The model for dealing with the chronically homeless at that time, both here and in most places across the nation, was to get them “ready” for housing by guiding them through drug rehabilitation programs or mental-health counseling, or both. If and when they stopped drinking or doing drugs or acting crazy, they were given heavily subsidized housing on the condition that they stay clean and relatively sane. This model, sometimes called “linear residential treatment” or “continuum of care,” seemed to be a good idea, but it didn’t work very well because relatively few chronically homeless people ever completed the work required to become “ready,” and those who did often could not stay clean or stop having mental episodes, so they lost their apartments and became homeless again.
In 1992, a psychologist at New York University named Sam Tsemberis decided to test a new model. His idea was to just give the chronically homeless a place to live, on a permanent basis, without making them pass any tests or attend any programs or fill out any forms.
“Okay,” Tsemberis recalls thinking, “they’re schizophrenic, alcoholic, traumatized, brain damaged. What if we don’t make them pass any tests or fill out any forms? They aren’t any good at that stuff. Inability to pass tests and fill out forms was a large part of how they ended up homeless in the first place. Why not just give them a place to live and offer them free counseling and therapy, health care, and let them decide if they want to participate? Why not treat chronically homeless people as human beings and members of our community who have a basic right to housing and health care?”
Tsemberis and his associates, a group called Pathways to Housing, ran a large test in which they provided apartments to 242 chronically homeless individuals, no questions asked. In their apartments they could drink, take drugs, and suffer mental breakdowns, as long as they didn’t hurt anyone or bother their neighbors. If they needed and wanted to go to rehab or detox, these services were provided. If they needed and wanted medical care, it was also provided. But it was up to the client to decide what services and care to participate in.
The results were remarkable. After five years, 88 percent of the clients were still in their apartments, and the cost of caring for them in their own homes was a little less than what it would have cost to take care of them on the street. A subsequent study of 4,679 New York City homeless with severe mental illness found that each cost an average of $40,449 a year in emergency room, shelter, and other expenses to the system, and that getting those individuals in supportive housing saved an average of $16,282. Soon other cities such asSeattle and Portland, Maine, as well as states like Rhode Island and Illinois, ran their own tests with similar results. Denver found that emergency-service costs alone went down 73 percent for people put in Housing First, for a savings of $31,545 per person; detox visits went down 82 percent, for an additional savings of $8,732. By 2003, Housing First had been embraced by the Bush administration.