Supportive Housing Cuts Costs of Caring for the Chronically Homeless

Abstract

IN THE LATE 1990S, SEATTLE LEADers recognized the city had a problem. Homeless people with severe alcoholism consumed a tremendous share of public dollars, cycling in and out of emergency departments and the criminal justice system. The city’s political, business, and hospital leaders joined forces with social service and substance abuse treatment agencies to adopt a new strategy not only to curb costs, but also to keep so many chronically homeless people from dying on the streets. One of their first calls was to the Downtown Emergency Service Center (DESC), a group that ran housing projects targeting mentally ill and other vulnerable homeless populations. The city’s leaders asked the DESC to take a “housing-first” approach by creating a new facility where chronically homeless people with severe alcohol abuse problems could find shelter without first having to stop drinking or enter treatment. Bill Hobson, executive director of the DESC, explained that most shelters or housing facilities make treatment or abstinence a condition of housing. But the population Seattle was targeting included individuals who had repeatedly failed treatment programs— some as many as 20 times, Hobson explained. “Let’s accept that these individuals can’t or won’t stop drinking, and they are hurting the greater society with their use of crisis services,” he explained. The DESC adopted a “harmreduction” strategy, which aimed to reduce the harmful effects of drinking on the individual and on society, Hobson explained. The organization identified homeless people who incurred the greatest public costs because of their alcohol use problems and offered them individual apartments in a new facility at 1811 Eastlake. The facility opened in 2005 with a 24-hour staff of social workers and other clinicians. Staff helped residents access social and medical services and worked with them to address behavioral issues that had caused them to lose previous housing. Most residents continued drinking despite discussions with staff about the harmful effects of doing so. “Harm reduction is about helping people prepare to change,” Hobson said. It was a radical experiment, with its share of critics. But it worked. The housing-first model used by the DESC at 1811 Eastlake has been emulated by communities across the country working to eliminate chronic homelessness among individuals with severe substance abuse problems, mental illness, or other chronic diseases. Between 2006 and 2010, the number of beds in such supportive housing programs in the United States increased from 176 830 to 236 798. The United States Interagency Council on Homelessness (USICH) also has embraced the housing-first approach to chronic homelessness as a pillar of its plan to end homelessness in the United States. “Chronically homeless individuals are extremely expensive for the taxpayer,” said Barbara Poppe, executive director of the USICH. “[Supportive housing] benefits the entire community because people are not languishing on the streets.”