The concept can seem pretty radical: Take homeless people whose lives are a mess — even addicts, alcoholics, and schizophrenics who won't take their meds — and give them their own apartments, without requiring that they clean up first, get a job, or "behave."
Support them, yes, and provide comprehensive case management and all the needed services. But if they go on a bender, or even end up in prison, don't put them back on the street.
Think of permanent housing not as something you earn, but as a human right, and as a foundation people need to rebuild their lives.
It's called Housing First, and since its beginnings in New York City in the early 1990s, it has been proven to more effectively move people out of homelessness — especially chronic cases — than the traditional system of shelters and tightly structured social services.
Studies across the country have found Housing First kept, on average, about 85 percent of clients in permanent housing for at least a year, twice the success rate of the old model.
In Rhode Island, Housing First was introduced in 2005, run by Riverwood Mental Health Services, a Warren-based community mental health provider, with $300,000 from the state, $175,000 from the United Way of Rhode Island, and vouchers from Rhode Island Housing.
The local results have been even better: Of 41 people tracked, 38 are still in permanent housing, says Eric Hirsch, a Providence College sociologist who has evaluated the program.
Hirsch also estimated that, based on the average cost of hospital stays, emergency room visits, imprisonment and shelter stays, the system saved a net $7946 per person in the first year of participation, after accounting for the cost of services used, case management, and housing.
"It's a consistent pattern across the country that you save money," Hirsch says.
And it's also a more realistic, practical approach, says Don Boucher, the program manager: "If you're trying to get an acutely paranoid schizophrenic into a specific appointment . . . it's not a matter in many cases of not wanting to do it — it's an inability to do it." With housing and patient, persistent case managers, on the other hand, this program has turned lives around.
But the philosophy can still be a hard sell, and though the state has continued to provide $300,000 per year for the program — plus a grant for $580,000 over two years — efforts to expand it and make it a mandatory service failed.
"We get some iteration of 'You're just going to give somebody an apartment for nothing?' " says Jim Ryczek, executive director of the Rhode Island Coalition for the Homeless. "So I think there's a lot of work to be done in shifting values."
A bill did pass making the program a service that the Rhode Island Housing Resources Commission "may" offer, and given other program cuts, level-funding is a coup. But looking ahead, commission executive director Noreen Shawcross says she doesn't know what her budget directive will be for 2010, or what other needs will compete with this program.
"Part of the whole challenge of dealing with homelessness is dealing with the crisis at hand vs. keeping our eye on those long-term goals," Shawcross says. "So far we've been able to keep this program going, and it's something I am personally committed to, but we also have to make sure, for example, that no family with children is left out on the street."
Last month, the program, which has grown to house 115 people, got a big cash infusion from the federal government: a $2 million, five-year grant from the Substance Abuse and Mental Health Services Administration (SAMHSA) that will allow 50 more people to enter the program in the next 15 months, plus 40 more later on, and pay for support services for another 200 people.
But Rhode Island's homeless problem is growing much faster than that. In fiscal 2001, 336 people who used shelters had been homeless for more than a year, while the number climbed to 1124 in 2007.