In the early 1990s, Pathways to Housing, a New York City-based nonprofit, launched what at the time was seen as a revolutionary approach to dealing with the homeless. Its "Housing First" model challenged conventional wisdom by offering "permanent supportive housing" without a requirement that homeless individuals participate in services such as chemical-dependency or mental-health treatment, although such services were available to those who chose to engage.
Over the years, as this low-barrier homeless-housing model was adopted nationwide, Housing First programs have reported that individuals tended to stabilize once housed. They were then more likely to engage in services that improved their health outcomes while reducing the financial drain on the criminal-justice, emergency-services and health-care systems.
Based on this experience, the Housing First approach has become a centerpiece of initiatives to end homelessness in communities across the country. Since 2007, Housing First has contributed to an 11 percent overall reduction in homelessness. The latest statistics from the U.S. Department of Housing and Urban Development (HUD) indicate that chronic homelessness decreased by 31 percent between 2007 and 2015. The number of homeless families declined by 12 percent over the same period, and homelessness among military veterans has dropped by 36 percent since 2009. Although cost-savings estimates vary, studies show that Housing First saves thousands of dollars per person every year.
But now, insufficient funding and a challenge from conservatives may make this a make-or-break moment for Housing First.
The Housing First model has enjoyed bipartisan support for over a decade. As part of his "compassionate conservative" agenda, President George W. Bush put the resources of the federal government behind an initiative to end chronic homelessness and made Housing First part of that effort. In 2002, Bush tapped Phillip Mangano, a Massachusetts Republican, to head the U.S. Interagency Council on Homelessness. Mangano remains a Housing First champion, insisting that it is the morally and fiscally smart response to homelessness. The Obama administration has built upon Bush's precedent with initiatives to end chronic homelessness as well as homelessness among veterans, youth and families.
A challenge to this consensus now comes from the political right. Kevin Corinth of the American Enterprise Institute (AEI), among others, has questioned growing public investments in the Housing First model. In a recent New York Times column, he argues that the Housing First approach "goes wrong when it says that housing for the chronically homeless must be permanent" and that "supportive services should be offered, but cannot be required." And in a new AEI paper, he further questions the extent to which permanent supportive housing "attracts more people into homelessness or keeps people homeless longer." Corinth suggests that expenditures should be better targeted to more rapidly transition homeless individuals into the private housing market.
Christy Respress of Pathways to Housing DC responds that nearly all Housing First residents do engage in services. "Because we're not telling people what they have to do, they are more open to accepting services," she said in a recent phone interview. And although self-sufficiency is everyone's goal, she points out, the chronic conditions that lead to an individual's homelessness can be ongoing and long-lasting.
Whereas Corinth questions additional public investment, others aim to secure adequate funding and scale it up. "We know what to do. We know how to do it," Mangano insisted at a recent AEI forum on the topic. "It's the scaling of the response so that it's adequate to meet the need." But funding is in short supply. Congressional funding to create 25,500 permanent supportive housing units is an immediate goal.
Jill Khadduri and Brooke Spellman of Abt Associates, a research and consulting firm focused on poverty reduction, call for strategically mobilizing resources to respond to the need, something Respress echoes. All three look to engaging non-traditional partners, such as the business community and hospitals, and leveraging other private and public funding sources.
It's clear that the investment pays dividends when it is made. Salt Lake City has effectively ended chronic homelessness, and the funding of federal HUD-Veterans Administration Supportive Housing vouchers beginning in 2008 has brought dramatic reductions in homelessness among veterans.
But if the bipartisan consensus on Housing First is breaking down, tough times may be ahead for those working to end homelessness. With so many successes to point to and the goal of putting the misery of homelessness behind us within reach, that would be a sad outcome indeed.