For the first time in nearly a decade, Hawaii's homeless population is falling.
Data released last month shows that, while the archipelago still has the highest homelessness rate in the United States, in the last year the number of homeless people across the state has fallen by 9 percent, from 7,921 to 7,220.
The implementation of "Housing First" strategies played a significant role in the drop, according to the statewide Point in Time count. In the nearly two years since Governor David Ige declared a state of emergency in response to Hawaii's homelessness crisis, the state has funneled millions into shelters and housing programs like Housing First, adding hundreds of new housing units to islands where the average cost for a one-bedroom apartment is $1,800 per month.
Hawaii officials hope that as the state's homeless population falls, decreases in health-care costs will soon follow. In Hawaii and across the country, the homeless strain the health-care system; Honolulu's Queen's Health System hospital eats some $10 million in unpaid hospital bills from treating the homeless. Studies in Los Angeles, Portland, and Seattle have all found that Housing First programs lowered the overall costs to the city of caring for the homeless.
Advocates of Housing First believe getting people off the streets and into more permanent housing should be the priority, and that recovery from other issues such as substance abuse or mental illness will naturally follow. But, as Will McGrath reported in Pacific Standard earlier this year, for some individuals suffering from substance abuse, housing is not always the cure-all.
McGrath visited Fort Lyon, a psychiatric hospital-turned-prison-turned-"sober utopia" in a remote region of Colorado, where the state's chronically homeless can recover from addiction in a campus-like, supportive environment before seeking housing and work on their own.
James Ginsburg, the director and co-founder of this residential program, told McGrath that, while he is a supporter of Housing First, and even ran the program in Denver for six years, at least some people with substance use disorders have to get out of their current environment in order to break their destructive habits:
Having run Housing First, the thing that really motivated me to open this place was walking in on people dead in their housing,” [Ginsburg] said. These were people who had moved into apartments through his programs. He found one man with a needle still in his arm. Another was slumped backwards in a recliner, a lethal cocktail of rubbing alcohol and orange juice at his side. A complex hierarchy of needs exists for people who are homeless. In Ginsburg's opinion, housing should not always come first: "Fort Lyon is for people who are dying in their addiction."
In Hawaii, as in many parts of the country, substance abuse is a top diagnosis among the homeless population, and increased housing units will only go so far.