Position Paper – April 23 2025
BC RURAL HEALTH NETWORK IMPLEMENTATION COMMITTEE
Housing for Rural Vulnerable Populations
Context and Background
Since 2016, British Columbia has been under a state of a public health emergency due to the opioid crisis. Declaration of the crisis was prompted by the significant increase in opioid-related overdose deaths from drug poisoning and rates have remained perilously high, with most recent reports citing 6 opioid-related deaths a day across British Columbia [ref]. Alongside the drug overdose crisis, the persistent problem of unstable housing has been exacerbated due to a confluence of influences including increasing housing price and lack of availability. From a broader perspective, it also reflects reverberations of the financialization of housing (housing as a commodity as opposed to a human right), the lack of investment in prevention and our colonial legacy. This has an impact across the population including those who are un- or underemployed, underpaid, and those with disabilities, leading to the most pronounced effects of inadequate housing being experienced by vulnerable populations who do not have the social or financial capital to navigate this quickly changing environment. Among these groups are those who struggle with drug addiction and those who live with mental illness
Although both groups may struggle with difficulties maintaining stable employment, leading to a lack of resources to rent, and increased eviction and foreclosures, the root cause and resources needed for both groups are discreet and although there is overlap between the two, homogenizing these groups leads to inadequate resources for both and increased system costs. Meeting the housing needs of vulnerable populations requires a nuanced understanding of the tiers of support and wrap around services to meet population level needs.
An immediate consequence of not disaggregating the needs of both groups is over-burdening the housing-support system and missing lack of specialized resources in shelters to adequately support those with addictions and, differentially those with mental health needs. Within the private housing market, this has significant consequences for both groups but additionally, within government supported housing, lack of recognition of the differential needs can lead to inadequate supports for both. Those with addictions challenges need focused, staged housing the reflects each step in the addiction recovery process from immediate post-treatment to long-term recovery. Being surrounded by recovery supports is essential, while being exposed to casual substance use may be detrimental. Likewise, long-term recovery needs include relational care to support commitments to sobriety and resources to address root causes of the addiction. Although there may be an overlap with mental health issues for those with addiction issues (or mental health issues may be a by-product of addiction issues), once through recovery, they may be able to assume an increasing independence. This may not be the case for those with mental health issues, particularly more sever conditions that may not resolve over time and, depending on acuity, may require safeguards to mitigate anti-social behaviour. Although the causes and conditions for both groups are distinct, the resultant propensity for unstable housing is common to both, which has given rise to a common solution. We need to reverse this and consider the distinct needs of each group and variation within each group the ensure needs are met and resources and used expediently.
Within this context of differentiation, British Columbia requires a housing strategy for vulnerable populations, seen through a rural lens, to meet the growing challenge is low population density communities that lack the resources brought about through economies of scale in larger centres. At the core of this strategy, we need to focus on up-stream solutions. As noted by the Canadian Observatory on Homelessness COH), lasting solutions require a shift from emergency response to prevention and housing supports.[1]
For the purposes of this statement, we use the COH definition, which recognizes the changing circumstances of housing and includes those who are:
• Unsheltered (living on the streets or places not intentioned for human habitation)
• Emergency sheltered (homelessness shelters, and domestic violence shelters)
• Provisionally accommodated (temporary accommodation, lacks stability)
• At-risk of homelessness (precarious economic or housing situation, or unsafe/inadequate housing)
Through a Rural Lens
Housing availability in rural communities presents unique challenges that extend beyond the general housing crisis observed in urban areas, particularly when overlayed with distinct vulnerably populations. These challenges are compounded by geographic isolation, workforce shortages, and economic dependencies. Addressing housing instability for both those with mental health issues and those for substance use issues in these settings requires a tailored approach that considers the specific dynamics of rural life. Rural considerations include:
- Geographic Barriers
Geographic isolation in rural areas significantly limits access to centralized housing and support services. Vulnerable populations in these regions often face long travel distances to access addiction treatment, mental health care, or even basic necessities like groceries and employment opportunities. Limited public transportation exacerbates these barriers, making it difficult for individuals to secure and maintain stable housing.
- Economic Trends and Housing Costs
The economic fabric of many rural communities is tied to resource-dependent industries such as forestry and mining. These industries often experience boom-and-bust cycles, leading to periods of economic instability that affect housing affordability. Additionally, the migration of urban dwellers to rural areas during the COVID-19 pandemic has caused housing costs to rise exponentially, further reducing the availability of affordable options for both those with mental health and substance use issues.
- Workforce Shortages
Rural areas often experience a lack of service delivery workers for necessary support services, including social workers, therapists, and housing managers. The scarcity of skilled workers reduces the availability of wrap-around services that are critical for stabilizing housing for individuals with differential, complex needs, such as mental health or substance use challenges.
Additionally, construction labourers and contractors are in short supply in rural BC. This constrain further impacts availability of affordable housing in rural markets.
- Cultural Sensitivity and Indigenous Perspectives
Indigenous populations in rural BC face systemic barriers that exacerbate housing instability. These barriers include intergenerational trauma, lack of culturally sensitive housing solutions, and historical inequities, and intersect with other vulnerabilities. Addressing these issues requires collaboration with Indigenous communities to develop culturally appropriate housing that integrates traditional practices and values.
Recommendations
The following recommendations are predicated on valuing a harm reduction approach to stabilizing housing for both those with mental health and substance use issues, but are underscored with the need for policies to reduce stigma. This must be recognized as an additional barrier in rural communities for both groups and the lack of anonymity and attendant reputational burden is increased due to low population numbers. The recommendations must also be grounded in the context of recognizing that inadequate housing for vulnerable populations is an issue of human rights. Within this context, we recommend the following:
- Distinguishing between housing needs for those with substance use issues and those with mental health issues, recognizing that although they are often correlated, the mental health supports are needed for those with mental health issues to remain independent of recovery from substance use, and give rise to the need for different interventions.
- That the system response moves away from the focus on and attendant resource allocation towards emergency response (e.g., shelters) to the prevention of housing precarity for those with mental health challenges and those with substance use challenges, and context and purpose-specific longitudinal, integrated wrap-around supports be developed for each group with clear input from those with lived and living experience.
- As per (2) above, attention to transitional, second-stage housing is essential to meet the evolving needs of community members moving through mental health mitigation or drug addiction recovery.
- That a comprehensive cost-effectiveness analysis be undertaken to determine:
- system costs of mis-applied or lack of resources to meet the differential needs of each group including the costs of unintended outcomes when the two groups are provided the same housing resources and
- actual costs benefit of upstream wrap-around care when compared to the collective health, social and system resource usage.
- That a holistic approach be taken to addressing the housing needs of both populations. This requires that we recognize the need for longitudinal wrap-around care and interventions to maintain stable housing situations, beyond the initial procurement of housing and the recognition that housing needs may change, depending on the trajectory of recovery or on the mitigation of underlying health issues. This requires adequate resources.
- Continue to support “housing first” models, where vulnerable populations are provided with safe and stable housing with context-specific wrap-around supports and then linked with mental health or addictions recovery supports, while recognizing low-barrier housing as an essential housing option.
- Recognize and respond to the complexity of “dual diagnosis,” when mental health issues coincide with substance use issues and require integrated, as opposed to siloed, treatment strategies by ensuring integrated care.
- That particular attention be given to youth struggling with mental health or addictions issues, recognizing the increased vulnerability of this cohort and the need for purposeful supports for system navigation (for example, obtaining status cards or bank accounts).
- Policy changes are crucial for addressing housing shortages in rural areas. Incentivizing developers to build affordable and supportive housing through tax breaks or grants can stimulate construction in low-density areas. Policies that prioritize rural housing development, combined with increased funding for local support services, can help bridge the gap.
- As the current housing crisis is multi-factorial, collaboration between diverse key system partners including municipalities, regional districts and the provincial government is essential. This could be optimized by regional “housing development councils” made up of elected and non-elected members.
- Telehealth and remote support technologies can play a pivotal role in addressing service gaps in rural areas. These technologies enable vulnerable populations to access mental health care, addiction treatment, and housing support remotely, reducing the impact of geographic isolation.
- Community-led initiatives offer promising solutions to the housing crisis in rural areas. Co-housing models and cooperative housing projects tailored to local needs have demonstrated success in stabilizing housing for at-risk populations. These models often incorporate shared resources and mutual support systems, which can reduce costs and foster a sense of community.
Addressing housing instability for populations with substance use challenges and populations with mental health issues through a rural lens requires a disaggregated, multifaceted approach that considers geographic, economic, and cultural dynamics alongside the root cause for the individual. Part of this requires leveraging resources to attend to modifiable social influences, including improving self-esteem, self-confidence and self-worth. By leveraging community-based solutions, advocating for targeted policies, and integrating technology, rural communities can develop sustainable housing solutions for vulnerable populations and mitigate care provider burnout. These efforts must prioritize culturally sensitive, long-term support systems that go beyond initial housing procurement, ensuring that vulnerable populations not only find housing but also maintain stability and dignity in their lives in a way that meets their discrete needs.
