A Pathway to Ending Homelessness: A Home

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We’re proud to collaborate with The Nation in sharing insightful journalism related to income inequality in America. The following is an excerpt from Nation contributor Greg Kaufmann’s “This Week in Poverty” column.


In 1992, Pathways to Housing founder Dr. Sam Tsemberis offered a novel approach to ending a seemingly intractable problem: “The cure for homelessness is a home. It’s that simple,” he said.

He developed the “Housing First” model for the most severely psychiatrically disabled and addicted homeless people in New York City. It first provides a person with an apartment, and then combines that housing with comprehensive services in mental and physical health, substance abuse, education and employment. The apartments are scattered throughout a community, which fosters a sense of self-determination and speeds reintegration.

Homeless veteran George Krider poses for a portrait at a homeless shelter in San Diego. Krider has lived on and off the streets since leaving the navy with the rank of Petty Officer Second Class. (AP Photo/Gregory Bull)

“People want to feel normal,” Christy Respress, executive director of Pathways to Housing D.C., tells me. “That doesn’t really happen if ‘home’ is some building that says ‘Pathways to Housing’ across the front, and everyone knows that anyone who walks into that building has a serious mental illness.”

Since its inception, the nonprofit organization has housed more than 2,000 people in New York alone. It now has affiliates in Washington (D.C.), Philadelphia and Vermont, and the Housing First model is used in programs across the U.S., Canada, Europe, and Australia. Numerous studies have consistently shown that the program ends chronic homelessness for 85 to 90 percent of participants (in contrast to a 45 percent success rate for programs requiring an individual to “get clean and sober” and take psychiatric medicine prior to receiving housing).

“Eighty percent of people in the program are using alcohol and/or drugs when they come in,” says Respress, “because we are targeting people with severe disabilities who are unable to make it in other programs; or they don’t meet requirements because they haven’t admitted that they have a mental illness, or they haven’t stopped drinking. But they still want housing, and they need a safe place in order to start working on their treatment and recovery.”

What really made the program take off in the late 1990s was a five-year study showing that participants had higher retention rates, improved long-term housing outcomes, and decreased time in jail, emergency rooms, and hospitals — “all three of which are incredibly expensive,” says Respress — compared to participants in programs that require people to accept treatment before being offered housing. These results garnered bipartisan political support for the program.

“Since there is not a belief in the U.S. that there is a ‘right’ to housing, the data is important in making the argument for this kind of investment,” says Respress. “Ultimately, it’s less expensive to have someone in their own, subsidized apartment — with comprehensive wraparound services — than to leave them to fend for themselves on the streets or place them in shelters or more traditional transitional housing programs.”

Pathways provides its wraparound services through Assertive Community Treatment (ACT) teams that use evidence-based care that has been studied since the 1970s. Each team consists of a substance abuse specialist, vocational counselor, nurse, psychiatrist, mental health worker and a peer specialist. The peer specialists are essential because they are recovering from homelessness, mental illness and addiction themselves, and show the client that recovery is possible. The team works with its clients in their homes.

“You can teach a person to cook at St. Elizabeth’s Hospital on an electric stove, but then they move into their apartment and they have a gas stove and can’t get to the grocery store. It’s a whole different set of skills, so we do that in their apartment with them, which is also what the clients want,” says Respress.

The total cost for the Housing First program is approximately $22,000–$24,000 annually per client. That’s about $54 a day — compared to a hospital bed at $1,500 a day, a jail cell at $735 a day, or even a shelter with services that costs $78 a day. Even keeping a person homeless costs more money than a Pathways apartment, if you add up the police trips to jail, ambulance use and emergency room visits.

Currently in D.C., four Pathways ACT teams — with a clinician-to-client ratio of one to ten — serve 300 formerly homeless individuals. Additionally, a case management team serves 145 individuals identified by the D.C. Department of Human Services as the most medically vulnerable and hardest to serve among the chronically homeless population. These clients are also provided with individual apartments and slightly less intensive services, with one case manager for every twenty clients.

The business community has been very supportive of the program, with the Downtown Business Improvement District (BID) and the Golden Triangle BID funding some street outreach services, which receive scant city funding. Six Pathways outreach workers walk the streets, get to know people in the homeless community, and develop trusting relationships that lead quickly to making the offer of housing.

“It’s a fascinating partnership we have with the business community,” says Respress, “because it’s really a cutting edge investment in homeless services. They understand that it could take one year, or five years, for us to develop a relationship with a homeless individual [that results in a home], but we are ending homelessness one person at a time.”

However, the city’s commitment to ending homelessness seems less steadfast than that of the business community. Despite the fact that there are 3,553 homeless single persons in D.C. — and the National Alliance to End Homelessness estimates that about 25 percent of the homeless population has serious mental illnesses — there is no dedicated source of public funding specifically targeted to address the needs of homeless people living with severe mental illnesses. Respress says Pathways to Housing D.C. currently has vouchers for 445 units and would need approximately 250 to 300 more to meet the needs of the very most disconnected, psychiatrically disabled homeless people. But even the city’s current vouchers are in jeopardy.

“The city is looking at potentially reducing them by not filling vacancies as people die or leave their apartments,” says Respress. “There’s just no excuse for having people who are homeless on our streets — we know the answer and we have the tools. We can end homelessness in D.C. today if we put together the advocacy, political will and funding to bring this program to scale.”

You can stay informed and get involved in the effort to end chronic homelessness in the nation’s capital and elsewhere by signing up for the Pathways to Housing e-newsletter.

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  • peacebypiece

    “There is no dedicated source of public funding specifically targeted to address the needs of homeless people living with severe mental illnesses.” Why not? There is the possibility of good news. “We can end homelessness in D.C. today if we put together the advocacy, political will and funding to bring this program to scale.”

  • kinski

    Thank you for this story. I really wish there were a program like this in Los Angeles, where something like 30% of the country’s homeless population lives. I see more tents erected every single day on the streets around my home as downtown is gentrified and the traditional tent-city areas are squeezed out. I believe that the freedom to put a roof over your head is an inalienable right, and so long as we’re going to regulate what sort of a roof people can make and not allow people to build their own structure or shanty-town, we MUST go the next step and provide what European cities provide: no-questions asked, permanent housing for these folks. Are we a 3rd world country, or 1st world? We must decide. But regulation without financial support is inhumane. Humans have been building shelters for themselves for millions of years out of whatever materials they can scrounge up with their resources. What gives us the right to make basic human subsistence illegal now.

  • http://www.facebook.com/profile.php?id=639434021 Kitte Lishuss

    A compassionate, humanitarian approach is not only morally appropriate, it is also lots cheaper!

  • RT2012

    After being homeless in Shawnee, Ok asking for help and being shown what that help can do, I see why many people never ask. The overwhelming ministorial alliances’ judgements prevailed and it wasn’t pretty. Being a woman left to those judgements brings about discriminations at there worst with nowhere to turn with governmental positions taken over by one in the same. Denied constitutional rights outside the mainstream such as thr right to vote in a timely manner, denied a postoffice box for a stable address, denied my own personal beliefs or be denied services run by so called non-profit organizations in part funded by in part by government…. ALL played into the discrimination. This also included the so called local justice system.

  • Homeless helper

    Los Angeles uses the housing first model. There is a great program for homeless veterans through PATH – People Assisting the Homeless. There is no religious affiliation and it is open to anyone. There are locations in LA, West LA, Signal Hill and San Diego.