurence Roy

Laurence Roy is associate professor at McGill University. Her team conducts projects on psychosocial rehabilitation, community integration, occupational engagement and recovery of adults who live with mental illness or experience psychosocial challenges, particularly in the areas of housing, homelessness, education and justice involvement

Tonia L. Nicholls

Tonia L. Nicholls is a Professor, Department of Psychiatry, UBC and the Lead, Forensic Research and Distinguished Scientist at BC Mental Health and Substance Use Services (BCMHSUS). Her research examines the intersections of law and mental health related to the provision of services to persons in conflict with the law and diverse marginalized populations.

Zhirong Cao

Zhirong Cao is biostatistician at the Douglas Mental Health University Institute.

Eric A. Latimer

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