Housing First
Housing First is a social policy approach aimed at addressing homelessness by prioritizing immediate access to permanent housing without preconditions such as mandatory treatment or participation in support programs. Developed in the 1990s by psychologist Sam Tsemberis in the United States, this model operates on the premise that securing stable housing allows individuals to better focus on improving their overall quality of life, including employment and sobriety. Unlike traditional models that require homeless individuals to meet several prerequisites before obtaining permanent housing, Housing First provides voluntary support services alongside housing, enabling residents to choose whether or not to engage in treatment.
The program consists of two main models: permanent supportive housing, which assists those with severe disabilities and chronic homelessness, and rapid re-housing, designed to help a broader range of homeless individuals achieve independence. Evidence suggests that Housing First has been effective in reducing homelessness rates, with high housing retention statistics. Critics, however, argue that the program may not adequately address substance abuse and mental health challenges, as treatment participation remains optional. Overall, Housing First has gained international recognition and endorsement from organizations such as the U.S. Interagency Council on Homelessness, reflecting its growing influence in homelessness policy.
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Housing First
In social policy, Housing First is an approach to housing assistance that emphasizes providing housing as quickly as possible to people experiencing homelessness without them having to meet preconditions. Once the individuals have permanent homes, the program provides voluntary support services. The model is a strategy to eliminate chronic homelessness. Housing First was developed in the United States in the 1990s and has spread internationally. The approach differs from other housing assistance programs that require individuals experiencing homelessness to meet certain mandates, such as participation in mental health care, drug addiction treatment, or transitional housing, before receiving help. Housing First is a cost-efficient program that has demonstrated success in keeping people off the streets and in permanent housing. However, the approach has received criticism for failing to address drug and alcohol abuse and mental health issues.
Background
Chronic homelessness is used to define individuals with disabilities, including mental illness or drug addiction, who have experienced homelessness for one year or more or have experienced homelessness four times in the last three years. To address the issue, the US Department of Housing and Urban Development (HUD) has attempted to provide housing and social services to those in need. However, the agency traditionally required unhoused people to get treatment for their disabilities and satisfy other mandates before setting them up with permanent housing.
The McKinney-Vento Homeless Assistance Act of 1987 was the US government's first major response to tackling homelessness. The law provided funds for transitional and permanent housing, psychiatric care, and substance abuse treatment. The intention was to gradually prepare the unhoused population for independent housing, an approach known as Housing Readiness.
HUD has administered homeless services through the continuum of care model. The model requires individuals experiencing homelessness to enter treatment and therapy and then complete a step-by-step process, including moving through transitional housing, before becoming eligible for permanent shelter. Continuum of care has disadvantages. Some individuals do not meet the restrictive preconditions. For those who do, the program is long and difficult, and many participants become discouraged. If participants refuse treatment, they are dismissed from the program and forced back onto the streets.
Housing First was created as an alternative to continuum of care. Sam Tsemberis, a psychologist who founded the nonprofit Pathways to Housing in New York City, devised the model in 1992. The unhoused men and women who Tsemberis worked with told him that they needed a place to live before they could seek treatment or therapy. Tsemberis developed an idea to give shelter to individuals experiencing homelessness without requiring mandatory tests or other conditions. He offered them free support services, but they did not have to utilize them. The Housing First approach flip-flops the continuum of care model. First, it provides people experiencing homelessness with stable housing and then treatment and therapy. US president George W. Bush implemented the model in 2004.
Overview
Housing First operates under the theory that people must first have a place to live before they can get a job, become sober, or partake in counseling. Once their living situation is secure, then individuals can work on improving the quality of their lives. Participants in Housing First sign standard lease agreements. They are not bound to additional requirements outside the lease. Voluntary support services, such as substance abuse treatment and psychiatric care, are available, but participation is not necessary to maintain the lease.
Two main program models make up Housing First: permanent supportive housing and rapid re-housing. Permanent supportive housing is geared toward people with severe disabilities, mental health issues, and drug addiction who have experienced homelessness for long periods. Program participants receive long-term rental assistance and access to support. Rapid re-housing caters to a variety of unhoused individuals. The program aims to help people find housing and foster their independence. Residents have access to short-term rental assistance and support programs.
Housing First has been implemented across the United States, Canada, Europe, Australia, and New Zealand, and was credited with reducing homelessness in the 2010s by lowering the number of people on the streets and yielding high rates of housing retention. In the United States, about 565,000 people were homeless in 2015, according to HUD. That number dropped by 11 percent—more than 72,000 people—between 2010 and 2015. HUD also said that more than 83,000 people were chronically homeless in 2015. This marked a decrease of 31 percent—23,000 people—between 2010 and 2015, a decline that is largely attributed to the Housing First program.
Nearly a decade later, however, the US and other countries reported the highest rates of homelessness ever recorded. In 2024, according to HUD, an estimated 771,480 people experienced homelessness, and 152,585 people experienced chronic patterns of homelessness. These rates represented an increase of 19 percent and 27 percent, respectively, over figures in 2007, when the data was first collected by HUD. Further, Black populations experienced homelessness at disproportionate rates to the rest of the US population, with Black people comprising 32 percent of all people experiencing homelessness in 2024 while making up just 12 percent of the total US population. Factors contributing to such significant increases included a major deficit in affordable housing in the US, rising inflation rates, and ongoing impacts of systemic racism, among other causes. Additionally, experts pointed to the COVID-19 pandemic as a significant factor, due to the discontinuation of homelessness prevention programs during that period.
Despite increases in rates of homelessness, studies continued to show the benefits of the Housing First model. In 2015, a study that tracked a Housing First program in five Canadian cities showed that over the course of two years, participants remained in housing for about 63 to 77 percent of the time. In the United States, permanent supportive housing has a retention rate as high as 98 percent, while under rapid re-housing, residents remain in their homes between 75 and 91 percent of the time after one year, according to the National Alliance to End Homelessness, an American nonprofit organization. The Housing First model is also cost-efficient for many communities. By providing individuals experiencing homelessness with permanent housing, some studies have shown they are less likely to use emergency services, such as hospitals, shelters, and jails. Before Housing First, the state of Utah spent $20,000 annually on each person experiencing chronic homelessness. In 2015, more than ten years after the state implemented the program, the cost dropped to $12,000 per unhoused individual. Research continued to support the Housing First model into the 2020s, especially its ability to provide greater housing stability to individuals.
On the other hand, Housing First has garnered criticism over its effectiveness in addressing drug abuse and mental health issues. Because treatment is optional, the program does not help address residents' addiction or psychiatric issues. Continuum of care programs, which include treatment as a requirement, have lower housing retention rates but typically make more progress in addressing drug and mental health issues.
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