Housing First: A permanent housing program for the chronically homeless

Joey Stanton slept on the streets of Seattle for 1,095 nights; it rained for more than half of them. Cold, wet, but "independent from the system," Stanton says he avoided shelters and instead wandered from block to block, a can of beer hidden in his pocket, searching for a new spot on the streets to call home for a night. 

Jobless, homeless and suffering from head injuries after being beaten up in an alley, Stanton tells 60 Minutes Overtime that he was rejected from the shelter system the few times he visited, due to his high blood alcohol levels. Not until Stanton was labeled as a "high-utilizer" for costing thousands in public funds, because of regular emergency room visits and ambulance services, did an outreach worker find him - lying spread eagle in a damp bush - and offer him free, permanent housing. No rules, no conditions, just a place to live through Housing First, a unique program aimed at helping the chronically homeless find permanent housing with no strings attached. The only caveat? As the outreach worker told Stanton: "you can't hit people."

After some persuading, Stanton took the deal and was transferred to his own unit in 1811 Eastlake, one of the Downtown Emergency Services Center (DESC) in Seattle's 15 buildings. 

"The shelter system is dangerous and unreliable...people need permanent housing that is not contingent on meeting certain milestones," says Executive Director of the Downtown Emergency Services Center in Seattle (DESC), Daniel Malone. "People need stability so they can change."

Though stable, Stanton says 1811 was a constantly chaotic environment, while also being the perfect place to "look at yourself in the mirror and change."

"People would drink a light beer instead of hand sanitizer, or do drugs safely instead of injecting themselves with dirty needles that could kill them," Stanton says about his experience. "It wasn't a fun fairytale… but things grew for me from there. I had a bathroom, a sink, space to myself... things people take for granted."

"People deserve time and investment, they deserve something as simple as permanent housing so they can start living."

Homelessness, though gradually on the decline over the past decade, is an issue that has made its way into the national spotlight after housing prices skyrocketed past the wages of many across major cities in the U.S., as reported by 60 Minutes in Sunday's Unsheltered. This surge of people living on the street prompted President Trump's Council of Economic Advisers to release a "State of Homelessness in America" plan in September. The federal initiative suggests beating systemic homelessness through heavy policing, market-rate housing and attaching strings and preconditions to government-funded aid, policies that organizations like the National Alliance to End Homelessness call punitive. The alliance instead supports Housing First. Simple sounding, the program, created in New York by psychologist Dr. Sam Tsemberis in the 90's, insists that housing is the only solution to homelessness.

In an interview with 60 Minutes Overtime, Tsemberis explains that Housing First combats other "rewards based" housing models, and that it was founded with the belief that housing is a human right. Equally important is "client based" support, a flexible and consumer-driven way to help people with mental health or substance abuse problems. 

"Mental health and addictions are relapsing life-long conditions, so when housing is tied to your recovery which is unstable, it's like saying some people can never be housed," Tsemberis emphasizes.

The program has also been shown to have economic incentives for municipalities, proposing that permanent housing for the chronic homeless is more cost effective than paying for their hospital visits, jail time or array of expensive services.

But once even coined "bunks for drunks," critics of Housing First say taxpayer money is being wasted on housing those who are not pushed to seek treatment, but instead put in "toxic" environments that can offset their recovery. 

"What do you say to the homeless person who wants to overcome their addiction but knows that he will be led into temptation if he lives in a place where he's surrounded by people who are actively using?" asks Stephen Eide, a senior fellow at the Manhattan Institute for Policy Research. "As for the cost-efficiency argument…[it's] almost totally bogus. Advocates want to argue that Housing First is more humane, fine. Don't try to trick people in how it's an amazing boon for the budget."

That's also the position of Ralph Nunez, President and CEO of the Institute of Children, Poverty and Homelessness, who says that not only is Housing First costly, but it also further induces the cycle of homelessness. He believes the "cure" is through education and job training, and that society needs to stop relying on "pipe dream slogans," such as Housing First to solve anything.

"Housing First should be for people who end up in shelters from a financial misfortune because they have a high rate of being able to handle it, and transition into normal society with a little help," Nunez said. "Some people can't live because they're at the bottom of the ladder. You're in a shelter already, let's add education and job training so you have a solution."

Both Nunez and Eides believe the key to solving homelessness in the U.S. is a mixture of housing options--from transitional shelters and permanent homes, to service housing for the mentally ill. 

Looking beyond the U.S., many countries with low rates of homelessness heavily implement Housing First to tackle the problem. 

Finland has fewer than 300 homeless people on the street, according to the most recent data provided by the Y-Foundation, and Juha Kaakinen, CEO of the Y-Foundation, a key developer of housing in Finland, believes that in eight years the problem will be completely eradicated through solid partnerships between government and municipalities, and by applying Housing First. 

"It certainly helps that Finland has this social welfare system, but I absolutely believe that it can be implemented in countries like the U.S. It's surprising that a country that is at the center of so much global policy and innovation can't fix this epidemic in their own country," Kaakinen says.

Dr. Sam Tsemberis agrees that reframing the way the government handles homelessness is key to carrying out Housing First, saying that "the homeless in society are the last visible signs of our failed and complex economic system...we can't walk past them with our noses up and act like we didn't cause this and then refuse to help." 

DESC's Daniel Malone believes the problem goes much deeper, and stems from society's lack of empathy over people that are struggling. 

"Everyone wants the vulnerable in society to be like car washes; you go through a quick program all messed up and come out squeaky clean and if you can't do that, there's something wrong with you," Malone said. "That's just not how it works: people deserve time and investment, they deserve something as simple as permanent housing so they can start living." 

And Joey Stanton did just that. After two months in 1811, he says he became sober and reconnected with his family. He now works as a researcher at the University of Washington, helping others with their addictions.

"It's not a fun fairytale," Stanton gruffs, dry and indoors as it thundered over the streets of West Seattle, "but it sure as hell works."

To see 60 Minutes' full report on homelessness in Seattle, click here.