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
Tsemberis.
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.
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.”
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.
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 housed.
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 months housed vs 6 months prior to housing).
The South King County pilot project
,
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 2015,
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.
Footnotes: