Twenty-five years ago, the federal government’s response to homelessness shifted. With bipartisan support in a Republican-led Congress and from both the Clinton and eventually the Bush administrations, the Department of Housing and Urban Development (HUD) began responding to homelessness as primarily an affordable-housing problem, with what became known as “Housing First” policies. The federal government marshalled its resources to move as many chronically unsheltered homeless people off the streets and into permanently subsidized—that is, free—apartments as possible, even if that meant removing requirements for recipients to abstain from using drugs or participate in treatment for mental-health or addiction problems. Politicians and experts alike signaled that America was poised to declare victory over homelessness within a decade. That victory never came.
Today, a growing number of Americans see these policies as misguided—a demonstrable failure. Cities across the United States, but particularly in the West, have seen tragic and debilitating growth in their homeless populations, despite spending billions on building subsidized housing under the Housing First vision. Frustrated state legislators in Georgia, Missouri, and Utah have enacted legislation that aims to curb street camping, prioritize treatment of underlying mental-health illnesses and addictions, expand access to short-term shelter, and otherwise push back on the premise that free-housing policies warrant the bulk of attention and funding.
Voters have started to rebel as well. The decisive 57 percent victory in Austin’s unexpected referendum on banning street camping in 2021 was the first sign that failed federal policies were alienating the public. A recent poll of Arizona voters commissioned by the Cicero Institute found that more than three-quarters of voters believed that homelessness was getting worse under current policies, and that more than 80 percent supported removing people camped on the street and moving them into short-term shelters and treatment. A combined 49 percent of Arizona voters saw addiction or mental illness as the underlying cause of homelessness, while only 25 percent aligned with the federal government’s insistence that the root cause is a lack of affordable housing. Among voters of both parties and across racial demographics, the poll found that skepticism of Housing First was rampant.
These findings align with other polls across the country. In Utah, a state that saw its unsheltered homelessness population drop by 91 percent from 2005 to 2015 only to triple by 2022, voters share many of the same concerns as Arizonans. In a January 2023 poll, 72 percent of voters saw unsheltered homeless camps as a threat to public safety, and approximately nine in ten attributed chronic homelessness to mental illness or substance addiction, not housing.
Even academic researchers who support the Housing First model in principle are struggling to sidestep indicators that the primary issues affecting unsheltered homeless people are addiction and mental health—not affordable housing—and that Housing First has done little to improve their situations. A University of California San Francisco study released in June 2023 found that more than 80 percent of California’s homeless population, including both sheltered and unsheltered, reported serious mental-health conditions, for which one in four had been hospitalized. Two-thirds reported regularly using drugs, less than half of which ever reported receiving treatment. Nearly another third spent time in prison or a long stay in jail in the six months prior to becoming homeless. Merely 4 percent reported leaving their last housing before becoming homeless because housing costs were too high.
The study does not bifurcate the results based on sheltered or unsheltered populations, though the prevalence of underlying conditions—and thus unsuitability for housing-only assistance—is likely much higher for the unsheltered homeless. For example, more than one-tenth of that population in San Francisco reported having entered homelessness from free, permanent supportive housing—a powerful refutation of Housing First.
Housing First programs fail to reduce homelessness, and in some cases show higher fatality rates than among people living on the street. For example, the Urban Institute found that 12 percent of the participants in a Denver permanent supportive-housing program died over the three years of the study, compared with 8 percent in the control group. More broadly, approximately 2 percent of homeless people die annually in the Denver metro area. The tragic and alarming death toll of some Housing First programs warrants greater scrutiny from policymakers.
Public sentiment appears to be turning against Housing First, even as federal grant requirements compel local homelessness nonprofits to abide by HUD’s misguided priorities. States are taking important steps to redirect whatever resources and policies they have control over toward treatment and short-term shelter. More states should follow suit.
But local and state policymakers are largely powerless to move federal resources away from failed permanent supportive-housing programs. With federal policy changes unlikely to come soon, states need to find more creative ways to regulate the homelessness organizations operating within their jurisdiction.
One answer may be for states to create operating licenses for local Housing First organizations that require them to abide by certain standards consistent with the growing evidence and public consensus against programs that ignore underlying conditions, perpetuate homelessness, and have deadly outcomes. For example, state officials could revoke the licenses of—and shut down—programs that fail adequately to move clients into treatment, irrespective of their federal funding. Jeopardizing these programs’ ability to operate unless they move away from the worst aspects of Housing First will undoubtedly create tension between states, the homelessness organizations, and the federal government. But this sort of regulatory pressure—which jeopardizes their ability to operate unless federal regulations become more flexible—could turn local Housing First organizations into a powerful lobbying group pushing the federal government to expand its homelessness priorities beyond free-housing policies that often forbid organizations from requiring treatment. Their institutional survival would depend on it.
In the face of abysmal outcomes in their communities, voters should not be forced to accept the raw deal that the federal government has made with Housing First nonprofits. Fortunately, state policymakers are answering the public’s call by taking the lead on creating an alternative vision of homelessness policy rooted in the realities facing America’s cities.
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