“housing first” approach to homelessness

Politifact (prompted by an appearance of HUD Secretary Shaun Donovan on The Daily Show)  just did a detailed cost analysis of something I’ve been meaning to cover for some time — the “housing first” approach to helping the homeless:

Pioneered in the 1990s in New York City, it puts street dwellers in publicly subsidized rooms of their own and connects them with drug treatment, job placement and psychiatric services with the goal of stabilizing their lives. Unlike many treatment programs, housing-first initiatives don’t require participants to get sober first.

“Housing first is a kind of ‘come as you are’ approach. We encourage folks to accept services, and as a result people change their behaviors,” said Brenda Rosen, executive director of Common Ground, a housing-first homelessness program in New York City.

The approach succeeds and saves money, advocates say, because it targets the chronically homeless — those who have been homeless for a year or more and commonly suffer from addiction or mental illness. That segment of the homeless population uses expensive public services at very high rates — emergency rooms, police and fire, and courts.

According to Politifact, former homelessness policy czar under George W. Bush, Philip Mangano, analyzed homelessness costs and housing first costs across many cities.

“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,” he said.

Other studies have also shown drastic reductions (up to 80%) in hospital visits, detox visits, and incarceration rates.

What’s more, a study from the Journal of the American Medical Association shows that savings increase over time as a person stays housed longer.  Additionally, despite the lack of rules around substance use, alcohol consumption decreases over time.

Housing first programs have a high tenant retention rate — often around 80% for 6 months.  It was largely the push for such programs that led to an impressive drop or 30% in U.S. homelessness rates from 2005 to 2007.

Elizabeth Epstein, research professor at the Center of Alcohol Studies at Rutgers University in New Jersey, disputes that approach. She says alcoholism is an addiction that is not irreversible and that putting people together in a drinking environment makes it much harder for them to quit.

“Honestly, the idea doesn’t make any sense to me,” she says. “I think that money would be better spent by providing them treatment and not allowing them to drink in their living quarters.”