The idea behind Housing First is simple: Housing is a basic right of all human beings, regardless of income or mental health status. As the name suggests, housing comes first, then other issues can be dealt with. When it was introduced in the early '90s, Housing First contrasted the more traditional Treatment First model, which abides by the idea that the homeless who suffer from behavioral issues must "graduate" from treatment before they are provided with a place to live.
Since the first implementation of the Housing First model in 1992 in New York City, its use has spread, replacing many traditional programs in cities across the U.S. and Canada throughout the 2000s. More than 100 Housing First programs have gone into effect across the world, including in Australia, Belgium, England, Finland, Portugal, and Sweden.
Part of the reason that Housing First began is that researchers have found the Treatment First model to be ineffective for those who cannot handle structured and restrictive environments—typically, those who experience chronic homelessness—since they are likely to drop out of the treatment programs and remain on the street. Chronically homeless people (those who experience long-term and/or multiple episodes of homelessness) exert an enormous weight on society. Some estimates show that one homeless person living on the street costs taxpayers $35,000 to $150,000 a year due to incarceration, hospital costs, and emergency shelter use. On the other hand, housing these people costs only $13,000 to $25,000 a year.
Still, there are more than 600,000 homeless people in the U.S., 200,000 of whom are not sheltered (in an emergency shelter, safe haven, or otherwise) on a given night (PDF). While a substantial body of research (including a recent wide-ranging study in Canada) has shown the effectiveness of the program, proponents acknowledge the need for continual improvement. Some observers have expressed concern that Housing First models aren’t adequately supported by supplemental programs, that the policies aren’t marketed well to voters, or that they might not work for specific populations. New studies have refined and supplemented the popular New York City model to account for the variety of pre-existing conditions that lead the city-wide illness of chronic homelessness.
A report published this past April on the Transitions to Home (T2H) program in Hamilton, Ontario, presents a wide-ranging overview of the lessons learned from the past six years, including quantitative data analysis and qualitative interviews. Pacific Standard spoke to the researcher Julia Woodhall-Melnik of McMaster University and principal investigator Dean Waterfield (director of housing and homelessness, Wesley Urban Ministries) about the landlords and baseball games that set the T2H program apart from others.
“We’re the Pittsburgh of Ontario,” Waterfield says of the Hamilton metro area. The city of about 520,000 suffered a similar economic transformation in the late 1990s to that of the Rust Belt. By 2000, large portions of the city were suffering from poverty, and there was a huge increase in use of emergency shelters, substance addiction, and mental health issues.
Like Pittsburgh, Hamilton is now experiencing an upturn in economic activity, especially in the health and human services sector. While the growth of these new industries have been a boon to the community, the presence of social service organizations has attracted an even larger population of patients suffering from mental health issues and/or substance addiction, many of whom did not have stable housing. Chronic homelessness continued to grow rapidly.
To deal with the problem, the city of Hamilton created what they called a "Homeless Blueprint," which included a commitment to Housing First. The pilot program launched in 2007, while the T2H program began formally operating in 2010, as a collaboration between local non-profit Wesley Urban Ministries and local men's shelters.
The current study was focused on Hamilton's chronically homeless male population, which limits the report's takeaways. It was conducted by Woodhall-Melnik and her colleague James Dunn of McMaster University and funded by Canadian government agencies.
WHAT WAS DIFFERENT
- Direct leasing: Unlike the most well-known Housing First model, New York City’s Pathways to Housing, T2H does not lease apartments and then sublet to program participants. Instead, T2H advocates on behalf of participants so that they can rent directly from landlords. Participants who are on welfare can also have their rent paid directly to the landlord from their monthly check, which can ease landlords’ concerns about getting paid rent on time.
- Housing worker: In addition to case managers who work on a one-on-one basis to counsel participants and assist them in accessing services, T2H employs one full-time housing worker to locate housing for participants and advocate for the landlord. Waterfield says the presence of the housing worker is essential: “It helps the landlords feel like they’re not alone. They’re human, too, and a lot of them care about what happens to their tenants. So they see their tenants getting support ... and we connect [the landlords] to resources.”
- Recreational activities: T2H, unlike the Pathways to Housing model, provides various recreational activities, including sports programs, movie day, cooking classes, and gym passes for participants. “It helped individuals overcome that social isolation, to rebuilt trust and communication with people in a community,” Woodhall-Melnik says. “It’s a basic fundamental clinical strategy," Waterfield says. "If you can come out to play a day’s worth of baseball without having used a substance, our case managers can then say, 'If you can do it on that day, you can do it on a different day.'”
- Engagement with potential participants: Since T2H was run by non-profit Wesley Urban Ministries, along with other local men’s shelters, most referrals came from emergency shelters. The study revealed that many of the program’s target audience had never heard of the program. Waterfield says where to find eligible individuals can depend on the city. For instance, Hamilton’s psychiatric hospital has been closed, and many U.S. cities use that as a main source. In Hamilton, the local city library, hospital-emergency-room social workers, and day centers were potential recruitment areas identified by the study.
- Better, efficient collaboration: As many non-profits around the world know, the competition for funding and human resources is detrimental to groups that should otherwise be working together. The report revealed that T2H was hampered by the tangle of social services organizations in Hamilton. Woodhall-Melnik suggests T2H implement cross-program training so all service workers can understand what’s available to participants. She also suggests redistributing funding from a higher institutional level to discourage competition for funding.
In general, according to the report, Hamilton’s T2H program has decreased shelter use and increased housing stability for T2H participants compared to men who were eligible for T2H but were not enrolled. Qualitative interviews also indicated strong relationships between participants and their case workers, who serve a therapeutic as well as social role in helping the participants acclimate to healthy lifestyles.
In fact, some participants were so attached to their case managers that they felt victimized by a common issue in social work: the high turnover rate. With more resources, T2H hopes to implement a rotational system so that participants can have primary and secondary case managers so they do not become so dependent on just one person.
T2H has secured funding for another five years from the Canadian government. Their next step is to expand capacity and recruit more participants into the program. “Obviously, what we would like to see in five years—I doubt it, but I hope—because of strong prevention efforts, re-housing, and engagement strategies, that we will not need these programs," Woodhall-Melnik says. "We’ll be able to say we eradicated long-term homelessness."
While the report was mostly concerned with the effectiveness of the program itself, interviews with T2H participants matched up with previous research that showed a correlation between early childhood trauma and adult homelessness. “There’s a lot of negative stigma attached to the population that we work with,” Waterfield says. “I just ask people, ‘Have you ever wondered what happens to that child who is sexually or physically abused when they grow up?’ You feel sorry for them. You think it’s outrageous for anyone to not want to help those kids. But what about them as adults?”