Housing First in Saskatchewan: What the Evidence Shows
Housing First, the evidence-based approach to ending homelessness by providing permanent housing before requiring sobriety or participation in treatment, has been tested across Canadian cities for nearly two decades. In Saskatchewan, where homelessness and housing instability intersect with high rates of addiction and mental health challenges, the model has both strong support and notable implementation gaps.
The Core Housing First Principle
The central premise of Housing First is simple: stable housing is not a reward to be earned through treatment compliance, but a precondition for treatment to work at all. Decades of research have shown that people struggling with addiction, mental illness, or both are far more likely to engage meaningfully with health and social services when they have a stable place to sleep.
Before Housing First became the dominant model, most support systems operated on a "treatment first" or "continuum of care" model — people were expected to demonstrate readiness, sobriety, or participation in programming before being offered stable housing. The results were predictably poor. People who could not meet those thresholds cycled repeatedly through emergency shelters, hospital emergency rooms, and police cells.
Housing First inverts the sequence: housing first, then wrap-around supports. The evidence from multiple countries and Canadian provinces suggests this produces dramatically better outcomes, both for individuals and for the systems that serve them.
Evidence from At Home/Chez Soi
Canada's most comprehensive Housing First trial, At Home/Chez Soi, ran across five cities from 2009 to 2013. The Mental Health Commission of Canada oversaw the project, which enrolled more than 2,000 participants experiencing homelessness and mental illness.
The results were substantial. Participants in the Housing First stream spent significantly more time stably housed than those in the treatment-as-usual stream. They showed better outcomes on measures of community functioning, quality of life, and mental health, and they used fewer high-cost emergency services. The cost analysis demonstrated that Housing First participants generated lower overall system costs, primarily by reducing emergency room visits and police interactions.
The trial also found that Housing First worked effectively across different types of participants — those with severe mental illness, those with co-occurring substance use disorders, and those from Indigenous communities — though the supports required varied. This underscores the importance of wrap-around services tailored to individual need rather than a single program design.
Saskatchewan's Housing Challenges
Saskatchewan presents some particular challenges for Housing First implementation. The province's rental vacancy rates in cities like Saskatoon have fluctuated considerably, and affordability pressures have made it harder to scatter-site participants into market housing — the preferred model in Housing First research. When affordable units are scarce, programs face the choice of concentrating participants in designated buildings, which reduces some of the model's effectiveness, or competing unsuccessfully in a tight rental market.
There are also capacity constraints in the community mental health and addiction services that Housing First participants need after they are housed. The model does not work as a housing-only program — the wrap-around supports are essential. In communities where wait times for mental health services are long or addiction treatment beds are few, housed participants can struggle to access the care they need.
What Effective Programs Require
The research is clear about what makes Housing First work: sufficient housing supply at accessible rent levels, adequate and responsive wrap-around support services, and coordination between housing providers, health services, and community organizations. None of these conditions are fully within the control of any single program or agency.
This is why Housing First works best when it is embedded in a broader coordinated system rather than delivered as a standalone program. Coalitions like the SCAA, through their Housing Working Group, can help map what currently exists, identify gaps, and coordinate the kinds of cross-sector investment that no one agency could sustain on its own.