Monday, March 14, 2016

Why Housing First?

Why Housing First?

Why do the supporters of Housing First believe that substance abuse should not be a bar to housing?
The Housing First model originated with a psychologist who discovered that people in housing stabilize more often than people not in housing. He discovered this before 1992, and his name is Sam Tsemberis1.

The Housing First model is really pretty simple:

...provide housing first, and then combine that housing with supportive treatment services in the areas of mental and physical health, substance abuse, education, and employment. Housing is provided in apartments scattered throughout a community. This "scattered site" model fosters a sense of home and self-determination, and it helps speed the reintegration of Pathways clients into the community.2

Pathways to Housing (Tsemberis’ organization) claims a housing retention rate of 85-90%.
Mentally ill and substance-abusing patients adhere to therapy better; tolerate housing better; and are less likely to commit crimes when housed.

Why?

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.”3

What’s different about the model, other than “put them in homes”?

The client participates in support services as long as they need them, but participation in a structured program is not a requirement for clients to keep their housing. Clients must only agree to meet with a member of their ACT team five times a month. Multi-disciplinary Assertive Community Treatment teams (ACT) provide clinical, vocational, and health services that are client-driven. These teams are available on-call 24 hours a day, seven days a week.4

Not every program that claims to be using “Housing First” really is using “Housing First.” This is a critical distinction. You can see from the above that the Housing First model means having support staff on-call 24/7. It means support is client-driven, not provider-driven.

We know that 88% of those who have housing in the “Housing First” model are likely to keep it. Only 47% of those not in that model are likely to keep it.

We know that the recidivism rate of former criminals is lower (by 71%) among those who are housed5. The study was conducted in Vancouver, B.C. Our own data over the last few years show this trend is real; the number of days spent in jail is reduced by 66%6 (6 months housed vs 6 months prior to housing).

The South King County pilot project7,8 showed a reduction in jail bookings (not the same as jail time), and drug and alcohol use was reduced.

Further, we know that Housing First, applied to the mentally ill and substance abusers, is cheaper than leaving them to live on the streets. This is seen in Utah, Florida, Seattle, Vancouver, Los Angeles. The amount saved per person housed depends on many variables, however. A Vancouver study, published in JAMA in 20159, found no difference in quality of life at 2 years, but substantial cost savings ($14k vs $22k, per person).

It is only common sense that the Housing first model could be appropriately applied to the disabled, the elderly, the infirm, and the chronically ill as well as to the mentally ill and to substance abusers. In a sense, the most vulnerable of the most vulnerable truly need the protection of homes. In addition, all of the homeless are experiencing degradation of their health. This is an inevitable result of living in the weather. And, to be honest, most of the homeless would be happy with substandard housing – it’s better than the streets, the tents, the cardboard boxes. They’d gladly accept a large waterproof box with a locking door, if they and they alone had the keys.

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