Is Homelessness Prevention a Fantasy?
Meandering through Montreal’s efforts and diagnosing some of its problems.
Earlier this year, I wrote an essay for my “Social Entrepreneurship” class concerning Inuit homelessness in Montreal. Essentially, in Canada, Indigenous populations were subject to injustice, discrimination, and genocide. In large part due to this legacy, conditions in the northern ancestral home of Inuit in Canada are horrendous, with high rates of sexual and physical abuse, high costs of living, and negligible employment opportunities. Subsequently, Inuit people often come south looking for reprieve and end up impoverished or homeless.
Here are some statistics that bolster the point:
70% of Inuit living in Montreal migrated from Nunavik (the northern third of Quebec)
55% of all Nunavik Inuit in Montreal are low-income or homeless (55% of Inuit interviewed have an average income of $650/month; 27% have no income at all; n=75)
Indigenous people are 27x more likely to become homeless than average, Inuit in Montreal are 80x more likely to become homeless.
And some pathos:
“It is the most vulnerable individuals living in Nunavik—the abuse victims, those lacking employment opportunities, and those who cannot keep up with the cost of living—that are likely to leave their communities to pursue a better life in the South. Imagine, for example, living in such a bleak situation that you are willing to leave your friends, family, and community. You arrive in Montreal as a visible minority whose first language is Inuktitut (Caron et al., 2020). These structural disadvantages are high-risk factors for homelessness.”
Throughout the essay, I did a lot of handwaving and buzzword-ing to keep within the word count and shoehorn class concepts. In one thousand words, I concluded that the disproportionate suffering of Inuit in Montreal is due to inadequate planning from Montreal’s municipal government—specifically, a “lack of culturally appropriate services.” Though I expect this to be at least partially true, I want to examine this claim in more depth. Why would Montreal, or any city for that matter, purposely neglect this expensive and visible humanitarian issue?
I. Where is the money going?
Currently, the federal government invests 1.6 billion annually for homelessness through the “Reaching Home” program. Approximately 150 million is allocated to “prevention,” “430 million to housing projects,” and 532 million to “client support services.”
In the 2023-2024 budget, “Quebec will spend $1.8 billion (half of which is federal funding) over six years to build 8000 social and affordable housing units.” “7500 of those units are for low and moderate-income households.” Quebec is also earmarking 338.2 million to “boost efforts to combat homelessness.” Of this 338.2 million, 214.5 million is to build 500 housing units for people at risk of or already homeless, and 123.7 million for “Increasing emergency assistance to address homelessness” (103.5 million), “Promoting social reintegration” (15.2 million), and “Enhancing support for culturally safe services for Indigenous people experiencing homelessness” (5 million) (Government of Quebec, 2023).
Notably, Montreal has no publicly run emergency homeless shelters. Anecdotally, The Old Brewery Mission—Quebec’s largest homeless shelter—has only recently begun prevention efforts and currently only has a small team of under ten people working on prevention.
So, to summarize: the lion’s share of homelessness funding federally and provincially is to build housing; outside of housing, treatment trumps prevention; and specifically tailored prevention (e.g., “culturally appropriate services”) is smaller than general prevention spending by one order of magnitude.
II. Is enough money going to prevention?
We’re all friends here, so let me reveal my hand—my argument is that not enough money goes to prevention. From the numbers above, prevention and treatment seem relatively on par; however, an ugly reality hides behind those numbers.
Clearly, most prevention spending is allocated to building housing units. In the abstract, this is great! More housing is good, and more housing for low-income citizens is even better. However, good programs aren’t necessarily effective preventative mechanisms. To measure the efficacy of a prevention program, we must examine the counterfactual world.
Is it the case that if not for those 500 new housing units, 500 people would have been unhoused? Probably not. They may have moved, found worse places to live, or cut money from their food budgets to support living expenses. It’s plausible that some of those 500 residents may have resorted to couch-surfing or even spent a night or two at a shelter. However, that isn’t the homelessness we care the most about.
The homelessness we care the most about is chronic homelessness—homelessness which has lasted for longer than 6 months over the past year or 18 months over 3 years. Chronic homelessness is the most visible, most expensive, and most heartbreaking form of homelessness. Chronic homelessness is what you picture when I write “homelessness,” and it looks like the severe drug use, mental illness, and trauma victims you may encounter walking downtown. These individuals end up unhoused after failed systems—such as those in Nunavik—encounter an unprepared society—such as Montreal. In 2015 Montreal, there were 3016 chronically homeless people. It’s a small number, all things considered.
Now, considering all things, the chronically homeless are likely the hardest to reach—to end up in their situation, they often have empty social networks, severe behavioural issues, and multiple addictions. These factors don’t pop up because the rent is slightly too high. Rather, severe trauma, neglect, and youth homelessness compound into an untenable situation.
Housing unaffordability does matter—it correlates to homelessness and has the most directly exacerbating effect on every contributing factor. However, when considering highly specific forms of homelessness—Inuit homelessness in particular—addressing housing affordability is probably not as cost-effective as the “culturally appropriate services.” This is because the people using these services are likely situated upon multiple intersections of vulnerability to homelessness.
Services like medical clinics and Friendship Centers, like Qavvivik or the Montreal Native Friendship Center, can do much more to address social isolation, language barriers, and employment all at once. Consider the Indigenous Support Workers Project, which recently had its budget cut. The amount of people they can employ, search for, or support is directly linked to its budget. So, to amend my previous thesis, I argue that the amount we spend on prevention should be increased and reallocated towards high-leverage, niche areas.
III. An Aside: What comes first? Addiction or homelessness?
Addiction makes homelessness exponentially harder to treat. Addicts are often unstable, dysregulated, and stuck. Many want to get clean, but the process is difficult and in my limited experience, many more fail than succeed. Even treatment becomes harder and requires ever more safe supplies, naloxone, methadone, etc. Similarly, addiction exacerbates mental illness symptoms and can contribute to the development of new ones.
Likewise, homelessness makes homelessness harder to treat. The longer someone has spent homeless, the likelier they have lost social connections, built addictions, suffered trauma or exacerbated their mental health symptoms. Below, I reviewed some pertinent literature. Here, I am attempting to bolster the point that it is easier (and thus, more worthy of resources) to stop someone from entering homelessness than trying to remove someone from current homelessness.
In a study of homelessness in Melbourne, Guy Johnson and Chris Chamberlain found that two-thirds of homeless people only develop substance abuse issues after entering homelessness (n=4291). Additionally, 60% of the sample who became homeless before 18 developed substance abuse issues, compared to only 14% of people 19 and older. This paper highlights myriad pathways for how this happens; for example, someone who falls into homelessness may use drugs due to peer pressure or to fit into their new reference group. My problem with this paper, however, is that they operationalize “substance use issues” through three commonly used definitions (which, I think, are too narrow). An individual must meet one of these three: 1. approached the agency for substance abuse treatment, 2. Had been in or is in detox or rehab, and 3. Case notes identify substance abuse as an issue. This is reasonable, but it likely leaves open a lot of recreational or heavy drug users who slip into homelessness before they reach this criteria. (2008)
In a review of this question by Eugenia Didenko and Nicole Pankratz, they highlight that approximately two-thirds of homeless cite drugs or alcohol as a major or primary cause of housing loss. 80% of the homeless report using one or more new drugs since losing housing. Finally, the consensus seems to be that substance abuse problems get worse as the time spent homeless increases (2007)
In Canada’s most recent point-in-time count of homelessness, only 25.1% of homeless reported addiction or substance abuse as the cause of housing loss (n=13432). However, the report admits that this is likely underreported because the survey doesn’t account for previous addictions or substance abuse (and likely due to social desirability bias as well) (2022).
In this Pennsylvania study by O’toole et al., they find that 58% report drug or alcohol use as one of the three reasons they became homeless (n=531). Notably, approximately 70% use the same or less amount of drugs as they had before homelessness. This reduction in drug use is attributed mostly to a lack of funds and coincides with increases in illegal means of making money (2004)
We have two safe conclusions to draw. Firstly, people become harder to treat after entering homelessness either because their substance abuse worsens or at least because they lose stability and enter a new lifestyle. Secondly, the relationship between substance abuse and homelessness is complex and bidirectional—many people become homeless because of their substance abuse, and many people develop substance abuse issues only after becoming homeless.
Overall, this has not updated me significantly in either way—with the absence of a straightforward conclusion, I still believe that prioritizing homelessness prevention over treatment is a more effective method of allocating funding.
IV. Why isn’t more spent on prevention?
In my original essay, I framed the lack of preventative measures as neglectful. Realistically, it is simply the path of least resistance. Prevention is hard and often intangible, whereas treatment is relatively easy and immediately gratifying.
Prevention is hard to do
Why somebody falls into homelessness is overdetermined. Housing costs, mental health, social support, and so on all contribute to homelessness in varying ways. Focusing on one determinant isn’t enough. Further, being disconnected from social and government institutions is a risk factor for homelessness—youth who don’t know where to go, people without education, isolated people—which means that identifying people at risk of homelessness is necessarily difficult.
Consider an anecdote from a coworker of mine at the shelter—on top of his current experience, he has 20 years of experience working as a social worker at CPS. He told me that a big problem with providing services to at-risk people is that the hardest-to-serve people are the least likely to be served—the difficult-to-find, work with, and understand children are the most likely to slip through the cracks, and thus the most likely to be homeless.
Prevention is hard to measure
Isolating for one determinant of homelessness and “preventing” is quite difficult. Conversely, treatment generally “prevents” one problem at a time. If a homeless person is hungry, we provide a meal. We can infer that, without the meal, they would have remained hungry.
This illustrates the first real problem with measurement: how bounded the problem is. Homelessness treatment is essentially prevention for the problems that currently homeless people face (to prevent hunger, we provide meals; to prevent infection, we distribute safe supplies; etc.). The homeless population's problems are relatively bounded—health, shelter, and food.
With “prevention” in the more general sense, we have to deal with many unrelated, hard-to-consider problems. How do we prevent social isolation? Housing unaffordability? Sexual abuse in Nunavik? Eviction? Addiction? Everybody’s path to homelessness is unique.
Treatment is much easier because when someone is homeless, they are constantly interacting with shelter systems and can literally explain what problems need addressing. Secondly, the numbers are much more concrete. Each currently homeless person has names, faces, and case files. We know approximately how much food, shelter, and supplies are required to service that population. Conversely, the at-risk population is an estimate at best. Thus, the amount of resources required is harder to determine, and the impact of those resources is harder to measure.
To illustrate, at the OBM, prevention meant calling around for leads, trying to identify potentially at-risk people, and trying to get them help. Those first steps were incredibly time-intensive and limiting. Beyond those difficulties, determining a budget before finding the service population is nigh impossible.
Political difficulties
A lot of the following information is anecdotal, coming from interviews I conducted with various Montreal homelessness groups and associates while consulting for a large Quebec Homeless shelter.
Firstly, preventing homelessness is often less important than preventing more immediate and severe harm. According to some interviewees, every winter, the political will for general prevention dries up because resources are needed to prevent people from freezing to death on the streets. In general, preventing starvation or epidemics is more pressing than the stream of people falling into homelessness. Ultimately, cities are stuck in a vicious cycle of debt servicing and passing the buck; thus, as the homeless population grows, the necessity to focus on treatment does as well.
Secondly, there are political rivalries in the Montreal homelessness space. The two major players are RAPSIM and Housing-First advocates. RAPSIM is older and more established—they see homelessness as an emergency problem that necessitates emergency treatment. They oppose coordinated access programs and data sharing due to privacy concerns. The Housing-First advocates care more about general prevention and dislike transitional housing. Some specific problems this has caused:
These rivalries have invited “bullying,” politicking, and lobbying that prevent the CIUSSS (responsible for the province’s health and social services) and the broader provincial government from implementing large plans.
The national housing strategy mandates coordinated access—but RAPSIM opposes this. The CIUSSS has to propose a coordinated access strategy and align existing programs but, as of April 2022, was still focused on COVID-19 programs.
Funding for homelessness in QC is “exceedingly private,” and groups compete fiercely for funding—taking a zero-sum approach and lauding their specific approach as the best one.
Ultimately, Montreal is especially bad at cooperating, which has turned a cluster of problems into a clusterfuck of problems.
V. What I learned
To prevent homelessness, we need to craft a giant net, catching everyone who slips through the cracks of society. The fibres of these nets are all different—social isolation, health, mental wellness, jobs, housing affordability, and so on—but they must all weave together to effectively mitigate the flow of people into homelessness. Thus, homelessness prevention isn’t done with one program. It must be done in a thousand ways at once.
I’ve revised my beliefs. I still believe we should prioritize prevention over treatment, in general. However, “just do more prevention, lmao,” is less appealing to me than before. Though, I am increasingly more inclined to support more nebulous prevention efforts over increased affordable housing units as a tool for homelessness prevention.
Lastly, I will eat some of my words. I don’t think Montreal has been neglectful. Lazy, inefficient, and frustrating—yes. But not neglectful. There are many problems to address in Montreal, specifically. I still believe that the lack of “culturally sensitive services” is one of those problems. This is a hard problem to understand, let alone fix. Homelessness is not inevitable—it is preventable, and some may say it is even solvable.
Please let me know your thoughts in the comments below. I challenge you to destroy me in the marketplace of ideas with any new considerations, thoughts, or research.