Homelessness 101: Housing First??
Okay. Okay.I was a skeptic. I didn’t believe that Housing First could work in Memphis, or any other city that didn’t have an Assertive Community Treatment (ACT) team.
Why didn't I believe it?
Because Dr. Sam Tsemberis’ Pathways in New York, the gold standard for Housing First, has had an ACT team from its beginning. That’s what made, and still makes it work so well. Memphis has never had an ACT team. We still don’t have one. But we have Housing First and it’s working for most of the chronically homeless men and women who’ve been housed through the program. Providers of housing also meet regularly and work together to help re-house those who leave (or need to leave) their housing placement.
Because I didn’t think that private landlords would be willing to rent apartments to people who were so addicted to alcohol or drugs or mentally unstable that even their own families couldn’t help them anymore. Some did, and still do. Some couldn’t or wouldn’t.
Because I didn’t think for one minute that the people implementing Housing First would be able to secure the level of services needed to help chronically homeless people with untreated schizophrenia or florid bipolar disorder housed. HUD came through with some $ for services in the beginning, and Memphis’ top-notch providers are keeping the vast majority of those who’ve been housed over the years stably housed. Still, those with untreated schizophrenia or bipolar disorder, complicated by anosognosia, remain homeless, primarily because they refuse services, treatment, and housing.
Because I didn’t think that keeping the apartments the chronically homeless peoples had finally secured would be a motivator for them to try to reduce—much less stop—their drinking or drugging. In fact, I’d never even considered it. Reportedly, it is a motivator for some or many.
So was I right about anything? Unfortunately, yes.
I was right when I felt sure that the sickest homeless people wouldn’t escape the concrete killing fields of homelessness unscathed. Five of the first forty housed in Memphis died in the first year. The deadly damage had already been done.
Encampment in the parking lot next to the building where my office was in the heart of downtown and a block away from Calvary Episcopal Church, where our Street Ministry was located. I knew most of the ones in the encampment.
I was right when I said there were some who were so psychotic that nothing less than involuntary commitment to give them a chance to stabilize on their medications would work. We still can't get them involuntarily committed for their own health and safety.
I was right when I said that Housing First isn’t for every chronically homeless person. Some, if not many, DO need to get clean and sober first. (One of Memphis’ clients, who was said to be addicted to crack cocaine, sold everything, including the appliances, in the house they’d rented for him and it made the evening news as they hauled him off to jail.)
I was right when I argued that putting almost all of HUD's funding into Housing First would result in the closure of most of HUD-funded transitional housing that provided long-term residential treatment and recovery services to help the individual get clean and sober and go on with his/her life.
I’d rather have been wrong on these too.