Housing First is Harm Reduction

Safe shelter is a basic need; like food, water and air.  We don't tell people who are hungry that we will feed them just as soon as they complete their drug treatment program, or enroll in mental health services.  That would be cruel and frankly, criminal.  So why is it that some housing programs require people to do these things before we will provide them with safe housing.  It makes no sense to me.  The Housing First approach is based on the concept that a homeless individual's first and primary need is to obtain stable housing, and that other issues that may affect the person can and should be addressed once housing is obtained. It is the recognition that issues like mental health and substance abuse can be better managed and addressed when a person is in stable housing.  It is the concept that housing is used as a tool for recovery and not as a "prize" for compliance.  The thinking that a person can or will get clean and sober while they are living on the streets is false and dangerous.  The expectation that a person with chronic mental illness is going to stabilize on medication and attend regular appointments with a therapist is ridiculous.  To tell a person with a chronic health condition that they must comply with medical appointments and adhere to medication regimens or jeopardize their opportunity for housing is inhumane.  You cannot punish people into self sufficiency.


The Housing Readiness model means that we as providers, determine when the individual to be served has jumped through enough of our hoops and is "ready" to be housed.  I think this model is flawed in a number of ways, not the least of which is that the sickest and most vulnerable people are the ones who are left on the streets.  If we are serious about ending chronic homelessness and we want to prevent people from dying on the streets, we need to house the most vulnerable first. 


If I hear one more case manager or service provider tell me that, "Johnny chose to be homeless as  he did not meet his treatment or housing plan goals, and was discharged from the program," I think my head will explode.  Case managers will often talk about people being "non-compliant" with medical appointments, or that they stopped taking their medication medication, or the refused to go to substance abuse treatment so they are kick out of housing programs. Sometimes providers will say that when people are non-compliant with housing plans or medical plans, they need to experience the consequences of their behavior.  Death on the streets should not be the consequences for anyone for any reason. The fact that someone is not adhering to medical advice means their health is further compromised and discharge from housing only means that they are more likely to die on the streets. 
This approach makes no sense to me.


The Housing First model is evidence based.  There is a lot of research out there to support this model.  The research also shows that when people are in stable housing situation, they are more likely to engage in mental health services, health outcomes improve dramatically, people are more likely to seek recovery from substances and overall mental and physical health outcomes improve.


Someone who has been a mentor to me says that the first rule in caring for people is to "Do no harm".  This is a mantra that is taught to healthcare professionals around the world.  I think if we are making decisions that can potentially cause harm to a person we serve, we need to rethink our service delivery model.


Just my opinion,


Much Love,
Jonathan