My
one and only brush with accidental homelessness unforgettably
sensitized me to this issue. Newcomer to the US, focus on my science
made me choose a basement apartment off the NIH campus in Bethesda,
Maryland. Landlord an elderly widower retired from the NIH, a safe
dwelling I surmised, little knowing that just a few months later, he'd
trigger a short circuit in his house and it would go up in flames.
Happening the day after Thanksgiving, both at home, we were both lucky
to get out alive. Once the hubbub of firetrucks, police cars and
ambulance chasing clean-up specialists cleared, he drove us to a
downtown Bethesda hotel, promising I'd be back in my apartment within
two weeks. The weeks passed with no progress. Meantime, thanks to those
clean-up specialists, I'd been left standing in the clothes I wore.
Sheer accident that I rushed out wallet in hand. Everything else packed
and sped off for 'smoke damage clean-up'. Sheer luck a colleague looking
to sub-let got me into another place within a month. All this to say
that even though my experience was positively luxurious compared to the
truly homeless, I can well appreciate the hell that is to be homeless.
Where
to sleep, to bathe, to go to toilet, get a meal. We take these
essential basics of daily living for granted when we have a home to call
our own. And that's not all. Situation's incalculably worse for those
homeless even more unlucky to not be in the tropics. For such, staying
warm through bitterly cold days and nights for weeks and months on end
is yet another imperative on a long list of others we 'homed' take for
granted and we still aren't done with the imperatives. A homeless woman
has an additional imperative, how to stay safe and unmolested at all
times of day and night. Sounds like a surefire recipe for insanity, no?
Shocking then that it took an outsider to divine that rather than
carrots and sticks, having a roof over one's head is the most essential
first step for a homeless person to get on the track back to relative
normalcy, maybe even permanently.
The radical visionary who divined this is Sam Tsemberis, founder of Pathways to Housing. The radical aspect of Tsemberis' solution stems from giving homes without preconditions
to people with all kinds of serious and chronic problems ranging from
addiction to other serious mental health problems. This is in direct
contrast to how social policy traditionally addressed homelessness in
the US, i.e., a reward system. It went somewhat like this. Let's
say homeless person issues are x, y, z while the bureaucrat's carrots
are 1, 2, 3. Social policy dictated to the homeless you solve issue x,
say addiction, we'll give you reward 1, say counseling. A trained
psychologist, his stint doing outreach with the mentally ill in New York
City in the early 1990s revealed to Tsemberis his epiphany about the
homeless. It also reveals the blinkers even the most well-intentioned
can harbor. Paternalism is deeply ingrained in the conventional
understanding of the homeless. The homeless are perceived to lack ability to function. However, submerging himself in the world of the homeless taught Tsemberis that on the contrary, the homeless are enormously resourceful.
I
too got the same insight from watching someone at close quarters.
During my time at the NIH, I met a brilliant researcher working in the
building next to mine. Diagnosed with a mental disorder and forcibly
institutionalized, having then managed to partially extricate herself,
some years later she re-surfaced as a homeless person in the
neighborhood. At unpredictable moments, she'd show up in the lab late at
night as I harvested a thick stack of cell culture plates. She'd lean
on a nearby counter and recount her experiences living on the street.
Which intersections were best for panhandling. What time was best to
panhandle at the intersection between Old Georgetown Road and Democracy
Boulevard. How she negotiated with other panhandlers to gain a corner at
this busy intersection. Which supermarket dumpsters were best for bread
and other baked goods. Where years earlier, we'd discussed the latest
paper on Toll-like receptor
structure, now she'd regale with her varied and rich insights about
life on the street. Not to mention I never found out how she even
managed to get onto campus, let alone into the lab. I thought exactly
the same as Tsemberis. What amazing resourcefulness!
Equipped
with the insight that the homeless are nothing if not resourceful,
Tsemberis created a team peopled by outsiders that included a recovering
heroin addict, a former homeless, a psychologist and a poet survivor of
incest (1).
Team in hand and with a $500000 in federal funding, Tsemberis started a
pilot project with 139 chronically homeless his team immediately housed
and offered counseling. The results? A retention rate of ~85%, far
better than the 60% that was the then best metric. All this way back in
1997. When Tsemberis published his findings in 2000 in Psychiatric
Services (2),
a fairly respectable peer-reviewed journal, predictably, old hands in
the homeless services community looked askance at this rude short shrift
to conventional wisdom and by an outsider to boot (3, 4, 5, 6).
However, as the years passed, empirical data by others who implemented/pilot tested Housing First (7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17) bolstered support for it. Even the US federal government found it dramatically shrank addiction and health care costs (18).
Success has been inconsistent when the local administration's
commitment has been likewise, as in Washington D.C. Pilot projects in
other countries such as Germany (19) showed promise. Homeless services
researchers in the UK propose Housing First deserves serious
consideration there as well (20, 21, 22) even as there's considerable resistance to the idea (23, 24, 25). Several studies in Canada find in favor of Housing First (26, 27, 28, 29, 30, 31, 32, 33). It also finds favor in Australia (34).
Analysts
attribute the success of Pathways to Housing and its ascent to
orthodoxy as Housing First to the juxtaposition of key individuals with
unique gifts and qualifications. Dennis Culhane, a researcher who
works closely with policy makers and is 'unusually adept' at
translating research findings to policy positions (35), the charismatic Sam Tsemberis, founder of Pathways to Housing, and policy maker Phil Mangano
(36). Sold by Mangano to local mayors as a consumer choice model rather
than a coercive measure (37), Housing First appealed to politicians
keen to erase visible signs of capitalism's failure and what could be a
more compelling sign than the chronically homeless visibly sleeping in
city parks.
Pathways to Housing and Housing First
aren't interchangeable. However, both assert right to housing as a
fundamental right. This is the reverse of beliefs that have historically
shaped US welfare, namely, people have to first prove themselves worthy
of government benefits or have earned it. However, there are unique
aspects to what Pathways to Housing did in New York City. That blueprint
isn't fully fleshed out even by its architects and already the model is
being exported all over the US and even elsewhere. Several dangers are
inherent to such an approach. Other policy makers may not have the same
goals and commitments. Elsewhere, Housing First could easily become a
tool for enforced gentrification of minority-dominated inner city
blocks. It could be used as a cosmetic cover to relocate the chronically
homeless to city outskirts without investing the corollary efforts
necessary to get them on the path to autonomy and self-sufficiency (38).
In other words, out of sight, out of mind could be a critical weakness
of Housing First that could be easily exploited by less scrupulous
policy makers keen to wall-paper a serious social problem that's also
very embarrassing to leaders and policy makers in what's undoubtedly the
wealthiest country in the world.
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https://www.quora.com/Why-are-housing-first-homeless-shelter-programs-so-effective/answer/Tirumalai-Kamala
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