Sam Tsemberis came up with a novel solution to solving chronic homelessness: give people homes, no strings attached.
Homeless services once worked like a reward system. Kick an addiction, get a home. Take some medication, get counseling. But Tsemberis’s model, called “housing first,” said the order was backward. Someone has the best chance of improving if they’re stabilized in a home.
It works like this: First, prioritize the chronically homeless, defined as those with mental or physical disabilities who are homeless for longer than a year or have experienced four episodes within three years. They’re the most difficult homeless to reabsorb into society and rack up the most significant public costs in hospital stays, jail sentences and shelter visits.
Then give them a home, no questions asked. Immediately afterward, provide counseling, a step research shows is the most vital. Give them final say in everything — where they live, what they own, how often they’re counseled.
You can read more about the Housing First model at Pathways to Housing, the organization Tsemberis founded and runs. What's beautiful about Tsemberis' approach is how it comes from a place of empathy for the homeless, rather than distrust or disdain, which is how the current system of helping the homeless approaches them. First he realized that these were people with an inherent resourcefulness and strength, contrary to most people's opinions of them as lazy drunks and drug addicts.
And so, it perhaps came as a surprise when, in the early nineties, he took a job in New York City doing outreach for the mentally ill, which brought him into close contact with the homeless. He soon sank into their hidden world, noting the complexity of its social rules and survival tactics. How some experts perceived homelessness, he said he realized, was fundamentally flawed. This world’s denizens, in fact, were profoundly resourceful.
“We were equating the severity of diagnosis with ability to function,” he said. “But surviving in homelessness is labor intensive, exhausting and complicated. It calls for a skill set of functionality.”
By living among the homeless and understanding their plight, Tsemberis saw that the stress of being homeless is so great it is almost impossible to recover while living on the street.
Housing First was developed to serve the chronically homelessness who suffer from serious psychiatric disabilities and addictions. Traditionally, the chronically homeless live in a cycle of surviving on the street, being admitted to hospitals, shelters, or jails and then going back to the street. The stress of surviving each day in this cycle puts a tremendous amount of pressure on the individual’s psychiatric and physical health. “Living in the street,” one Pathways to Housing client said, “It makes you crazy.”
The traditional structures in place to “help” the homeless population often make things worse, particularly for those who suffer from mental illness. Shelters and transitional living programs often require people to pass sobriety tests and other hurdles before they can be considered for housing programs. Housing is considered a reward for good behavior instead of a tool to help stabilize a homeless-person’s mental health. This attitude cuts out the people who need the support the most, effectively punishing them for their conditions.
By following up housing with mental health treatment, Housing First has been able to keep the chronic homeless off the streets with a higher effectiveness than other models, at a lower long-term cost. Perhaps not surprisingly, the program cuts exactly along the fault lines of the debate between the Right and the Left on welfare.
Not everyone agrees. Although Housing First was adopted by the George W Bush administration, it remains unpopular on the right of the political spectrum, and not just among people who believe that citizens should “earn” state support. The initial cost of Housing First is expensive, and many people are resistant to the idea of providing housing for homeless drug addicts without first enrolling them on to a rehabilitative programme.
This strikes at the heart of the debate about the root causes of homelessness, which is fundamentally about two arguments, according to Nicholas Pleace, a housing policy expert at the University of York and researcher with the European Observatory on Homelessness, an arm of the European Federation of National Organisations Working with the Homeless (Feantsa).
“There is the idea of essentially structural causation: economic downturn, cuts to welfare, service and benefits, limitation with services with, for example, regards to mental health and the care system,” Pleace says. “But then you’ve also got what we call individual pathology, which tends to be argued by those on the right, more about individual actions, choice and characteristics.”
The article notes that former New York mayor Michael Bloomberg was one of those opposed to Housing First, instead using taxpayer money to give the homeless one-way tickets out of town. In the years he tried a series of moves to lower homelessness, the Coalition for the Homeless note that homelessness in NYC rose to all-time highs.
This is yet another reason having more affordable housing in our cities is imperative. The world is moving into cities, and the rate of housing construction is not keeping up. One flaw of Housing First is that it doesn't work unless such housing is available, and the Guardian article notes that it hasn't worked to reduce homelessness in Los Angeles. The scale of the problem in LA is so large that Housing First can barely make a dent, so little affordable housing is available to use as a base to work from.
I won't pretend to have studied all the research on this issue with any sufficient depth, but the initial story caught my eye for more than just its counterintuitive solution but for how it came about. Tsemberis assembled a team of outsiders to think through solutions from a point of empathy for the people they were trying to help.
There was need of a change. So he assembled a very small, very unusual team. None of them had any training in homelessness. They, too, were outsiders. One was a recovering heroin addict. Another was a formerly homeless person. Another was a psychologist. And the last, Hilary Melton, was a poet and a survivor of incest.
“We were people who weren’t that far removed from the people we were serving,” recalled Melton, who runs Pathways Vermont. And so, over long conversations, they fashioned the rough contours of what would become housing first.
Isn't that often how the most difficult of problems are solved, with fresh thinking from fresh thinkers and a radically different perspective or approach?