The Benefits of a Housing First Approach to Homelessness

On any given night in America, more than half a million people experience homelessness. The coronavirus and our failed national response have decimated the job market, and with bans on eviction scheduled to end within weeks, the situation is going to get a lot worse over the coming months. As cities continue to grapple with how to address this growing crisis of housing and homelessness, more should adopt a housing first approach.

Traditionally, homelessness has been dealt with by cities as either a nuisance to be policed away or as an issue of personal responsibility that governments ought only to address through a series of complex, patronizing, and ineffective barriers to housing aid. Since 2006, the criminalization of those experiencing homelessness has “increased in every measured category” all across the country. In Los Angeles, while the city allocated $100 million “to deal with the homelessness crisis, a staggering $87 million was spent on arresting unhoused people, locking them up in city jails, and releasing them with no resources.”

Even the money that is not spent on policing and criminalizing homelessness is still largely ineffective at actually tackling the problem. This is because many policies require individuals to clear a series of hurdles before getting housing assistance. Individuals or families may be required to find steady work, address mental health issues, or prove sobriety before receiving housing. All of these steps first require the kind of stability that permanent housing can provide. Thus, a simpler, cheaper, and kinder policy with a proven record of effectiveness is to just start by giving people housing.

The National Alliance to End Homelessness defines “housing first” as:

“[A] homeless assistance approach that prioritizes providing permanent housing to people experiencing homelessness, thus ending their homelessness and serving as a platform from which they can pursue personal goals and improve their quality of life. This approach is guided by the belief that people need basic necessities like food and a place to live before attending to anything less critical, such as getting a job, budgeting properly, or attending to substance use issues.”

As this definition demonstrates, a housing first approach sets no unnecessary barriers to achieving permanent housing, and then once individuals are housed uses that stability to assist with other issues like mental health or a job search. On its face, it makes perfect sense why this approach would be most effective at curbing chronic homelessness; since the unifying experience of homelessness is a lack of housing, and a housing first approach begins by providing housing. Numerous case studies across the country and around the world have shown that relative to other approaches to tackling chronic homelessness, housing first is more effective at reducing long-term homelessness and is cheaper than alternatives due to less reliance on emergency services.

In 1992, Canadian psychologist Sam Tsemberis of New York University conducted what has become a landmark study in housing first policy. He started with the somewhat radical idea that he would give housing to some of the most demanding of the chronically homeless — those with schizophrenia, trauma, or substance abuse — with no strings attached. Drug treatment and medical care were provided to those who requested it, but were not mandated. Tsemberis found that after five years, 88% of participants in his housing first program were still in their apartments, and that the cost of care was substantially lower than the shelter, jail, and emergency room amalgam they had been floating between before his program began.

Tsemberis’ overwhelmingly positive results led to a number of experiments at the state and local level throughout the country. Seattle, Denver, and Portland, Maine all ran their own tests and found cost savings similar to Tsemberis. Salt Lake City, Utah implemented its own housing first program in 2006 and within 9 years the state saw a 72% decline in homelessness after giving folks permanent housing with little to no strings attached.

Between 2006 and 2007, Rhode Island implemented a pilot program to house 48 individuals. A study of Rhode Island’s program by Hirsch et al. concluded that those served by the programs were more satisfied with their housing situation, felt they were making progress towards their physical health, mental health, and social goals, and that they used dramatically fewer publicly funded emergency services.

In neighboring Massachusetts, the Friends of Boston’s Homeless organization maintains a page of personal success story from their own housing first initiative. Take Michael, a 71-year-old man who after a nasty fall at work as an electrician lost his home and began sleeping on the streets. He was homeless for 14 years, during which time he frequented the emergency room and was arrested for disorderly conduct. Since obtaining housing through a housing first program in 2012, Michael has begun to work on his mental and physical health. He has not visited the emergency room or been arrested since. After 14 years of depression, substance abuse, and criminalization, Michael has friends and a sense of community once again.

Success stories just like Michael’s can be found all over the world, wherever the housing first philosophy has been implemented. In Regina, Saskatchewan, a small program serving just 26 people saved the city almost $2 million. It lowered hospital admissions and the length of stays while housing folks like Lindsey BigSky. Lindsey had been homeless for 8 years, and now that he has a place to come home to and slip off his shoes at the end of each day, he feels safer and says that housing first has changed his life.

Between 2011 and 2016, researchers in France followed a program across four major cities that housed 300 of the most-at-need individuals experiencing chronic homelessness. Like other studies around the world, Tinland et al. found that 85% of participants who received the housing first treatment remained housed. Hospital stays were also cut in half, and those who were housed expressed greater quality of life improvements than the 300 individuals receiving standard homelessness interventions.

Recently, Finland became the first country to adopt housing first as national policy. As Juha Kaakinen, one of the drafters of Finland’s national housing first plan, articulated:

“Everybody has their own story, their own history. They have their own resources. They may also have their own problems… You may need rehabilitation, detoxification, etc. These other elements are important. But to get these things done successfully, you must provide permanent housing. That way you can be sure that you are not kicked out the next morning and you can plan your life ahead.”

Housing first checks all of the boxes. It has proven to be much more effective at achieving sustainable long-term decreases to chronic homelessness while simultaneously cutting costs. It sets people up for success and provides them the stable foundation needed to deal with ancillary challenges like mental health issues or addiction.

Perhaps above all else, it is a more equitable and humane approach to chronic homelessness. The housing first philosophy acknowledges people’s agency and humanity, then offers a helping hand and a sense of community instead of a bureaucratic scolding characterized by surveillance and humiliation. Canada, the United States, and the rest of the world should adopt housing first as a national policy. With solutions like this, ending homelessness in our lifetime is possible.

Image Source: https://www.pikist.com/free-photo-ihtkh

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