Housing First or Treatment First?

homelessness, housing, Housing Policy

Perhaps the most prominent debate about service delivery models for people who are experiencing homelessness revolves around the question: should housing come before treatment, or should treatment for people who are homeless and experiencing mental illness and/or addiction issues come before housing?

Housing First is a service model that advocates for the provision of permanent housing to people experiencing homelessness before engaging homeless individuals in treatment for mental illness, addiction recovery, or concurrent disorders.

In contrast, the Treatment First service model prioritizes the treatment of mental illness before the housing of homeless individuals (Padgett et. al. 2011). The Treatment First model has informed many service delivery models and public policy designs that require homeless people to provide evidence that they are prepared to live in permanent housing (e.g. the staircase model and continua of care programs operate under the philosophy of Treatment First). The assumption underlying this policy and programming philosophy is that homeless people are not able to sustain tenancy and self-sufficiency without first receiving treatment for mental illness. In other words, sobriety and the active, consistent treatment of mental health disorders act as the necessary pre-conditions for attaining housing.

This philosophy still dominates many of the policy debates over Housing First and Treatment First models, however numerous studies with strong research designs have provided support for the contention that homeless people with mental illness and concurrent disorders are able to sustain tenancy when they are provided with appropriate support for their respective conditions (see Busch-Geertsema 2013, Tsemberis 2011, Tsemberis et. al. 2008, Padgett et. al. 2006).

What do you think should come first–housing or treatment?

 

References:

Busch-Geertsema, Volker (2013). “Housing First Europe Final Report.”: http://www.habitat.hu/files/FinalReportHousingFirstEurope.pdf

 

Padgett, D. K., Stanhope, V., Henwood, B. F., & Stefancic, A. (2011). Substance use outcomes among homeless clients with serious mental illness: comparing housing first with treatment first programs. Community mental health journal, 47(2), 227-232.

Padgett, D. K., Gulcur, L., & Tsemberis, S. (2006). Housing first services for people who are homeless with co-occurring serious mental illness and substance abuse. Research on Social Work Practice, 16(1), 74-83.

Tsemberis, S., Gulcur, L., & Nakae, M. (2004). Housing first, consumer choice, and harm reduction for homeless individuals with a dual diagnosis. American journal of public health, 94(4), 651-656.

Tsemberis, S. (2011). Housing First: The pathways model to end homelessness for people with mental illness and addiction manual. European Journal of Homelessness _ Volume, 5(2).

*For more information on the Treatment First model (written by advocates of this model), see King, R. and Martin, F. (2016). “Treatment first for mentally ill individuals, not housing” San Francisco Chroniclehttp://www.sfchronicle.com/opinion/openforum/article/Treatment-first-for-mentally-ill-individuals-not-8319570.php

Groton, D. (2013). “Are Housing First Programs Effective? A Research Note”: https://www.wmich.edu/hhs/newsletters_journals/jssw_institutional/individual_subscribers/40.1.Groton.pdf

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Measure HHH passes in Los Angeles

Homlessness, housing

On Tuesday, November 8, 2016, voters in the city of Los Angeles passed Measure HHH, the Homelessness Reduction and Prevention, Housing and Facilities Bond. This is a $1.2 billion bond measure that will be used to fund the construction of 8,000-10,000 high quality affordable housing units for people who are experiencing homelessness in Los Angeles. The measure will also fund the development of housing for people who are at risk of becoming homeless and mental health care facilities.

While the presidential election has occupied the minds of many Americans this week, the mayor of Los Angeles, Eric Garcetti, assured Angelenos that measure HHH provides evidence that local governments will continue to tackle complex issues such as homelessness. On Tuesday night, he was quoted by the Los Angeles Times: “There is nothing to be depressed about in Los Angeles when we wake up tomorrow…[Los Angeles] is willing to take on the toughest challenges.”

Measure HHH required a 2/3 majority of voter approval (66.67%) in order to pass and as of Thursday, November 10, 2016, the measure has received 76% of the vote. For more on measure HHH, check out the news coverage:

Los Angeles Times (11/9/2016): http://www.latimes.com/local/la-me-la-transit-homeless-20161109-story.html

CBS Local (11/9/2016): http://losangeles.cbslocal.com/2016/11/09/prop-hhh-homeless/

Los Angeles Daily News (11/9/2016): http://www.dailynews.com/government-and-politics/20161109/election-2016-los-angeles-voters-give-prop-hhh-green-light

City of Miami vs. Wells Fargo and Bank of America

Homlessness, housing discrimination, Housing Policy

Recently, Wells Fargo has undergone intense scrutiny for its questionable sales and employment practices (for more information, check out the New York Times coverage: http://nyti.ms/2e6ZH6l). However, Wells Fargo’s lack of business ethics precedes this recent scandal. This week, the City of Miami is filing suit with the U.S. Supreme Court against Wells Fargo and Bank of America for allegedly practicing racial discrimination against homeowners in mortgage terms and foreclosures during the 2008 housing crisis. The City of Miami asserts that Wells Fargo and Bank of America charged homeowners of color with disproportionately larger fees and unreliable terms for their mortgages. Such exorbitant fees made it difficult for homeowners to keep up with their mortgage payments. (In other words, the mortgages were more expensive than they should have been, which made it more likely that the homeowner would default on the payments.) When homeowners of color wanted to refinance their homes in order to save them, Wells Fargo and Bank of America refused. White homeowners operating under similar economic conditions were able to refinance their homes with these institutions without contestation. Twelve other cities (including Los Angeles, Kansas City, and Philadelphia) have signed on to this suit.

The legal support for this lawsuit comes from the Fair Housing Act of 1968 which was passed with the intention of abolishing housing discrimination. One of the practices that the law specifically addresses (and bans) is discriminatory lending practices.

The lending institutions (and the interest groups that support them) argue that this lawsuit is frivolous because the City of Miami and the other plaintiff cities cannot prove that the discriminatory lending practices led to decreases in property tax revenue (thus affecting the entire city and not just individual borrowers).

The Supreme Court is considering whether or not to take the case.

Here is more information on this lawsuit:

National Public Radio’s coverage of the lawsuit (November 8, 2016):

https://www.npr.org/player/embed/501099505/501121095“>https://www.npr.org/player/embed/501099505/501121095

Los Angeles Times coverage of the lawsuit (November 8, 2016):

http://www.latimes.com/business/la-fi-miami-housing-banks-lawsuit-20161108-story.html

If you are interested in the history of housing policy (and housing discrimination) in the United States, I recommend reading Michele Dickerson’s book Homeownership and America’s Financial Underclass: Flawed Premises, Broken Promises, New Prescriptions (Cambridge University Press, 2014). Dickerson holds the Arthur L. Moller Chair in Bankruptcy Law and Practice and she is a University Distinguished Teaching Professor at the University of Texas at Austin. This book would provide excellent background for anyone who is seeking to understand the underlying causes and the implications of the current lawsuit brought by the City of Miami.

Housing discrimination is one of the many factors affecting homelessness in the United States. (For more information on the specific attributes of the relationship between housing discrimination and homelessness, see the CERD Housing Report: https://www.nlchp.org/CERD_Housing_Report_2014.pdf). If the Supreme Court proceeds, will this lawsuit be able to attain some modicum of justice for the homeowners in Miami (and the other twelve plaintiff cities) who experienced homelessness after foreclosure?

 

 

 

“On the Streets” – Los Angeles Times documentary series on homelessness

Homlessness, Inequality, Los Angeles, personal experience

Los Angeles Times reporter Lisa Biagiotti has started a twelve part documentary series on homelessness in Los Angeles. The objective of the series is to connect the staggering statistics on homelessness in Los Angeles with the personal stories of people who are experiencing homelessness in the city.

The documentary is free and accessible to view on youtube, here is the link: ON THE STREETS — a feature documentary on homelessness in L.A.

The series is very effective at showing how varied experiences (and causes) of homelessness can be.

Some of the many quotes from the homeless people who were interviewed by Biagiotti in the film include:

“We’ve only been homeless for about two months…my husband and I had a set back…and then we lost everything, and now we’re down here [skid row].”

“I used to be somebody, now I’m somebody else, you know what I mean? I have a high school diploma and a college degree and they look at me like I’m homeless…I’m not homeless, I’m houseless because I don’t have a house. Homelessness is a state of mind.”

“It’s not sad but if you can’t make a certain amount [of money] and buy and apartment and afford to eat and do other things…you have to [live in your car].”

“My husband got arrested…because a guy attacked me. Now he’s serving 180 days and I ain’t got nowhere to go right now…he [my husband] told me to stay over here by the jail until I get out, but he don’t get out until December 31st and I don’t got no where to go.”