Housing First: Assisting People in Finding Stability

Over half a million people were currently experiencing homelessness in the United States during the last point-in-time count. When someone is experiencing homelessness, seeking shelter can be all consuming, making health-improving actions seem insurmountable. Read on to learn more about Housing First policies and how to advocate for these policies in your community.

Housing help for homeless

Housing is an essential need for human survival. However, for over 580,000 people in the United States during the last point-in-time count, street or shelter homelessness was their daily reality. Of those individuals, 30% were experiencing homelessness as a family and 70% were individuals.

Homelessness can impact anyone, but individuals experiencing homelessness are more likely to be male, racialized groups, and have histories with substance use, mental health challenges, or incarceration.

Being precariously housed, under-housed, or homeless can be so all-consuming for the brain that seeking shelter is the only priority for survival or well-being. Unfortunately, that usually includes being prioritized over health-improving behaviors like getting sober or stabilizing mental health.

Supporting individuals to get out of homelessness can have drastic positive impacts in all areas of their lives and specially on having a stable life.

Housing First: Program definition

Prior to the radical idea of Housing First policies, housing solutions for someone experiencing homelessness were typically based on a “housing readiness” assessment. Housing readiness refers to models that essentially set targets or thresholds for individuals who are experiencing homelessness, as if testing their ability to survive in or maintain housing. These models are especially counterproductive to someone experiencing addictions and/or mental health challenges. That's because relapses were often sufficient to stall someone from proceeding to housing or, worse, to be removed from a program altogether. This consequence can have devastating impacts on someone experiencing homelessness, and their loved ones or advocates, whereas Housing First models that focus on success may be better.

Housing readiness typically saw someone move from a shelter, often after an extended stay, to something like a dormitory. Then, from a dormitory, maybe after months or years of precarious housing or homelessness, into public or subsidized housing units.

Housing First models ensure that housing is not contingent on stabilized mental health medications, sobriety, or the like. Furthermore, Housing First models are not designed to be “housing only.” Instead, Housing First models aim to provide the stability that might be necessary for some individuals to be in a position to shift their focus from seeking shelter to improving health in other areas. Organizations that provide housing support under a Housing First model typically have staff responsible for providing clients with support to access rehabilitation services, psychiatric support, and more.

From a health perspective, steady and reliable housing typically contributes a life improvement for people who need to prepare for life-changing decisions for better health.

Benefits of Housing First

The health benefits of Housing First models extend beyond the immediate benefits of supporting patients actively experiencing homelessness. These benefits will begin to span the lifespan as the research demonstrates that Housing First models have high rates of success in maintaining housing for patients for years to come.

The research on Housing First demonstrates a significant benefit to maintaining housing and decreasing homelessness compared to traditional models, including those with significant and complex health needs, such as severe mental health disorders or addictions.

Housing First models make treating and maintaining health possible for patients experiencing severe mental health conditions or addictions. The model does so by reducing or eliminating the brain’s need to focus on survival needs, such as shelter for the night. The future of homelessness services under a Housing First model will continue to support healthier lives for complex patients, which is good news for everyone.

Moreover, the benefits of Housing First models even extend to those caregivers and loved ones of someone experiencing homelessness. For example, a parent of a young adult experiencing homelessness and addiction may face substantial anxiety for their child. Housing First models that increase their likelihood of recovery and housing placement assistance may have substantial positive mental health impacts. In fact, during and after their time loving someone actively experiencing homelessness, they may find mental health benefits in the opportunity to advocate for increasingly common Housing First models.

Home first and mental health

What does all of this mean for health, you may ask? For a patient experiencing homelessness and concurrently facing severe mental health challenges, accessing a home can be so difficult that it seems impossible and not the first resource. For a person who has bipolar disorder, post-traumatic stress disorder, or other mental health conditions that impact their ability to complete daily tasks, the housing readiness model presents so many barriers to housing that they are unable to move beyond the first few “steps” into more stable housing. This could keep these patients circling through shelter systems and emergency departments in hospitals for years.

A patient with severe mental health conditions requires stability to be in a position to positively and continually improve their state of health. When a person knows they have a safe place to sleep at night, the brain is free to focus on bigger or deeper challenges that impact the overall state of well-being, like getting the necessary help for a diagnosis. Moreover, a patient unable to find stability in housing may be unable to locate a home, navigate a housing market and the related bureaucracies, or find the support they need to stay in their true home. By prioritizing house approach for these patients, they are better equipped to utilize available mental health services and strive toward overall wellness.

Pathway to housing: Helping patients with substance abuse

Similarly, for a patient experiencing homelessness and simultaneously struggling with substance use, accessing housing can feel like an insurmountable hurdle. When a person facing addiction is more focused on where they will sleep at night than the impacts of their addiction on their physical and mental health, it can be overwhelming to prioritize sobriety. Where a Housing First model helps is that the knowledge of safe shelter for the night and the foreseeable future allows the brain to begin to work on other longer-term, potentially more profound issues, such as getting necessary help with substance use.

Housing readiness models not only make access to safe shelter a hurdle, but can also make ongoing sobriety a challenge. In a typical housing readiness model, a patient facing addictions may be required to enter and “successfully complete” detoxification and rehabilitation programming, exiting without a safe or stable place to go. When exiting rehab, a patient who is homeless may be heading back onto the streets or into a shelter, facing triggers and struggles that challenge their new sobriety. Moreover, these challenges may increase the risk of relapses, further risking their ability to access stable housing in the long run as they do not move up the “steps” for housing readiness models.

How to support the most vulnerable members of your community

Readers should consider this a call to action to support the most vulnerable members of our communities. Housing First has demonstrated benefits for long-term housing and for improving the health of individuals. Consider identifying the available Housing First supports or programs to help the homeless in your community and joining their teams of volunteers. If no Housing First program exists in your area, educate policy-makers and local leaders, advocating for the provision of Housing First programs in your community. And if you know someone experiencing homelessness, consider whether they are aware of Housing First programs and if they want help accessing them– you just might make a very big impact on the health of someone you care about.

While every Housing First model is different and may have different processes in place for program entry, it is likely that an advocate can reach out on behalf of someone experiencing homelessness to make first contact. Housing First models are appearing all over the country and around the world, so searching for a program in your community is a great place to start supporting someone you know who is experiencing homelessness. Ask about how an individual can enter the program, what information might be needed to begin the process, and how an individual can reach them to become involved in their program.

Housing First policy prioritizes access to stable housing, without restraints or ultimatums, as a way to improve life and health for individuals experiencing homelessness. Housing First policies are dignified for those experiencing homelessness and their loved ones.

Housing First refers to the model where housing is treated as a right of all individuals, regardless of their current mental health or substance use patterns. In a Housing First model, individuals experiencing homelessness are not required to get their mental health medications stabilized or get clean from their substance use conditions ahead of time. Instead, they’re encouraged to get stable in their housing and concurrently, or when ready, seek any additional supports they may need. At no time in a Housing First model is it positioned as contingent on changing behavior as housing for all.