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iAUDIT! - Without a doubt, the most controversial component of current homeless policy is Housing First, the strategy that places permanent housing at the forefront of homelessness response. Thousands of studies, reports, and articles have reviewed, dissected, and analyzed Housing First’s successes and failures. Advocates insist the policy’s apparent failure is due to being watered down by shifting political support. They insist most programs are only “low fidelity” versions of true Housing First, where some of the vital elements are underfunded and understaffed. “Full fidelity” Housing First matches housing types to client needs, and in what may be a shock to many critics, requires tenants to pay 30 percent of their income (even general relief) for rent. The idea behind full fidelity Housing First is that placing someone in stable housing, providing proper services, and getting them used to paying rent prepares them for living independently.
In some ways, full fidelity Housing First is similar to its philosophical rival, contingency management. Both require clients to be active participants in their housing solutions. Both require them to pay rent, even if it’s a nominal amount. Where they part, however, is in their long-range expectations. Housing First places no conditions on entry or continued housing. Acceptance of services like substance abuse recovery or mental health counseling are not required. Contingency management, on the other hand, is a tiered approach, where clients are expected to assume more responsibility for their life choices as they progress through the system, including getting a job and seeking appropriate treatment as needed. The Union Rescue Mission in Skid Row practices contingency management for its clients.
Given its similarities with contingency management, we need to go back to Housing First’s origins to understand why it has a long record of failure, despite almost constant increases in funding. Housing First was developed by Dr. Sam Tsemberis, professor of psychiatry at Columbia University in New York. He and his team asked people experiencing homelessness what they needed and wanted to resolve their homelessness. The near-universal response was, of course, stable housing. By eliminating barriers such as committing to treatment, people would be placed in housing quickly, after which they would be offered support services, and progress toward independent living. Stable housing would make service interventions more successful.
A close reading of the preceding paragraph shows Housing First’s fatal weakness as a universal solution to homelessness. Dr. Tsemberis’ team asked homeless people what they most needed. This approach is predicated on 1) the client’s ability to coherently answer and 2) the person’s willingness to accept housing in the first place. We must remember Housing First was developed in the early 1990’s, years before the opioid and methamphetamine epidemics. The incidence of substance abuse and untreated mental illness among the unhoused was much lower than it is now. As I have previously written, statistics show about half (or more) of the unhoused population suffer from at least one of these two problems, plus the physical disabilities that accompany them. Half of the people with a serious mental illness don’t know they have a problem, and more than 90 percent of chronic substance abusers don’t want recovery assistance. The ability of people in either group to make informed, coherent decisions in their own self-interest is questionable at best. Even if they do accept housing, when they experience behavioral issues, the damage they cause can be substantial. Repair costs were among the primary reasons the Skid Row Housing Trust went bankrupt, and the City of San Francisco has paid more than $30 million in repair costs to hotels it contracted with to house homeless people during the pandemic.
Rather than being a randomized test of a cross section of homeless people, the initial Housing First programs were based on pre-selected groups who did not have to be coaxed into accepting housing. In addition, academic studies by their nature use fairly small populations. Housing First’s initial success, therefore, was based on a limited number of clients predisposed to accept housing entering tightly controlled programs. As 30 years of experience has shown, these programs have not performed well when scaled to large cities.
Why has Housing First failed to meet the homelessness crisis? To a great extent, the answer depends on who you ask. Critics point to statistics that show the nation’s supply of permanent supportive housing more than doubled between 2013 and 2024, along with 144,000 new rapid rehousing and 122,000 units of other permanent housing for homeless people. Yet in that same time span, unsheltered homelessness increased by 18 percent. A 2024 study from the Cicero Institute cited studies from Psychiatry Online (published by the American Psychiatric Association) and the National Academies of Science that Housing First has shown no empirical evidence of improved health outcomes for people in its programs. These findings bolster the argument that Housing First isn’t designed to support the current unhoused population.
Advocacy groups, on the other hand, claim problems can be laid at the feet of “low fidelity” Housing First programs that do not fully implement its policies. They say many government agencies do not provide sufficient funding or support services, and therefore clients do not receive the full spectrum of assistance they need. Advocates also cite community resistance to new housing, especially supportive housing. They can site studies showing more positive outcomes for people in Housing First programs. Unfortunately, most of these programs were conducted under the same controlled conditions as the initial ones, or they are from other countries with entirely different governmental, medical, and social structures. We must also remember Housing First’s failure is not unique to Los Angeles; it has failed to produce the promised results all across the country. In the few places it has worked, like Houston and Dallas, Housing First is just one component of larger homelessness programs that include shelters and treatment centers.
Despite being promoted as a universal solution, Housing First was never meant to be a stand-alone program. As a report from the US Interagency Council on Homelessness stated in 2020, Housing First should be one of several options in a larger “toolbox” of solutions. That report points out that after Housing First became HUD’s official policy in 2013, unsheltered homelessness began rising rapidly. To quote from the report, “The housing first approach has produced concerning results. Advocates for housing first argue that increasing the number of subsidized vouchers and permanent supportive housing units decreases unsheltered homelessness. Yet unsheltered homelessness increased 20.5 percent while subsidized housing vouchers increased by 42.7 percent. Taken together, these facts suggest that the provision of subsidized or dedicated housing has not led to reducing the total population of people experiencing homelessness”.
In response to advocates who claim no barrier policies are needed to get people inside, the report also says, “Housing first proponents argue issues such as sobriety, participation requirements and program compliance should not be a barrier to continuing to receive subsidized housing. Yet participation requirements may well be a key element to improved health and increased self-sufficiency, thus reducing the number of people experiencing homelessness”. The report also noted that as Housing First became official policy, the number of transitional living units decreased, removing one of the key tools to move people inside more quickly. There was also a certain amount of semantic wordplay involved in the purported success of Housing First. Many transitional units were reclassified to “rapid rehousing” (such as time-limited subsidized housing) that meet HUD’s Housing First requirements. The physical facilities remained the same, but as the report says, “Reclassifying 101,746 individuals that moved from transitional programs to rapid rehousing programs as no longer experiencing homelessness has been cited as evidence of the reduction of homelessness. This reclassification has also been used to support the effectiveness of housing first, thus this may not represent a true reduction”.
Why has Housing First persisted as the policy of choice despite its problems? In a very real sense, the original concept of Housing First has been hijacked by a coalition of housing, homelessness, social justice, and commercial interests. One of the coalition’s favorite slogans is “Housing is a human right”, which may or may not be true depending on one’s definition of housing. Advocates have made housing a goal unto itself, rather than a means to achieving personal and financial independence. If housing (defined as a unique private space for the exclusive use of one person) is a human right, then government has an obligation to provide it. Thus, Housing First’s original--and minimal--requirements for client participation become subservient to the overriding moral obligation to house someone as a social justice issue. As Devon Kurtz wrote in the Cicero Institute study I cited before, this also means housing must be provided indefinitely and perpetually, regardless of tenant behavior. This is why so many people fall back into homelessness after being “housed”, as I most recently wrote here. Finally, advocates’ arguments reduce homeless people to passive victims. Once in the system, they must be cared for in perpetuity, and any attempt to incentivize them to leave subsidized housing is branded as cruel and elitist. In fact, this belief creates what homeless advocate (and formerly homeless person) Jess Echeverry of SOFESA calls “generational homelessness” as the system creates permanent dependence on supportive housing.
Finally, there is a powerful financial incentive to maintain the Housing First status quo. In Los Angeles, it has created a multi-billion-dollar industry that rewards rhetoric instead of results. As long as the huge constellation of service agencies claim they are helping the homeless, they are paid, and paid well. As I detailed in a previous CityWatch column, nonprofits have seen their cashflows, asset portfolios, and executive compensation skyrocket under Housing First policies. Some nonprofits have developed impressive real estate portfolios as more permanent housing facilities open. Because service acceptance is voluntary, outreach providers can charge for as many “encounters” as it takes to get someone into housing. And of course, building new housing means more construction jobs, so labor groups support the current system. Defining housing as a human right has also given so-called progressive leaders like Scott Weiner a convenient justification for supporting massive development in the name of increasing the supply of affordable housing, and therefore reducing homelessness, a concept that has, to date, failed, as described by Zelda Bronstein in 48hills.com.
Housing First achieved some success when it was tightly controlled and applied to small populations. After more than 30 years of trying to make it work, it is clear it is the wrong solution; it is a program using outdated methods aimed at a population that no longer exists. There is little hope for reform to occur at the local level. Advocate groups have a stranglehold on the narrative, and innovation has been cast aside in favor of recycling the same leadership in new positions. Reform needs to come from outside the system, from the state and from HUD itself, which has used Housing First as its official policy for more than a decade. Housing First isn’t the cause of the failure of homelessness programs; it is its misapplication and use for a purpose for which it was never intended that has left so many people on our streets.
(Tim Campbell is a resident of Westchester who spent a career in the public service and managed a municipal performance audit program. He focuses on outcomes instead of process in his iAUDIT! column for CityWatchLA.)
