In Vancouver’s Downtown Eastside, the Housing First model once offered hope for a path out of homelessness. Yet, cracks are beginning to show as this model is tested in one of Canada’s most complex neighbourhoods. Vancouver’s experience with Housing First suggests that housing alone may not be enough in neighbourhoods like the DTES, where support services, mental health care, and stable housing are in short supply. Rising homelessness, addiction, and public safety concerns have exposed gaps that reveal a crucial question: Can Housing First truly solve homelessness here, or does the model fall short of addressing the underlying issues?
A Simple Solution with Complex Challenges
Originating in the United States in the 1990s, the Housing First model emerged from the principle that stable housing is a fundamental prerequisite for addressing other issues, such as addiction and mental health challenges. Over the past 15 years, the model has gained traction globally, including in Canada, where it has become a cornerstone of homelessness policy. Its premise is simple: provide immediate, unconditional access to housing, followed by optional support services to maintain it.
On paper, the model is highly effective. Numerous studies have shown that it drastically reduces homelessness among those with chronic mental health and addiction issues. Statistics Canada reported that Housing First initiatives had, in some regions, provided long-term stability for many previously homeless individuals. However, despite the approach’s broad adoption, Canada has seen homelessness increase by around 20% between 2018 and 2022, with Vancouver among the hardest-hit cities. This surge points to potential flaws in implementation rather than the model itself, highlighting the need for more comprehensive strategies.
A Case Study in Housing Complexity
In Vancouver’s DTES, Housing First is a well-intentioned but challenging promise. With one of the country’s largest homeless populations and a high prevalence of mental health and substance use disorders, the DTES is uniquely difficult to serve. Vancouver’s high housing costs further complicate the model’s effectiveness. While Housing First seeks to provide stable homes, the city’s severe shortage of affordable housing has left vulnerable residents with few options. Many who find housing in the DTES are placed in Single Room Occupancy (SRO) hotels, which are notoriously overcrowded, unsanitary, and lacking essential amenities. Though these units offer a form of shelter, they often do not meet the “housing stability” envisioned by Housing First advocates.
Adding to the complexity, the DTES also faces a profound crisis of public health and safety, driven by the widespread availability of fentanyl and other synthetic drugs. While the Housing First model assumes that stability comes from having a home, it often overlooks the deep-seated issues of addiction and mental health that pervade areas like the DTES. Without robust support services, many residents struggle to sustain housing, leading to repeated cycles of homelessness.
Raincity Housing’s Assertive Community Treatment
One adaptation of the Housing First model in Vancouver is Raincity Housing’s Assertive Community Treatment (ACT) team. Based in the DTES, this non-profit-led initiative offers more than just housing—it provides a full suite of support services to help residents navigate the challenges of tenancy. The team, funded initially by the Mental Health Commission of Canada, includes health professionals, addiction counsellors, peer specialists, and even an occupational therapist, working with residents to address the complex web of issues they face.
The ACT team’s holistic approach focuses on personal choice, self-determination, and harm reduction. With a participant-to-staff ratio 10:1, the team provides individualized attention, which is vital in a community where standard solutions often fall short. By ensuring residents have a say in their housing and health decisions, ACT has shown that tailored support can make a meaningful difference. Yet, the demand for such services far outstrips supply, and ACT’s success underscores a broader truth: Housing First works best when accompanied by comprehensive, wraparound care.
The Role of Health and Social Services in Housing Stability
As Vancouver grapples with Housing First’s limitations, health and social services are stepping into critical roles. Plans are underway to expand affordable and supportive housing in the DTES. New developments aim to provide residents with access to healthcare and mental health services directly within housing projects. The upcoming community building project, a collaboration between BC Housing, the City of Vancouver, and the Vancouver Coastal Health Authority (VCHA), will integrate these essential services, creating a “one-stop” solution for vulnerable residents.
Ravi Kahlon, British Columbia’s Minister of Housing, acknowledges the limitations of SROs as a long-term solution, noting the need for housing that goes beyond mere shelter. “This shows how, by working together, we can create innovative housing solutions to ensure people living in the DTES have access to safe and appropriate housing options,” Kahlon stated. The project is emblematic of a shift toward more sustainable and supportive housing models—an evolution many argue is long overdue in Vancouver’s DTES.
The Systemic Challenges to Housing First’s Success
Despite the widespread adoption of Housing First, the surge in homelessness across Canada and the United States suggests that implementation challenges may be undermining the model’s effectiveness. In the U.S., homelessness jumped by 12% between 2022 and 2023 alone. Experts argue that rising housing costs, insufficient social services, and an inadequate stock of affordable housing all play a role in limiting Housing First’s potential. The model can falter in high-cost cities like Vancouver when housing is scarce, unaffordable, or substandard.
Furthermore, addiction and mental health support often lag behind housing provision, leaving many tenants without the resources they need to sustain their homes. This is particularly problematic in the DTES, where public safety issues related to addiction and mental health disorders are prevalent. Critics argue that while Housing First emphasizes immediate housing, it does not adequately address the “why” behind homelessness—a gap that leads to high rates of recidivism in housing programs.
Reimagining Housing Solutions
For Housing First to thrive in Vancouver, it must adapt to the unique realities of the DTES. The city’s evolving approach is beginning to recognize that housing stability for vulnerable populations requires more than just providing a roof – it requires a combination of health, social, and community services that address the root causes of homelessness. Programs like ACT have demonstrated the value of comprehensive, community-based support in promoting long-term housing retention. Still, these models need broader support and expansion to reach all those in need.
As Vancouver’s homelessness crisis deepens, the lessons learned from these programs suggest a path forward: a shift from purely housing-focused solutions to integrated models that recognize the interconnectedness of housing, health, and social support. By emphasizing a truly comprehensive approach to homelessness, Vancouver has the potential to lead in redefining the Housing First model for communities facing complex social challenges like the DTES.
Building a Better Future for Vancouver’s Downtown Eastside
In the heart of Vancouver, the Downtown Eastside stands as both a challenge and an opportunity—a place where well-intentioned models like Housing First are tested and redefined. The limitations of the current approach highlight the need for innovative solutions that can address the multifaceted realities of homelessness. Vancouver’s commitment to expanding supportive housing, combined with holistic programs like ACT, reflects a promising step toward creating sustainable housing solutions that go beyond bricks and mortar.
However, lasting change will require continued collaboration between government, community organizations, and residents. If Housing First is to fulfill its potential, it must evolve to meet the needs of those it serves, recognizing that housing is just one piece of the puzzle. With a community-driven, integrated approach, Vancouver can set a new standard in addressing homelessness—not only for the DTES but for urban centres worldwide.
Denise is a long-time advocate for affordable and dignified housing in the Downtown Eastside. Having lived in SROs and volunteered in homeless shelters, she brings a personal understanding of the housing crisis and its impact on the community. Her work reflects years of lived experience, frontline work, and commitment to creating better living conditions for DTES residents.
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