Housing First

Homelessness is a world problem, but for now we’ll focus on the United States because other countries may not be able to address the issue the same way the US can due to the differing causes for homelessness in other countries. As a United States issue, and working off of 2015, over half a million people experienced homelessness. This number is based on point in time data (information collected once a year), so this information is very likely short of the actual numbers. The good news is that these numbers have actually been in decline over the past decade.

Social Solutions has some other interesting homeless statistics breakdowns to include the 80,000 plus considered chronically homeless and the fact that over half a million young people under the age of 24 have experienced homelessness extending beyond a week. Populations most at risk of homelessness include approximately 1.4 million veterans, the poor, and those suffering from mental health issues (of course there is overlap in these populations). The risk continues, but over the past decade or so, there has been a major change in how to view the solution.

Until about 15 years ago, the idea had been a continuum of care model that suggested people needed to prove they could stay sober, or symptom free by taking medications, or various other ways to show they could remain stable prior to being given housing assistance. There was no empirical evidence to show this method worked, and having worked in the field with many of these individuals, it is obvious that it doesn’t work that well. When you think about it, how can it work? It is asking someone with no stability in their live to force some sense of stability before providing something that can help maintain that stability.

The Housing First initiative, founded by Dr. Sam Tsemberis, is a different viewpoint. In order to start someone on the path to stability, you have to provide some stability in their lives. This means that housing is provided to the individual who needs it with no conditions. It allows the freedom of choice to seek help or not, and provides additional assistance in the form of substance abuse treatment, mental health treatment, and employment assistance among other things. Dr. Sam Tsemberis has literally written the book on Housing First.

You may have read an article last year about how Utah switched to Housing First and all but eradicated homelessness. While this may sound like a wonderful thing, it may not all be sunshine and roses. There is a problem with reporting and the populations which are actually being served. Homelessness isn’t just the chronically homeless population which Housing First seems to focus on, but the chronically homeless population is one where a lot of money is spent by return visits to the hospital, return visits to substance abuse care, and return visits to jail.

A study in New York testing the differences between groups served by continuum of care and housing first suggests less use of substance treatment facilities, high housing stability, better perceived choice, and no significant difference in substance use or psychiatric symptoms. This is an interesting study because, while it doesn’t show that Housing First lowers drug use, it does show that these individuals can remain in a stable environment and require fewer resources overall due to that stability. Another article linked by housing first proponents suggests that there has been major success in lowering overall costs, and also lowering substance abuse between models.

Unfortunately, during research, I was unable to obtain any outcomes reporting which I sought going into this. Some of the websites have not been updated since 2014, and information does not seem to be gathered with regards to individuals being able to not just remain stable but also get their feet back under them, so to speak. I would have liked to show how an individual in this program was able to gain stability, get a job, and graduate to self-sufficiency. However, I did not receive word back from Pathways to Housing, even when others to whom I spoke suggested I contact them. Perhaps a follow-up will be in order once this happens.

I have seen this program work first hand with many individuals (suffering mental health issues, mostly) able to maintain stability and live in the community for long periods of time. This may not be for every homeless population, but it’s good to have another alternative to spending a lot of money on continued forced treatment, jails, and medical care due to the dangers of living on the streets. As such, I suggest more states follow Utah (and Canada for that matter) and adopt a statewide plan for Housing First.

Until next time,

JB

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