A collaborative approach is required to build health care pathways that will end homelessness in Canada. Clinicians can play a role by tailoring their interventions using a comprehensive new clinical guideline on homelessness published in CMAJ (Canadian Medical Association Journal).
The guideline aims to inform clinicians and encourage collaboration with community organizations and policy-makers around priority steps and evidence-based interventions to treat homeless and precariously housed people at risk of homelessness.
"Homelessness has become a health emergency, not just a social issue. And we now know how to end it," says Dr. Kevin Pottie, Bruyère Research Institute and the University of Ottawa, Ottawa, Ontario. "It is critical to bring more clinicians into the conversation about homelessness and vulnerably housed people."
A network of clinicians, academics, governmental and nongovernmental stakeholders, called the Homeless Health Research Network, as well as five people with lived experience of homelessness, created the guideline. A steering committee with representatives from across Canada helped coordinate the process.
"Housing is medicine," says Amanda DiFalco, a fellow at the Institute of Global Homelessness and someone who has experienced homelessness herself. "We need to integrate this guidance into health policy and how we teach the next generation of clinicians."
Clinicians can learn to adapt their clinical approach to meet a patient's needs -- both social and medical.
The guideline recommends the following interventions to help patients who are homeless or vulnerably housed:
- 1. Permanent supportive housing: connect homeless or vulnerably housed people with a local housing coordinator or case manager to provide links to housing options
2. Income assistance: help people with income insecurity to find and access income-support resources
3. Case management: ensure people with mental health and substance use disorders access local mental health programs and psychiatric services
4. Opioid agonist therapy: provide access to opioid agonist therapy in primary care or a referral to an addiction specialist
5. Harm-reduction: identify appropriate management for people with substance use issues, or refer them to local addiction and harm reduction services
The homeless population in Canada has changed considerably over the last 25 years, from mostly middle-aged men to increasing numbers of women, youth, Indigenous people, older adults and even families. The estimated homeless population in 2014 was 235,000, of whom 27.3% were women, 18.7% were youth, 6% were recent immigrants or migrants, and a growing number were veterans or seniors.
"The successful implementation of the guideline starts with permanent supportive housing, commonly known as Housing First," says coauthor Tim Aubry, University of Ottawa. "Once successfully housed, individuals and families are in a much better position to receive the health care that they need."
Inner City Health Associates, the Canadian Medical Association and the Public Health Agency of Canada funded the guideline. The Homeless Health Research Network will update the guideline every five years.
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