Cities across the United States have tested the housing first model and found that it works very well, presenting a compelling case that housing first should be expanded where it is already used on a small scale and implemented where it is not public policy.
Despite the immediate costs and political resistance with building housing for chronically homeless people, the shift to putting homeless people in permanent, personalized shelter is justified on a range of grounds. Housing homeless people reduces the total public expense of housing, medical care, family services and other welfare provided to such vulnerable people. Housing homeless people also increases their opportunities to live more productively, thereby generating before-unrealized personal and societal benefits. In addition to the additive public purse and utilitarian arguments, communities should change their approach to homelessness because a lack of housing is itself a human rights violation and it also contributes to the violation of other basic human rights.
- Homelessness Today and the ‘Housing First’ Concept
There are estimated to be about 500,000 homeless Americans on any given night. Of these, about 80,000 are thought to be chronically homeless. This number is under-representative for two reasons. First, it does not capture the turnover among homeless people. It is estimated that about 2 million Americans experience homelessness during any given year. Second, the census of homeless people surely undercounts people. Homeless people are often good at sleeping in places where they are hard to find. Doing so ensures a complete night’s sleep. The Nathan Kline Institute for Psychiatric Research found that, in New York City, 1 in 3 homeless people go uncounted in the official census.
Unsheltered homelessness is also geographically unique; there are unsheltered homeless people everywhere but, as anyone who visits San Francisco can tell you, homeless people in the street are much more visible on the West Coast. In California, Hawaii, Nevada, and Oregon more than 50 percent of homeless people are unsheltered. Meanwhile, in New York, 5 percent of homeless people are unsheltered.
However, sheltering homeless people takes various forms. For example, many cities take a ‘progressive approach’ to homeless: moving homeless people into a temporary shelter, then into transitional housing and hopefully eventually into permanent housing. Alternatively, cities can provide homeless people with permanent housing right away, called the “housing first” model. The major difference between the progressive approach and housing first is that housing first provides permanence and reliability for both the homeless person and those with whom they interact. In contrast, progressive models suffer from an inherently unstable structure whereby a homeless person may move to a different location if their circumstances, or those of the shelter, change.
Change undermines the chances for successful stabilization of chronically homeless people; they often suffer other challenges that lead to their homelessness. “Estimates suggest that at least 40 percent have substance use disorders, 25 percent have some form of physical disability or disabling health condition, and 20 percent have serious mental illnesses,” according to a study Paul Guerin conducted for the City of Albuquerque. People require as much stability as possible, including a permanent physical location, where community support and social services can help them.
Housing first, as an alternative option for dealing with homelessness in America, is a relatively new development. It was first implemented in Los Angeles and New York City in the late-1980s and early-1990s in response to the combined threats of social welfare cuts and rising real estate markets. It has since grown in popularity, adopted to varying degrees by cities like Cleveland, New Orleans and Minneapolis, supported by the Interagency Council on Homelessness, and advocated by various NGOs. Most important for present purposes, housing first has already proven to be effective despite its relatively recent appearance on the public policy scene. There is little need to debate about whether it should be adopted at all, but a critical need to raise awareness about its benefits in reducing chronic homelessness and thereby improving the lives of chronically homeless people, improving the communities in which they live, all while reducing the burden on welfare programs.
- Reduced Costs, Increased Gains
Overwhelming evidence shows that housing first programs reduce the cost of chronically homeless people on government welfare programs. Below are a few examples of how costs are saved — and by how much.
The Colorado Coalition for the Homeless provides housing for 2,500 homeless people in Denver. They reported in 2006 that emergency room costs related to the chronically homeless that they housed reduced by 34 percent, inpatient hospital costs went down by 66 percent, detox visits reduced by 82 percent, and incarceration costs reduced by 76 percent.
Researchers also assessed the impact of the housing first program in Seattle, showing that housing first initiatives targeted to chronically homeless alcoholics can save 50 percent of the health and social services costs relative to current models, including the cost of providing housing. This cost saving amounted to $2,500 per person per month.
The cost savings of housing first programs have also been documented in Albuquerque, New Mexico, and Salt Lake City, among many other cities. In fact, the demonstrated effectiveness of housing first programs led the George W. Bush Administration, not known for its progressive social policies, to be the first administration to adopt housing first as official federal policy. Monetary support for housing first was expanded in the American Recovery and Reinvestment Act of 2009 — a.k.a. the Obama stimulus — with $1.5 billion earmarked for the Homeless Prevention Fund, and the policy has been retained as a recommended best practice by President Trump’s Interagency Council on Homelessness.
The effectiveness of housing first programs is not limited to cost savings; people’s quality of life improves when they have housing, as opposed to when they do not. Often about 75 percent of housing first recipients are still in their housing after two years, compared with only 25 percent of homeless people in other systems. In San Francisco, that number exceeds 95%. But the benefits are more extensive than that simple change. There are a range of ancillary benefits that contribute to an improved quality of life. For instance, one study showed that recipients of housing first accommodations are more likely to maintain their medication regime.
Housing first programs should or must be coupled with other social support programs. It is likely that other support programs, such as substance abuse support, education and job training, and food vouchers are all more effective — if not just as effective — and less costly when paired with a housing first model then when homeless people are transitory.
III. Ongoing Violations of Legal Rights if Systems Do Not Change
Finally, but perhaps most important, housing first programs fulfill an internationally recognized human right put forth by the International Covenant on Economic, Social and Cultural Rights, which was signed by the U.S. in 1977 and is recognized by 166 nations.
Moreover, The World Health Organization ranks housing as the most important factor influencing life expectancy. Being homeless impacts a person’s ability to find employment, to maintain cultural practices, to offer their children a consistent education. Those without homes are also particularly vulnerable to violence, including sexual violence. The continued disrespect of this laundry list of basic rights of our fellow citizens, many of them military veterans, is unacceptable.
Housing first is a sound policy option to implement respect for our country’s most vulnerable citizens.