Breaking the Cycle

By Griffiths, Sian | New Internationalist, June 2017 | Go to article overview

Breaking the Cycle


Griffiths, Sian, New Internationalist


Twenty-five years ago Sam Tsemberis was running an emergency homeless project for a New York psychiatric hospital.

'Our job was to interview people who were homeless and mentally ill and determine if they were a danger to themselves. We took them in - involuntarily. We had to call the police. It was painful work.

'We also saw a lot of people who didn't need hospitalization. They were in bad shape and had been out there a long time.'

Tsemberis kept seeing the same faces back on the street - over and over again.

'It was obvious we needed to do something different.'

He began to ask homeless people what they wanted.

'They said they needed a place to live. I wasn't convinced.'

Housing programmes then were geared to folks who were clean and sober. 'The mindset was that people in acute distress couldn't manage their own housing.'

But these people couldn't stay sober, hated taking medication and weren't willing to try.

'That's when I got into the housing business,' Tsemberis quips.

Armed with a half-million dollar grant, he launched Pathways to Housing. The core idea: housing first. Give the homeless a roof over their head and make sure they have support. Dr Tsemberis and his team enlisted psychiatrists, social workers and nurses. Once people have their own home, he says, 'you have a better shot at treatment'.

Staying put

After five years a staggering 80 per cent of his Pathways to Housing participants had managed to stay in their homes - a far higher success rate than the traditional 'staircase' model where people transition to a permanent home through a series of steps, proving their worthiness in the process.

A wider study of this approach (now dubbed 'Housing First') across 11 US cities had a similar success rate. In addition, healthcare costs shrank and addictions were better managed.

The evidence sparked interest across America. Lloyd Pendleton, a conservative business executive and former head of humanitarian services for the Mormon Church in Utah, was sceptical.

'I was raised as a cowboy and I have said over the years, "You lazy bums, get a job, pull yourself up by the bootstraps",' he told one interviewer.

But Pendleton changed his mind after listening to Sam Tsemberis at a 2003 conference on homelessness. He learned that chronic homelessness was costly. Homeless people have increased interactions with the police, the courts, prisons and hospitals. Giving these people stable housing with support, he found, would simply be cheaper.

Pendleton launched a pilot in Salt Lake City with 17 of 'the most challenging chronically homeless individuals we could find'. Two years later they were still in their homes.

Pendleton then led a statewide effort to implement Housing First (HF). In 2015 the state declared an end to chronic homelessness.

The Housing First model has now spread to 20 US cities.

It's also moved north of the border. In 2008, the the Canadian Mental Health Association (CMHA) began an $80 million study of the HF model. The five-year 'At Home/Chez Soi' survey concluded that 75 per cent of Canadian Housing First participants stayed in their homes. Life satisfaction was high and participants said they felt safer.

It was also cost neutral - every dollar devoted to Housing First reduced healthcare, social service and justice-related costs by a dollar. The CMHA study pegged the cost at $10,500-$16,500 per person per year.

The small prairie city of Medicine Hat, Alberta (population 60,000) adopted Housing First in 2009. The Mayor, Ted Clugston, recalls saying 'some dumb things' when he first heard about HF. But he soon became a convert. It made financial sense and it's 'the most humane way to treat people'. Six years later Medicine Hat had also declared an end to chronic homelessness. …

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