Thursday, September 14, 2023

Looking at U.S. "Housing First" Initiatives: Why Fixing Homelessness Is Not As Easy As Buying the Homeless Houses

Homelessness is hardly a new issue. What is new is how the public encampments and street disorder caused by the homeless ramped up since the pandemic. It is one of those problems that is going to get worse before it gets better. One possible solution that has been thrown around is "Housing First." It sounds like a rallying cry for people who care genuinely care about the downtrodden. At its core, Housing First is simple. It is a policy that provides unconditional, permanent housing as quickly as possible. It is not uncommon to provide support services afterwards to ensure continuity and stability for those housed. 

The assumption made by Housing First proponents is that the root problem is not having a home. For these proponents, the substance abuse and mental health issues that the homeless have are a byproduct of not having a home. Once they have a home, they can find a job, tackle their underlying problems, and stabilize, or so goes the argument. 

I do agree that homelessness creates instability in one's life. Having shelter is one of the essential physiological needs under Maslow's Hierarchy of Needs. A roof over one's head is going to make life easier than living on the street. Providing housing also can offset other costs of the chronically homeless, e.g., arrests, emergency room use, shelter use. That being said, Housing First is an inadequate policy. As I pointed out back in 2014, housing policy is more complex than "give the homeless homes and that will solve everything."

A May 2023 briefing paper from the Cato Institute covers the Housing First policies in Salt Lake City, Utah; the state of California; and Houston, Texas. In Salt Lake City, much of the success was likely due to methodological reporting issues. As for California, the homeless population grew along with the funding for Housing First. Cato points out that Housing First worked in Houston, but its success was "partly attributable to the low cost of housing and elastic housing supply in that city." Better coordinated efforts over a smaller city, along with a nonprofit at the helm and "compassionate enforcement" policies, seemed to attribute to Houston's success. Given the adverse effects of land-use regulations and rent control, I cannot say that I am surprised. Removing such harmful policies would create greater housing supply, thereby decreasing the prevalence of homelessness. 

A 2020 report from the Manhattan Institute creates even more doubt of Housing First's legitimacy. To quote the report, "Claims made on behalf of the campaign to tend homelessness - that Housing First has ended veterans' homelessness, chronic homelessness, or homelessness at he community level - are not based in "evidence," as the term is normally understood." 

What is more from the Manhattan Institute report is that "there is no evidence-based proof of Housing First's ability to treat serious mental illness effectively, or drug or alcohol addiction." Reason Magazine provides intuition for that finding: "Placing mentally ill people and those with substance abuse problems unsupervised in housing units doesn't provide them with the help they need. As one homeless expert told me, it mainly results them dying alone in a room." As a 2020 Heritage Foundation report illustrating the flaws of Housing First shows, taking a "Treatment First" approach provides a preferred alternative. 

It is praiseworthy to want to help the homeless. However, what we are seeing play out in the United States is that cities most heavily relying on the Housing First thinking have some of the worst homelessness problems in the United States. This post is not meant to be a treatise to solve all homelessness. Even so, removing government regulations that constrict housing supply and making sure that there are services that target substance abuse and mental health issues among the homeless. As an additional note, intensive transitional housing are preferable to permanent housing for all except the most vulnerable. That way, we can help the homeless be more self-sufficient in the long-run. What is for certain is that using taxpayer dollars to pay for unconditional, permanent housing does not put an end to or mitigate chronic homelessness.

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