Three days with Dr. Sam Tsemberis, innovator of the Housing First model for ending homelessness 

Dec 13, 2023

CMHA Ottawa is one of the biggest providers of Housing First in Canada – we got to spend some time with its visionary inventor

At CMHA Ottawa, we are proud to call ourselves a Housing First agency. The Housing First approach is woven into everything we do. 

In the Housing First model, people experiencing chronic homelessness in addition to mental health and addictions issues are provided with independent and permanent housing of their choosing—without conditions—prior to additional supports and services. At CMHA Ottawa, we use a Housing First approach to serve eligible individuals with severe and persistent mental illness and/or substance use disorder who are experiencing chronic homelessness or are vulnerably housed.  

Housing is the first step to recovery. In 2022-2023, 81% of our clients were successfully housed. That year, 251 individuals were helped by our Housing Outreach Team in finding and/or maintaining a home of their own. Additionally, we own and operate an award-winning 41-unit scattered site condominium program that is widely considered by experts to be an exemplary model of the Housing First philosophy in action. Our Housing Team also administers more than 600 rent supplements.  

Monday: Special Convocation in honour of Sam Tsemberis at uOttawa + interview and panel discussion  

Dr. Sam Tsemberis. Photo courtesy of uOttawa.

The Pathways model of Housing First is the most effective and extensively researched approach to ending chronic homelessness for most individuals. On Monday, Dec. 4, 2023, its inventor, the CEO of the Pathways Housing First Institute, Dr. Sam Tsemberis, was conferred with an honourary doctorate from the University of Ottawa, recognizing how his trailblazing work has impacted people around the world, especially among the most marginalized people in society.  

As one of the largest Housing First providers in Canada, CMHA Ottawa was on hand for the convocation ceremony and—along with our friends from the uOttawa Centre for Research on Educational and Community Services (CRECS)—co-presented a live interview and special panel discussion that followed. The event was the final chapter in our organization’s 70^th anniversary celebrations. 

The live interview with Dr. Tsemberis was conducted by our CEO at CMHA Ottawa and one of Dr. Tsemberis’ biggest fans, Dr. Susan Farrell. Much of the conversation focused on the importance of conveying to the general public and decision-makers just how effective Housing First is; to share this important message beyond social service providers and researchers.  

One of Dr. Farrell’s questions for Dr. Tsemberis—which she says she’s pondered for 15 years in preparation for the conversation—was what Dr. Tsemberis would tell world leaders if he had 90 seconds with them in an elevator. 

It all comes down to political will. Dr. Tsemberis’ message to world leaders:

“I want to tell you that this whole issue that you’re fighting about—chronic homelessness—doesn’t have to be this way. There is a very good, very effective, cost-effective method that meets conservative and progressive ideologies, and you can solve this thing. If you have three years left of your term, you can do it and take credit for it by the time the next election comes.” 

Sam Tsemberis

From left: Tim Aubry, Susan Farrell, Catharine Vandelinde, Sam Tsemberis, Leif Harris, John Sylvestre. Photo courtesy of uOttawa.

Following the interview, there was a panel discussion about Housing First from the lens of a tenant, a provider, and a researcher. The discussion was led by Dr. John Sylvestre, Professor at the uOttawa School of Social Sciences, and featured Drs. Tsemberis and Farrell along with Leif Harris, a student at Carleton University and a CMHA Ottawa Housing First tenant; Catharine Vandelinde, Executive Director at Options Bytown; and our friend Dr. Tim Aubry, Professor at the uOttawa School of Psychology, Co-Chair of the Canadian Housing First Network, and a leading homelessness researcher with CRECS.   

Tuesday: Launch of Social Prescribing initiative in Housing First programs at CMHA Ottawa and Options Bytown  

Sam Tsemberis and Christina Mutschler at CMHA Ottawa.

The following day, a group of select frontline staff from our agency and Options Bytown were joined by Drs. Tim Aubry, Christina Mutschler, and our guest of honour, Dr. Tsemberis, for the launch of a new social prescribing initiative and study by CRECS. 

The purpose of the initiative is to support clients of CMHA Ottawa and Options Bytown’s respective Housing First programs in building community by providing them with opportunities to engage in activities offered locally in Ottawa (e.g., going to museums, cooking classes, volunteering). In a day-long session, the group rolled up their sleeves and set to work on launching the initiative, which is now underway.  

About the initiative: Social Prescribing in Housing First Programs 

By Christina Mutschler, PhD. 

Homelessness affects approximately 235,000 Canadians every year, and people who are homeless or who have histories of homelessness are more likely than the general population to experience chronic mental health challenges. People with serious mental illness and histories of homelessness face ongoing challenges with community integration, recovery, and social exclusion even once they are stably housed. 

In the early 1990s, Housing First was developed by Dr. Sam Tsemberis to support people with serious mental illness who are homeless to move directly from the streets into housing of their choosing, without any pre-conditions. Housing First research has shown that participants leave homelessness sooner than people in usual homelessness services and they also achieve more stable housing over time. While Housing First has addressed people’s immediate and long-term housing needs, the evidence does not show that it is superior to other services at improving long-term health and social outcomes, such as improved community integration, recovery, and community functioning. 

The proposed project pilot tests the integration of “social prescribing” into Housing First programs, to enhance Housing First’s effectiveness at addressing loneliness, community integration, and ultimately enhancing citizenship. Social prescribing connects people with community resources to address social needs. It is practiced widely across the UK, is identified as a best practice in the UK health system, and has gained growing interest internationally. To date, it has not yet been implemented in Housing First programs.  

The pilot is being implemented with case managers at CMHA Ottawa and Options Bytown who provide the Housing First model to clients. The intervention is developed by Drs. Tim Aubry and Christina Mutschler, in collaboration with Dr. Sam Tsemberis (the creator of Housing First), two PhD students at the University of Ottawa, Minda Wood and Elyse McCall-Thomas, and master’s student Allie Hayes. Further, stakeholders from both agencies, including managers, case managers and Housing First clients, have been actively involved through all phases of the intervention development.  

This research project contributes to improving the lives of some of the most vulnerable and under-served people in Canada. This project provides real supports and services to people who are highly marginalized and socially excluded, focusing on enhancing their rights to citizen participation, while also addressing their rights to long-term stable housing.   

This strengths-based and recovery-focused project is now underway. Stay tuned to the CMHA Ottawa website for more information as the study progresses. 

Wednesday: Presentation to Infrastructure Canada 

Susan Farrell’s title slide from her presentation to Infrastructure Canada.

The following day, Drs. Aubry, Farrell and Tsemberis presented to Infrastructure Canada, the department of the Government of Canada responsible for federal public infrastructure policy. Dr. Tsemberis provided an overview of Housing First and its proven effectiveness, Dr. Aubry spoke about successful Housing First programs across the country (of which, of course, CMHA Ottawa is one of the biggest), and Dr. Farrell provided a look at Housing First in action through our agency’s programs and services, highlighting the CMHA Ottawa condo program. 

And so concludes our three days with an individual whose work has deeply affected how we operate. The team at CMHA Ottawa would like to offer our sincere thanks to Dr. Tsemberis for his time, leadership, advocacy and ongoing partnership. We would also like to congratulate him on his honourary doctorate from the University of Ottawa – it’s well deserved. We thank you for your ongoing collaboration and look forward to your next visit, dear friend and wise mentor!