Housing First, Employment and Health Second

The concept behind the “Housing First” movement is to provide unhoused individuals with free or extremely discounted housing, without first requiring that they find employment or receive any medical or mental health services. Obviously, since the vast majority of people pay a lot of money for their own housing, this quickly becomes a controversial issue.

The Issue

There are estimated to be more than 550,000 homeless individuals in the United States. In 2019, New York City spent $3 billion to support its homeless population, while California plans on spending $4.8 billion to addressing homelessness over the next two years.

According to one study, each homeless person costs the public on average about $36,000 annually. A founding member of the Housing First movement estimated that in many individual cases, the cost per person can be well over $50,000. These expense figures include costs associated with running shelters, providing food, emergency medical care, and policing, among other things.

Why Put Housing First?

When a person is on the street, their primary concerns are about physical safety and food. Although 20% of the homeless population is dealing with a mental health disorder and 16% are suffering from chronic substance abuse issues, these critical needs become secondary to survival.

It’s extremely difficult when you don’t have a home to focus on working through past traumas, depression, or anxiety, tracking your insulin levels, remembering to take medication on a routine basis when you don’t have a way to tell what time it is, or having the energy to go around filling out job applications when most of society literally doesn’t even want to look at you.

It was this realization that led proponents of the Housing First movement to start insisting that we change how we prioritize things, placing housing before an insistence on securing a job or taking care of one’s health. Consider also that it’s often the stresses associated with being homeless that may lead a person to want to use alcohol or other substances in the first place, in order to escape the reality of what their life has become.

The idea is that once a person feels safe, they can more easily address their other needs. Instead of staying up all night fearful of being assaulted, they can get some sleep, feel rested, and then during the day spend some time addressing their sobriety, mental health, physical health, and employment.

Can it Work?

In 2005, in the State of Utah, there were 1932 chronically homeless individuals. Ten years later, following institution of a Housing First model, that number dropped 91% to 178 homeless individuals.

In an interview about the program, it was explained that their approach is to first provide people with a place to live and then help them to work on the issues that led to their being homeless in the first place. They went on to say that it’s not a house them and forget them approach. Having a clean and safe place to live makes people healthier, reduces their medical needs, saves taxpayers money, and decreases stress levels, making it easier for the now formerly homeless to work on issues such as treating a medical condition or finding a job. Besides, most employment applications require an address.

But, giving away housing must be expensive… right? Well yes and no. It is expensive, but studies have shown that homelessness is often more expensive.

According to figures from Utah, it costs $19,208 per year to address the needs of each homeless person. This includes things like emergency room visits and calls to EMTs, stays in shelters, and time spent in jail. Because of their desperate situations that include living outdoors in all kinds of weather and in unsanitary conditions they tend to get sick more, and being homeless it’s almost certain that they won’t have health insurance. They also get more desperate and may end up being arrested for stealing food.

Still in Utah… providing housing and a case manager can cost as little as $7800 per person per year. Also consider that a house or apartment can be used year after year and thus the cost of purchasing housing gets spread out over time, whereas the cost to care for a person living on the streets is an ongoing and indefinite expense.

Results

One study found that 79% of Housing First participants were in stable housing after a six-month period. A second study found that 41% more Housing First participants remained housed after a five-year period than those in traditional programs aimed at addressing homelessness. Other studies have yielded similar results.

That said, a separate study prepared for HUD (US Department of Housing and Urban Development) suggested that while it may be more successful in achieving stable housing when compared to traditional programs, providing free housing can obviously be more expensive depending on how long that housing is provided.

Conclusion

Many people consider Housing First to be counterintuitive. The idea is that a person needs to earn their home or at least be in a frame of mind to take full advantage of the opportunity. Others argue that giving a home to someone for free when they’re paying for their own home simply isn’t fair and they worry that it may cause others to feign need in hopes of acquiring their own home for free.

But, let’s consider the type of home we’re talking about. A free home will not be of the same quality that someone with a full-time job would likely have. In other words, you’re paying not only for a roof over your head, but for all the amenities that make your place a home. If someone offers you a home for free, it’s going to be very basic. It’s also going to be a temporary situation. Plus, it means that you’ve had to endure a life on the streets for months or years before you’d be eligible.

Nobody is given a free luxury home. They’re simply given a small place to stay while they work towards self-sufficiency. In the meantime, the public is saving money, which means that tax dollars could in theory be redirected to other areas. It may not be a perfect plan and there are certainly issues that need to be worked out, but so far Housing First programs appear to be showing some potential.