March 26, 2025 • 33 mins
In Episode 10: Why Supportive Housing Matters of A Way Forward Podcast | Presented by Beem Credit Union, hosts Jessica Samuels and CMHA Kelowna CEO Mike Gawiuk to discuss the critical role of supportive housing in addressing homelessness and mental health. They delve into key topics such as Housing First, complex care, and the broader systemic issues impacting affordable housing in Canada.
Key Topics Discussed:
1. Understanding Supportive Housing
- The difference between Housing First and complex care.
- Why supportive housing is a crucial component in addressing homelessness.
- The role of wraparound services in housing stability.
2. Housing as a Social Determinant of Health
- How access to safe, stable housing impacts mental and physical health.
- The historical recognition of housing as a human right (e.g., UN declaration, Canadian Housing Strategy Act).
- The significance of federal funding through the Reaching Home initiative.
3. The Evolution of Housing First
- Origins of Housing First: Developed by Sam Tsemberis and the Pathways to Housing model in New York City.
- The At Home/Chez Soi study in Canada and its impact on policy.
- Challenges in implementing Housing First effectively, including the need for adequate funding and comprehensive support services.
4. Complex Care and Its Role in Supportive Housing
- The introduction of complex care by the BC government.
- Differences between Housing First and complex care, particularly in levels of autonomy and service provision.
- How complex care supports individuals with high needs, including mental health, substance use, and brain injuries.
5. Addressing Misconceptions and Policy Challenges
- Why Housing First has received criticism and how misinterpretations of the model have affected its implementation.
- The need for a multi-faceted approach ("silver buckshot" rather than a "silver bullet").
- How systemic issues like housing affordability and the toxic drug crisis impact supportive housing efforts.
Key Takeaways:
- Supportive housing is more than just shelter; it includes necessary wraparound services to ensure stability.
- Housing First works when implemented correctly, but requires proper funding and comprehensive support.
- Complex care provides a higher level of support for individuals with severe needs but operates differently from Housing First.
- There is no single solution to homelessness; a combination of strategies is necessary to address diverse needs.
**Resources**
Housing – a SDoH
https://www.cpha.ca/what-are-social-determinants-health
https://www.medicalnewstoday.com/articles/housing-and-health#key-factors
Housing Strategy / Reaching Home
https://housing-infrastructure.canada.ca/housing-logement/ptch-csd/index-eng.html
https://housing-infrastructure.canada.ca/homelessness-sans-abri/index-eng.html
Housing First – history and practical application
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Jessica Samuels (00:00):
Hi, I'm Jessica Samuels. Welcome to A Way
(00:02):
Forward presented by Bean CreditUnion. I'd like to acknowledge
this podcast takes place on theancestral traditional and
unceded lands of the OkanaganSelix people. Our topic today is
supportive housing. And CMHAKelowna CEO Mike Golick and I
are going to specifically diginto housing first and complex
(00:23):
care.
These are two terms that are inhigh rotation right now. And so
we are going to really take alook at what they are and what
it is that they really do. Mike,maybe we can start this one with
you just giving us a little bitabout your background in the
(00:44):
mental health sector and how itpertains to supportive housing
and housing.
Mike Gawiuk (00:49):
Yeah. So I've been at this for a number of years,
and I got my start workingfrontline with young people, and
in particular young people whoare at risk of and some that
were experiencing homelessness.So that's where it started. I've
(01:14):
been involved ever since.Through my career, I've had
opportunity to build new anddifferent programs.
Many years ago, I was helping tobuild the youth shelter here in
Kelowna and then start a littleyouth housing program. And so
(01:40):
really got a sense of what itlooked like for young people and
the specific issues that theywere facing as it pertained to
the potential experience ofbeing unhoused. And then I came
over to CMHA. And again one ofthe things that stood out for me
is that I saw a lot of familiarfaces that I had seen as young
(02:03):
people and some of them weren'tdoing particularly well. So, I
mean, certainly that led andbrought a lot of passion around
how can we do things different.
And so since that day, theopportunity to be involved in
(02:29):
developing supportive housing.Since I've been here, there's
been four buildings that we'veopened. Launching a Housing
First and a Housing First forYouth program, along with our
scattered site housing program,where we lease units in the
(02:53):
private sector and supportpeople to live in community and
taking on that housing firstperspective. I've had a lot of
experience, have been connectedto some work that has taken
place nationally around youthhomelessness. I'd say the time
(03:19):
we're in right now is prettyinteresting when it comes to the
issue of people who are unhousedand the approaches that are
being undertaken to help them.
And I know we're going to talk alittle bit about Housing First
today. And I know that's onethat's pretty controversial.
(03:40):
I'll certainly try to do my bestto sort of explain the
realities, what it is and whatit isn't.
Jessica Samuels (03:49):
Yeah. Okay. Yeah. And part of the reason why
we're talking about it, youknow, before on this podcast,
we've talked about socialdeterminants of health. And
we've we we know that housing isa social determinant of health.
What was interesting to me isthis specific components about
housing or homes that allows itto be that or kind of qualifies
(04:11):
it, and allows folks to excel intheir well-being and their
mental health, or at least havestability in those areas when
they have safe housing. Can youshare a little bit more about
that, maybe even just startingoff with that understanding when
we say a social determinant ofhealth, what does that even
(04:33):
mean? And why does it keepcoming up in this space? Folks,
I want to start there so that wecan really set the foundation,
which will get us to where youmentioned.
Mike Gawiuk (04:45):
Yeah. I mean, social determinants of health
are identified as non medicalfactors that influence health
outcomes. There's a number ofdifferent social determinants of
health, like income, poverty.Money is a social determinant of
(05:12):
health. Those that are inpoverty are more likely to
struggle with health issues,mental health concerns, those
pieces.
Having a home is not just about,again, as we talked before, the
four walls and the ceiling andprotecting you from the
elements, but home meanssomething different for
(05:35):
everybody, whether that'ssafety, whether that's family,
whatever that looks like. Havingaccess to food, nutritious food
that you can afford. Withoutthat, your physical health is
not going to be very good. Soall of these factors, again, non
(06:00):
medical factors, societal andsystemic that impact and have an
impact on our health andwell-being.
Jessica Samuels (06:08):
All right. Okay. And thank you for that. So
when we go back to talkingabout, housing and having a
home, a social determinant ofhealth, it was also long since
been declared by, the UN as abasic human right. I think that
was in the late 40s and '48.
Canada said, yes, we agree. Theydeclared it as well in 1976. And
(06:32):
then they kind of underscoredthat in 2019, when they passed
the Housing Strategy Act. Canyou tell us just a little bit
about that act and why it wassignificant?
Mike Gawiuk (06:44):
Well, think, I mean, is, again, it reinforced
or tried to enshrine housing asa human right. How we're doing
around protecting that humanright looks a whole lot
different. In the context ofthis conversation, again, as it
applies to people who areunhoused, homelessness, and the
(07:09):
issue of resourcing. What wasalso part of that act was
funding for a program calledReaching Home. And Reaching Home
really is one of the federalgovernment's approaches to
supporting communities toaddress preventing and ending
(07:38):
homelessness.
Kelowna happens to be adesignated community through
reaching home, which means moneycomes from the federal
government directly to thecommunity.
Jessica Samuels (07:52):
Can I just pause you there? I just realized
that you just said somethingthere. So Kelowna is a
designated community. If it'sthe Canadian housing strategy,
does that mean that not allcommunities are a designated
community?
Mike Gawiuk (08:08):
Under the reaching home umbrella, not every
community across the country is.So Kelowna is, West Kelowna
isn't. And so that creates forinteresting challenges because
if you're funded throughreaching home, there can be,
again, if you're in a largerarea, geographical barriers
(08:29):
where you can provide serviceand you're not able to provide
service. But that's been thefederal government's go directly
to communities to address thisissue of homelessness. It ties
into housing first for a fewreasons.
Jessica Samuels (08:51):
Okay. So Kelowna has been one of these
communities. CMHA Kelowna hasbeen a recipient. So tie that
all together, how it supportedthe housing program through this
organization, through thecommunity and further.
Mike Gawiuk (09:04):
Yeah. And I don't want to be long winded on this.
I want to try to explain it assimply as possible and then get
into housing first. CMHA hasreceived funding through
Reaching Home for differentprograms. One of those programs
(09:27):
was the Housing First programthat we launched in 2016.
And I remember back in the dayhere at CMHA, we had a gazebo in
the back parking lot and thenthere was someone that was
unhoused and they were sleepingin the gazebo. When we got that
funding, I was like, that'sgoing to be our first housing
(09:50):
first client. And we were ableto work with him to rapidly move
into housing. So we've benefitedthere. We've also benefited from
reaching home funding to helpsupport some of our youth
homelessness initiatives likeBright Minds.
It's also provided us supportfor Rent Bank as well. So we've
(10:16):
been fortunate to get some ofthose funds to be able to
implement programs and move somenew things forward. Okay. And
then there's a catch. And thenthere's housing first and where
this fits into it.
And I can talk a little bitabout it. There's the because
(10:41):
housing first was the thing fora while, right?
Jessica Samuels (10:44):
Yeah.
Mike Gawiuk (10:44):
And the history of Housing First as it goes is
there's a Sam Semberes is hisname. Pathways to Housing is the
organization, and he's in NewYork City, and he's actually a
psychologist from Montreal. Andin the early 90s, he was working
(11:08):
in hospitals in New York anddealing with a lot of people
with serious mental illness. Andwhat he was seeing was on his
way home after work, he'd seepeople that had been in the
hospital, that they had gotten,stabilized on medication, this
kind of thing, and here theywere sleeping outside. Sort of
(11:31):
this counterintuitive approachcame in and he said, If this is
homelessness, what if we givepeople homes and try that out?
And so that's what he did. Butin addition to that, with
(11:52):
Housing First, also broughtalong a comprehensive and fully
supported a number of wraparoundservices. So that included
psychiatric care, primary care,mental health, substance use,
(12:14):
other things. And the idea oftaking someone from the streets,
housing them first, and thenworking to address those issues
was counterintuitive. It showeda level of success for a period
of time.
And then it really took off inCanada in 02/2009, I believe it
(12:40):
was. There was a study that wascommissioned by the Mental
Health Commission of Canadacalled At Home Chezsois. And it
was a $110,000,000 researchstudy that looked at housing
first versus treatment as usual.So it was a randomized control
(13:03):
trial in five cities across thecountry: Vancouver, Winnipeg,
Montreal, Toronto, and Moncton.That research project
demonstrated was that housingfirst, when done correctly, this
is the catch, significantpositive impact for people.
(13:30):
It's not going to be the thingthat works for everyone. But in
terms of housing stability, thescores versus treatment as
usual, was significant. Themoney that was saved, you know,
again, for every $10 that werespent, dollars 21 were saved in
(13:53):
cost offsets to hospitals andpolice and those kinds of
things. Of course, what happenedis those cost offsets didn't get
reinvested into housing andhomelessness, so it created
challenges. But that studyreally was the benchmark study
in this country that took a lookat housing first and and showed
(14:17):
that it could be successful whendone correctly.
Jessica Samuels (14:21):
This is the foreshadowing there. So, you
know, my next question is, doesit seem to be getting a bad rap
and is really where that whendone correctly comes into play?
Because now I feel like there'sa pushback like you like housing
first is almost a dirty word.
Mike Gawiuk (14:40):
Yeah. I mean, it's become that, I think so. I think
there's a few things that havehappened. So the impact of at
home chaiseuil in terms offunding and the reaching home
funding we talked about, itinfluenced it. It influenced to
the point where the federalgovernment said that 50% of
(15:01):
reaching home funds must gotowards housing first programs.
Now, here's the catch. At thattime, the amount of money that
came into Kelowna, specificallythrough Reaching Home, was about
$500,000 a year. 50% of $500,000is $250,000 to do a Housing
(15:24):
First program. It was superchallenging. The only way that
we were able to move it forwardwas through partnerships with BC
Housing, who provided rentsupplements, and Interior Health
at that time was launching anassertive community treatment
team.
(15:46):
And those robust supports arepart of what's necessary to make
housing first, housing first. Sothe government moved on making
this again a policy approach,funded it for pennies on the
dollar, right? Compared to whatwent into Shaysois. And because
(16:08):
it was the thing that wasgetting funded, all of a sudden,
was doing housing first.
Jessica Samuels (16:15):
Because people want the thing. Fair enough,
it's human nature. We've gotsome wicked, wicked problems out
there in our community and justgive us the thing to do to fix
it.
Mike Gawiuk (16:25):
Yeah. And we're looking for the silver bullet.
And when we started the project,we actually had Sam Semberes
come to town to do some trainingwith our staff, to also talk to
the community about HousingFirst, what it was, what it
wasn't. And that's when I wasintroduced to the term that it's
(16:46):
housing first, not housing only.Part of the challenge is housing
first is a very specific model.
It's called a fidelity model andit's kind of like a recipe.
There's principles. If youfollow those principles, you
(17:08):
ultimately demonstrate success.When you don't, what you have is
people that get put in places,left to their own devices,
damage happens to apartments andpeople end up back out on the
streets. And so what I would sayin our experience, we've
(17:32):
attempted to follow a fidelitymodel of housing first.
And when you do that again, itdoesn't necessarily work for
everyone. But in our adultprogram, we're at just over 80%
of people who we house sustaintheir housing. And we were just
part of a similar study, a babyat home with our youth program,
(17:58):
and looked at young people, ourHousing First for Youth program,
plus integrated services throughFoundry. We were one site and
there were three sites inToronto. Because we had access
to Foundry, the clinicalsupports and services that exist
(18:18):
there, and we had our housingfirst case workers, we've seen a
ninety percent success rate inpeople who have found housing
and maintain their housing.
Jessica Samuels (18:30):
Okay.
Mike Gawiuk (18:31):
But I can tell you again, when housing first is the
thing, everybody becomes ahousing first provider and it
doesn't look like the originalidea, doesn't follow the model,
things tend to break down. Andthe other part is that where
(18:52):
there's been a hit as far asHousing First goes is because
we're seeing increases inunhoused people, again, across
the country, Housing First mustbe a failure. While Housing
First is a philosophy, HousingFirst is a program model,
(19:14):
Housing First was never designedto address broader systemic
issues like housingaffordability. So when we first
started in Kelowna, you couldfind an apartment and you might
be able to pay $750 8 hundreddollars a month. And for those
that we supported with a rentsupplement, it was actually
(19:35):
affordable.
Well, things have changeddramatically on the housing
front in terms of affordabilityand availability across the
board. Obviously, housingaffordability is an issue that
we're struggling with across thecountry. And so that dynamic
(19:55):
changes what you can do. Theother thing that changed along
the way, and I would say reallyhas had an impact on things, is
the drug poisoning crisis. Andso we were starting before that
became a thing.
(20:18):
And as we're seeing now, alongthe way, that's had a really
significant impact oncommunities, on people in our
communities, and certainly interms of the people that are
struggling, some of thechallenges with brain injury and
(20:41):
those elements, the needs andthe supports that are required
look different. That leans alittle bit into this notion of
complex care.
Jessica Samuels (20:57):
And that was the next part of that. So we're
talking about housing first, nothousing only, wraparound, the
support services and thedemonstrated success that if for
many, not for everyone, that ifyou follow this fidelity model,
it's going to achieve thoseresults, those successes, but
then introduce things like whatyou just talked about in complex
(21:19):
care. So let's pivot to that alittle bit. So then would
complex care be a form ofhousing first?
Mike Gawiuk (21:28):
So in order to address these issues, again,
there's no one solution that'sgoing to work. And, you know,
again, the diversity of peoplewho are unhoused can look quite
different. Not everybody who isunhoused has an acquired brain
(21:49):
injury and this and this, Butcertainly some of the people
that are the most visible andhave the most impact in society
certainly are. And so complexcare was created by the
provincial government just a fewyears ago. And the idea behind
(22:14):
it was in some ways closer tohousing first from the
standpoint of the amount of andtypes of resources that were
made available to individualswho were really struggling.
So access to clinical supports,again, be that psychiatry or a
doctor or substance usecounseling or any other clinical
(22:40):
supports for individuals who arestruggling. Because, again, we
were finding people in ourcommunity who were having tons
of challenges and had beenthrough multiple systems and it
hadn't been successful. So thiswas, is and continues to be one
(23:01):
attempt to address that. Howit's looked across the province
is different. So complex care inthe context of Kelowna, how it's
operated and how it was chosenwas to be more smaller
congregate care settings.
So there's a four bedroom homeand there's a 12 bedroom home
(23:25):
where people reside. They'reprovided with 20 fourseven
supports and Interior Healthattaches themselves to that. And
that is for some people who are,again, really struggling with
multiple complex issues. Wherethe difference between the
(23:45):
principles of Housing First andComplex Care differ a little
bit. Housing First was based onpeople's right to choose,
autonomy and the belief thatonce housed and supported, they
(24:07):
would make the choices to accessdifferent clinical services.
Complex care provides a lot ofthe supports, provides a place
to stay, and it's nuanced. Butthe autonomy piece that Housing
First entailed is not quite thesame. Right? And it speaks to
(24:36):
something else. Right.
And it speaks to the challengethat we have in our communities,
feeling helpless to be able todo anything. It's an interesting
progression, right? You look atan approach that's got more of a
voluntary nature to it, showssome success. But due to the
(24:58):
fact that it's not appropriatelyfunded, it's not delivered
according to the plan, You throwthe whole thing out and you go
to a place where and this is ascenario we find ourselves in
now and the struggle that wehave around the notion of people
(25:20):
are really ill. And so thatnotion of choice starts to get
challenged and we get to a placewhere we move from choice and
autonomy to compassionate,involuntary care.
And those things kind of bump upagainst each other. Right? And
(25:46):
it's not to suggest that therearen't people in the community
that require a high level ofsupport. However, if there's a
belief that exists that thereare some people that can't make
decisions for themselves and weneed to move forward with
compassionate care that'sinvoluntary, that's going to run
(26:11):
counter to the model that we'vehad. And so that also then
impacts the perception ofHousing First and success that
it may or may not have had.
We're grappling with an issueand we're grappling with
challenges that, again, there'sno one answer for. There's
(26:36):
multiple answers that arerequired in order to meet the
needs of a very diversepopulation. And that's from
prevention all the way to highneed support through complex
care. And in an environmentwhere we're looking for that
silver bullet, one of the termsthat's been used is that we need
(27:00):
a silver buckshot. It needs tospray a little bit all over the
place, and we need more thanjust one approach.
And so, yeah, we're in a reallyinteresting and challenging
place as it applies toaddressing these issues.
Jessica Samuels (27:21):
Wow. I mean, the impacts or the implications
or lack thereof are so broad.And just there's two questions I
want to ask you just as weprepare to wrap up here. One,
you were talking about complexcare relatively in the scheme of
supportive housing, housing new,And providing supports for
(27:44):
people who have really complexproblems. So then it it got me
thinking, if we didn't havethese resources and we didn't
have these things in placebefore, can I make the assertion
hypothesis then that the folkswho are currently unhoused in
our community, again, not tospeak about all of them, these
(28:05):
are individuals who have complexneeds?
So what I was saying is that ifthe resources weren't there
before to house them or havebeen limited there, then we
wouldn't have the ability tosuccessfully house them. So
therefore, they would beunhoused. This is kind of the
thinking that I'm going. Or isthat oversimplifying?
Mike Gawiuk (28:23):
I say some people.
Jessica Samuels (28:26):
Some people.
Mike Gawiuk (28:27):
It's not a blanket statement. No. Because, you
know, not everybody who's inthat situation requires that
level of complex intervention.Right.
Jessica Samuels (28:41):
Yeah. Okay. Thank you for that. The other
thing we talk about, you use theterm success and sustain
housing. And I think what'simportant to mention when we
talk about supportive housing,complex care, housing first, is
how is success defined?
Because I think also, again,another one of my hypotheses is
(29:01):
that part of the reasonsometimes when we're talking
about supportive housing or thistype of program, broadly
speaking, success looks like,and you moved out and you're
fine and you're market housingand you have a job and, you
know, everything's hunky dory.And that may be the case. But
success, if I'm understandingcorrectly, is not necessarily
(29:22):
defined that way in thesecontexts.
Mike Gawiuk (29:24):
I would I would say success definitely looks
different based on theindividual. For those that have
the capacity to do those thingsand get to that place, that's
great. There are going to bepeople who have complex
(29:45):
challenges that are going torequire a level of significant
support for a long period oftime, and some may need that for
their entire life. So again, notwo people who are unhoused are
(30:06):
necessarily the same. And so theTV movie of the week, feel good
story, there's some of that.
But on the other side of thecoin, there are some people that
are really, really impacted andneed a level of support that
they may require for, like Isay, a good portion of their
(30:29):
life. They may stabilize or insome cases, it's a longer term
approach that they may need forthe rest of their lives.
Jessica Samuels (30:37):
Mike, thanks for digging into this with us
today. Huge topic.
Mike Gawiuk (30:41):
Yeah, it is. I did joke earlier, but there's one
thing that I did want to addbecause, again, Housing First
has taken a bit of a hit.There's no doubt about that. But
there are places actually whereit is showing success. So I
(31:02):
joked earlier about Finland.
Jessica Samuels (31:03):
Finland
Mike Gawiuk (31:07):
has done an amazing job in terms of addressing the
issue of homelessness in theircountry. Now, they take a
housing first approach, but whatthey also do and what government
there has done is investedsignificantly in social housing
(31:29):
and the affordability factorthat goes with that. So the
availability, the supply ofhousing that people can afford
has made a huge difference forthem. The success rates that
they've seen have been quiteincredible. And so what that
(31:53):
shows again is that it'snecessary to look at both
things.
We've talked about beforehousing is healthcare. It is. It
may not certainly again be theonly thing required. For some
(32:14):
people, that's enough. For otherpeople, it's housing plus those
wraparound supports that's goingto be the thing that makes the
difference.
Finland showing us that it canbe ultimately done. They're
taking an approach that'sworking. So at least that gives
some hope and optimism that, youknow, things can ultimately
(32:37):
change.
Jessica Samuels (32:38):
Mike, thank you so much for this discussion.
Okay, so we know that was a hugetopic, and we are going to
include some of the links to thehistory, the social determinants
of health, and some of theinformation about complex care
and housing first, of course, onour A Way Forward podcast page
(32:59):
presented by Beam Credit Union,and that is on the
cmhacolona.org website. As well,you can always email us at
awayforwardcmhacolona dot org ifyou have questions or comments
about this topic or any topic.And again, as always, please do
take good care. Beam CreditUnion supports mental health
(33:21):
initiatives across BritishColumbia because caring for each
other builds stronger, moreconnected communities.
United has won. Beam's foundingcredit unions now serve 190,000
members across BC.
Hi, I'm Jessica Samuels. Welcome to A Way
(00:02):
Forward presented by Bean CreditUnion. I'd like to acknowledge
this podcast takes place on theancestral traditional and
unceded lands of the OkanaganSelix people. Our topic today is
supportive housing. And CMHAKelowna CEO Mike Golick and I
are going to specifically diginto housing first and complex
(00:23):
care.
These are two terms that are inhigh rotation right now. And so
we are going to really take alook at what they are and what
it is that they really do. Mike,maybe we can start this one with
you just giving us a little bitabout your background in the
(00:44):
mental health sector and how itpertains to supportive housing
and housing.
Mike Gawiuk (00:49):
Yeah. So I've been at this for a number of years,
and I got my start workingfrontline with young people, and
in particular young people whoare at risk of and some that
were experiencing homelessness.So that's where it started. I've
(01:14):
been involved ever since.Through my career, I've had
opportunity to build new anddifferent programs.
Many years ago, I was helping tobuild the youth shelter here in
Kelowna and then start a littleyouth housing program. And so
(01:40):
really got a sense of what itlooked like for young people and
the specific issues that theywere facing as it pertained to
the potential experience ofbeing unhoused. And then I came
over to CMHA. And again one ofthe things that stood out for me
is that I saw a lot of familiarfaces that I had seen as young
(02:03):
people and some of them weren'tdoing particularly well. So, I
mean, certainly that led andbrought a lot of passion around
how can we do things different.
And so since that day, theopportunity to be involved in
(02:29):
developing supportive housing.Since I've been here, there's
been four buildings that we'veopened. Launching a Housing
First and a Housing First forYouth program, along with our
scattered site housing program,where we lease units in the
(02:53):
private sector and supportpeople to live in community and
taking on that housing firstperspective. I've had a lot of
experience, have been connectedto some work that has taken
place nationally around youthhomelessness. I'd say the time
(03:19):
we're in right now is prettyinteresting when it comes to the
issue of people who are unhousedand the approaches that are
being undertaken to help them.
And I know we're going to talk alittle bit about Housing First
today. And I know that's onethat's pretty controversial.
(03:40):
I'll certainly try to do my bestto sort of explain the
realities, what it is and whatit isn't.
Jessica Samuels (03:49):
Yeah. Okay. Yeah. And part of the reason why
we're talking about it, youknow, before on this podcast,
we've talked about socialdeterminants of health. And
we've we we know that housing isa social determinant of health.
What was interesting to me isthis specific components about
housing or homes that allows itto be that or kind of qualifies
(04:11):
it, and allows folks to excel intheir well-being and their
mental health, or at least havestability in those areas when
they have safe housing. Can youshare a little bit more about
that, maybe even just startingoff with that understanding when
we say a social determinant ofhealth, what does that even
(04:33):
mean? And why does it keepcoming up in this space? Folks,
I want to start there so that wecan really set the foundation,
which will get us to where youmentioned.
Mike Gawiuk (04:45):
Yeah. I mean, social determinants of health
are identified as non medicalfactors that influence health
outcomes. There's a number ofdifferent social determinants of
health, like income, poverty.Money is a social determinant of
(05:12):
health. Those that are inpoverty are more likely to
struggle with health issues,mental health concerns, those
pieces.
Having a home is not just about,again, as we talked before, the
four walls and the ceiling andprotecting you from the
elements, but home meanssomething different for
(05:35):
everybody, whether that'ssafety, whether that's family,
whatever that looks like. Havingaccess to food, nutritious food
that you can afford. Withoutthat, your physical health is
not going to be very good. Soall of these factors, again, non
(06:00):
medical factors, societal andsystemic that impact and have an
impact on our health andwell-being.
Jessica Samuels (06:08):
All right. Okay. And thank you for that. So
when we go back to talkingabout, housing and having a
home, a social determinant ofhealth, it was also long since
been declared by, the UN as abasic human right. I think that
was in the late 40s and '48.
Canada said, yes, we agree. Theydeclared it as well in 1976. And
(06:32):
then they kind of underscoredthat in 2019, when they passed
the Housing Strategy Act. Canyou tell us just a little bit
about that act and why it wassignificant?
Mike Gawiuk (06:44):
Well, think, I mean, is, again, it reinforced
or tried to enshrine housing asa human right. How we're doing
around protecting that humanright looks a whole lot
different. In the context ofthis conversation, again, as it
applies to people who areunhoused, homelessness, and the
(07:09):
issue of resourcing. What wasalso part of that act was
funding for a program calledReaching Home. And Reaching Home
really is one of the federalgovernment's approaches to
supporting communities toaddress preventing and ending
(07:38):
homelessness.
Kelowna happens to be adesignated community through
reaching home, which means moneycomes from the federal
government directly to thecommunity.
Jessica Samuels (07:52):
Can I just pause you there? I just realized
that you just said somethingthere. So Kelowna is a
designated community. If it'sthe Canadian housing strategy,
does that mean that not allcommunities are a designated
community?
Mike Gawiuk (08:08):
Under the reaching home umbrella, not every
community across the country is.So Kelowna is, West Kelowna
isn't. And so that creates forinteresting challenges because
if you're funded throughreaching home, there can be,
again, if you're in a largerarea, geographical barriers
(08:29):
where you can provide serviceand you're not able to provide
service. But that's been thefederal government's go directly
to communities to address thisissue of homelessness. It ties
into housing first for a fewreasons.
Jessica Samuels (08:51):
Okay. So Kelowna has been one of these
communities. CMHA Kelowna hasbeen a recipient. So tie that
all together, how it supportedthe housing program through this
organization, through thecommunity and further.
Mike Gawiuk (09:04):
Yeah. And I don't want to be long winded on this.
I want to try to explain it assimply as possible and then get
into housing first. CMHA hasreceived funding through
Reaching Home for differentprograms. One of those programs
(09:27):
was the Housing First programthat we launched in 2016.
And I remember back in the dayhere at CMHA, we had a gazebo in
the back parking lot and thenthere was someone that was
unhoused and they were sleepingin the gazebo. When we got that
funding, I was like, that'sgoing to be our first housing
(09:50):
first client. And we were ableto work with him to rapidly move
into housing. So we've benefitedthere. We've also benefited from
reaching home funding to helpsupport some of our youth
homelessness initiatives likeBright Minds.
It's also provided us supportfor Rent Bank as well. So we've
(10:16):
been fortunate to get some ofthose funds to be able to
implement programs and move somenew things forward. Okay. And
then there's a catch. And thenthere's housing first and where
this fits into it.
And I can talk a little bitabout it. There's the because
(10:41):
housing first was the thing fora while, right?
Jessica Samuels (10:44):
Yeah.
Mike Gawiuk (10:44):
And the history of Housing First as it goes is
there's a Sam Semberes is hisname. Pathways to Housing is the
organization, and he's in NewYork City, and he's actually a
psychologist from Montreal. Andin the early 90s, he was working
(11:08):
in hospitals in New York anddealing with a lot of people
with serious mental illness. Andwhat he was seeing was on his
way home after work, he'd seepeople that had been in the
hospital, that they had gotten,stabilized on medication, this
kind of thing, and here theywere sleeping outside. Sort of
(11:31):
this counterintuitive approachcame in and he said, If this is
homelessness, what if we givepeople homes and try that out?
And so that's what he did. Butin addition to that, with
(11:52):
Housing First, also broughtalong a comprehensive and fully
supported a number of wraparoundservices. So that included
psychiatric care, primary care,mental health, substance use,
(12:14):
other things. And the idea oftaking someone from the streets,
housing them first, and thenworking to address those issues
was counterintuitive. It showeda level of success for a period
of time.
And then it really took off inCanada in 02/2009, I believe it
(12:40):
was. There was a study that wascommissioned by the Mental
Health Commission of Canadacalled At Home Chezsois. And it
was a $110,000,000 researchstudy that looked at housing
first versus treatment as usual.So it was a randomized control
(13:03):
trial in five cities across thecountry: Vancouver, Winnipeg,
Montreal, Toronto, and Moncton.That research project
demonstrated was that housingfirst, when done correctly, this
is the catch, significantpositive impact for people.
(13:30):
It's not going to be the thingthat works for everyone. But in
terms of housing stability, thescores versus treatment as
usual, was significant. Themoney that was saved, you know,
again, for every $10 that werespent, dollars 21 were saved in
(13:53):
cost offsets to hospitals andpolice and those kinds of
things. Of course, what happenedis those cost offsets didn't get
reinvested into housing andhomelessness, so it created
challenges. But that studyreally was the benchmark study
in this country that took a lookat housing first and and showed
(14:17):
that it could be successful whendone correctly.
Jessica Samuels (14:21):
This is the foreshadowing there. So, you
know, my next question is, doesit seem to be getting a bad rap
and is really where that whendone correctly comes into play?
Because now I feel like there'sa pushback like you like housing
first is almost a dirty word.
Mike Gawiuk (14:40):
Yeah. I mean, it's become that, I think so. I think
there's a few things that havehappened. So the impact of at
home chaiseuil in terms offunding and the reaching home
funding we talked about, itinfluenced it. It influenced to
the point where the federalgovernment said that 50% of
(15:01):
reaching home funds must gotowards housing first programs.
Now, here's the catch. At thattime, the amount of money that
came into Kelowna, specificallythrough Reaching Home, was about
$500,000 a year. 50% of $500,000is $250,000 to do a Housing
(15:24):
First program. It was superchallenging. The only way that
we were able to move it forwardwas through partnerships with BC
Housing, who provided rentsupplements, and Interior Health
at that time was launching anassertive community treatment
team.
(15:46):
And those robust supports arepart of what's necessary to make
housing first, housing first. Sothe government moved on making
this again a policy approach,funded it for pennies on the
dollar, right? Compared to whatwent into Shaysois. And because
(16:08):
it was the thing that wasgetting funded, all of a sudden,
was doing housing first.
Jessica Samuels (16:15):
Because people want the thing. Fair enough,
it's human nature. We've gotsome wicked, wicked problems out
there in our community and justgive us the thing to do to fix
it.
Mike Gawiuk (16:25):
Yeah. And we're looking for the silver bullet.
And when we started the project,we actually had Sam Semberes
come to town to do some trainingwith our staff, to also talk to
the community about HousingFirst, what it was, what it
wasn't. And that's when I wasintroduced to the term that it's
(16:46):
housing first, not housing only.Part of the challenge is housing
first is a very specific model.
It's called a fidelity model andit's kind of like a recipe.
There's principles. If youfollow those principles, you
(17:08):
ultimately demonstrate success.When you don't, what you have is
people that get put in places,left to their own devices,
damage happens to apartments andpeople end up back out on the
streets. And so what I would sayin our experience, we've
(17:32):
attempted to follow a fidelitymodel of housing first.
And when you do that again, itdoesn't necessarily work for
everyone. But in our adultprogram, we're at just over 80%
of people who we house sustaintheir housing. And we were just
part of a similar study, a babyat home with our youth program,
(17:58):
and looked at young people, ourHousing First for Youth program,
plus integrated services throughFoundry. We were one site and
there were three sites inToronto. Because we had access
to Foundry, the clinicalsupports and services that exist
(18:18):
there, and we had our housingfirst case workers, we've seen a
ninety percent success rate inpeople who have found housing
and maintain their housing.
Jessica Samuels (18:30):
Okay.
Mike Gawiuk (18:31):
But I can tell you again, when housing first is the
thing, everybody becomes ahousing first provider and it
doesn't look like the originalidea, doesn't follow the model,
things tend to break down. Andthe other part is that where
(18:52):
there's been a hit as far asHousing First goes is because
we're seeing increases inunhoused people, again, across
the country, Housing First mustbe a failure. While Housing
First is a philosophy, HousingFirst is a program model,
(19:14):
Housing First was never designedto address broader systemic
issues like housingaffordability. So when we first
started in Kelowna, you couldfind an apartment and you might
be able to pay $750 8 hundreddollars a month. And for those
that we supported with a rentsupplement, it was actually
(19:35):
affordable.
Well, things have changeddramatically on the housing
front in terms of affordabilityand availability across the
board. Obviously, housingaffordability is an issue that
we're struggling with across thecountry. And so that dynamic
(19:55):
changes what you can do. Theother thing that changed along
the way, and I would say reallyhas had an impact on things, is
the drug poisoning crisis. Andso we were starting before that
became a thing.
(20:18):
And as we're seeing now, alongthe way, that's had a really
significant impact oncommunities, on people in our
communities, and certainly interms of the people that are
struggling, some of thechallenges with brain injury and
(20:41):
those elements, the needs andthe supports that are required
look different. That leans alittle bit into this notion of
complex care.
Jessica Samuels (20:57):
And that was the next part of that. So we're
talking about housing first, nothousing only, wraparound, the
support services and thedemonstrated success that if for
many, not for everyone, that ifyou follow this fidelity model,
it's going to achieve thoseresults, those successes, but
then introduce things like whatyou just talked about in complex
(21:19):
care. So let's pivot to that alittle bit. So then would
complex care be a form ofhousing first?
Mike Gawiuk (21:28):
So in order to address these issues, again,
there's no one solution that'sgoing to work. And, you know,
again, the diversity of peoplewho are unhoused can look quite
different. Not everybody who isunhoused has an acquired brain
(21:49):
injury and this and this, Butcertainly some of the people
that are the most visible andhave the most impact in society
certainly are. And so complexcare was created by the
provincial government just a fewyears ago. And the idea behind
(22:14):
it was in some ways closer tohousing first from the
standpoint of the amount of andtypes of resources that were
made available to individualswho were really struggling.
So access to clinical supports,again, be that psychiatry or a
doctor or substance usecounseling or any other clinical
(22:40):
supports for individuals who arestruggling. Because, again, we
were finding people in ourcommunity who were having tons
of challenges and had beenthrough multiple systems and it
hadn't been successful. So thiswas, is and continues to be one
(23:01):
attempt to address that. Howit's looked across the province
is different. So complex care inthe context of Kelowna, how it's
operated and how it was chosenwas to be more smaller
congregate care settings.
So there's a four bedroom homeand there's a 12 bedroom home
(23:25):
where people reside. They'reprovided with 20 fourseven
supports and Interior Healthattaches themselves to that. And
that is for some people who are,again, really struggling with
multiple complex issues. Wherethe difference between the
(23:45):
principles of Housing First andComplex Care differ a little
bit. Housing First was based onpeople's right to choose,
autonomy and the belief thatonce housed and supported, they
(24:07):
would make the choices to accessdifferent clinical services.
Complex care provides a lot ofthe supports, provides a place
to stay, and it's nuanced. Butthe autonomy piece that Housing
First entailed is not quite thesame. Right? And it speaks to
(24:36):
something else. Right.
And it speaks to the challengethat we have in our communities,
feeling helpless to be able todo anything. It's an interesting
progression, right? You look atan approach that's got more of a
voluntary nature to it, showssome success. But due to the
(24:58):
fact that it's not appropriatelyfunded, it's not delivered
according to the plan, You throwthe whole thing out and you go
to a place where and this is ascenario we find ourselves in
now and the struggle that wehave around the notion of people
(25:20):
are really ill. And so thatnotion of choice starts to get
challenged and we get to a placewhere we move from choice and
autonomy to compassionate,involuntary care.
And those things kind of bump upagainst each other. Right? And
(25:46):
it's not to suggest that therearen't people in the community
that require a high level ofsupport. However, if there's a
belief that exists that thereare some people that can't make
decisions for themselves and weneed to move forward with
compassionate care that'sinvoluntary, that's going to run
(26:11):
counter to the model that we'vehad. And so that also then
impacts the perception ofHousing First and success that
it may or may not have had.
We're grappling with an issueand we're grappling with
challenges that, again, there'sno one answer for. There's
(26:36):
multiple answers that arerequired in order to meet the
needs of a very diversepopulation. And that's from
prevention all the way to highneed support through complex
care. And in an environmentwhere we're looking for that
silver bullet, one of the termsthat's been used is that we need
(27:00):
a silver buckshot. It needs tospray a little bit all over the
place, and we need more thanjust one approach.
And so, yeah, we're in a reallyinteresting and challenging
place as it applies toaddressing these issues.
Jessica Samuels (27:21):
Wow. I mean, the impacts or the implications
or lack thereof are so broad.And just there's two questions I
want to ask you just as weprepare to wrap up here. One,
you were talking about complexcare relatively in the scheme of
supportive housing, housing new,And providing supports for
(27:44):
people who have really complexproblems. So then it it got me
thinking, if we didn't havethese resources and we didn't
have these things in placebefore, can I make the assertion
hypothesis then that the folkswho are currently unhoused in
our community, again, not tospeak about all of them, these
(28:05):
are individuals who have complexneeds?
So what I was saying is that ifthe resources weren't there
before to house them or havebeen limited there, then we
wouldn't have the ability tosuccessfully house them. So
therefore, they would beunhoused. This is kind of the
thinking that I'm going. Or isthat oversimplifying?
Mike Gawiuk (28:23):
I say some people.
Jessica Samuels (28:26):
Some people.
Mike Gawiuk (28:27):
It's not a blanket statement. No. Because, you
know, not everybody who's inthat situation requires that
level of complex intervention.Right.
Jessica Samuels (28:41):
Yeah. Okay. Thank you for that. The other
thing we talk about, you use theterm success and sustain
housing. And I think what'simportant to mention when we
talk about supportive housing,complex care, housing first, is
how is success defined?
Because I think also, again,another one of my hypotheses is
(29:01):
that part of the reasonsometimes when we're talking
about supportive housing or thistype of program, broadly
speaking, success looks like,and you moved out and you're
fine and you're market housingand you have a job and, you
know, everything's hunky dory.And that may be the case. But
success, if I'm understandingcorrectly, is not necessarily
(29:22):
defined that way in thesecontexts.
Mike Gawiuk (29:24):
I would I would say success definitely looks
different based on theindividual. For those that have
the capacity to do those thingsand get to that place, that's
great. There are going to bepeople who have complex
(29:45):
challenges that are going torequire a level of significant
support for a long period oftime, and some may need that for
their entire life. So again, notwo people who are unhoused are
(30:06):
necessarily the same. And so theTV movie of the week, feel good
story, there's some of that.
But on the other side of thecoin, there are some people that
are really, really impacted andneed a level of support that
they may require for, like Isay, a good portion of their
(30:29):
life. They may stabilize or insome cases, it's a longer term
approach that they may need forthe rest of their lives.
Jessica Samuels (30:37):
Mike, thanks for digging into this with us
today. Huge topic.
Mike Gawiuk (30:41):
Yeah, it is. I did joke earlier, but there's one
thing that I did want to addbecause, again, Housing First
has taken a bit of a hit.There's no doubt about that. But
there are places actually whereit is showing success. So I
(31:02):
joked earlier about Finland.
Jessica Samuels (31:03):
Finland
Mike Gawiuk (31:07):
has done an amazing job in terms of addressing the
issue of homelessness in theircountry. Now, they take a
housing first approach, but whatthey also do and what government
there has done is investedsignificantly in social housing
(31:29):
and the affordability factorthat goes with that. So the
availability, the supply ofhousing that people can afford
has made a huge difference forthem. The success rates that
they've seen have been quiteincredible. And so what that
(31:53):
shows again is that it'snecessary to look at both
things.
We've talked about beforehousing is healthcare. It is. It
may not certainly again be theonly thing required. For some
(32:14):
people, that's enough. For otherpeople, it's housing plus those
wraparound supports that's goingto be the thing that makes the
difference.
Finland showing us that it canbe ultimately done. They're
taking an approach that'sworking. So at least that gives
some hope and optimism that, youknow, things can ultimately
(32:37):
change.
Jessica Samuels (32:38):
Mike, thank you so much for this discussion.
Okay, so we know that was a hugetopic, and we are going to
include some of the links to thehistory, the social determinants
of health, and some of theinformation about complex care
and housing first, of course, onour A Way Forward podcast page
(32:59):
presented by Beam Credit Union,and that is on the
cmhacolona.org website. As well,you can always email us at
awayforwardcmhacolona dot org ifyou have questions or comments
about this topic or any topic.And again, as always, please do
take good care. Beam CreditUnion supports mental health
(33:21):
initiatives across BritishColumbia because caring for each
other builds stronger, moreconnected communities.
United has won. Beam's foundingcredit unions now serve 190,000
members across BC.
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