How Housing First dogma exacerbates and perpetuates homelessness pain and suffering in California and Silicon Valley

 
 

Stanford's Institute for Economic Policy Research unpacks the sad story of how monies and resources that could've (should've?) gone to cheaper and faster shelter and congregate homelessness solutions got sidetracked into the brutally expensive, slow and ineffective subsidized Housing First farrago.

A dearth of shelters

About 70 percent of the homeless in California are unsheltered, more than in any other state. A primary reason for the sizable unsheltered population is the low stock of emergency shelters and transitional housing. Between 2007 and 2020, while the total homeless population increased in California, the shelter capacity remained flat for a decade before rising again after 2017, and the bed counts at transitional housing facilities had a continuous decline. 

While the development of shelters has stagnated, there’s been a push for “Housing First” among many advocates and policymakers who believe permanent housing plus supportive services is the most important step to solving chronic homelessness.

Housing First is both an ideology and a practice developed in the 1990s that broke from the model of requiring homeless people to transition from emergency shelters to more permanent subsidized housing only when they met certain criteria around sobriety or treatment for mental illness.

The Housing First approach immediately provides homeless clients with an apartment and supportive services for drug addiction and/or mental illness (Tsemberis 2004). The supportive services are provided but participation is not required of the homeless clients.

Some benefits were attributed to Housing First, including higher housing stability, fewer emergency room visits, and improved medication adherence (Tsemberis, Gulcur, and Nakae 2004; Padgett, Henwood, and Tsemberis 2015; Aubry et al. 2016; Buchanan et al. 2009).

Meanwhile, Housing First showed no effects in reducing drug use, alcohol consumption, psychiatric symptoms, or enhancing the quality of life (Rosenheck et al. 2003; Mares, Greenberg, and Rosenheck 2007; Stergiopoulos et al. 2010).

Throughout the 2000s, Housing First received ample attention from academics, news media, and policymakers. But the policy carried unintended consequences when resources were diverted from shelters and other interim housing to building permanent housing projects.

For example, then-San Francisco Mayor Gavin Newsom presented a 10-year plan in 2004 that promised 3,000 new permanent supportive housing units in the following decade.

At the end of the decade, the city had been on track in creating permanent supportive housing. But city planners didn't anticipate an influx of homeless people, for whom the original plan was unable to accommodate.

The shelter capacity was weakened as the plan “directed the City to move its focus away from traditional emergency shelters and toward shelters with 24-hour crisis clinics and sobering centers.” As a result, the city reduced 440 year-round emergency shelter beds between 2005 and 2014 while adding only 26 beds with some crisis or sobering management (City and County of San Francisco 2014).

With a rising homeless population and a shrinking shelter capacity, San Francisco’s unsheltered homeless population doubled from about 2,655 to 5,180 between 2005 and 2019. After the 10-year plan ended in 2014, city planners began building shelters again, but it was too little too late.

It takes about four years to complete an affordable housing project in the Bay Area, costing about $400,000 to $700,000 per unit, typically a studio, one-bed, or two-bed apartment (Bay Area Council Economic Institute 2021). {Editor’s note: In San Jose, virtually all permanent affordable/permanent supportive projects invested in over the past few years cost closer to $1m/unit.}

Cheaper, faster alternatives exist. For example, a bed costs about $43,000 in a shelter and $73,000 in a “tiny home” — compact housing units that can be quickly built (Bay Area Council Economic Institute 2021). While these options have disadvantages such as crowding and restrictive rules and are less permanent or aesthetically appealing than long-term houses, policymakers need to weigh those shortcomings against the suffering of people sleeping on the street. {Editor’s note: San Jose’s tiny homes projects are far less restrictive than typical congregate shelters, offering greater degrees of privacy and autonomy, pets, and belongings.}

In states with sufficient housing stock and a small number of homeless people, Housing First can solve the "houseless" problem. Still, intensive care is needed if the root cause of an individual’s homelessness is mental illnesses, drug addiction, or alcohol abuse (Pearson 2007).

In contrast, in places with a housing shortage, such as coastal California, there is a long wait before permanent housing becomes available, which defies the original vision of Housing First to immediately provide an apartment (Tsemberis, Gulcur, and Nakae 2004). As cautioned in a JAMA paper, the high capital costs to develop permanent supportive housing in some localities can prohibit Housing First as a viable option (Kertesz and Weiner 2009).

In 2020, only one-third of California’s homeless moved into permanent housing, 47 percent were awaiting housing and still accessing services, and 16 percent were no longer engaging in services (San Jose Mayor's Office 2021). While waiting for permanent housing, it’s imperative for homeless people to have a safe place to sleep. The longer people stay unsheltered, the more their mental and physical health deteriorates, making it harder for them to go back to the labor force, find housing, and regain financial stability. 

Read the whole thing here.

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