Housing First began when people asked: What if something else worked better?
“The world changes according to the way people see it, and if you can alter, even by a millimeter, the way people look at reality, then you can change the world.” — James Baldwin
By Tom Peterson
In the early 1980s, during the Reagan administration, a homelessness epidemic suddenly hit a scale not seen since the Great Depression. Many thought the problem was temporary, so the response was an emergency response: night shelters and soup kitchens, with much of the energy coming from the faith communities. The problem didn’t go away; in the following decades, the challenge of homelessness has seemed to intractable. But a few people began looking at it differently.
Tanya Tull — going beyond shelter
Tanya Tull sees things others miss. And then she creates based on what she sees. She has not only founded five nonprofits but she also began a began the “housing first” movement. This rapidly growing movement has its roots with Tull in the late-eighties in Los Angeles and with Sam Tsembiris the early nineties in New York City.
While in her early twenties — and after three months of receiving welfare — Tull became a social worker. She soon found herself working for a time in the Skid Row area of Los Angeles. She left that work to pursue a few other activites for a while. Then in 1979 she read a news article about hundreds of children living in the same Skid Row hotels she had known a decade earlier. She shifted her energy to found “Para Los Niños” to help those children. Later she founded an organization for housing in the area. And in 1988, she started “A Community of Friends” to create affordable housing in partnership with mental health agencies that provided services to the residents.
Knowing that shelters were not the long-term answer, Tull later founded Beyond Shelter to help homeless families find permanent housing. The idea was to place families in homes, and then provide the supportive services they needed to become self-sufficient. Beyond Shelter has gone on to develop affordable housing in low-income neighborhoods, along with support services for the residents. Tull’s approach is credited with helping thousands of families in Los Angeles County get permanent housing, and her institute has trained more than 1,000 people in the housing first model.
Around this time, as Sam Tsembiris wondered about the homeless people he passed as walked to work at Belleview Hospital in New York City. Tsembiris, too, became obsessed with the challenge and after a while he left Bellevue to become a street outreach worker. He knew the system for dealing with chronically homeless people was broken; before they could be rewarded with housing, people first had to deal with their addictions, mental illness and other challenges. It didn’t work.
Watching the never-ending stream of homeless people cycling from the street to treatment programs and hospitals and then back to the street, in 1992 Tsemberis gathered a small group to listen to the people they served. This led them to an approach similar to the one discovered by Tanya Tull: get the person into safe housing and then work with them on their other issues.
“We began taking people from the streets into an apartment of their own… nothing fancy but the privacy and dignity of being able to live not in a crowded shelter setting,” he told a TEDx audience. “There, they could cook and eat what they wanted, watch television, do what they wanted. Have dignity.”
As clinicians, “we had put aside our own beliefs about what was clinically possible for someone who has serious mental illness,” such as schizophrenia or bi-polar illness. “It turns out that our clinical expertise was discordant with what people wanted.”
Their approach had two parts: First, the group helped people find an apartment (with a rental stipend allowing the person to pay a landlord) and, second, they offered wrap-around service teams that would visit them in their homes. This helped with observation and helped the residents avoid going from one agency after another. “It seems, in hind sight, so simple that somebody who had to walk to the church program to get breakfast and then find a place where they could use the bathroom during the day and then walk another two miles to go to the shelter at night would do so much better in an apartment where the kitchen, bathroom and bedroom were all in one place. They had those survival skills all along, they just weren’t as evident to us.”
A proven model
As the early results began to be known, others tried the controversial model. Terrence McCoy writes in the Washington Post:
Success begat success. Several years later, the federal government tested the model on 734 homeless across 11 cities, finding the model dramatically reduced levels of addiction as well as shrank health related costs by half. “Adults who have experienced chronic homelessness may be successfully housed and can maintain their housing,” the report declared…
Homelessness has long seemed one of the most intractable of social problems. For decades, the number of homeless from New York City to San Francisco surged — and so did the costs. At one point around the turn of the millennium, New York was spending an annual $40,500 on every homeless person with mental issues. Then came Tsemberis, who around that same time unfurled a model so simple children could grasp it, so cost-effective fiscal hawks loved it, so socially progressive liberals praised it.
Today, Tsembiris is the CEO of Pathways to Housing, the organization he founded in 1993. His model has been replicated in more than 40 U.S. cities and is spreading internationally as well. The organization boasts that after three years, “85 percent of those people are still in their apartments, which is the highest success rate of any housing model that has been created.”
Besides saving taxpayers money, another side effect of permanent supportive housing for the chronic homeless is that it opens up the capacity of the shelters, feeding programs and other services there to help those who homeless temporarily.
“The mere formulation of a problem is far more essential than its solution, which may be merely a matter of mathematical or experimental skills,” said Albert Einstein. “To raise new questions, new possibilities, to regard old problems from a new angle requires creative imagination and marks real advances in science.”