and a corollary

Save Money – Treat, Rather Than Criminalize, People Diseased With Substance Addictions

“Ironically, ending homelessness is actually cheaper than continuing to treat the problem. “It’s not a matter of whether we know how to fix the problem. We have the cure for homelessness—it’s housing. What we lack is political will.” “Going from homelessness into a home changes a person’s psychological identity from outcast to member of the community. The old model was well intentioned but misinformed. You actually need housing to achieve sobriety and stability. Not the other way around.” Sam Tsemberis, Psychologist, New York University

“If you want to end homelessness, you put people in housing. This is relatively simple.” “Homelessness is stressful. It’s nearly impossible to get off drugs or battle mental illness while undergoing such travails.” So, to in part cut costs but also to save lives, the state started setting up each chronically homeless person with his or her own dwelling.” Gordon Walker, Utah State Director, Housing and Community Development Division

Using data from the 65 cities — of all different sizes and demographics — the cost of keeping people on the street added up to between $35,000 and $150,000 per person per year. Conversely, after the housing-first programs had been established, the cost of keeping formerly homeless people housed ranged from $13,000 to $25,000 per person per year. “We learned that you could either sustain people in homelessness for $35,000 to $150,000 a year, or you could literally end their homelessness for $13,000 to $25,000 a year.” Philip Mangano, Homelessness Policy Czar under President George W. Bush

Homelessness is, to say the least, a multifaceted and difficult problem. Poverty, the lack of living wage jobs, mental illness, and the diseases of drug addiction and alcoholism all play a part. Solving these issues has proved intractable for even the most capable political, civic, religious and philanthropic leaders. And yet, most of the traditional approaches to solving the problem of homelessness have placed the burden on the shoulders of those least capable of dealing with the issues – the homeless.

Before being provided for or given shelter the homeless must overcome drug addiction, must overcome alcoholism, must overcome mental illness, must be employed, and on and on. But as the research shows, it is virtually impossible to overcome these problems while homeless. It flies in the face of simple common sense.

But there seems to be a perverse, vindictive human need to criminalize people for being homeless, to punish them for having terrible diseases of addiction, to blame them for the lack of true, living wage, healthcare providing jobs. It is almost bizarre. As the quotations above indicate, we as a society are willing to spend more to punish, criminalize and incarcerate the homeless, the mentally ill and the addicted, than what it would cost to treat and house these individuals. We are willing to spend more on multimillion dollar prisons than less on treatment centers and low-cost housing. To add to the societal insanity, punishing, criminalizing and incarcerating are proven failures in resolving the problems, whereas treating and housing show a fair degree of success.

Pragmatism is beginning to take root in growing areas of the country. The “Housing First Program,” which has been implemented in places as diverse as Utah and New York, is proving to save money while at the same time actually helping resolve the problems. Much is being written and studied on the subject, but one of the clearest presentations is this from the National Alliance to End Homelessness:

What is Housing First?

Housing First is a homeless assistance approach that prioritizes providing permanent housing to people experiencing homelessness, thus ending their homelessness and serving as a platform from which they can pursue personal goals and improve their quality of life. This approach is guided by the belief that people need basic necessities like food and a place to live before attending to anything less critical, such as getting a job, budgeting properly, or attending to substance use issues. Additionally, Housing First is based on the theory that client choice is valuable in housing selection and supportive service participation, and that exercising that choice is likely to make a client more successful in remaining housed and improving their life.

How is Housing First different from other approaches?

Housing First does not require people experiencing homelessness to address the all of their problems including behavioral health problems, or to graduate through a series of services programs before they can access housing. Housing First does not mandate participation in services either before obtaining housing or in order to retain housing. The Housing First approach views housing as the foundation for life improvement and enables access to permanent housing without prerequisites or conditions beyond those of a typical renter. Supportive services are offered to support people with housing stability and individual well-being, but participation is not required as services have been found to be more effective when a person chooses to engage. Other approaches do make such requirements in order for a person to obtain and retain housing.

Who can be helped by Housing First?

A Housing First approach can benefit both homeless families and individuals with any degree of service needs. The flexible and responsive nature of a Housing First approach allows it to be tailored to help anyone. As such, a Housing First approach can be applied to help end homelessness for a household who became homeless due to a temporary personal or financial crisis and has limited service needs, only needing help accessing and securing permanent housing. At the same time, Housing First has been found to be particularly effective approach to end homelessness for high need populations, such as chronically homeless individuals.

What are the elements of a housing first program? Housing First programs often provide rental assistance that varies in duration depending on the household’s needs. Consumers sign a standard lease and are able to access supports as necessary to help them do so. A variety of voluntary services may be used to promote housing stability and well-being during and following housing placement.

Two common program models follow the Housing First approach but differ in implementation. Permanent supportive housing (PSH) is targeted to individuals and families with chronic illnesses, disabilities, mental health issues, or substance use disorders who have experienced long-term or repeated homelessness. It provides long-term rental assistance and supportive services.

A second program model, rapid re-housing, is employed for a wide variety of individuals and families. It provides short-term rental assistance and services. The goals are to help people obtain housing quickly, increase self-sufficiency, and remain housed. The Core Components of rapid re-housing—housing identification, rent and move-in assistance, and case management and services—operationalize Housing First principals.

Does Housing First work?

There is a large and growing evidence base demonstrating that Housing First is an effective solution to homelessness. Consumers in a Housing First model access housing faster and are more likely to remain stably housed. This is true for both PSH and rapid re-housing programs. PSH has a long-term housing retention rate of up to 98 Studies have shown that rapid re-housing helps people exit homelessness quickly—in one study, an average of two months—and remain housed. A variety of studies have shown that between 75 percent and 91 percent of households remain housed a year after being rapidly re-housed.

More extensive studies have been completed on PSH finding that clients report an increase in perceived levels of autonomy, choice, and control in Housing First programs. A majority of clients are found to participate in the optional supportive services provided, often resulting in greater housing stability. Clients using supportive services are more likely to participate in job training programs, attend school, discontinue substance use, have fewer instances of domestic violence, and spend fewer days hospitalized than those not participating.

Finally, permanent supportive housing has been found to be cost efficient. Providing access to housing generally results in cost savings for communities because housed people are less likely to use emergency services, including hospitals, jails, and emergency shelter, than those who are homeless. One study found an average cost savings on emergency services of $31,545 per person housed in a Housing First program over the course of two years. Another study showed that a Housing First program could cost up to $23,000 less per consumer per year than a shelter program.