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Given the opportunity, homeless youth with serious mental illness can stay off the streets, study indicates

Toronto, September 28, 2016

By Emily Holton

Dr. Nicole Kozloff
Dr. Nicole Kozloff
(Photo from University of Toronto)

The innovative Housing First approach to ending homelessness is just as effective for youth as it is for their older counterparts, a new national study suggests.

The Housing First concept is simple: move homeless people with serious mental illness quickly into safe, decent housing without preconditions such as sobriety. From there, they can begin to work on the issues that contributed to their homelessness.

Research shows that this approach works; homeless adults with mental illness are better able to move forward with their lives when they have a stable place to live. A study published online today in the journal Pediatrics provides the first evidence that this approach works for homeless youth as well.

Researchers from the Centre for Urban Health Solutions at St. Michael’s Hospital followed 156 homeless youth (aged 18-24) with serious mental illness in five cities across Canada for two years. Eighty-seven participants received independent, permanent housing for which they paid up to 30 per cent of their income toward rent (Housing First). These participants had access to intensive psychosocial supports and had to have weekly contact with a case manager, who could help with anything from job hunting to navigating the health care system.

The control group of 69 participants received the usual services available in their cities, such as shelter beds.

By the end of the study period, the Housing First group had spent 65 per cent of the two years in stable housing, compared with 31 per cent for the control group. This study shows that many homeless youth with mental illness have the independent living skills to utilize Housing First successfully, said Dr. Nicole Kozloff, a child and adolescent psychiatrist, a research fellow at St. Michael’s and the lead author of the paper.

These results are encouraging because stable housing is an important building block for a healthier life, Dr. Kozloff said.

“All the strategies we know can help with mental illness are very difficult to implement without safe, stable housing,” said Dr. Kozloff. “Making sure you have peer or family support, attending therapy, keeping track of medication, getting bloodwork, eating properly and getting enough sleep – these things become extremely challenging when you’re living on the street.”

While Housing First has been widely researched and implemented for homeless adults, it had never been tested in youth.

“I focused the study on homeless youth because there’s real potential for this group that the right, early intervention could prevent a lifetime of chronic health and social difficulties,” said Dr. Kozloff. “The risk for youth on the street is so high: they have a significantly decreased life expectancy compared to housed youth.”

All study participants lived with serious mental health problems: around one-third had a psychotic disorder, one-third had post-traumatic stress disorder, half were experiencing major depression, two-thirds had problems with drugs and half had problems with alcohol. Forty per cent were deemed at moderate or high risk of suicide.

The average age of the study participants was 22.

This study was part of the At Home/Chez Soi research project, the biggest study ever to evaluate the Housing First approach.

This study received funding from Health Canada through the Mental Health Commission of Canada.


This paper is an example of how St. Michael's Hospital is making Ontario Healthier, Wealthier, Smarter.

About St. Michael's Hospital

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael's Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.

Media contacts

For more information or to arrange an interview with Dr. Kozloff, please contact:

Leslie Shepherd
Manager, Media Strategy, St. Michael's Hospital
416-864-6094
shepherdl@smh.ca