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Helping the Homeless: The Complex Reality of Simple Solutions

There are lots of ideas out there for bringing the numbers down. But so far nothing seems to work better than simply getting a roof over their heads, even if it’s only a dilapidated motel room.

A homeless person sleeping on the lawn next to Los Angeles’ City Hall.
A homeless person sleeping on the lawn next to Los Angeles’ City Hall. The city’s new mayor has a program that aims to move 17,000 of the unsheltered off the streets within a year. (David Kidd/Governing)
Many years ago, a senior member of Congress told me something provocative and slightly poignant. “The things I believe in are really very simple,” he said. “They’re just terribly difficult to achieve.” He didn’t lay out the specifics. I think he was talking about health care. But I’ve remembered it ever since.

It’s a description that applies to many of the policy dilemmas of today — simple enough, but seemingly intractable. A lot of experts who study homelessness believe something similar about it: The problem is that we lack affordable housing. If we took down the regulatory barriers that are blocking new housing construction, they argue, we could make a serious improvement in the homeless problem in the United States.

I’m not sure I believe that, for reasons I’ll explain later. But one thing about homelessness is relatively simple. We have good numbers. We don’t have to guess about those. We know the statistics because of the existence of AHAR, the Annual Homeless Assessment Report compiled for the Department of Housing and Urban Development. AHAR isn’t perfect, but it tells us a lot of the things we need to know if we are to do something meaningful about the homelessness predicament in our cities.

When the AHAR people undertook their most recent national assessment, they found about 582,500 people living homeless. Some 60 percent were in shelters; the rest were in makeshift camps or out on the street. Nearly 30 percent were considered chronic cases, usually meaning they had been without a home for more than 12 months and suffered from a diagnosed disabling condition, such as mental illness or drug addiction. But more than half the sheltered homeless had worked at some point during the previous year, and, perhaps surprisingly, 40 percent of the unsheltered had done so as well. Still, the number of homeless on the streets had increased over the previous couple of years, as concern spread that shelters were a source of COVID-19 and other serious diseases.

THOSE WHO CLAIM that these numbers reflect a simple problem, or one with an easily defined solution, are simply wrong. Homelessness in America is due to a confluence of factors, including the closing of in-patient mental institutions without the promised replacement of community treatment centers, the demolition of single-room-occupancy apartments in urban areas, and the overall wage stagnation across the country in the last half-century.

The most common proposed solutions fall into two basic categories: “Continuum of Care” and “Housing First.” They are sometimes described as alternatives, but often they turn out to be complementary.

Continuum of Care is the model that has traditionally prevailed. It is conventionally described as the work of a planning body that coordinates housing and services funding for homeless families and individuals. It is based on the idea that no one intervention — not housing, not counseling, not job training, not medication — is going to do much alone.

Continuum of Care has led to the identification of homelessness as a billable medical issue. That may make logical sense, but critics have long pointed out not only that it’s impractical to treat so many problems together but that it imposes unreasonable amounts of red tape in evaluating who can benefit from help. In Norfolk, Va., to cite just one example, applicants for help have been administered a battery of 27 questions that includes such things as “Has your drinking or drug use led you to be kicked out of an apartment?” The more questions answered affirmatively, the better the chances of getting assistance. Meanwhile, countless needy homeless people are denied any help at all, other than a bed in a shelter.

It’s only in the last decade or so that local agencies have begun using an entirely different and deceptively simple approach, Housing First, based in part on the ideas of the mid-20th-century psychologist Abraham Maslow, who posited a hierarchy of human needs, with the ones on the bottom rung necessary for someone to reach the higher stages. Applied to homelessness, this often means providing the homeless with a decent roof over their heads and worrying about treatment later.

Developed in large part by the social scientist Sam Tsemberis and the longtime federal administrator Philip Mangano, Housing First has been tried in a growing number of American cities. It still requires cooperative landlords and often employs case managers and other Continuum of Care strategies, but the housing itself comes before anything else. Some of the communities that have tried it have reported remarkable results. Utah County, which includes the city of Provo, has reported that 87 percent of Housing First clients were maintaining their housing for at least a year and that chronic homelessness had declined by 50 percent over several years.

But Housing First has its detractors as well: They argue that it amounts to putting people away in boxes, outside the scrutiny of the urban middle class, and does little to address their underlying pathologies. “The cycle of homelessness isn’t broken by temporarily putting a roof over someone’s head,” critic Kerry Jackson wrote. “More than housing, the homeless need to overcome the disorders that in a real sense chased them into the street.” Housing First, in his view, subsidizes the disorders that are the root causes of homelessness. Jackson and other critics argue that whatever Housing First may have accomplished in Provo and a select number of cities, chronic homelessness in the nation as a whole has increased by about 15 percent in the past eight years.

ALL OF THIS BRINGS US BACK TO THE SIMPLEST SOLUTION: more affordable housing. Most of the homeless are not mentally ill. If we started dismantling the regulatory barriers that prevent affordable units from being built, so it is argued, the numbers would start heading dramatically downward. This notion has gained increasing traction in the last couple of years, but there are reasons not to buy it.

Those reasons have been addressed most cogently by Alan Mallach, the widely respected urbanist who is a senior fellow at the Center for Community Progress. “Removing regulatory hurdles moves the needle a little,“ Mallach wrote recently, “but a lot less than many people believe. … Prices have to fall a long, long way before they become affordable to even working-class people.” The homeless, Mallach added, “don’t have enough money to afford housing even at the bottom of the market.” He insists that the only practical response at this point is a dramatic increase in the number of government housing vouchers, available to the homeless with few or no strings attached.

This debate is taking place at a moment when public officials at all levels are scrambling to come up with something that might work. President Biden pledged recently to reduce homelessness by 25 percent in two years, in part through Housing First. Gov. Gavin Newsom of California has put forward a program that will spend $12 billion over five years, with much of the money directed into temporary housing and many of the chronic homeless placed into a form of conservatorship.
Tents housing homeless people along a walkway in Los Angeles.
Tents housing homeless people along a walkway in Los Angeles. (David Kidd)
But Ground Zero in the current campaign against homelessness is Los Angeles. On the day Karen Bass took over as mayor in December, she proclaimed that relieving homelessness was her first priority. The numbers backed her up. In per capita terms, L.A. has the nation’s most pervasive homelessness problem: 42,000 people at last count, more than 25,000 of them chronic cases.

Bass quickly launched Inside Safe, a program to move 17,000 people off the streets in the first year. She vowed that 4,000 of them would be housed during her first 100 days in office. By mid-March, there were tokens of success: Inside Safe had moved 945 of the homeless indoors. It didn’t come close to hitting the target, but it was a beginning.

But there were problems. Most of those in the program were moved into motels, some of them far from the neighborhoods they wanted to live in. Some of the motel rooms lacked basic conveniences such as soap and linens. The goal was to get the motel-dwellers into permanent housing as soon as possible, but at least it was a step forward. “You get people off the street right away,” Bass said, “which is where you get a motel.” She said the early returns refuted the notion that the outdoor homeless actually preferred living on the street.

Inside Safe is designed to add some forms of continuing care into the housing process — a melding of Continuum of Care and Housing First. “We will not solve the problem,” Bass concedes “if we do not address mental health and substance abuse.” But the first priority has been to get the program’s clients inside, even if it happens to be inside a dilapidated motel room.

Housing First isn’t perfect. But an examination of the record seems to suggest that it works better than anything else that has been tried so far. To paraphrase Abraham Maslow, you have to start somewhere. Often that’s the bottom.
Alan Ehrenhalt is a contributing editor for Governing. He served for 19 years as executive editor of Governing Magazine. He can be reached at
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