Currently in Toronto over 13,000 people are on the waitlist for mental health and addictions supportive housing. Understanding this population and how to meet their needs addresses an often overlooked health equity gap. This report is an analysis of the waitlist for mental health and addictions supportive housing in Toronto. It examines the characteristics of applicants, their support needs and housing preferences, and the patterns of wait times and outcomes of applying. Understanding the unique needs of this population will enable policy-makers to coordinate investments to ensure better outcomes. Further, it will provide an opportunity to develop program standards, common definitions and criteria and identify options to better meet client needs. 

Most of the data are extracted from the administrative database of The Access Point, the coordinated access system for this supportive housing. This report summarizes a more detailed technical report which is also available. 

Highlights of the Research Findings

• Demand for supportive housing far outstrips supply. In a recent two-year period, over 4,000 new people applied while less than 600 were placed in supportive housing. 
• Most applicants have long wait times. Nearly 60 percent (4,431) of applicants on the waitlist had been waiting for housing for two or more years and those waiting longest (top 10% on the waitlist) had been waiting 4.5 years or longer.
• Support needs vary, e.g. looking after the home, meal preparation, managing medications, avoiding crises, and addressing drug or alcohol use. The vast majority of applicants needed support in more than one of these areas.
• Applicants have high levels of housing need as well as great need for supports. More than half of them (52%) self-identified as homeless or in temporary housing when they applied. 
• A large majority of applicants stated a preference for self-contained supportive housing units. Only six percent specifically requested shared accommodation. 
• Applicants were diverse in their living situation, health and clinical issues: Homeless applicants included 11 percent (of total applicants) residing in shelters, 7 percent in hospital, 3 percent in jail, and 16 percent with no fixed address.
• One-third of applicants had mood disorders and another third had psychotic disorders, with anxiety and various other diagnoses among the rest. 
• Over one-third of all applicants reported problematic substance use.
• One-quarter of applicants reported current or recent criminal justice system involvement.
• One in every eight applicants reported high hospital inpatient use for mental health reasons (50 or more inpatient days in the two years before they applied).
• Support needs varied across the above applicant characteristics. However, two broad groupings were evident: people with psychosis diagnoses, higher hospital inpatient use, and functional support needs; and people with problematic substance use, criminal justice involvement, and needs related to managing crises. 
• One-fifth of people who were placed in a supportive housing unit were selected by the housing provider rather than drawn from the wait list. These “partnership applicants” were less likely to report being homeless and reported fewer support needs on average.
• There is wide variation in how long people wait for supportive housing. This may be the result of direct access for some applicants through partnership arrangements; boarding homes which have higher turnover and therefore faster access; and the inherent complexity of matching people with specific needs and preferences to particular housing and supports.
• Applicants’ wait times from application to placement in housing did not vary substantially based on mental health diagnosis, homelessness, inpatient hospital use or partnership status. But people with problematic substance use, criminal justice involvement, or more support needs tended to wait longer.
• Applicants are not always placed in the support intensity they request when they apply. This is attributable both to the more numerous openings in boarding homes that provide daily support, and to the absence of clear system-wide definitions of support intensity.
• Diverse needs and limited openings make it challenging to match applicants to suitable housing. Half of applicants offered supportive housing refused the first offer made. 
• Applicants declined by housing providers because their support needs were too high were more likely to report problematic substance use, criminal justice involvement and homelessness.