Is Housing First the “proved way” to solve homelessness, or is it exacerbating drug and alcohol addiction? Here are the pros and cons of the ten-year history of Housing First and its successes and failures. Housing first is ground zero in the war on homelessness. The next evolution in the fight must start with an honest appraisal of where we are and what we’ve learned.
The definition of Housing First
Housing First is a social services policy for homeless programs and charities. The philosophy of the policy is that housing should come first in delivering aid to the homeless before any other social services such as mental health, addiction rehabilitation, job training, or other family services. The premise is that without shelter, expecting people to make meaningful progress on the root cause of their homelessness is unrealistic. Said another way, without stable housing, it is impractical for people to get themselves able to enter the workforce and provide for themselves.
No strings attached
A key attribute of Housing First is that the housing should be provided with “no strings attached.” The idea is that conditions on housing, such as sobriety or enrollment in training programs, make the housing arrangement more complex. Therefore, the “strings” can delay or even prevent homeless people from using available housing services and prolong their homelessness.
Not shelters; permanent
One of the goals of Housing First Programs is to provide enough housing for all homeless people. The goal is also to make housing available long enough for the homeless to advance their lives. Housing First aims to provide more Permanent and transitionary housing than Temporary Housing, as defined below.
Type of Housing
Government and charitable organizations label housing for the homeless as Permanent, Transitionary, or Temporary. Permanent Housing is for individuals who cannot care for themselves due to severe disability or mental illness. For people who can not provide for themselves, permanent housing is the proposed alternative to living on the streets. This type of housing can be within institutions focused on mental illness or disabilities. Transitionary Housing is housing set aside for some time, usually at least six months. Often, this housing is connected to addiction recovery and job training services. Finally, Temporary Housing can be very short-term, even on a nightly basis, to get people off the streets, provide a roof over their heads, and often a meal.
History of Housing First
The federal government adopted the Housing First philosophy over time, starting in the 1990s as HUD implemented its Continuum of Care Program (CoC), which distributes grants to states and cities to fight homelessness. It fully matured in 2014 under the Obama administration with the publication of HUD’s Housing First in the Permanent Supportive Housing Brief.
Even by 2009, Housing First was widely adopted, as described below in a good history of Housing First in an article by the Heritage Foundation:
“By 2009, Housing First had become the de facto policy at the local, state, and federal level, as local service providers oriented their programs toward federal funding priorities in order to maximize their ability to receive HUD grants. During this period, 234 cities officially adopted the philosophy of Housing First and submitted “10-year plans to end homelessness.” [i]
Current Adoption of Housing First
Housing First is the current policy supported by HUD as it distributes its homeless grants. Many states and cities have also adopted Housing First as the policy for guiding their homeless programs and to position themselves to receive HUD grants. In 2022 HUD distributed $4.2 billion in homeless grants. [ii]
The Controversy of “No Strings Attached”
Housing First stipulates that no strings should be attached to housing offered to the homeless. The theory is that Housing should precede any other social services, such as addiction or job training. The argument is that without housing, the lives of the homeless are too desperate to allow other services to be effective. But what should come first – treatment or housing?
Treatment First
Many people working with the homeless believe treatment for severe mental illness or addiction should come before housing. Without treatment, it is argued, the accommodation is either not used or enables the underlying problem to remain unaddressed and worsen. Here is a good article summarizing this argument from Michele Steeb – A senior fellow with the Texas Public Policy Foundation and the author of “Answers Behind the RED DOOR: Battling the Homeless Epidemic:.”
“Californians demand accountability and results, not settling for the status quo”, Newsom [California Governor Gavin Newsom] said in a recent statement as he announced his new budget. “As a state, we are failing to meet the urgency of this moment.” Yet the homelessness industry he’s helped establish — first as mayor of San Francisco, then as governor of the Golden State — isn’t designed to achieve meaningful results. Called “Housing First,” it’s a model that explicitly rejects accountability. Its champions opined that homelessness is “solved” by providing people with permanent housing without conditions — no sobriety, no expectations of even the most basic of standards of behavior and cleanliness and no expectation of work, ever. In other words, no expectation of change, ever. Predictably, it’s not working. But there’s hope — real hope. When the underlying diseases of mental illness and addiction are addressed (diseases that are either a precursor to or are a result of homelessness), we can redeem lives, families, and communities.
Dependency problem
The other problem with “No Strings Attached” is that it can cause dependency on government or charitable programs. This can discourage recipients from moving to financial independence. This is a common complaint of welfare programs in the U.S., not just programs focused on homelessness. More.
Here is a good summary of the problem from Steve Eide of the Manhattan Institute in a report entitled Housing First and Homelessness: The Rhetoric and the Reality.
As noted, the large-scale Family Options Study (2015) showed robust rates of residential stability for the families receiving a permanent housing intervention. Accordingly, the study has been seen as supportive of Housing First, particularly as regards the “whole systems orientation. But it also found evidence that housing subsidies, instead of granting recipients the freedom to focus more on employment and less on their housing instability challenges, actually led to diminished work effort. In sum, housing subsidies increased rates of housing stability (and, as noted, at a greater cost than other interventions) but not self-sufficiency.
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Is Housing First “Evidence Based?”
Proponents of Housing First argue that it is “evidence-based.” This means there is a body of studies, generally conducted around the time of HUD’s formal adoption of Housing First in 2014, that show Housing First gets people into Permanent Housing faster, and they stay in the housing longer. A good summary of the evidence and the studies backing it up are included in the Housing First Summary on the Community Solutions Website. A good analysis of the strengths and shortcomings of the evidence is presented in the Manhattan Institute Report.
Strengths
From the Manhattan Institute:
Whether looking at how many days housed as the measure of residential stability, or how many participants remained in housing at the end of the study, Housing First–style interventions have demonstrated real strength at addressing homelessness.
While it may have been the case 30 years ago that homeless policymakers doubted whether people with untreated serious mental illness and other social challenges could hold on to their housing if those challenges were not addressed first, there is less doubt about that point now. This is the thinking behind claims about how the Housing First literature “proves” how to “end homelessness.”
The evidence for the success of Housing First defines success in housing as getting people off the streets. But these measurements do not address the success in returning the homeless to lives of financial independence. The studies do not look at the community as a whole and how the communities can best use their limited resources to prevent homelessness. This is why even in times of low unemployment rates the homeless crisis is rampant.
Weakness
The proponents of Housing First believe that homelessness is, first and foremost, a housing problem, and homelessness can be solved by supplying more permanent housing within a community. The solution then becomes one of building more public and charitable housing. The limitations of this thinking are described well by the Manhattan Institute Report.
But claims that Housing First has been shown to end homelessness elide the distinction between evidence at the individual level and the community level. Housing First advocates’ rhetoric that investing in permanent supportive housing will end homelessness raises hopes of ending homelessness at the community or national level. For example, Los Angeles County’s Measure HHH, which authorized $1.2 billion in bonds to build thousands of permanent supportive housing units, had the working title “Housing and Hope to End Homelessness.” However, as noted above, California’s experience has been increased investment in permanent supportive housing and increased homelessness. Given that, according to advocates, hundreds of localities have adopted Housing First, one might have expected at least a handful of examples of communities where Housing First has eliminated or drastically reduced homelessness in a manner noticeable to the broader public. That has not been the case.
Officials in New York and Los Angeles continue to embrace the goal of ending homelessness, as did some candidates for the 2020 Democratic presidential nomination. But no community has truly ended homelessness using Housing First, and certainly not any community facing crisis-level homelessness. We would not say that a community has ended murder based upon a qualitative analysis of its police department, but rather the absence of murder. If ending homelessness must remain the goal of homelessness policy, governments should define success in a way that can be independently verified by the public. The public can observe homelessness. It cannot easily observe and analyze service systems’ capacity and competence. Thus, ending homelessness should mean the absence of homelessness, as observable to members of the public.
Laws of the Land
Here is a list of behavioral attributes – should they be against the law?
- Loitering in Public
- Defecation on the streets
- Sleeping on the streets
- Camping in public places
- Public Intoxication
- Dangerous behavior from mental illness or addiction
- Open drug use
- Open drug dealing
Laws enforcing citizen behavior standards are diverse across the country. Some states and localities enforce virtually all the items on the above list; others enforce almost none. Cities such as Portland, Seattle, San Francisco, and Los Angeles enforce only the laws concerning dangerous behavior. Most walk a fine line between attempting to protect their communities’ vibrancy and safety while respecting and protecting the homeless. Most do not allow extreme public intoxication, dangerous behavior, or open drug use in their cities. These are met with arrests with repeat offenders facing jail time or other social services interdiction.
When camping and intoxication are allowed on the streets, the homeless problem is visible and directly impacts residents. The laws and the enforcement of the laws are a local choice of the citizens. All such laws are passed at the state, county, and city levels. The federal government is not involved. The argument for lax regulations and enforcement is done out of respect for the homeless. The thought is they have nowhere to turn and should be treated with deference. The idea for strict behavior laws and enforcement is that everyone benefits, including the homeless. The thought is that standards of behavior are essential for all people, including the homeless. When the standard fails, the state then has the power to intercede to impose social services.
Housing First policies do not specifically address or recommend laws related to public behavior. But the “No Strings Attached” policy has indirectly encouraged leniency on behavioral standards of the homeless.
The tough love issue
Here are excerpts from an article interviewing Denver Mayor Michael Hancock by Sharon Boyd of CBS News:
“When you approach people with housing-first, which I think is a laudable very important step for people who are ready to be housed, you can’t do that with people who are dealing with an acute mental health challenge or are sick with substance abuse disorder. You have got to have a suite, a variety of services, that meet people where they are,” he said. “That’s what we’ve been trying to do here.” It’s working for many. But some, he says, will never get treatment voluntarily.
“We are bounded by laws that say you can’t make somebody take treatment. We also have to take a look at our laws and say how can we compel people to get treatment,” Hancock said. He has lawyers looking into involuntary commitment in some cases and calling on the legislature to pass a law allowing police and outreach workers to force some into treatment.
HUD Position on Housing First
In contrast, here is the position of the definitive document on Housing First from the Department of Housing and Urban Development (HUD):
* Homelessness is first and foremost a housing crisis and can be addressed through the provision of safe and affordable housing.
* All people experiencing homelessness, regardless of their housing history and duration of homelessness, can achieve housing stability in permanent housing.
* Everyone is “housing ready.” Sobriety, compliance in treatment, or even criminal histories are not necessary to succeed in housing.
* Many people experience improvements in quality of life, in the areas of health, mental health, substance use, and employment, as a result of achieving housing.
The HUD document never addresses the laws of the land or what to do about forced treatment in cases where the individuals cannot help themselves. However, the overall leniency of getting everyone into housing with no conditions is built on the premise that homelessness is a housing problem, with no consideration of personal responsibility. Those supporting Housing First would point out that this is a question of wrap-around services, not housing. However, the reality is that communities adopting Housing First generally adopt leniency on behavior laws and personal responsibility. This is the current dilemma in the war on homelessness.
Conclusion
All Americans are concerned about the homeless. We worry about them; we want to help. We hope our government and our charities are solving the problem. Some of us see the homeless every day, leading lives of desperation. Others of us only encounter the homeless in the news or on social media. We all wonder why the problem is so pronounced and challenging to solve. The answer to that question should start by reviewing the Housing First policy. A review of its goals, history, and controversy is a microcosm of the complex problem of homelessness and why it prevails in a nation spending billions fighting it. It shows we haven’t mastered how to help our fellow man effectively. It shows the difficulty of how to mix big hearts with tough love. It demonstrates how divergent public opinion makes change and progress difficult in a divided nation. So, Housing First marches on, and unfortunately, so does homelessness.
[i] The Heritage Foundation. The “Housing First” Approach Has Failed: Time to Reform Federal Policy and Make it Work for Homeless Americans. August 4, 2020. Available here.
[ii] USGovernmentSpending.com [Internet]. Total for Housing Assistance, Homeless Assistance Grants. Retrieved March 15, 2023. Available here.