How 'Housing First' Reduces Homelessness And Saves Money

Nov 26, 2014

Homelessness is a problem in the United States that affects every state, and Vermont is no exception.

But a model of handling homelessness called Housing First is getting a lot of attention lately, because it not only helps get people off the streets, it also saves money.

It's also, perhaps, somewhat counterintuitive when you first hear how Housing First works, but it's been in use in Vermont for a few years now through the group Pathways Vermont, and they say the approach works like no other.

We met with Pathways Vermont executive director Hilary Melton at the group's office in South Burlington.

"We have a long history in this country of trying to support people to get better in order to get housing," Melton explained. "It's a kind of staircase analogy of moving from streets into shelters, from shelters into transitional housing to treatment programs and finally into permanent housing. We've found over the years that in fact that model does not work, and the results and the research that has followed -- it's two decades worth of research -- has shown that what ends homelessness is housing."

Housing First skips that staircase and simply moves a person into permanent housing. Once that person is housed, the Housing First model gives them services tailored to the person's needs, such as mental health and substance abuse treatment. "That's the most effective bang for our dollar to support people to get out of this horrible cycle of homelessness."

"If you're living on the street, it's impossible to get better and do the things that people are asking that you do. And for people who are challenged by homelessness, there's sleep deprivation, not knowing where you're going to be, that kind of pressure that being homeless brings onto a person is enormous," Melton explained. Once a person is housed, they're in a better position to work on those problems, and there's evidence that people do the best when they are in a community-based setting, especially if they've been able to have some input into the kind of community they want to live in.

Melton said while Housing First is more effective than the staircase approach to housing, the reason it's been embraced nationally, internationally and by Department of Housing and Urban Development, the Veterans Administration and the Interagency Council on Homelessness is because it costs less.

Pathways Vermont started in Vermont as a five year grant program. Among the data is a cohort of 129 people. In the six months after those individuals started with Pathways Vermont, the amount of money spent on those people dropped by over $1 million from what was spent in the six months before they were housed.

"The prisons cost dropped from $700,000 to $200,000. The hotel costs went from $155,000 to $43,000, the $1 million for psychiatric hospitalization dropped to $1,500. So a million dollars on psychiatric hospitalization, versus $1,500 on people living in the community," Melton emphasized. "How can we not look at those numbers and make decisions based on those numbers? We're already spending an enormous amount of money on the same population, and we can do it better cheaper."

Pathways Vermont uses a scattered site model for housing, working with landlords in communities all around Vermont. In five years, the program has housed 250 people, 160 of those were considered chronically homeless. Melton said they couldn't do it with the hundreds of local landlords who are willing to take a chance by housing people without credit and rental history.

The Housing First model is getting a lot of attention in the national media. The New Yorker wrote about the success it's had in Utah. The Economist wrote about a town in Canada that has cleared their waiting list for housing.

While it's become the preferred model for funding, Melton said it's taking the system longer to catch up. Part of that is because people are not asked to be sober or required to meet "treatment compliance" standards. "You're just taking people at face value that they are homeless and what cures homelessness is housing."

Housing First has an 85 percent retention rate, meaning that 85 percent of the people getting housing first do not go back to homelessness.

"There's 15 percent of people that at first shot at it don't do so well. What do you think people talk about? People talk about the 15 percent that aren't doing well, and don't look at the 85 percent of people, the 160 people who were chronically homeless who you don't see anymore on the streets," Melton said. "People say where are we going to get the money to end homelessness? We're already spending it. Just how can we spend it in ways that are cheaper and better for people, and can spend it in ways that will help end homelessness?"