Housing First is a policy that prioritizes providing unconditional and permanent housing as quickly as possible to homeless people, which acts as the foundation for other supportive services. It was first discussed in the 1990s, and in the following decades became government policy in certain locations within the Western world. There is a substantial base of evidence showing that Housing First is both an effective solution to homelessness and a form of cost savings, as it also reduces the use of public services like hospitals, jails, and emergency shelters. Cities like Helsinki and Vienna in Europe have seen dramatic reductions in homelessness due to the adaptation of Housing First policies, as have the North American cities Columbus, Ohio, Salt Lake City, Utah, and Medicine Hat, Alberta.
Housing First is an alternative to a system of emergency shelter/transitional housing progressions which characterize the Continuum of Care and staircase housing models. Rather than moving homeless individuals through different "levels" of housing, whereby each level moves them closer to "independent housing" (for example: from the streets to a public shelter, and from a public shelter to a transitional housing program, and from there to their own apartment or house in the community), Housing First moves the homeless individual or household immediately from the streets or homeless shelters into their own accommodation.
Housing First approaches are based on the concept that a homeless individual or household's first and primary need is to obtain stable housing, and that other issues that may affect the household can and should be addressed once housing is obtained. In contrast, many other programs operate from a model of "housing readiness" — that is, that an individual or household must address other issues that may have led to the episode of homelessness prior to entering housing.
The Housing First strategy is a comprehensive solution incorporating support for homeless people in all aspects of their personal and social life. It does not intend to provide housing for the people in need and forget about them. The Housing First philosophy is a paradigm shift, where quick provision of stable accommodations is a precondition for any other treatment to reduce homelessness. Meanwhile, this approach relies on layers of collaborative support networks that promote stability and eliminate factors that cause or prolong homelessness. The support system addresses social and structural issues such as healthcare, education, family, children, employment, and social welfare. Evidence from Housing First implementation in Finland has shown it to result in significant cost savings.
General principles Housing First is an approach that offers permanent, affordable housing as quickly as possible for individuals and families experiencing homelessness, and then provides the supportive services and connections to the community-based supports people need to keep their housing and avoid returning to homelessness.
History
In the late 19th century, Don Bosco pioneered both the concept that would later become known as Housing First in Italy as well as pioneering the concept that would provide Dorothy Day the basis for her Catholic Worker Movement House of Hospitality founded in 1933. Bosco himself was inspired by and created a need society based on the teachings of St. Francis de Sales, a 16th and 17th century clergyman who was also at the forefront of early movements insisting that basic needs of the people be met first without various rules and regulations.
The formal Housing First Model has its origins in "Supported Housing" implemented in North America during the 1990s. For many years, the conventional action taken in regard to people experiencing homelessness was that of psychiatric hospitalization, where doctors considered individuals diagnosed with severe mental illness incapable of functioning in all areas of life and that they required around-the-clock supervision and support. This also reflected the idea prevalent at the time that all or a vast majority of people experiencing homelessness were suffering from mental illnesses. However, by the 1980s, experts began to raise questions regarding the underlying assumptions of this approach.
In response, a "staircase" approach began to be utilized. The staircase approach for people experiencing homelessness had three goals: training people to live in their own homes after being on the streets or in and out of hospitals; making sure someone was receiving treatment and medication for any ongoing mental health problems; and making sure someone was not involved in behavior that might put their health, well-being, and housing stability at risk, particularly that they were not utilizing drugs or alcohol. Permanent housing was seen as the end goal of the program. This model is similar to the Continuum of Care model for homelessness prevention, a model that has widely been used in the US.
This model had several flaws. Those served by the staircase model often became "stuck" in staircase services, because they could not always manage to complete all the tasks necessary to proceed. Participants were often evicted from housing due to failure to abstain from drugs and alcohol and refusing to undergo psychiatric treatment. Programs also had high levels of standards beyond those expected from a "typical citizen" - participants were expected to be the "perfect citizen" in order to continue.
Supported housing services developed as an alternative to staircase services for psychiatric patients. In contrast to the staircase approach, former psychiatric patients were very quickly provided with ordinary housing and received flexible help and treatment from mobile support teams. Support was provided for as long as was needed. Importantly, supportive housing did not require individuals to abstain from drugs or alcohol and providers did not expect full engagement with treatment as a condition for being housed.
Building on the supported housing model, but applied to people experiencing homelessness, Housing First was developed by Sam Tsemberis, a faculty member of the Department of Psychiatry of the New York University School of Medicine. Housing was provided 'first' rather than, as in the staircase model, 'last'. Housing First offered rapid access to a settled home in the community, combined with mobile support services that visited people in their own homes. There was no requirement to stop drinking or using drugs and no requirement to accept treatment in return for housing. Housing was not removed from someone if their drug or alcohol use did not stop, or if they refused to comply with treatment. If a person's behavior or support needs resulted in a loss of housing, Housing First would help them find another place to live and then continue to support them for as long as was needed. Tsemberis founded Pathways to Housing in New York City in 1992 to implement this model.
The Housing First model was also being developed independently outside the USA. One notable published example was Community Action Projects Ltd (CAP Ltd) in Manchester, UK, formed in 1971 as a non-profit limited liability company and charity, and disbanded in 2005. CAP Ltd was an unstaffed community group which pioneered rights-based projects for homeless people with additional needs, including projects for people leaving mental healthcare hospitals and for young homeless people. The method and lessons were adapted in the 1980s by other groups in Manchester including for street homeless people in poor health due to severe alcohol misuse. The group used low-cost publications to share their findings, aiming to influence mainstream social housing providers.
Research conducted in the late 1990s by pioneering American social researcher Dennis P. Culhane and others demonstrated that the housing first model was more effective at ending long-term homelessness than previous models of care. The systemic use of comparative research demonstrated the model's effectiveness. The first comprehensive meta analysis to compare types of accommodation-based interventions for people experiencing homelessness and their impact on housing stability, conducted by the Campbell Collaboration and commissioned by the Centre for Homelessness, found that programmes such as Housing First result in significantly better housing stability than models with less or no tailored support. These findings were based on a review of 28 studies covering 51 accommodation interventions, and involving 8,390 participants.
Definition Housing First for the chronically homeless is premised on the notion that housing is a basic human right, and so should not be denied to anyone, even if they are using alcohol or other substances. The Housing First model, thus, is philosophically in contrast to models that require the homeless to abjure substance-abuse and seek treatment in exchange for housing. This includes 'Treatment first' models, which provide temporary housing while addressing mental, physical and substance use needs, but only offer permanent housing on the condition that treatment plans are adhered to.
Housing First, when supported by the United States Department of Housing and Urban Development, does not only provide housing. The model, used by nonprofit agencies throughout America, also provides wraparound case management services to the tenants, without the precondition of sobriety. This case management provides stability for homeless individuals, which increases their success. It allows for accountability and promotes self-sufficiency. The housing provided through government supported Housing First programs is permanent and "affordable," meaning that tenants pay 30% of their income towards rent. Housing First, as pioneered by Pathways to Housing, targets individuals with disabilities. This housing is supported through two HUD programs. They are the Supportive Housing Program and the Shelter Plus Care Program. The Housing First approach has also been tailored by housing agencies to meet the needs of survivors of domestic violence who are experiencing homelessness.
Execution The Housing First Model is executed through either a scattered-site or project-based implementation. A scattered-site Housing First program is a model in which residents are offered the opportunity of being housed in individual housing units throughout a community. This model integrates participants in a community as opposed to assembling multiple or all participants in one project or location. In a project-based Housing First implementation, residents are offered units within a single housing project or site. This model congregates multiple or all participants in one locality. In both the scattered-site and project-based Housing First programs, residents are given access to a wide variety of supportive health and rehabilitation services which they have the option, although not mandatory, to participate in and receive treatment.
Weekly staff visits as well as a normal lease agreement are also a part of the program. Consumers have to pay 30 percent of their income every month as rent. Rather than have a homeless person remain in an emergency homeless shelter, it was thought to be better to quickly get the person permanent housing of some sort and the necessary support services to sustain a new home. But there are many complications that must be dealt with to make such an initiative work successfully in the middle to long term.Abel, David, "For the homeless, keys to a home: Large-scale effort to keep many off street faces hurdles", Boston Globe, 24 February 2008.PBS, "Home at Last? – A radical new approach to helping the homeless", NOW TV program, 21 December 2007.
Evidence and outcome
Australia