By Ben Goldson
In recent years, the “Housing First” model has become thrust to the forefront of the debate around homelessness, with its numerous advocates pointing to its apparent success in trial programmes. However, although this data is heavily weighted in its favour, Housing First has not escaped criticism from those less convinced of its reputation as the solution to chronic homelessness.
Developed in the late 20th century, Housing First has since won supporters across the globe. From its origins in the United States of America, the programme has been picked up by policymakers inside and out of government, who point to research, which appears to prove Housing First’s superiority over traditional models in the sector. At the same time, this rapid ascension has not come without criticism, which ranges in its severity. So far, these objections do not seem to have significantly impacted its popularity, which continues to grow due to its image as a kinder and more effective model of dealing with the underlying issues that drive people onto the street.
The term is itself credited to Tanya Tull, who, as a social worker based in Los Angeles during the late 1980s, was confronted by a surge in the numbers of homeless families. As a response, Tull created the Beyond Shelter organisation, offering an alternative to the segmented approach, which was predominant at the time. Based on a number of steps that eventually end in permanent housing, this model, which would be organised into local “Continuum of Care” bodies in 1995, inevitably entails a stay in homeless shelters, where residents are typically required to take part in treatment programmes before advancing to the next stage of their rehabilitation. Although these shelters no doubt save lives, they are not free from the dangers of homeless life. In practice, residents can get stuck in the system, trapped in between the demands and reality of the Continuum’s steps. Beyond Shelter, in contrast, provided permanent housing from the start, with the only requisite being that there was no immediate danger to a child’s life. This was a significant departure from the Continuum of Care, and while subsequent Housing First programmes did not stick religiously to Tull’s mission, they would be broadly informed by the upfront nature of Beyond Shelter.
A major milestone came in 1992, with the experiment reaching the academy by way of New York University psychologist Sam Tsemberis. Having created his own group, Pathways to Housing, Tsemberis would use the resulting data to codify the official Housing First model over the next decade or so. Unlike the pragmatic mission of Beyond Shelter, formed at the coalface as an emergency solution to the everyday problem of homeless families, Pathways to Housing was concerned with studying rough sleepers suffering from substance abuse issues, taking just under 250 of them in for a study conducted over the next five years. Their progress was contrasted against that of a control group of individuals being processed through the Continuum of Care, with the data forming the basis for a heavily cited study in 2000, which found that, although the control group participated more in their required rehabilitation programmes, the actual success rate of this captive audience was the same as their less restricted counterparts. Moreover, the latter were also more successful in the wider goals of either policy, remaining stably housed while their less fortunate peers struggled with the Continuum’s steps to permanent residence.
As a result, it appeared that the Continuum of Care’s critics had been right all along. With the new legitimacy obtained through peer-review, Housing First would soon attract the attention of the American government. In what appeared to be an unlikely partnership, the work of Pathways to Housing, which maintains that the core of his programme is the concept of housing as a human right, would be picked up by the Republican administration of George W. Bush. Facilitating this was Bush’s appointee to the United States Interagency Council on Homeless (USICH) Philip Mangano, who emphasised Tsemberis’ findings that participants in Pathways to Housing reported higher consumer satisfaction than the control group. This concept of rational choice reflected the Bush government’s wider promotion of market-based solutions to social problems that place an emphasis on personal responsibility, labelled “compassionate conservatism” by its advocates. Despite the immediate unity over Housing First, however, there remained a fundamental tension that reflected the contrasting agendas of those promoting it, with Mangano accused of using the new model as an excuse to close shelters and cut services while doctoring the resulting figures to show a 30 percent reduction in homelessness rates. Although these questions about Bush’s support for Housing First would remain unresolved by the time that he came to the end of his second term, the bulk of the evidence indicated that it did indeed work better than the existing orthodoxy. As a result, when a localised crash in the American mortgage market spread rapidly in late 2007, Housing First would eventually be selected as USICH’s best practice model for dealing with homelessness, a lucrative nod from the agency responsible for coordinating how more than five billion dollars is spent every year.
With millions of properties being foreclosed upon, outsider Democratic candidate Barack Obama overcame centrist frontrunner Hillary Clinton to lead the party to victory in the 2008 election. An early move was the passage of the Homeless Emergency Assistance and Rapid Transition to Housing (HEARTH) Act, which ordered USICH to create a nation-wide approach for dealing with Americans forced into the streets by the economic turmoil. Completed in 2010, the “Open Doors” strategy would enshrine the Tsemberis model in the administration’s response, which appeared to have had some success. When Obama left office at the conclusion of his second term in 2016, half a million people in the United States were estimated to have been experiencing homelessness, around a hundred thousand less than when he took office. While this fell far short of USICH’s ambitious goal of ending chronic and veteran homelessness by 2015, the results were still promising. Particularly sharp was the decline in people “unsheltered” by the system, with the number of individuals “sheltered” by the Continuum of Care remaining relatively steady. Since then however, these declines have plateaued under the administration of Donald Trump, while advocates raise concerns about the recent removal of Obama-era USICH Director Matthew Doherty and his replacement by Robert Marbut. A former AmeriCorps administrator for Texas governor Rick Perry, Marbut had left to forge a career as a private consultant to local authorities, with his self-described “velvet hammer” approach diverging sharply from Housing First. Instead, Marbut advocates for an entrenchment of the Continuum of Care model’s harshest features, most ominously the construction of large-scale homeless shelters away from populated areas, which activist group Invisible People likened to the more notorious centres where undocumented migrants are currently being detained on a mass scale by the Trump administration.
Although the future for Housing First in the United States may have dimmed for the time being, it had long since spread its roots abroad by the time that Trump took office. With programmes in place across the world, particularly in Europe, the programme is not going anywhere soon. Along the way however, the unresolved questions dating back to the Bush era have re-emerged. In a 2011 piece by Nicholas Pleace of the University of York, three main queries were raised, the first of which being exactly what Housing First means in practice. In his evaluation of various programmes claiming to implement the Tsemberis model, Pleace found that there were a various systems on offer, all of which claimed the title of Housing First. Along with this confusion, potential limits of the programme are also raised, particularly whether it places too great an emphasis on the notion that the causes of homelessness are personal, relating to issues such as substance abuse as opposed to societal reasons that people are unable to afford housing. Although Pleace does conclude that, in terms of policy, Housing First is an advancement, it is not the easy solution that it has perhaps been portrayed as by its more enthusiastic supporters. Whether or not this is deliberate, it does appear that the rush to denounce the Continuum of Care model has swept treatment up along with even voluntary programmes provided by the state to supplement Housing First.
Outside of these questions of ideology, Housing First’s greatest obstacle to ending homelessness remains the minor scale to which it has been implemented. To date, the largest programme appears to be the Department of Housing and Urban Development (HUD) partnership with the Veteran’s Administration, which issued around 90,000 of its clients vouchers for private housing in 2019. This example is something of an outlier however, drawing on greater public sympathy for homeless veterans, to the point where laws have been passed criminalising false claims of military service for material gain. As a result, the annual price tag of around US$10,000 per person is easier to accept when only extended to those who become homeless after serving in the armed forces. Behind the joint programme between HUD and the Veterans Affairs Supportive Housing (HUD-VASH) initiative, the next largest programme was a two-year study in Canada which monitored just 2,000 participants. Like most, the Cross-Site at Home/Chez Soi project was successful in its immediate aims, yet still only had a direct effect on a tiny minority of the globally unhoused, estimates of which range from the hundred millions to the billions if “inadequate shelter” is counted. With the resulting cost of universalising Housing First a daunting prospect for national governments, even when gathered into bodies such as the United Nations, there has been a heavy reliance on the twin forces of academia and philanthropy setting up small-scale programmes in the more affluent sections of the globe. While the results are promising, and have hopefully helped to dispel existing conceptions about homelessness, the unfortunate reality is that Housing First currently remains out of reach for the vast majority of those who need it, who are left to wait, perhaps indefinitely, for an immediate and permanent place to live.
Ben Goldson is a news and current affairs broadcaster at 95bFM radio in Auckland.