What is Housing First?
Housing First is an approach that prioritizes providing permanent housing to homeless individuals without any requirements before accessing or retaining such housing. Housing First’s primary goal is to remove homeless people from the streets or shelters to permanent government subsidized housing, while offering certain services to hopefully improve housing stability. Services such as treatment for mental illness and addiction diagnoses are not required. In fact, government subsidized ‘Housing First’ programs cannot mandate participation for substance abuse and mental health services, or they will lose funding.
Even before billions were allocated during the COVID-19 pandemic from 2009–2019, the federal government increased homelessness assistance spending by 200%. From 2014 to 2019, the number of rapid rehousing and permanent supportive housing units increased by 42.7%. Yet for that same period, the number of unsheltered homeless individuals increased by 20.5%
What is Treatment First?
Treatment First requires people to abstain from drugs and alcohol and adhere to treatment programs to become eligible for independent housing. A Treatment First approach typically provides evidence-based treatment programs that empower individuals to break free from the cycles of addiction, mental illness, trauma and homelessness. Participation is required, progress is monitored, and ongoing treatment is available and tailored to the individual’s needs. A big downside to the Treatment First model is that the success rates are low initially, relapse is common, and treatment is not available to everyone due to poor health care coverage and affordability.
What’s not working?
In 2013, the HUD declared that Housing First would solve the homelessness crisis and instead the unsheltered homelessness population is up 30 percent since 2013. According to a 2023 HUD report the number of Americans living in homeless shelters and on the streets increased to an all-time high. From 2014 to 2024 HUD’s policies have removed more than half of the 200,000 treatment-oriented transitional housing beds in communities throughout this country.
After 12 years of federal and state funding and implementation, it has become quite clear that Housing First and Treatment First strategies have been unsuccessful in reducing homelessness. Since the federal government began collecting data in 2007.The increase in homelessness between 2022 and 2023 was the largest ever recorded. Unfortunately in 2024 another record was set as homeless numbers increased again to over 770,000 in this country.
In a Treatment First model, millions of people struggling with life threatening illnesses are simply not afforded treatment. It’s also imperative that these at-risk individuals have a place to go after treatment or relapse is even more likely. At a minimum, Transitional Housing with ongoing supportive services must be made available for this model to be successful in the long term.
Summary
As standalone models, Housing First and Treatment First are clearly not working as over 60% of the homeless population suffers from either substance abuse and/or mental illness. Addiction and mental illness are treatable and manageable diseases with long term care, but there is no cure. So, simply providing shelter will not cure a disease. Providing treatment without continuing care and affordable housing is not working either. Neither model has been successful in helping human beings in the longer term. Operating independently of one another, these two models are short term stop gaps at best. Clearly, it isn’t the amount spent on the crisis that caused the failure of these initiatives, but the design of the policies and programs themselves.
According to a 2019 report from the University of California Los Angeles which analyzed data from 64,000 surveys, it was discovered that 75 percent of the unsheltered homeless have substance-abuse disorders. The study goes onto state that 78 percent of this population have mental health disorders, and 84 percent have physical health conditions.
The numbers do not lie. The United States has lost approximately 60 percent of its transitional housing units between 2013 and 2023. Transitional housing was an essential component of the continuum of services for homeless people who need additional support and accountability versus greater autonomy. Transitional housing provides the necessary supportive services to assist individuals and families in transitioning to a self-sufficient lifestyle. These supportive services help individuals improve life and job skills, create job and income growth, while achieving longer term sobriety and improved mental health.
The Solution:
Transitional housing with supportive services should be the key component of significantly reducing homelessness in this country. The federal government should stop prioritizing the costly and inefficient housing-first approach. Government funding for programs should be tied to improved outcomes, such as reduced substance abuse, better mental health, moving people into self-supported housing, and reducing overall rates of homelessness.
A new and improved transitional housing model is needed that requires individuals to seek treatment for human conditions such as mental illness and substance abuse. A model that prepares individuals and families for affordable housing with supportive services for conditions that are treatable but do not have a cure. A model that provides affordable housing opportunities for those who are willing to work to improve their lives.
When longer term sobriety and improved mental health occur, it increases housing and job stability. Lives are changed and society becomes better. A transitional housing model that enables service providers the opportunity to work with individuals and families in a safe and structured environment for a period of 6 months to 2 years is a must.
This model must audit and track desired outcomes and hold all parties accountable including federal, state, and local governments. Along with service providers, lawmakers, and the people receiving the support. Accountability is key as this model requires individuals and families to be prepared for longer term permanent housing and job placement.
The federal government and the HUD need to focus their efforts on making housing truly affordable. The federal government should donate land to build affordable housing units for states that are achieving the desired outcomes. Barriers to housing should not be as much of issue now. Additionally, matching funds should be provided from the federal government and HUD if states are achieving specific outcomes related to success rates of treating substance abuse, mental illness, job placement and transitioning into self-sufficient housing.
Local leaders need to work with nonprofit organizations to make sure that emergency and short-term shelters are available for those in crisis. At the same time, cities should maintain order on the streets by ensuring that public areas are free from tent encampments and that laws against illegal drug use and theft are enforced. Remember ‘Drug Free’ zones in the 1980’s? Florida has brought them back and this time they are being enforced.
Conclusion:
To significantly and permanently reduce homelessness, politicians at all levels must understand that chronic and long-term homelessness is a human issue as well as an affordable living issue.
In other words, these are simply not people who lack shelter and affordable housing. They are human beings where the majority are suffering from human conditions like mental illness, substance abuse, trauma, toxic living environments, and lack of job and life skills.
Meaningful change will begin to occur in this country when the states begin aggressively treating the core issues of homelessness such as mental illness, substance abuse, trauma, and lack of job and life skills development. Or they will continue to subject their homeless populations to the unenviable options of jails, institutions, and death. The Feds can provide the land and the states can provide the necessary services.
It’s going to take a non-partisan effort at a federal, state, and local level to make all this happen. Millions of people’s lives and their futures are depending on it, and failure should not be an option.