The following article was written by Ruth Gourevitch and Mary K. Cunningham. The post originally appeared on Urban Wire, the blog of the Urban Institute. Click here to read the original post on Urban Wire.
When asked what the most common misconception is about people experiencing homelessness, Mental Health Center of Denver supportive housing provider Takisha Keesee knew her answer right away: “That they want to be homeless.”
This myth enables apathy and maintains the nation’s status quo of too many people experiencing homelessness in an urgent affordable housing crisis.
On any given night in the US, about 550,000 people experience homelessness, and almost 89,000 are chronically homeless (PDF)). Sometimes they sleep in shelters, if a bed is available. But they may avoid shelters because of bed bugs, high rates of violence, or policies that prevent them from bringing their personal items or pets with them. Shelters may require sobriety or engagement in services. And couples are often split up when entering shelter, so some avoid it to stay together.
Almost 200,000 people live unsheltered (PDF) in the US. Many times, people sleep outside because it is simply their best option. This doesn’t mean they are choosing to be homeless. It means they don’t have a lot of other choices.
Early results from the Denver Supportive Housing Social Impact Bond Initiative (the Denver SIB) add to the evidence that those who experience homelessness want stability, and stability starts with housing.
How the Denver social impact bond debunks this myth
The Denver SIB program provides permanent housing and wraparound services for people who experience homelessness and cycle in and out of jail. As the research partner for this initiative, the Urban Institute randomly assigns people experiencing homelessness with multiple arrests to the permanent supportive housing program. From there, staff from the Colorado Coalition for the Homeless and the Mental Health Center of Denver work with local partners to locate the people selected to participate.
Between January 2016 and December 2017, 363 people were referred to the Denver SIB program. Within six months of referral, 311 were located. And of those located, 90 percent agreed to housing within six months. The average time between the initial meeting and a client agreeing to housing was just six days, and 81 percent agreed to begin the housing application process within just a day of being located. Of the 240 people with approved housing applications, almost all participants leased up into housing (96 percent).
This means of the 363 people experiencing chronic homelessness who were randomly selected to receive treatment, 63 percent engaged with the service providers and moved into housing (also known as the project’s take-up rate). In other words, regardless of whether they were actively seeking help, 63 percent of participants engaged with the program and agreed to move into housing. Very few studies track take-up rates, making this evaluation one of the few benchmarks for engaging participants who are not actively seeking services.
These strong take-up numbers highlight the desire for housing among Denver’s chronically homeless population, debunking the idea that people would choose homelessness when given the option of permanent supportive housing.
The importance of meeting people where they are
People living on the street for long periods often suffer from co-occurring mental health and substance use disorders. They are criminalized for being homeless, racking up nuisance crimes—such as trespassing, panhandling, public drinking and urination, and sleeping in public spaces—which can lead to a street-to-jail cycle that is hard to break.
Street life is punishing. People are frequently victimized, adding to a lifetime of trauma that can come with being poor. Chronic physical health problems, like hypothermia, are sometimes a consequence of homelessness, while others, such as diabetes, are difficult to treat when sleeping on the street. In a lot of ways, our safety net has failed people over and over again.
One reason for the high take-up rate among Denver SIB participants is the program’s emphasis on Housing First, which doesn’t require participants to meet preconditions to entry, such as sobriety or a commitment to services. In meeting people where they are, the program breaks down barriers to housing. Instead of using housing as a reward for good behavior, housing is offered as a stabilizer.
Despite the success of the Housing First model in this context, significant substance use and mental health issues can make engagement difficult. At times, people selected for the program are in jail when service providers locate them, and meeting in this environment is not always conducive to establishing trust and building rapport.
Throughout every step of the process—from engagement to housing—Denver SIB participants’ needs are prioritized. Service providers take time to build trust and rapport with clients, allowing clients to largely decide what services they receive. When it is time for participants to move into their housing units, they work with service providers to pick a place that fits their needs—whether that’s a provider-owned building with 24-hour case management staff or a privately-owned unit in a quieter area.
|Maria moved into her new home in the Sanderson Apartments in November 2018. Through the Denver Supportive Housing Social Impact Bond, Maria has stable housing after experiencing homelessness for eight years. Photo by Maura Friedman/Urban Institute.
Engagement is a first step toward stability
Not only are people agreeing to housing at a high rate, but they are also staying housed. Two and a half years into the program (as of July 2018), 85 percent of the Denver SIB’s 285 participants remained in housing without exiting the program, and participants go to jail less often than before. We will track jail returns over time and will compare Denver SIB participants’ outcomes with a control group that did not receive supportive housing.
Housing providers agree that, for this high-need population, providing a roof over someone’s head is not enough to achieve stability. Providers offer one-on-one case management and referral services around the clock to Denver SIB participants, as well as classes ranging from cooking basics to anger management. These supportive housing services help clients get back on their feet and provide them with the foundation necessary to maintain their housing.
Changing the narrative around homelessness by providing long-term, supportive options
The idea that people who are homeless choose to live on the street perpetuates the false narrative that, unlike other people, they do not need or want stability.
As the Denver experience indicates, homelessness is very much a solvable problem, and homelessness is usually not a choice. When we remove barriers and provide long-term housing with voluntary, wraparound services in a way that treats people experiencing homelessness with dignity and provides the resources they need to thrive, people can find and stay in housing.
As Takisha said, “I don’t want to make it sound simplistic, but it is pretty simple. You give somebody [experiencing homelessness] that support—that, ‘Hey, I’m here for you if you need.’ It opens doors.”