The "housing first" approach to homelessness | News | Halifax, Nova Scotia | THE COAST

The "housing first" approach to homelessness

Famed activist Sam Tsemberis explains to the Nova Scotia Housing & Homelessness Conference.

The "housing first" approach to homelessness
Sam Tsemberis

People involved in agencies that help and advocate for the homeless are good people, trying to make the world a better place, but they can get caught up in the inside baseball of the non-profit and social service agency world, employing buzzwords and acronyms at a head-spinning rate, sometimes losing the forest for the trees. And Sam Tsemberis is something of a rock star in the homeless activist world, so I wasn't sure what to expect from him, as the keynote speaker at the Third Annual Nova Scotia Housing & Homelessness Conference in Halifax this week.

Thankfully, Tsemberis is remarkably plain spoken, unafraid to take strong political stands and, well, sensible. And the attitudes expressed at the conference largely demonstrate that Halifax's homeless advocates get it: they're cutting through the partisan divides and agency defending that can define the social service world, and instead are concentrating on the concrete goal of ending chronic homelessness.

Tsemberis is founder and CEO of Pathways to Housing, an agency that started in New York City but now also operates in Washington DC, Philadelphia and Vermont. He coined the phrase "housing first" to describe Pathways' approach to housing, which is simple and straight-forward: Give homeless people a place to live. There's a bunch of stuff that can, and should, come after that, including help with addictions and mental health issues, if needed, but the initial providing housing part of the equation is unconditioned. If you're homeless, you get a place to live.

During his speech, Tsemberis talked about the history of anti-poverty programs in the United States. In the 1950s and '60s, "the war on poverty" was concerned with three groups, said Tsemberis: the poor of the rural south and Appalachia, and the migrant poor in the southwest. Whatever the initial intention of the programs, they quickly took the view that these poor were a kind of "other"—other than the eastern urban architects of the programs—and that the quality of "being poor" was a character flaw. If only they could be taught how to read, or to dress properly, etc, then they could raise up out of poverty. That approach is all wrong, said Tsemberis.

"If we were just a group of normal people, gathered here, and we were asked to address unemployment, what would be your response?" he asked the crowd. "Jobs!" came the response. "And so, what should be the answer to homelessness?" he asked. "Housing," came the response.

"There’s a kind of tacit, or underlying belief system," Tsemberis told me later in the day, "that people have to earn housing, and housing is often, in the existing system, used as a carrot—if you get your act together, then we’ll give you this, which is in some very misguided way intended to incentivize people to go into treatment [for addictions or mental health issues]."

In his speech, Tsemberis used the example of a highly educated woman who ended up homeless, being required to go to classes in bizarre subjects like dressing for a job interview, before she could move from a cot in the homeless shelter to a larger, more private area in the same shelter.

"She could've taught the classes," he said. "She didn't need to go to classes. She needed a place to live."

I asked Tsemberis if addictions or mental health issues on the one hand, and homelessness on the other is a chicken-and-egg proposition: are you homeless because you have an addiction, or do you become addicted because you're homeless and have no other way to deal? But Tsemberis completely rejected the question. "Addictions have been around for thousands of years," he said. "Homelessness has only been around for 20. So it’s not the addiction that’s making people homeless. It’s poverty that’s making people homeless. And the fact that the meager housing, supported social housing resources are very restrictive in who they allow to go into housing.

"If you know anything about psychological treatment," he continued, "unless the person really wants the treatment, they’re not going to benefit from it, if they’re just doing it because what they really want is something else, like housing, so they’re just going through the motions. You’re wasting your time in that system—people are just paying lip service, not really changing as a function of the treatment, unable to actually maintain sobriety, successfully engage in psychiatric treatment because they’re doing it to actually get housing, so that’s just a constant waste of resources on everybody’s part. When people actually want housing, why bother them with treatment? How could someone possibly be interested in treatment which requires, you know, at least you know you’re going to go home to sleep tonight. Without that knowledge, there’s no way you can pay attention to the issues of treatment."

It's now understood that a better use of resources is to get people housing, and then bring services to them, as needed. Tsemberis' model is simple: "work with the private market to provide housing, have off-site services that do home visits."

What's at issue is simply a lack of housing, said Tsemberis. "The federal government has not really stepped up to build the kinds of affordable housing people need. People are in the shelter system; it’s not a long drop to drug use. People who get homeless due to drug use are not the majority of people. It happens sometimes, but that’s no different than it was 50 or 60 years ago. People crash, and they get back in. The homelessness is about housing policy, not addiction policy."

I'll get into some of the local numbers in a future article, but the Housing First approach saves money, in that the money spent of addiction and mental health services has a higher success rate for housed people than for people on the streets.

"There’s tons of studies, very well documented, on the savings," said Tsemberis. "The only caution with making that the central argument is that it’s true for a significant group of people, you save lots of money—we’re talking about millions of dollars. But there’s also a group of chronically homeless who have gone nowhere near a service, has been in the woods or by the waterfront, and avoided all services. So are you going to reach out and engage that person? It’s going to cost you more."

The Halifax conference was used to announce a new strategy for addressing homelessness in Halifax. I'll give details of that soon. I asked Tsemberis what he thought of the local effort, and he didn't hesitate to respond: "I think they know what they're doing, have a good focus, and a determination."

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