Permanent supportive housing is a proven cost-effective effort that has also been shown to lower public costs associated with the homeless and their use of crisis services such as shelters, hospitals, ambulances, and jails; as well as improve their health and overall well-being.
Housing First is a permanent supportive housing program that is considered the “best practice” for governments and service agencies to use in their fight to end chronic homelessness. It’s used in X states and endorsed by the United States Interagency Council on Homelessness (USICH).
The primary goal of Housing First is to get homeless people into permanent, long-term housing. It differs in other shelters and housing programs, as it doesn’t require sobriety, drug treatment, psychiatric counseling or medications, or any service participation. However, supportive services are offered if the participant is interested.
Housing units are typically scattered around towns and cities, working with private landlords. The only requirements are that participants are required to pay 30% of the rent, which is usually paid for by Social Security benefits; and participants must meet with case managers twice monthly.
There is strong evidence that Housing First works:
- Reduces homelessness (Palepu 2013, Tsemberis 2000, Gulcur 2003)
- Reduces hospital utilization among individuals with persistent mental illness and problems with substance abuse and addiction (Cochrane-Stergiopoulos 2015, Fitzpatrick-Lewis 2011, Montgomery 2013, Nelson 2007)
- Reduces costs associated with hospitalizations and treatment for individuals with persistent mental illness and substance abuse problems (Srebnik 2013, Urban-Cunningham 2009)
- Decreases costs to emergency departments (Ly 2015)
- Decreases costs to shelters (Stergiopoulos 2015, Ly 2015)
- Decreases utilization of psychiatric hospitals for formerly homeless individuals with mental illness (Gulcur 2003)
- Cost less (generally) than programs that require sobriety or treatment before providing housing (Gulcur 2003)
- Improves housing stability for people with mental disorders (Stergiopoulos 2015, Palepu 2013, Tsemberis 2000)
- Improves housing stability and decrease hospitalizations among homeless veterans (Montgomery 2013)
- Improves mental health and well-being (Nelson 2007, Tsemberis 2012)
- Improves participants’ functioning in the community when programs have strong case management components (Cochrane-Stergiopoulos 2015)
- Significantly improves the higher quality of life than non-participants, as well as greater safety and comfort in their new dwellings (Patterson 2013)
- Increases treatment for substance abuse and addiction (Nelson 2007, Tsemberis 2000).
- Alcohol usage findings are mixed. One study indicates the use of alcohol and other substances declines among Housing First participants (Kirst 2015), while another indicates that substance use-related outcomes do not differ significantly between participants and non-participants (Somers 2015)
Results/Findings from Housing First Studies:
|City||ER Visits||Hospital Inpatient Costs||Jail time/costs|
|Orange County, CA||-78%||–||-100%|
2006 cost study with 150 chronically homeless individuals in a Denver, CO Housing First program
Charlotte, NC study with 85 chronically homeless individuals
Cost Comparison of Housing First vs. living on streets
Seattle, WA – 95 chronically homeless individuals with severe alcohol problems with health care use were studied to analyze the cost while living on the streets, then while in a Housing First program.
- $86k living on streets
- $42k while living in Housing First Program
- That’s a 51% cost reduction
Orange County, CA – an in-depth report analyzed the costs of 252 chronically homeless individuals on the streets, and in various housing programs, including Housing First programs.
- Average cost per person:
- Living on streets = $100,759
- Permanent supportive housing = $51,587
- That’s a 49% cost reduction
- Average costs for 10% most costly:
- Living on streets = $439,787
- Permanent supportive housing = $55,332
- That’s an 87% cost reduction
With so much evidence-based research illustrating success with the Housing First program, why are there still so many homeless in America?
If you read the Citizens Again proposal to building a single location, you’ll see that many of the great things Housing First provides, the Citizens Again City will provide as well, but on a much larger, more cost-effective scale.
Read through the Citizens Again website, or stay tuned for many more blog posts to explain.