The United States Department of Housing and Urban Development defines a chronically homeless person as, “someone who has experienced homelessness for a year or longer, or who has experienced at least four episodes of homelessness in the last three years (must be a cumulative of 12 months), and has a disability.” A good portion of homeless individuals struggle with substance abuse and mental illness.
According to the Substance Abuse and Mental Health Services Administration, in 2003, “38% of homeless people were dependent on alcohol and 26% abused other drugs.” Substance abuse and dependency oftentimes disrupt relationships and cause individuals to lose their jobs, attributing to their homelessness if the individual is incapable of achieving the financial means to maintain their housing status. In many cases, substance abuse can be a result of homelessness rather than a cause. People who suffer from homelessness oftentimes turn to drugs and alcohol to cope, striving to attain relief from their problems. As time progresses and the substance abuse continues, dependency accumulates and job stability is even more difficult to obtain.
The SAMHSA also found that “20 to 25% of the homeless population in the United States suffers from some form of severe mental illness.” Serious mental illnesses disrupt and even prevent people from performing daily functions and necessary life skills, like forming and maintaining relationships. Oftentimes those homeless individuals suffering from mental illnesses are willing to accept care and treatment, but even with ongoing care and provided housing, it is difficult for mentally ill homeless people to achieve independent residential stability. Supported housing programs and the services they offer such as “mental health treatment, physical health care, education and employment opportunities, peer support, and daily living and money management skills training,” listed by the National Coalition for the Homeless, are vital in reintegrating these individuals into their communities.
According to the Encyclopedia of Critical Psychology, housing is a fundamental factor in one’s health and is closely linked with one’s ability to maintain employment and a steady income. For homeless individuals suffering from mental illness, disability, and/or addiction, obtaining and preserving an adequate place to stay can prove to be quite difficult. Adequate housing refers to: “a home that is affordable, safe, in good shape, and either provides or enables access to needed supports.”
Without access to housing, those suffering from mental illness, disability, or addiction are less likely to receive the help that they need than those who have homes. Without necessary supports to overcome addiction and aid mental illness and disability, those suffering from chronic homelessness are more susceptible to long-term health conditions, hospitalization, malnutrition, and continued substance abuse. There has been controversy in recent years as to which model is most efficient in alleviating homelessness, the traditional transitional-housing method or the housing first approach.
Housing First is explained in the Journal of Primary Prevention as “an effective intervention that ends and prevents homelessness for individuals with severe mental illness and co-occurring addictions.” Housing first begins by “providing permanent, independent housing without prerequisites for sobriety and treatment, and by offering support services through consumer-driven Assertive Community Treatment teams.” Sobriety is oftentimes a major obstacle preventing chronically homeless individuals from obtaining and remaining housed in traditional housing due to its dependence on sobriety and readiness for independent housing.
According to Nestor M. Davidson of the Fordham University School of Law, the treatment first approach requires “that individuals be stabilized through a gradual process of acculturation, with each step in a ladder of greater independence conditioned on meeting service requirements such as following a regime of medication or maintaining sobriety.” Fordham further explains that the key difference between housing first and treatment first models are that the housing first approach provides shelter without any required treatment, but offers a variety of services that promote housing stability and overall individual well-being. These services are provided on an as-needed, voluntary basis, as explained by the National Alliance to End Homelessness.
Aside from the housing first intensive services being available and not mandatory as they are in traditional housing methods, what is the big difference between the two? The results. A non-blind, parallel-group, randomized control study, published in the Psychiatric Services journal, was conducted in five Canadian cities: Vancouver, Winnipeg, Toronto, Montreal, and Moncton. The cities were chosen to ensure that the population studied reflected the country’s racial and ethnic diversity and was representative of the country as a whole. A sample of 950 high-need, homeless, or precariously housed participants suffering from severe mental illnesses were randomly assigned to Housing First.
After one year, a follow-up was conducted and the results showed that 73% of the housing first participants and 31% of the treatment-as-usual participants remained stably housed. The improvement in overall quality of life and community functioning, too, was significantly greater among housing first participants when compared to the treatment-as-usual participants. The conclusion of the study supported that the housing first approach has the potential to make chronic homelessness obsolete among individuals suffering from severe mental illness, disability, and substance dependency.
According to another study directed by University of North Carolina – Charlotte associate professor of Social Work, Lori Thomas, housing first is more effective than traditional housing methods while reducing the overall cost of homelessness. The study was conducted by a Charlotte apartment complex, the Moore Place, which houses 85 chronically homeless individuals at any given time. The study concluded that in its first year, the Moore Place tenants saved nearly $1.8 million in health care costs, saw a 78% reduction in the number of emergency room visits, and spent 372 fewer days in the hospital. When provided permanent housing, these same tenants saw a 78% drop in arrests, likely due to a decrease in crimes related to homelessness (trespassing, loitering, public urination, begging and public consumption of alcohol), and spent 84% fewer days in jail, according to Caroline Chambre, director the Urban Ministry Center’s HousingWorks and one of the critical forces behind the Moore Place.
The land and the facility collectively cost roughly $6 million, but Chambre believes that the millions of dollars saved by the Moore Place will exceed the costs of the project. Moore Place tenants are required to contribute 30% of their monthly income as rent, the rest of their housing cost which is roughly $14,000 being covered by a combination of donations and government funding. Nonetheless, the study concluded that it is less expensive to give homeless individuals a place to permanently reside than not. “This compassionate perspective is a better way to honor the humanity of a person, but it also works from a fiscally responsible perspective,” Thomas said. “This really is a win-win.”
The Southern California Association of Non-Profit Housing agrees. The Los Angeles Homeless Services Authority and the Economic Roundtable performed a study investigating the costs to the public for supportive housing. The report compiled by Economic Roundtable found that the overall cost to the public decreased drastically when the homeless were housed, the average cost for impaired homeless adults decreasing by 79%. The report, titled Where We Sleep, was the first large-scale study for Los Angeles. The report found that the average overall cost associated with those living in supportive housing was $605 a month, while the average overall cost associated with those living in emergency shelters was $2,897 a month. LAHSA and Economic Roundtable also found that the average monthly savings to the public was $1,190 per individual when accounting for the average monthly rent subsidy for supportive housing and the capital costs for the development of housing units. “The key finding from this study is that providing housing and supportive services to vulnerable homeless individuals creates important opportunities to reduce public costs while also improving the quality of life for homeless persons,” said Daniel Flaming, president of the Economic Roundtable. “It is in the interests of taxpayers to provide housing and stability for homeless residents.”
While the housing first initiative has been found to be more effective than traditional housing practices, it is also less expensive. The tax dollars saved by further implementing housing first practices in other communities can go towards other important areas of the community, such as building public schools to alleviate over-crowding in our schools. Housing these individuals, too, provides stability, ultimately supporting them while they find the means to overcome their mental illness, disability, or substance abuse. When these individuals are ready to progress, they will be encouraged to search for employment, and if employed, will begin to pay taxes as well. With more tax payers, more tax revenue is being collected by the government, thus, more available money for the government to spend towards achieving things that are important to the community. Lastly, with more housing available to those living on the streets, no matter their struggles, there will be a fraction of the number of homeless living on the streets as there are currently. With less homeless individuals making the streets their home, there will be a reduction in homeless crime, less sanitation issues, and little to no homeless individuals roaming and begging on the streets, benefitting the overall appearance and attitude towards any given town or city affected by homelessness.
A limitation of housing first is that the primary target audience of housing first, homeless individuals suffering from mental illness, disability, and addiction, only makes up a small fraction of the homeless population. Violet Law of the National Housing Institute highlights that while although hundreds of cities that have implemented housing first facilities have reported a decrease in chronic homelessness, a decrease in funding towards other facilities are threatening “other homeless populations, such as families with children and teenagers who have aged out of foster care, in favor of one narrowly defined group.” According to the United States Department of Housing and Urban Development’s first-ever annual homeless assessment report, released in February 2007, 23% of the estimated 754,000 homeless people nationwide were categorized as chronically homeless. Just one month earlier, the NAEH released the results of a one-night count conducted in January 2005, which found that there were 744,313 homeless people nationwide, families making up 41 percent of the overall homeless population.
There is no doubt that the housing first initiative is the most successful model thus far working towards ending chronic homelessness. It is important that communities implement housing first for not just the chronically homeless individuals, but for all who simply need stability and a push in the right direction for however long the duration of that push might be. It is also very critical that temporary housing remain government funded as well, for not all homeless individuals are chronically homeless. If the government can manage to fund housing for both parties of chronic and non-chronic homeless, but ensure that housing first facilities are implemented more sporadically around areas characterized by high rates of chronic homelessness, rates of chronic homelessness and homelessness in general would decrease drastically, resulting in not only more people having a place to call home, but a better place for the general population of the United States to call home.