Grant: Travel Awards - Institute Community Support

Objective: Housing First (HF) is being established as an evidence-based practice for housing and supporting homeless people with a mental illness. The objective of the present study is to determine if HF increases the odds of employment in this population and if it affects income, including from informal and illegal sources. Methods: 2148 homeless people with mental illness were recruited from five Canadian cities. Participants were classified as high needs or moderate needs and then randomized to either HF or treatment as usual (TAU). Interviews were conducted every three months and included questions about employment activities and earnings. Regression models were estimated via generalized estimating equations. Results: The median follow-up time was 745 days. For moderate needs participants receiving HF odds of obtaining competitive employment increased with time. However, despite this increase their odds of obtaining employment were lower than the odds observed in the TAU group. For high needs participants, the odds of obtaining employment remained lower than those of the TAU group. Those employed at baseline, men, and younger participants had greater odds of being in employment. HF appears to increase earnings from government support for moderate needs participants, but not other types of income. Conclusion: This is the first large-scale study to use a randomized controlled design to study the effect of HF on employment outcomes of formerly homeless people with mental illness. Further research is needed to determine why HF led to lower odds of obtaining employment.