Housing First Policies Leave The Seriously Mentally Ill Unhoused, Untreated & On The Streets – Says Groups Challenging My Blog Post

(12-28-21) My blog last week, Conservatives’ Criticism Of Housing First Is Wrongheaded. Yes, Hugh Hewitt, That’s You, drew this response, arguing that my “defense of Housing First seems more like a reaction to criticism from Hewitt than a nuanced understanding of Housing First’s inability to address the needs – including appropriate housing and treatment – for the serious mentally ill population.” (Meanwhile, thank you to whoever sent me a Christmas angel anonymous!) 

Dear Pete,

As fellow family members, advocates, and analysts, we were surprised to read your article attacking criticism of Housing First and your characterization of people who are concerned with Housing First.

At the same time, we see your article as an opportunity to bring clarity to an issue often charged with political and ideological divisiveness. Our Coalition, Hope Street Coalition, was created to address alternatives to street suffering and the drivers of homelessness, particularly untreated serious mental illnesses and addiction.

We recognize that the current system most often leaves this population unhoused, creating further harm for this vulnerable population and the community.

Even before the article begins an image depicts a black figure directing a man’s head away from a homeless man lying on the sidewalk, suggesting that those who disagree with Housing First are willfully ignorant and un-compassionate. We argue, however, that the exact opposite is true. We are concerned and even opposed to the unilateral, one-sized-fits-all of Housing First approach because we have not averted our gaze but have examined it squarely – particularly from the perspective of the unhoused seriously mentally ill and addicted.

Housing First Is A Profound Mismatch For the Most Ill

Proponents of Housing First like to cite their support of evidence and best practices. In fact, while the study that you link to seems impressive, there are many other studies that show housing stability falls off precipitously after year three. In fact, the largest piece of evidence, from HUD’s Point In Time Count (PIC), shows unmistakable increases over the last five-years in unsheltered homelessness and increases in unhoused people experiencing serious mental illness and substance use disorder – despite funding and housing capacity that have reached all-time highs.

This does not mean that people are not housed nor benefit from Housing First. Nobody, not even Hugh Hewitt, is arguing that housing is not a crucial component to assisting those who are living on the streets. What is being argued is that the reality on the ground – particularly among the SMI population – does not match the Housing First rhetoric.

We all know that the broken and fragmented mental healthcare system that plagues our nation leads to episodic and chronic homelessness. Housing First is a profound mismatch for the SMI population because it positions a dwelling before obviously necessary clinical psychiatric care. We also know that Housing First is not housing fast, nor is it guaranteed housing – again, particularly for the SMI population.

Access to Housing First depends on bureaucratic processes which leave seriously ill people unhoused, untreated and on the streets – sometimes for years. Outreach workers make the rounds to find, identify, and possibly offer housing based on the availability of vouchers, interim and transitional bed availability, or hotel initiatives. If a person is SMI, their confusion, paranoia, delusions, hallucinations, and agitation often make them unwilling or unable to accept offers of housing and services.

Untreated, The Serious Mentally Ill Don’t Often Benefit From Housing First

If the stars align and they do accept it, they will likely not do well. They may be too frightened to go inside where their hallucinations can overwhelm them in a new environment. Instead, they may sleep in the yard, defecate in a backpack on the porch and incorporate their neighbors into their SMI thought disorders such that conflict is likely and eviction or abandonment of the housing may soon follow.

That reality, which often leads to tragedy before treatment, services, and housing, paints a picture of a continuum of care that needs significant reform to better address chronic serious mental illness and addiction. Homelessness is just one pain point of a broken and fragmented piecemeal “system of care and housing.”. Other pain points are over-representation in incarceration, acute hospital and emergency room revolving doors, overcrowding and, as you mentioned, shelters, that all lead to the same systemic disarrangement. Yet for many, where there is no requirement for accountability, there is no opportunity that can begin the path to recovery.

There is evidence that with the right supervision and support, compelling a person to participate in their own recovery is effective. We see this working with people in Assisted Outpatient Treatment (AOT). But what of those with advanced psychiatric deterioration too sick for AOT and independent living with drive by case management? Those are the individuals most often suffering unsheltered and exploited on the streets.

Housing First Advocates argue that we must wait for them to develop trust before interventions can be made successfully. How long must the public wait for people circling the drain to develop sufficient trust while bodies are stacked in morgues, community members tip toe over needle strewn streets, and businesses struggle daily to address feces, threats to their customers, and disorder?

While Housing First is not a radical idea, we reject the Housing First ONLY ideology and policy. This approach marginalizes experiences of families in mental illness crisis whose loved ones are in need of ‘treatment first’ and more appropriate residential treatment and housing. A housing continuum must include sustainable funding to incentivize the creation of more housing modalities like those documented in the “Housing that Heals” white paper that is garnering attention as a needed and reasonable alternative for those who are experiencing homelessness for clinical reasons.

For advocates of the unhoused mentally ill and addicted, we are told not to believe our eyes, our heartaches, and our tragedies by the “brook no criticism of Housing First” affordable housing and homelessness providers. It is akin to be pissed on and told it is raining.

As people working in the trenches and advocating for better treatment, and more housing, injecting a political component to a legitimate criticism of public policy is extremely disappointing. As we mentioned, our criticism is not due to our political leanings, whether liberal, moderate, or conservative, but out of our experience of understanding exactly how coordinated entry, Homeless Management Information System, shelter, and Permanent Supportive Housing programs work for the most vulnerable.

Characterizing this as political, ignorant, and un-compassionate is offensive and the worst kind of journalism.

Thoughtful and objective people with family members in the system are critical of Housing First simply because it does not deliver – it is not the panacea advertised by those who benefit from government grants that require a Housing First approach. What we hope for is a reasoned, approach inclusive of the level of need for all populations. We must not fall prey to the Housing First mantra confirmation bias and belief perseverance of those who let ideology trump appropriate treatment for those circling the drain.

Sincerely,

Paul C. Webster

Director

Hope Street Coalition

[email protected]

www.hopestreetcoalition.org

Evelia Davis, Phoenix, Ax

Janet Hays, New Orleans, La.

Raine Johns, Trinity, Fl.

Robert Marbut, San Antonio, Tx.

Michael Nason, Dana Point Ca.

Teresa Pasquini, El Sobrante, Ca.

From The Hope Street’s website:

What is Hope Street’s advocacy vision?

  • Reduction of homelessness. Hope Street Coalition supports outcome-driven approaches and programs that reduce unsheltered homelessness.
  • Removal of treatment barriers. Hope Street Coalition seeks the removal of barriers to treatment for mental illness and addiction – the two biggest drivers of street suffering.
  • Scale housing that heals. Hope Street Coalition supports the increase of clinically intensive residential care facilities to provide long-term stability and wellness.  Hope Street discourages the use of housing and non-clinical services as substitutes for clinical interventions.
  • Balanced individual and community interests. Hope Street opposes efforts that place the safety and best interests of the community below the decisions of individuals, who lack capacity to participate and function in primary activities of daily living, to harm themselves, go untreated, and risk their health and safety.

For whom does Hope Street advocate?

  • Hope Street fights for the most vulnerable of the homeless population: the unhoused mentally ill and addicted.  Focusing on this population will result in significant reductions in unsheltered homelessness, victimization, and destitution.

You can learn more about Hope Street by watching this interview between Paul Webster and Dr. Drew Pinsky.

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About the author:

Pete Earley is the bestselling author of such books as The Hot House and Crazy. When he is not spending time with his family, he tours the globe advocating for mental health reform.

Learn more about Pete.