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?



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