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Painted Brain | How Housing First Works, A Mental Health Intervention
We're bridging communities and changing the conversation about mental illness using arts and media.
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  • October 8, 2014

How Housing First Works, a mental health intervention

Think of it this way: you’re homeless. You have two options: One, get treatment for your issues for several months and prove that you can live on your own, or get housing immediately and get the treatment while housed.

Which of these two seems like the easier path to getting out of homelessness?

Housing First is an initiative to get homeless people housing almost immediately. It makes sense in a very simple way: we can end homelessness by providing housing to the homeless.

It’s wildly successful. Approximately 80 percent of people who were chronically homeless remained housed in 24 months in a number of studies. So why haven’t we done this before?

In the 1960s, institutionalization was a common fixture in mental health. When deinstitutionalization hit America in the 1980s, a number of people formerly institutionalized found themselves homeless, living on the streets, and with no systems of recovery. What came out of it was an era of outpatient treatment, where a case worker provided services and the family or individual had to find their own way. The case worker would provide money substitutes (food stamps and the like) or homeless shelter housing (impermanent) occasionally.

Housing First started here, in Los Angeles, in 1988 with PATH. Noting that families with no serious health or self threats were facing chronic homelessness, PATH social workers found housing for the families. It was surprisingly successful and research started on just how effective this could be for other homeless people.

In nearly every study, Housing First trumped treatment first. The main exceptions were cases involving individuals or families who needed stronger support systems, such as people who have survived domestic violence or substance abuse.

Critics cite that people who are homeless often have major issues, such as past and unresolved trauma, substance abuse issues, mental health issues, and so on, that are obstacles to housing. This leads into treatment first options, which is the antithesis of Housing First. Treatment First (as you can guess) offers primary needs of treatment before housing. In other words, get people the things they need for mental well-being first and then find housing. This was (and still is in some places) the primary mode of social work within homeless settings.

But surprisingly, Housing First is far more effective in keeping people off the street, and also saves some cities up to $4 million per year on emergency services.

Here’s how it works:

1. Set up a place to live with necessary accommodations. The term for it is “permanent housing.” Each chronically homeless person gets their own room with a bedroom and a bathroom. For anyone who’s been homeless, this is a great thing: no more traveling to the public library for bathroom use; no more sleeping in a homeless shelter with 20 other men or women in a single room on a cot. However, finding the buildings for Housing First is surprisingly difficult in practice. The initiative workers have to find a livable building with enough rooms, each of which contains a full bathroom, a full bedroom, and furniture. Most buildings like this aren’t for sale, cost too much, or are already old, so the easiest solution is actually finding the land and building the building.

2. Offer crisis intervention and needs services and regular case management services in-house. One of the biggest errors in social work is having clients visit the case manager. In-house case management services offer a centralized location and takes away a lot of obstacles to getting regular case management: mode of transportation, schedules, etc. The fewer obstacles there are, the more frequently a case manager can meet a client. In these cases, social workers will visit the building, and knock out their client’s needs in one day. No more missed appointments and no more irregular housing checks. This means signs of unmet needs, burgeoning health issues and imminent substance abuse relapses can be caught earlier.

Additionally, having a centralized location for people who are (or were) chronically homeless allows them a center to meet for substance abuse meetings, to get their food, to stay inside as they need.

It’s an overwhelmingly powerful and successful movement that’s been gaining traction. The last 60 years of research has led to several different options for people who are homeless. It’s possible that homelessness ends in our lifetimes.

Seth Amitin is a Masters in Social Work intern at Painted Brain

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