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More housing isn’t the solution to homelessness — it’s treatment

A homeless man sleeps in Macy's department store in Herald Square in Manhattan.

Stephen Yang

In a new paper, two University of California researchers claim that addiction and mental illness are not the cause of homelessness. Rather, the increasing number of people sleeping on the streets and in parks is merely due to a lack of affordable housing.

Having spent 13 years on the front lines running one of California’s largest programs for homeless women and children, and in five years of research since, I have found that the “Housing solves homelessness” myth has unequivocally devastated lives and communities and has squandered billions in annual taxpayer funding.

The Department of Housing and Urban Development rolled out Housing First — more aptly titled “Housing Only” — in 2013, promising it would eliminate homelessness within a decade. But HUD’s Annual Homeless Assessment Report paints a very different picture. Under Housing First, the nation’s unsheltered homeless population — largely those living on the streets — rose by 20.5%, despite a 200% increase in federal homelessness assistance spending in the decade leading up to 2019 and despite a 42.7% increase in the number of permanent housing units dedicated to the homeless during the 2014–2019 period. The new study claims that affordable housing, or a lack thereof, is to blame for a rise in homelessness. James KeivomIn California, the only state to have fully adopted Housing First in 2016, unsheltered homelessness grew by 47.1%, despite a 101% increase in spending and a 33% increase in the number of housing units dedicated to the homeless.

If we don’t fix homelessness, more New Yorkers will abandon the city All this occurred during a period of historically high economic growth accompanied by rapidly rising real wages. If housing alone were the key to solving homelessness, the unsheltered homeless population would have declined nationally and in California.

The theory behind Housing First is that the homeless cannot be helped unless they first have their own home. Once permanently housed, only then will the homeless accept services, such as substance abuse programs, counseling, work training and so on. Not only does this ignore the efficacy and cost savings of providing the homeless services in congregate living environments as is done in the program I ran for 13 years, it also ignores the foundational diseases with which the homeless largely struggle.

More than three-quarters of the street homeless are battling substance-use disorder and/or mental illness, and a majority of the addicted/mentally ill struggle with anosognosia — a deficit of self-awareness. To the surprise of few who understand these diseases, and who understand human nature, very few of the housed end up requesting services once they are comfortably housed and able to continue to engage in negative behaviors.

A homeless person sleeps in the ATM vestibule of a Chase Bank in Manhattan. James Keivom

What’s more, HUD defunded mental health, addiction counseling and employment-training services when it rolled out Housing First in 2013. Human wreckage and community wreckage have resulted.

Indeed, a 14-year-long Boston study completed last year revealed that the focus on housing rather than treatment and recovery saw impressive early results. But by year five only 36% of the housing recipients remained sheltered and nearly half of the cohort died due to a “trimorbidity” combination of medical, psychiatric and substance-use disorder.

The Housing First approach discourages behavioral changes and no longer funds the treatment the homeless need to address their underlying struggles. Moreover, it ensures that nearly everyone who enters the homelessness system stays in it, as they are provided subsidized housing for life, without any expectation of healing and work, ever.

Contrary to the title of the researchers’ new book, “Homelessness Is a Housing Problem,” the data have clearly revealed that Housing First — as a one-size-fits-all approach — does not work. We need a new approach — a human-first approach — that addresses the root causes of homelessness, which include trauma, untreated mental illness and substance abuse.

Michele Steeb is a senior fellow with the Texas Public Policy Foundation and oversees its initiative to transform United States’ and Texas’ homelessness policy. She is the author of “Answers Behind the RED DOOR: Battling the Homelessness Epidemic,” based on her 13 years of experience running Saint John’s Program for Real Change, a California-based program for homeless women and children.


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