In our first three episodes on the Cost of Homelessness, we explored how housing the homeless can often cost less than leaving people in the emergency system. But it isn’t always true for every person, program, or place—and saving money isn’t the main goal. Ending homelessness is about improving lives.

In this episode, we speak with Dr. Eric Latimer, Professor of Psychiatry at McGill and lead economist on Canada’s landmark At Home / Chez Soi Housing First study. He helps us look carefully at the evidence: Housing First dramatically improved housing stability and life outcomes, as well as offsetting up to 70% of the program's cost for people with high needs and about 50% for those with moderate needs.

While in this study Housing First didn’t fully "pay for itself", we discuss some fascinating reasons for that, and we explore why we shouldn't always expect cost-neutrality for programs that successfully reduce homelessness.

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Guest: Dr. Eric Latimer is a Professor in the Department of Psychiatry at McGill University and Research Scientist at the Douglas Mental Health University Institute. He was lead investigator for the Montreal site of the At Home / Chez So research and demonstration study on homelessness and mental illness and was its lead economist nationally.

Topics Covered:

• The results of Canada’s At Home / Chez Soi study, the largest Housing First trial ever conducted
• Why Housing First offset 50–70% of program costs, but didn't “pay for itself” in the short term
• Key reasons for variation across "cost of homelessness" studies: connecting people to health care and income supports, including moderate-need participants, and “regression to the mean”
• Comparisons with U.S., French, and Finnish studies and programs
• Why cost savings aren’t the real goal—ending homelessness is about dignity, health, and equity

Studies referenced:

• Effect of Scattered-Site Housing Using Rent Supplements and Intensive Case Management on Housing Stability Among Homeless Adults With Mental Illness: A Randomized Trial (2015)
• Housing First Impact on Costs and Associated Cost Offsets: A Review of the Literature (2015)
• Costs of services for homeless people with mental illness in 5 Canadian cities: a large prospective follow-up study (2017)
• Cost-effectiveness of Housing First Intervention With Intensive Case Management Compared With Treatment as Usual for Homeless Adults With Mental Illness Secondary Analysis of a Randomized Clinical Trial (2019)
• Cost-Effectiveness of Housing First With Assertive Community Treatment: Results From the Canadian At Home/Chez Soi Trial (2020)
• A Tale of Two Countries: A Comparison of Multi-Site Randomised Controlled Trials of Pathways Housing First Conducted in Canada and France (2021)

Production:

• Producers: Tristan Markle, Lina Moskaleva, and CJ Tremblay
• Sound and original music: Matthew Hayter, matthewhaytermusic.com
• This podcast is a project of The Publication Cooperative
• If you have thoughts, feedback, or ideas, email us at policycrimes@thepublication.ca

In this episode, Dr. Cheryl Forchuk — a leading Canadian researcher and mental health nurse — traces how hospitals shifted from rarely discharging patients into homelessness to doing so with alarming frequency.

In the 1980s, a discharge to “no fixed address” was so unusual it set off hospital-wide concern. By the 2000s, it had become routine. Forchuk led landmark studies showing that simple changes at discharge, such as connecting patients to housing advocates and fast-tracking income supports, could prevent homelessness altogether. These interventions not only stabilized lives, but also reduced strain and costs across the healthcare system.

We explore how hospitals can play a huge role in preventing homelessness and why homeless prevention is both cheaper and more effective than relying on emergency responses.

Get extras and support the show: https://thepublicationcoop.substack.com

Guest: Dr. Cheryl Forchuk is Distinguished University Professor at Western University and Assistant Director at the Lawson Health Research Institute. A registered nurse and researcher, she has spent decades leading collaborative studies on the intersections of homelessness, housing, and mental health. Her work has shaped discharge planning practices, Housing First models, and national policy conversations on treating housing as healthcare. This summer she was appointed to the Order of Canada.

Topics Covered:

• How discharges from hospitals became a pathway into homelessness
• Landmark studies on preventing “No Fixed Address” at discharge
• Why homelessness increases healthcare costs and hospital stays
• How health data suggests homeless numbers could be 3x higher than we thought
• Practical models to overcome agency silos and scale homeless prevention nationally

Studies referenced:

• Developing and Testing an Intervention to Prevent Homelessness among Individuals Discharged from Psychiatric Wards to Shelters and ‘No Fixed Address’ (2008)
• Preventing Psychiatric Discharge to Homelessness (2013)
• Hospital discharge planning for Canadians experiencing homelessness (2018)
• Validation study of health administrative data algorithms to identify individuals experiencing homelessness and estimate population prevalence of homelessness in Ontario, Canada (2019)
• Preventing Discharge to No Fixed Address – Version 2: Evaluation of a Best Practice Program to Prevent Discharge from Hospital into Homelessness (2023)
• Collaboration to Address Homelessness: Health, Housing, and Income (H2I) (2023)
• Opioid-related overdose deaths among people experiencing homelessness, 2017 to 2021: A population-based analysis using coroner and health administrative data from Ontario, Canada (2023)
• Community Stakeholders’ Perceptions of the Impact of the Coronavirus Pandemic on Homelessness in Canada (2023)
• Pathways of displacement: A pan-Canadian perspective on the nature and dynamics of rural and remote homelessness (2024)

Production:

• Producers: Tristan Markle, Lina Moskaleva, and CJ Tremblay
• Sound and original music: Matthew Hayter, matthewhaytermusic.com
• This podcast is a project of The Publication Cooperative
• If you have thoughts, feedback, or ideas, email us at policycrimes@thepublication.ca

Governments often ask whether we can afford to house people experiencing homelessness. Housing policy expert Steve Pomeroy flips the question: how much are we already paying to keep people homeless?

In this episode, he revisits his foundational cost of homelessness research showing supportive housing costs about one-third as much as emergency responses like shelters, hospitals, and police. Pomeroy explains why governments struggle to reinvest savings, points to structural drivers of Canada’s housing crisis, and outlines his Recovery for All plan — a costed roadmap to end homelessness for less than what we already spend on failure.

Get extras and support the show: https://thepublicationcoop.substack.com

Guest: Steve Pomeroy is one of Canada’s leading housing policy experts, whose early cost of homelessness studies in Toronto (late 1990s), British Columbia (2001), and a landmark 2005 national study helped establish the field in Canada. Beyond this foundational work, he has published widely on Canadian housing economics, affordability, and policy. He is Principal of Focus Consulting Inc., Senior Research Fellow with the Canadian Housing Evidence Collaborative (CHEC), and Industry Professor at McMaster University.

Topics Covered:

• Supportive housing vs. emergency system costs
• Methodology of Canada’s cost-of-homelessness studies
• Why cost-offsets often don’t immediately translate into budget savings
• Root causes of the homelessness crisis
• What it would cost to end homelessness in Canada

Studies referenced:

• Cost of Homelessness in British Columbia (2001)
• The Cost of Homelessness: Analysis of Alternate Responses in Four Canadian Cities (2005)
• Recovery for All (2020)
• Filling the hole in the bucket: Loss of existing affordable rentals massively undermining new affordable supply (2024)

Production:

• Producers: Tristan Markle, Lina Moskaleva, and CJ Tremblay
• Sound and original music: Matthew Hayter, matthewhaytermusic.com
• This podcast is a project of The Publication Cooperative
• If you have thoughts, feedback, or ideas, you can email us at policycrimes@thepublication.ca

Homelessness is one of the most visible and urgent policy challenges of our time. But what if the way we respond to it — through shelters, emergency rooms, and jails — is more expensive than simply providing stable housing?

In this first season of Policy Crimes, we’re investigating the Cost of Homelessness. And in this pilot episode we talk to Dr. Dennis Culhane, one of the world’s leading homelessness researchers who has laid the foundations of “cost of homelessness” studies.

Get extras and support the show: https://thepublicationcoop.substack.com

Guest: Dr. Dennis Culhane is Professor of Social Policy at the University of Pennsylvania. His groundbreaking research has been cited in thousands of studies and has influenced homelessness policy at every level of government — as well as inspiring Malcolm Gladwell’s article in the New Yorker, Million Dollar Murray, helping to popularize the idea of the “cost of homelessness”.

Topics Covered:

• The staggering public costs of leaving people unhoused
• How supportive housing programs for veterans, families, and the chronically homeless in the US have saved money and improved lives
• Why governments often fail to account for savings across departments, and over time

Studies referenced:

• Public shelter admission rates in Philadelphia and New York City: The implications of turnover for sheltered population counts (1994)
• Applying cluster analysis to test a typology of homelessness by pattern of shelter utilization: results from the analysis of administrative data (1998)
• Public Service Reductions Associated with Placement of Homeless Persons with Severe Mental Illness in Supportive Housing (2002)
• New Perspectives on Community-Level Determinants of Homelessness (2012)

Production:

• Producers: Tristan Markle, Lina Moskaleva, and CJ Tremblay
• Sound and original music: Matthew Hayter, matthewhaytermusic.com
• This podcast is a project of The Publication Cooperative
• If you have thoughts, feedback, or ideas, you can email us at policycrimes@thepublication.ca