"We need to genuinely listen to what people tell us they need": Identifying how to support individuals living with mental illness and/or substance use difficulties to thrive following homelessness in London, Ontario

While unhoused, persons who have experienced homelessness are frequently consumed with securing the necessary conditions to meet their basic needs including finding a place to stay for the night, finding food, and keeping safe. It is frequently assumed that when individuals secure a tenancy following homelessness, that their life naturally improves for the better in most or all areas of their lives. Unfortunately, recent research suggests that many individuals who secure housing after homelessness continue to live in a state of survival. While the importance of supporting individuals to secure and sustain housing cannot be understated, other aspects of a person’s life including being integrated in their community, having enough money to pay for basic needs, attaining mental well-being, and having opportunities to engage in meaningful activities are similarly important. This report describes a participatory project aimed at identifying the strengths and challenges of the system of support currently offered to individuals as they leave homelessness in London, Ontario. We collected this information to inform recommendations for refining existing supports and developing new supports that will enable individuals to move beyond surviving after leaving homelessness and thrive in their community after. Consistent with a participatory approach, researchers involved in this project worked in close collaboration with a community advisory board (CAB) that informed the design and delivery of all project activities. This CAB consisted of individuals with lived experience, service providers and leaders of organizations that serve individuals who experience homelessness. We executed this project in two Phases. In Phase I, we interviewed 56 stakeholders between July – December 2020 from three groups: individuals with lived experiences of homelessness living with mental illness and/or substance use difficulties; service providers working in organizations that support individuals as they are leaving homelessness; and leaders in these organizations. In all of these interviews, we asked participants to describe the strengths and challenges of the current system of support in London, and their perspectives on what individuals living with mental illness and/or substance use difficulties need to “thrive” following homelessness. Some individuals with lived experience were asked to take photographs of their daily lives to illustrate their experiences and perspectives. We analyzed these data, and identified five themes that describe stakeholders’ views on the current strengths and challenges of existing services, and what individuals need to thrive following homelessness: 1) Stuck in a system that prevents thriving; 2) Finding home is an ongoing journey; 3) Nurturing the conditions to develop and maintain supportive community; 4) “There isn’t a magic sense of belonging that comes with their house”; and 5) Responsive options for substance use support should be available and aligned to individual needs. In Phase II, we engaged the CAB in collaborative conversations to identify four policy and five practice recommendations from our Phase I findings which are presented in this report. Shifting systems to support individuals to thrive following homelessness has the potential to drastically improve a person’s life circumstances and may be an important strategy for preventing ongoing homelessness. This report is meant to stimulate discussions in London, Ontario and other municipalities about how we can help individuals to secure more than just housing alone following homelessness. The recommendations that we have developed and described in this report will form the basis for the next stage in our process, which will involve collaborating with a broad range of stakeholders in the London community to initiate the process of co-designing solutions. By offering this report, we hope to share the perspectives of stakeholders, engage the broad community in the co-design process, and provide information that will inform the development and implementation of services for individuals who experience homelessness in London. Further, we hope that the process described in this report may be used as a model for other communities who wish to identify opportunities for system improvement in the interest of promoting the health, well-being and living conditions of persons who are trying to create a home after living in housing precarity.

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