Homelessness has reached unprecedented levels across urban, semi-urban, and rural communities in British Columbia. From the Greater Vancouver Region to Northern communities, from the Gulf Islands to the cities and towns of the Interior, every region of the Province is experiencing the strain of inadequate housing and concomitant social, health, and economic issues. The focus of this report is the disproportionately high number of absolutely homeless and inadequately housed adults who have severe addictions and/or mental illness (SAMI). A great deal of public concern has been expressed about the overlap between mental illness, substance use, and homelessness. Approximately how many adults with SAMI need adequate housing and support in BC? Moreover, what are the evidence-based solutions to homelessness among this population, and what are the costs of implementing these solutions?

According to housing and support providers across BC, affordable housing is vanishing, evictions are on the rise, and waiting lists for social and supported housing continue to grow. As a consequence, homelessness and SAMI are placing greater pressure on the social service, health care, and criminal justice systems. In contrast to the cost of implementing solutions, what is the cost of the status quo?

In August 2006, the BC Ministry of Health – Mental Health and Addictions Branch asked the Centre for Applied Research in Mental Health and Addiction (CARMHA) at Simon Fraser University to provide up-to-date information about the scope of the problem, recommended solutions, and associated costs. CARMHA drew upon diverse sources of information including published literature, academic experts, decision-makers, and key informants throughout BC to generate answers to some of the most pressing questions regarding the needs of this population. We hope that this report will provide the basis for constructive action to deal with the overlapping problems of homelessness and severe addictions and/or mental illness.

The scope of this report includes the homeless – people who live on the streets, cycle through shelters and rooming houses, as well as those at imminent risk of becoming homeless – people who live in substandard or illegal accommodation and lack support for their mental illness and/or addiction. Our definition of SAMI includes all of the major Axis I disorders as defined by the Diagnostic and Statistical Manual (DSM-IV-TR), focussing on those individuals whose functional capacity is seriously compromised. This definition includes severe forms of substance use, eating, and anxiety disorders as well as mood and psychotic disorders. Finally, this report focuses on adults between the ages of 19 and 80 years, recognizing that homeless youth (with or without SAMI) have several unique needs which are an appropriate focus of concern in their own right.