MEDICINE HAT, Alta.—On an early fall day, in the city that made international headlines for eliminating homelessness in 2015, Peter Kerr woke up in the Salvation Army shelter.

Kerr, 61, figures he’s been on the streets for five years, off and on, in Medicine Hat. The small city tucked in the southeast corner of Alberta has seen its share of the spotlight for its successful housing program, but more than four years later, there are still people going through periods of homelessness — and there are still people working to catch them when they fall through the cracks.

As Kerr nurses a coffee at the Champion’s Centre — a community hub where volunteers offer free breakfast and a place to shower — he says he has trouble sleeping at the city’s main emergency shelter. But he hasn’t been able to string together enough work to afford a place of his own for a while now. He moved to Canada from his home of Belfast 20 years ago, mostly making ends meet with construction work and odd handyman jobs. The traditional sailor tattoos on his arms, a remnant of his life in Ireland, are pushing 50 years old, he says, pointing to a swallow with a thick outline on his forearm.

On this particular morning, he’s thinking about dropping in to talk to a worker at the Medicine Hat Community Housing Society. He’s gotten housing before, but he’s also been evicted more than once, which he attributes to a past struggle with alcohol addiction and an ongoing lack of stable income.

“If you don’t get work for one or two months, you’re just back on the street again,” he says.

But he says he’s getting fed up with the feeling of just killing time most days. Multiple moves have forced him to give away most of his possessions in recent years, including a trove of collectibles — “Everything: windup toys, scrimshaws, royal memorabilia,” he says — and he’s thinking more about finding a way to get a new permanent place of his own.

“It’s just getting work and getting financing. I don’t care if it’s a cheap place. I don’t care if it’s a small box.”

Medicine Hat is known as “the gas city,” a place where about 60,000 people live on top of abundant natural gas fields. It’s unique in Canada as the only municipality in the country that owns its own gas and electric utility. But the Housing First program has put it on the map in a new way, with an approach that’s become a key part of the movement to end homelessness across Canada and beyond: People get housing as a first step — without compliance-based strings attached.

Under Alberta’s 10-Year Plan to End Homelessness, introduced under former Conservative premier Ed Stelmach in 2008, the province’s seven largest cities all began working with Housing First principles. But no city has proven the program’s potential as much as Medicine Hat. Since the city embarked on its own 10-year plan in 2009, more than 1,200 people who were homeless or at risk of becoming homeless have gotten a place to live, including 322 children. At the same time, shelter use has been cut nearly in half.

But the plan doesn’t mean that the shelters are now empty, or that there’s no one ever left sleeping in their car or couch surfing. The Canadian Alliance to End Homelessness (CAEH) tracks Canadian cities’ progress in getting to “functional zero,” which means there’s a system to prevent homelessness and ensure anyone who ends up on the streets isn’t there long. For the CAEH, functional zero means a city has three or fewer people who have been homeless for six months or more. Medicine Hat has reached and maintained that target in the past, but the numbers fluctuate with changes in the economy or new people moving in. In November 2019, the city reported 10 chronically homeless people, up from just two in February and March of this year.

At the Medicine Hat Community Housing Society (MHCHS), homeless and housing development manager Jaime Rogers says ending homelessness at a community level is more complicated than some of the headlines made it seem four years ago.

In 2015, ending chronic homelessness meant the MHCHS could connect people to housing resources within 10 days of learning they don’t have a place to live. It was a five-year goal they set when they started their Housing First plan, and they achieved it — but it’s a measure of how well their system works, not whether there are literally zero people who are homeless at any given time.

Still, it underscores the potential in getting people a place of their own instead of leaving them with no options but the streets for years on end. Rogers says now, they aim to connect people within just three days. If the process goes smoothly, someone can get the keys to a new place within 24 hours.

“I think Medicine Hat was a proof of concept community,” Rogers says. “We showed that it could be done.”

The first step is an intake through MHCHS’s centralized assessment process, a crucial piece of how workers move people through the system and keep track of their needs. New permanent housing is the first priority, and once there’s a roof over a person’s head, a case worker helps them get resources to address issues that might have contributed to them being homeless in the first place. That could mean applying for income support like Assured Income for the Severely Handicapped (AISH), or getting treatment for an addiction.

But importantly, that’s always based on choice. Housing workers are required to show people in the program at least three new units — rushing them into the first available place, Rogers says, can actually make it more likely that it won’t work out in the long term. And they’re not at risk of losing their housing or access to resources if they don’t meet certain milestones.

“Sometimes people’s goals are going back to school, getting a job, getting their kids back. Sometimes it’s just ‘I just need to wake up tomorrow.’ That’s OK,” Rogers says.

At the Champion’s Centre, Kerr worried about his income, even though the MHCHS doesn’t make money or employment a barrier for getting housing. He’s hesitant about going back through the system anyway, saying he wants to find work and stability on his own.

Rogers and the people she works with know there are people who might not be ready to reach out for help, or who might be uncomfortable dealing with their system, as barrier-free and non-judgmental as they try to make it. Those clients might go through the assessment once, but cycle in and out of the program, in and out of housing. There’s always an open door for them to come back and try again, even if they’ve successfully gotten back on their feet before and left the program, which staff refer to as “graduating.”

“It’s not a rite of passage to retell your story and convince us you need help. If you say you need help, you need help,” Rogers explains.

Her organization also does plenty of groundwork to make sure people know about the help they offer, approaching people in local hangouts like the Champion’s Centre, or sometimes even doing intakes on the street.

“If I’m walking around in the evening I’ll be like, ‘Hey, what are you doing out here? Why are you sleeping on the ground?’

“It is not necessary in Medicine Hat whatsoever for people to be on the street.”

Medicine Hat Mayor Ted Clugston has become a “reluctant champion” of the city’s housing program. He says he’s fielded hundreds of interview requests about housing over the last four years, an odd role for a conservative politician who says he’d frankly rather talk about property taxes or how the downturn in Alberta has affected his city’s energy-dependent economy.

But he’s told his own story time and time again, about how he used to argue against affordable housing, and he wasn’t always on board with the concept of Housing First.

“I had an attitude that I had to work hard ... so why were we giving stuff away?”

He also worried that if the program was successful, as word got out, “everyone in the country would catch a bus or hitchhike to Medicine Hat because you could get a home. Obviously, a city of 63,000 people cannot solve the country’s problem.”

But now, even in Medicine Hat, which Clugston describes as “arguably the most conservative city in Alberta,” getting people off the streets and straight into homes is considered a win for fiscal conservatives, too.

“It’s costing you in emergency room visits or interactions with first responders, police, paramedics ... It costs $80,000 or maybe $100,000 to keep somebody on the street,” Clugston says. “Versus in Medicine Hat you can house them for maybe $20,000 or $30,000. There’s a cost savings to the taxpayer.”

The fears he used to have about the program haven’t been realized, and Clugston now says other cities should stop making excuses about why Housing First isn’t possible.

“All this Band-Aid stuff, that never works. You’ve got to solve the problem, and that’s the Housing First model.”

Medicine Hat has the advantage of being a smaller community with housing stock to spare. And the social service leaders not only personally know each other, but everyone on the streets, too, which makes it much easier to deal with service gaps. But Clugston says that shouldn’t stop bigger urban centres from using MHCHS’s single point of entry system as a model, and scaling up from there.

Rogers says Medicine Hat’s approach is doable in any community.

“It permeates in community: ‘Of course we can do it.’ It’s not a ‘rah-rah’ thing,” she says. “It’s like, people need help. Help them.”

As Medicine Hat prepares to mark a decade of Housing First in 2020, Rogers says they’ve learned that getting people into a new home is actually the easy part — helping them stay there can be a different story.

That’s why the city’s first permanent supportive housing building opened in 2017, just a few blocks from Rogers’ office in downtown Medicine Hat. The Canadian Mental Health Association (CMHA) runs the building, with support staff on hand 24 hours a day for 15 people who live there, in their own apartments. The CMHA now owns the building next door, too, and they’re preparing to move in 15 more people.

Permanent supportive housing program manager Jennifer McBride says for some residents, living in the building might be the first time they’ve had a secure place with privacy and safety, but where they can still reach out for human connection. Some have a history of getting repeatedly kicked out of places they’ve lived because of issues related to mental health struggles, or even just problems communicating with their landlord.

“We’ve known for a really long time that there were individuals that were in need,” McBride says. The CMHA ran a smaller-scale Housing First program before transitioning to their supportive housing service, and McBride saw people stay in that program for years, “just unable to exit because the need for support is so high.”

Two years on, art by permanent supportive housing residents covers the walls in the building’s hallways and common room.

Steve Wedell has done some of the biggest paintings, with bright, neon colours splashed across canvases featuring everything from ships and waterfalls to comic book-style fight scenes. For him, it’s mostly just a creative outlet, but some of the residents’ artwork is an emotional reflection of their past, including some paintings that tell stories about the trauma of the residential school system.

Not everyone in the building has a past experience of homelessness. They might be referred through different health or housing agencies, but they all go through the central MHCHS intake, and there’s a community conversation about what they need and whether they might be a fit for the building.

Wedell landed there after his previous apartment flooded and he got kicked out. He was hospitalized for a while afterwards for mental health treatment, and he says he could have easily ended up on the streets if he hadn’t gotten a spot in permanent supportive housing.

“People shouldn’t end up homeless to begin with,” he says.

The building’s common room is equipped with a piano and guitars for the residents, but they can also come down just to make themselves some food and spend time on the couch, or get help from the support workers if they need it.

Derrick Risling is one of the most familiar faces for the staff. He arrives in the common room with a wide smile and hugs for the support workers as they tease him about how he seems to be wearing a new outfit every time he walks through the door.

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Today, he’s wearing all black — sweatpants, a hoodie with a deep V-neck and the arms cut off, and a backwards baseball cap. He’s paired that with a cross on a long, silver chain and a sparkly earring in his right ear.

He can’t quite describe his style, he says. It changes every day, depending how he’s feeling.

“Like, who wears a giant red ruby earring in their ear? I do,” he says, laughing.

Risling, 24, has been at the permanent supportive housing building since March, moving in after he spent time in jail on charges related to a robbery. Since then, he says, everything about his life has changed.

“I had been in a pretty low situation before, a couple years back,” he says.

He’s focused now on moving forward, something he says is possible because of the support and acceptance from the building’s community.

“I wanted to do better in life — heal the brokenness and get over past trauma, life events that can shake and alter a person,” he explains.

“I feel like if I wasn’t in this place, I’d be way back into the same scene, same scenarios. This place has kept me afloat a couple times — more than a couple times.”

Some of Risling’s art hangs on the walls, too, but his drawings are also on the backs of his hands — he tattooed the rose on his right and the cross and angel wings on his left himself. He was raised Christian, he says, and it’s still an important part of his life. “Faith” is written in a flowing script on the inside of his wrist.

He’s thinking about going back to school to study art, and eventually make a career out of tattooing.

Most of the people who work in the building have a background in social work, and they’re on hand to help the residents with everything from basic living tasks to arranging counselling or health treatment they might need. But mostly, they create a sense of belonging and community for the people living there.

“It’s crazy how you can go from being ready to strangle somebody to just wanting a hug,” Risling says. “When you have those positive supports in your life that you know you can rely on, anything is possible.”

Lately, staff have been encouraging Risling to try new things, like publicly sharing his musical talents. He played a show at a local cafe recently, the first time he’s ever performed his original music live in front of strangers. On the day reporters are visiting his home, his middle finger on his left hand is bandaged up from a recent accident involving a dirt bike motor — but he picks up a guitar and plays it anyway.

The people he lives with now see him through his lows and highs, he says. And his home is a place where he doesn’t feel judged because of his past.

“When you’re talking about how you used to live a life with addictions or used to be looked down upon in society, people will tend to hold you to that standard and not look at the giant changes and leaps and bounds that you’ve made,” he says.

“I feel like my feet are under me.”

This year, Risling also spoke publicly at a gathering to mark Overdose Awareness Day. It’s become an emotional day for him.

He was thinking about the friends he’s lost, the people who have died after an overdose.

“We had just lost someone a day prior. That morning we found out,” he says. “Nobody wishes for that. Nobody says, ‘I’m going to do drugs to die.’ ... Nowadays, you don’t know what you’re getting.”

Last year, a Canadian Institute for Health Information report found Alberta’s smaller cities, including Medicine Hat, had more than double the rates of hospitalizations from opioid poisoning compared to Edmonton and Calgary. In 2018, 12 people died from fentanyl-related poisoning in Medicine Hat, a death rate of 17.5 per 100,000 people. According to Alberta Health’s most recent statistics, as of the end of June this year, four people in Medicine Hat have died from fentanyl-related poisoning.

And that’s changed the conversation about housing, too.

In the past, if people were coming out of a treatment centre or correctional facility and facing homelessness, the MHCHS would make a transition plan that might involve getting them a temporary hotel room. That way, workers would know where to find them, and they could start the intake process as quickly as possible for new housing.

But there were cases where people overdosed when they were alone. “And what that looks like — we had some deaths,” Rogers says.

Now, people who are waiting to go through the intake process have to wait in a shelter if they don’t have another option. At least that way, Rogers says, there’s a supervised place for them to stay until there’s a more permanent option. “It was a life and death situation,” she adds.

The MHCHS is now also planning to open a new nine-bed sober-living facility for people who have just finished an addictions treatment program or are waiting for a treatment bed after detox. The change came from consultations with people who have experienced homelessness, who said the lack of an in-between living space sometimes lands people back in unhealthy environments without enough support to stop using.

But many advocates are still calling for a supervised consumption site — where people can use drugs with health care staff on site to offer resources and reverse overdoses, if necessary. There were plans to open one in Medicine Hat, but after the United Conservative government was elected in the spring, they cancelled funding for the pending sites across the province while a panel conducted a “socioeconomic review” of their impact. The panel is expected to finish their report by the end of the year.

At the permanent supportive housing building, Cory Ziefflie is one of the residents who doesn’t spend much time in the common room.

He calls himself an introvert who doesn’t like people, but he appreciates the connection he gets from the building’s workers, and they’ve helped him be more integrated in the community. They never seem to leave him alone, he jokes when a support worker knocks on his door.

He lived in different Canadian Mental Health Association housing before, in his hometown of Lethbridge. But he found he wasn’t coping well without the kind of supports he has now. He keeps his living space neat, with a display of cards and old family photos on his fireplace mantle.

“This is what I’ve been trying to do all my life — get to this,” he says.

“I wish that everybody could find what I see … that they can grow from their own expectations.”

Rogers says that’s the whole idea behind the Housing First program.

“I think if our system is the exact same next year, we failed,” she says.

Her agency is still hitting their own targets for ending homelessness in their community, but there’s still more work to do, and better ways to reach people who are struggling. The Canadian Alliance to End Homelessness says the city is in the “final kilometre” of achieving functional zero.

These days, Rogers is most focused on what the next move is to meaningfully help more people bouncing in and out of shelters, spending their days in the Champion’s Centre, without a stable home to anchor them.

“I always say my job is not to convince people. ... My job is to create a system of care that is evidence-based, people-focused, harm reduction based,” she says.

“This is their community. It’s our responsibility to make sure they belong here.”

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