The Woman Who Pioneered “Housing First”

Three decades ago, one nurse came up with a radical idea: Give homeless folks suffering from addiction and mental illness a safe place to be themselves.

Tents that house homeless people in Vancouver, British Columbia, Canada.

Photo by Michael Wheatley/Getty Images

The Portland Hotel is located in a rough neighborhood of Vancouver, Canada, called the Downtown Eastside. An open-air drug market operates in a park across the street, and the benches there make it a popular spot for the neighborhood’s homeless people and alcoholics.

The hotel itself was built in 1908, and when Liz Evans took the keys in March 1991, 1908 was apparently the last time anyone had bothered to give it so much as a fresh coat of paint. It was a slum; paint peeled off the walls, the pipes leaked, the floor was filthy, and the lighting was dim. The Portland’s tenants were only there because it was one step better than living on the streets.

“We ended up being known as the ‘hotel of last resort,’” Evans remembers.

Evans had completed nursing school just one year earlier. She’d taken a job at Vancouver General Hospital but hated the way mental health patients were treated there, more as statistics than as people. And so she quit, took an interview with a nonprofit organization called the Downtown Eastside Residents Association, and got the job. Evans had been the only one to apply.

On paper, her job was to support 10 tenants at the Portland Hotel who were diagnosed with severe mental health issues. In fact, the entire hotel was hers to run as she saw fit. “To start, I focused a lot on practical things: vacuuming and cleaning, changing door locks, and trying to figure out how to paint a room and hang curtains,” she recalls. “I did everything from cleaning to personal care to helping people with their welfare workers or whatever issues people had. It was absolutely, completely overwhelming.”

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There were a lot of empty rooms in the hotel, so Evans also began to fill them up, taking people in off the street who were blacklisted from everywhere else. After just a few weeks, Evans was responsible for 60 or 70 people. “People who came with mental health issues, HIV, criminal histories, and drug use,” she says. “That is who needed the support.”

Outside of the hotel, the Downtown Eastside was just as beat-up as the building Evans was given.

In British Columbia, welfare checks are issued on the last Wednesday of every month, so once every four weeks, the Downtown Eastside is flooded with cash. Drug dealers circle the banks like sharks, looking for anybody with an outstanding IOU and potential customers who can rack up new debts. Government officials call it “Welfare Wednesday.” Residents of the Downtown Eastside call it “Wely” or “Mardi Gras.”

Evans remembers her first Welfare Wednesday working at the Portland.

On the ground floor of the hotel, just around the corner from her office, there was a rough bar called the Rainbow. “The bartender was a big guy who kept a baseball bat behind the counter,” Evans says. “On my first welfare day, he smashed some guy’s head open with that bat. Someone came screaming into the hotel to get me. I went running out—I remember, I was wearing the most inappropriate clothing, a cotton skirt and my hair in pigtails.”

The man lay on the sidewalk with his skull broken open. “I’m holding this guy’s brain in, and there’s blood everywhere, all over my skirt. I remember waiting for the ambulance to show up, wondering if he was going to live or die,” Evans recalls. “It was just one of those moments,” she adds. “What the fuck am I doing in the middle of all of this? Holy shit.” It was May 1991, and Evans was 25 years old.

“He was a Hispanic drug dealer, was what I was told,” Evans continues. “But as far as I was concerned, he was another drug user. That’s one of so many stories that illustrates the hatred of people who used drugs in the community, not just by the outside world, but by people in the community, too. Drug users were seen as scum.”

Everyone who lived at the Portland was severely addicted to drugs or alcohol. Evans estimates that 95 percent were injection users. “They were treating themselves badly and treating each other badly because they didn’t feel like their lives were worth much,” she says. “I was getting to know people and listening to their stories. And always the common denominator was, ‘My life is worth shit, and I don’t matter.’ That was the piece that really made me think about my mum and think, ‘Well, fuck, these are just people in the world who don’t feel like their lives have a right to occupy space.’”

“They literally moved every month because they were so complex to deal with.”

While she was never abused, Evans saw her own life in the lives of her tenants. “I had grown up with a mentally ill mother. I never had thought of her as sick; I just thought she was a really nice person who was broken and sad,” she explains. “And so I just saw [the Portland tenants] as broken and sad. These people are lovely, but they don’t fit. For whatever reason, there is no space for them. They don’t fit anywhere in the world, and the world, to them, feels like a very unwelcoming place.” Inside the Portland, she worked to create a sanctuary.

Her tenants were the hardest to house in Vancouver. A survey she conducted that year found that Portland tenants had lived, on average, 11 different places during the previous 12 months. “They literally moved every month because they were so complex to deal with,” she says. At the Portland, Evans found ways for those people to keep a roof over their heads. “That meant, when people were psychotic, not forcing them into a hospital,” she says. “When people were doing eccentric things, it meant not arresting them for it, and learning how to accommodate a lot of different, eccentric behaviors and characteristics.” Instead of pushing people to fit into the rules of the hotel, Evans bent the Portland’s policies and safeguards to fit around its tenants.

“One of the first guys we housed was a really sweet guy named Joe,” Evans begins. “He had a tendency to hear voices and then smash his fist through glass windows. That was just sort of his thing. He would hear something and then he would put his fist through glass or he would throw something out his window. He was a very gentle person, actually, very charming, sweet. The staff all loved him. But he would do this thing where he would smash windows, and that made him hard to house.”

Evans bolted his television set to his dresser so Joe could not throw his television out the second-story window. To prevent him from punching through the windows, she installed large sheets of fire-grade Plexiglas that were impossible to shatter. The same measures were taken throughout the hallways on Joe’s floor.

“We did lots of crazy things like that,” she says. “It was about accommodating people, really understanding who people were and creatively making space work for them.”

There were many subcultures within the Portland Hotel: heroin addicts who flopped around the building; stimulant users who stayed up all night smoking crack cocaine; and drinkers who got blind drunk on the alcohol in mouthwash and hand sanitizer. Evans quickly found that people were happier when there was a bit of balance among the different groups and enough of these different communities for everyone to feel at home.

The primary goal was not to fix people, but to give them a space to live in the greatest degree of comfort. 

Other tenants just took a little getting used to. In these cases, behavior that would have resulted in an eviction somewhere else simply became a personality quirk.

“We had this woman, Linda, who was 6-foot-2 and screamed at the top of her lungs all the time,” Evans recalls. “The first day she moved into the building, she screamed so loud, everybody in the lobby jumped three feet off the ground. It was terrifying. It was like somebody was being murdered—a terrible gut-wrenching screaming.”

The Portland’s staff and tenants realized that Linda’s shouting didn’t actually signal that anything was wrong. It was just an involuntary outburst. “When she moved into the hotel, there was a process of getting used to her,” Evans says. “But after about a week, I remember her walking through the lobby and screaming and everybody just going, ‘Oh, that’s just Linda.’”

The primary goal was not to fix people, but to give them a space to live in the greatest degree of comfort that the Portland could create. There were a lot of unhappy endings at the hotel, but endings that would have been worse had they occurred on the street. And Evans was able to give many tenants enough time to reconnect with family. One of those tenants was Tilly.

“She was a sex trade worker. Tilly was a beautiful First Nations woman, but she had had a really complicated childhood and had been severely abused,” Evans begins. “When I met her, she was still working in the sex trade. One night, she came back to the hotel after she had been extremely badly beaten. She was bloodied and bruised head to toe. She’d been raped. But she didn’t want me to call the police, and she didn’t want me to do anything.”

Evans walked her up to her room, cleaned her up best she could, and cradled her in her arms for hours that night. “I was holding her, and she was crying and sobbing. And what she kept saying to me over and over again was, ‘It’s my fault. I deserved it. I’m a bad person.’” It took Evans back to her childhood, when her mother’s detached nature and repeated absences left Evans feeling like she had done something wrong and that she was the reason her mother abandoned her. “I thought, ‘Holy fuck, there is no difference between me and Tilly, except that she had nothing and no one and no support, and I did,’” Evans says.

She worked with Tilly for years, helping her take small, incremental steps to improve her life. The victories were far from total but still real. “She was always in extremely violent, abusive relationships,” Evans says. “So it was really sad. I worked with her, but I couldn’t force her to charge any of the people who abused her, and I couldn’t force her to leave any of the abusive relationships she was in. But I could give her a home.” Tilly died of AIDS, but not until many years later.

“We accommodated people, no matter who they were.”

“We were too late for her because by the time I met her, she was already HIV-positive because nobody ever gave a shit about her when she was using. [No one] gave her a clean needle,” Evans says, still audibly angry. But before Tilly passed away, Evans had stabilized her heroin addiction with methadone and reconnected her with children with whom she’d previously lost touch.

At the time, the medical community would not have classified Tilly’s case as one where progress was made. But she had made a lot of progress. “In so many people’s minds in those days, what we did was seen as without value,” Evans remembers. “Because people only respected interventions that led to recovery or to rehabilitation.”

Evans was simply giving a home to people who, up until then, had been told they weren’t good enough to have one. The months flew by in a blur, but this chaotic period marked the beginning of something much bigger than the Portland’s tiny staff could have imagined.

“The hotel of last resort,” Evans says with fondness for the term. “We accommodated people, no matter who they were.”

In recent years, a social policy that’s gained attention from governments across North America is called “housing first.” It posits that by giving a person a roof over their head, you begin to stabilize a person’s life to a point where they can then work on their addiction issues, mental health problems, prospects for employment, and relations with family and friends. If you first give a person a home and ensure that they can stay there, research shows that this degree of stability will give them the space and the time that they require to figure out the rest.

When Evans began taking troubled tenants into the Portland Hotel in 1991, she didn’t have any grand strategy in mind. She certainly wasn’t conscious of the changes in social policies that her work at the hotel would gradually initiate in Vancouver. She was simply trying to be kind. But, at the Portland Hotel, a fascinating set of unintended consequences soon became evident. Evans found that when she told tenants they no longer needed to fear eviction—that they would not been thrown out to the streets for using drugs or disrupting others with symptoms of mental illness—her tenants often used less drugs and experienced fewer mental health outbursts. When she gave tenants a home that was truly theirs and removed the intense feelings of stress that they had previously felt from the constant threat of homelessness, their mental health improved, sometimes significantly so.

Nearly two decades before anybody called it “housing first,” in a beat-up hotel on East Hastings Street in Vancouver, people with complex combinations of mental health and substance abuse problems received rooms from which they would not be evicted.

Through the 1990s, The Portland Hotel grew from the one building in Vancouver's Downtown Eastside to the Portland Hotel Society and then to PHS Community Services Society, now one of the largest nonprofit social-housing providers in Canada. Evans left Vancouver and moved on to New York in 2014, but the tradition of kindness that she began at the old Portland Hotel continues there and at more than a dozen buildings that PHS came to operate across Vancouver and beyond.

This edited extract from Fighting for Space: How a Group of Drug Users Transformed One City’s Struggle with Addiction is published here by permission of the author. Arsenal Pulp Press, June 2018.