Housing first is a model to end homelessness that places individuals and families in permanent housing without barriers or pre-conditions. It addresses the most basic need of all persons experiencing homelessness: a lack of stable, permanent housing.
Stated as such it seems an easy enough solution, were it not for the sheer lack of affordable housing in major metropolitan areas and high rates of addiction and mental illness among the chronically unhoused. And between rent increases and rising inflation, maintaining stable housing in the U.S. is a challenge for a growing number of individuals and families. It begs the question: Is Housing First an effective policy to pursue, or is there another path to follow as we seek solutions for the rising number of homeless in the U.S.?
Central to Housing First “is a homeless assistance approach that prioritizes providing independent, permanent housing to people experiencing homelessness.”
When your next meal is uncertain or you don’t know where you’re going to sleep the following night, most of your energy goes toward meeting those immediate, basic needs. There is no time to consider filling out job applications or putting aside savings for an apartment. Stable housing eliminates the need to think only in the immediate sense and allows individuals (and families) time and safety to plan for a better future or recover from addiction or mental illness.
Housing First is also choice-based and flexible; it’s up to the individual to choose what types of services or assistance they may need. The root causes of homelessness are many, and so the solutions must be as well. It’s not uncommon to see Housing First followed by the phrase, ‘but not housing only’ to reflect this multi-faceted approach.
To implement a Housing First approach to ending homelessness, a program must adhere to its five core principles. Many organizations have their own phrasings and exact definitions, but all must follow this basic premise:
Without one of the above principles, Housing First is ineffective. Some organizations or policies may claim to have a Housing First-based system, but do not include harm reduction or paths to recovery, which is essential to helping someone overcome addiction. Others neglect the importance of community. Fear of isolation can keep people experiencing homelessness from accepting housing. Supportive housing units can be spread out, so it’s essential to help someone build a social network and integrate into a community.
The idea behind Housing First is not new. What makes it stand out from other forms of shelter is that it skips over the linear model of housing. In the linear model, stays at an emergency shelter are followed by transitional housing, where there is a time limit attached to how long someone can stay. Only after taking these steps is someone ready to move into permanent housing. It’s also not uncommon for transitional housing programs to require residents to agree to certain behaviors and standards, also known as “housing readiness” requirements, which vary by state and program.
Permanent housing removes any time limits or conditions to housing. Studies show that the longer someone remains homeless, the more difficult it becomes to recover from mental health issues and addiction. Asking a person without a stable environment to first recover before moving into housing of any kind is a near impossible task.
Housing first understands that to best help someone, there needs to be a solid foundation on which to base recovery and build savings. It’s not “one-size-fits-all,” but a continuum of care that prioritizes choice and requires cooperation from a wide variety of services to be successful.
Just as Housing First is not one-size-fits-all, neither is how it’s funded. Two primary categories of funding are public and private. Private funding includes foundations that give grants to nonprofit organizations to provide services, unrestricted donations, and other similar gifts.
The most common type of funding is public, which can come from the federal, state, and city levels. At the federal level sits the State Department of Housing and Urban Development (HUD), the largest federal funder for homelessness programs. HUD gives a limited number of grants to community organizations that provide evidence-based housing services. As of August 2022, HUD plans to give “up to $43,439,000 to support approximately 4,000 new incremental vouchers” to end homelessness through a Housing First approach.
Individual states and cities can also determine where to allocate funds to address homelessness. In the past, much of the funding has gone to immediate solutions to move people from the streets into any sort of shelter instead of permanent housing. As it continues to prove itself an effective solution to homelessness, however, some cities and states are turning their attention—and funds— toward organizations and communities working from this model.
In short, yes. Housing First is an evidence-based model with numerous studies to back its efficacy. The population for whom these policies are most beneficial are those who are chronically homeless and people who have recurring mental health problems or addictions. When all five principles of Housing First work in tandem, rates of recurring homelessness among these individuals decline.
A study out of UC San Francisco’s Benioff Homelessness and Housing Initiative looked into a permanent supportive housing intervention in Santa Clara County. The authors found that 86% of the homeless population deemed “hardest-to-treat,” which the intervention prioritized, “were successfully housed and remained housed for the vast majority of the [three year] follow-up period.”
In 2021, a group of researchers completed a thorough review on the documented effectiveness of Housing First for persons with disabilities (both physical and mental). They concluded programs that follow a Housing First model “decreased homelessness by 88% and improved housing stability by 41% as compared to treatment first programs.”
And not only does implementing a Housing First policy work, but it also decreases the overall cost of addressing homelessness. Use of costly emergency services such as ambulance rides and emergency room visits goes down, as much as 50-75% according to the National Institute of Health (NIH), once someone receives stable housing. Overall, for every $1 invested into Housing First programs, we save $1.44, according to the Community Preventive Services Task Force.
Housing First is not without its fair share of challenges and critics. If nonprofit programs and organizations do not adhere to all five principles of the Housing First model, its effectiveness decreases and contributes to “evidence” that Housing First is a faulty solution. Though a large body of studies already exists, more are necessary to continue to prove Housing First works to receive adequate funding.
Lack of funding is already one of the major challenges of Housing First programs. It is a cost-forward model that requires more affordable housing units and supportive services in the short-term, but leads to a reduction in cost over time. But in response to the cost, some cities balk at the price and instead continue to direct funding toward emergency services and temporary shelters. Some also put in place bureaucratic processes that make it difficult for programs to connect individuals and families with permanent supportive housing units.
Community integration is also one of Housing First’s greatest challenges. Though a key component and principle, putting it into practice is easier said than done. Permanent housing units can be more spread out, separating individuals and placing them in unfamiliar communities.
NIMBYism (not in my backyard), is also making headway in communities where new affordable housing units are being proposed. This backlash slows the rate at which individuals can find housing, all the while more and more people are facing increased housing instability.
Critics like to point out that, besides not enforcing treatment for substance abuse and mental health disorders, Housing First only targets a portion of those facing homelessness. Many individuals and families are already housed and only need rental assistance to prevent homelessness. Housing First, on the other hand, gives priority to people already on the street. In these cases, preventative and temporary measures like Safe Parking Programs may be more appropriate solutions.
In many ways, Housing First is only a start. Yes, it gets people off the street and increases stability, but it does not address the root causes of homelessness, from chronically low wages to substance abuse to systemic racism to rising inflation and rental costs. To be most effective, programs that follow a Housing First model must also partner with other providers and advocates to work to prevent these root causes, lest the cycle continues.
Rationalizing the increasing number of homeless and the effectiveness of Housing First is not easy. It makes sense to question its efficacy, especially when states report the highest levels of homeless populations since modern homelessness first appeared in the 1970’s. But we must take into account that Housing First policies don’t stop someone becoming homeless and that the need for affordable housing is fast outpacing availability.
So, does Housing First work? For these individuals, the answer is a resounding yes.
After suddenly losing her job, Kimberly, with support from Friends of Boston’s Homeless, received housing and supportive services to begin a new career.
Roberta had a history of substance abuse and mental health issues but received permanent housing and the care she needed through PLACES, a housing-first organization in Dayton, Ohio.
James, who experienced homelessness himself, shares the story of a young man who encountered barrier after barrier to receive emergency services, highlighting the necessity of Housing First programs.
Affordable housing, increased funding, and an emphasis on preventative measures are necessary to bridge the gap to end homelessness. Housing First works, but it needs more support. It will take time to implement on larger scales and advocates who continue to push for its use, as well as cooperation between city leaders, private funders and organizations, and public services. Encountering challenges does not mean Housing First is not worthwhile, especially when it continues to serve the most vulnerable among us.
Housing First requires more tracking, coordination, and communication across providers and programs than ever before.
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