Author: Lucy Gao
July 18, 2024
The Housing First philosophy
Currently, 653,104 people are estimated to be homeless in the United States. Experiencing homelessness is not only the lack of housing, but also the loss of many other liberties that are typically taken for granted. Losing a home is a compounding issue that results in barriers in every single area of a person’s life. For example, it is difficult to get hired for a job without a place to clean and dress professionally. Furthermore, there are also many biases that people may have against those who are homeless, making obtaining a job even harder.
Besides countless other barriers that homeless people experience, at the root of it all is the commonality of being without a home. One solution to this is the Housing First Model. This approach believes that people should have secure housing regardless of if they currently have a job or have substance abuse issues. Like many other programs, Housing First programs also offer social services but participation or meeting minimum behavioral requirements are not necessary to keep one’s housing. This means that people have the safety of not only always having somewhere to sleep at night, but a private space to call their own which is not often available through standard shelters. Supportive services are integrated and available, but led by client choice which allows people to make their own choices regarding what they would like support with.
Housing is a Human Right
Housing as a human right is a central concept to the Housing First philosophy that has been documented in many United Nations documents.
A 2021 report from the current Special Rapporteur on the Right to Adequate Housing, Balakrishnan Rajagopal details adequate housing as having “secure tenure”, meaning that people should not have to worry about having their home taken away. He also describes living in a space that aligns with a person’s culture as well as having access to other amenities such as schools and employment. Housing is not only having a roof above your head, but the right to live in a home that provides both safety and dignity.
Outcomes
Research on Housing First efforts has shown several promising outcomes. Programs nationwide have been able to maintain high rates of housing in a population that was previously chronically homeless. In a review of 26 studies, compared to Treatment First services, Housing First programs have “decreased homelessness by 88% and improved housing stability by 41%”. Along with decreased rates of homelessness, studies have seen a similar decline in use of emergency services including jail stays, emergency room (ER) utilization, and ambulance use. There is an overall lessening of contact with the criminal justice system. This is not only beneficial for people that have received housing, but great news for the general public as well. Moving people into adequate housing that they are likely to stay in directly helps social workers, police officers, ER workers, and many other people who have daily contact with this population. Even further, the burden on jails and hospitals is alleviated, reducing public costs of supporting these social services. The amount saved per person in a Housing First program can range from $900 up to $29,400.
One such example of a Housing First program is the Downtown Emergency Service Center (DESC) in Seattle, Washington. The DESC provides a network of services encompassing remedying immediate situations and more long-term support. Some examples of emergency programs are same-day shelter beds, medical services, and crisis diversion services. More long-term programs fall under case management where people can utilize supportive housing, mental health/substance use disorder treatment programs, and employment services. DESC also helps people access scattered-site apartments as another option for housing. This variety of options allows people to choose which programs and support would best help them personally.
One specific program they have implemented is bringing medical services onsite at their housing locations. This has improved access to outpatient facilities for people who may face other barriers at established locations in the city. Accessing preventative care is key to lowering emergency department use and other downstream health costs. More specifically, 1811 Eastlake,one of DESC’s housing locations, has shown similar results as previously mentioned research - reducing utilization of public services totaling in annual savings of $4 million. By meeting people where they are, DESC has demonstrated several benefits of embracing a Housing First approach.
Although there are many promising Housing First programs and studies already in place, these will not be successful without funding. Namely, staffing shortages and physical housing demands are currently overwhelming the system, which causes delays in housing placement and worse outcomes. There is no magical wand that can instantly solve all the challenges years of a growing homeless population pose, but providing housing is a crucial first step to take. In the face of a burgeoning homeless population, U.S. housing policy should continue to turn towards Housing First programs that clearly provide a valuable resource of supportive programs paired with housing that can address this crisis at its roots.
Glossary
Housing First: a policy approach that prioritizes providing permanent housing quickly to people experiencing homelessness, and afterwards paired with additional supportive services and treatments
Scattered Site Apartments: apartments that are rented from private landlords and enriched with comprehensive case management services
Treatment First: homeless assistance programs that require participation in substance abuse services among other treatments before receiving housing
United Nations: an international organization with goals to maintain international peace and security