A Surprising Solution for the Chronically Homeless

There are over 80,000 chronically homeless people in the United States. These are not the homeless people or families who are temporarily housed in shelters prior to being helped by the government’s social services structure that is designed to bring them back into the mainstream of American life. Rather the chronically homeless are frequently people suffering from mental illnesses or who are addicted to drugs or alcohol. They are often living on the street, and move in a continuous cycle through jails, hospital emergency rooms and shelters. The Department of Housing and Urban Development defines a chronically homeless person as “a homeless individual with a disabling condition who has been continuously homeless for a year or more.” Anyone who has seen a homeless person on the street who appears disheveled and unaware of their surroundings can attest that their problems may seem impossible to overcome.

However, in 1992, New York was the first city in the nation to introduce a dramatic new solution to chronic homelessness called Housing First.  Up until that year, homeless people with substance abuse problems or mental illnesses were only provided assistance in stages. They would first be provided temporary housing in shelters or otherwise, but they would not be moved into permanent housing until they first progressed through therapy and treatment. In other words, the chronically homeless would need to prove that they were ready for permanent housing by first overcoming their disabilities. The Housing First program turns that strategy upside down. Housing First furnishes the chronically homeless with immediate access to permanent housing that allows individuals to live independently. Then they are provided treatment for their various conditions.

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Housing for the Homeless, NYC

For some lawmakers the idea of providing a homeless person who is mentally ill, or a substance abuser, with permanent housing may seem unrealistic and a waste of government funds. However, a 2001 study by the University of Pennsylvania seems to support the Housing First concept. The study tracked 5,000 mentally ill people in New York City for four years. The University of Pennsylvania researchers tracked homeless people with severe mental illness through official records of their use of jails, hospitals and shelters in New York City.  Each of the participants in the study needed to be living on the street for at least two years, and then they were provided with permanent housing for another two years. When the homeless participants were introduced to their permanent homes, they were then furnished with comprehensive health support and employment services. The study demonstrated that the success rate for the chronically homeless was higher when they were given the opportunity to live in permanent housing without first being provided with treatment for their mental illness.

An interesting conclusion reached by the University of Pennsylvania study was that it would not cost New York more than it was currently spending if it supported the Housing First approach. In 2001, the City was spending $40,500 a year for shelter, jail and hospital services for a mentally ill homeless individual. The lead author of the study, Dennis Culhane, concluded that “by putting those same dollars into supportive housing, the solution can pay for itself.”  In fact, if the study had included the full range of savings resulting from reduced use of New York and federally funded homeless services, it is likely that the cost of housing the homeless mentally ill could have proven to be a savings for the government. Some of such reduced costs include those associated with maintaining public spaces associated with street homelessness, operating drop-in centers and street outreach programs, as well as reduced costs for the police and the courts. Another benefit of the Housing First approach is the increased sense of safety within poor neighborhoods. In addition, because the rehabilitation of dilapidated buildings is one of the primary means of creating housing for the homeless mentally ill, the positive economic impact on poor neighborhoods can be extensive. Last, but not least, is the benefit to the mentally ill homeless, who might have an increased sense of dignity and improved social connection to the neighborhood.

More recently, Mayor de Blasio has been supporting the continuation of the Housing First approach to get people off the streets permanently. In 2016, the Mayor pledged to add 15,000 units of permanent housing in New York City over a period of 15 years, or in other words, 1,000 units per year. However, Mayor de Blasio is not just focusing on the chronic homeless with mental illness or drug dependencies. Instead the 15,000 units will be used for anyone living on the streets. Nevertheless, the Mayor is aware of how permanent housing can help the chronic homeless population, and he has also agreed to set aside an additional 267 units of permanent housing for that group. In agreement with the University of Pennsylvania study, advocates for the homeless in New York City say that the Housing First approach works for almost everyone who has experienced chronic homelessness when it is combined with supportive services.  Combining the chronic population with the rest of the homeless population on the street, could lead to there being “almost nobody on the street” according to Brenda Rosen, the president and CEO of Breaking Ground, which provides permanent housing for 2,700 residents in New York City. Already the success of New York’s program has been estimated to be 90%.  This success rate is based on the number of formerly homeless individuals who remain housed after being introduced into the program.

Finally, as suggested by the researchers in the related University of Pennsylvania study discussed above, significant funds can be saved by the City if it continues to adopt the Housing First approach. Focusing on the chronically homeless, who cost the City more money than other homeless groups, a study by Columbia University determined that New York already saves approximately $15,000 per participant. These savings are principally due to reduced jail time and reduced costs for inpatient and crisis health services, and there are significant benefits to the homeless individual as discussed earlier. In conclusion, the Housing First program has met with success in many other large cities across the country, including Los Angeles, Chicago and San Francisco, and a particularly positive development is that the program has started being adopted by smaller communities across the country too.