Housing First: A Simple Solution to a Complex Problem

Posted by on Jun 5, 2015

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Key Lesson:  Always be open to the possibility that the most complex problems can be solved by the simplest solutions. 

Sam Tsemberis started working with the homeless community in New York City in the early nineties. As a psychologist, his job was to identify and treat — sometimes against their will — people suffering from mental illness. At the time, access to homeless services worked like a reward system. If a homeless person wanted a home, for example, she needed to quit her addiction first.

But Tsemberis quickly learned that the system didn’t really work — that the people who needed services the most weren’t always able to change their behavior. He also began to understand that being homeless has nothing to do with the ability to function, telling the Washington Post:  “Surviving in homelessness is labor intensive, exhausting and complicated. It calls for a skill set of functionality.”

Armed with these insights, Tsemberis convened a small working group of people with a variety of perspectives on homelessness. They concluded that the system was backward, and that living in a stable home was critical to improving behavior. Their solution:  Give them a home, no questions asked. Then provide counseling and access to other services. And give them the final say over all of these choices. His critics, Tsemberis says, “thought this was crazy.”

Richard Rebout, who studies homelessness, says “the whole thing sounded nutty to us at the time. But the data became so overwhelming.” A large-scale federal government study revealed that the model dramatically reduced addiction levels and also reduced health related expenses by 50%. In Utah, state officials declared that homelessness had been eliminated by implementing the model, and that it had saved them millions:  “It was costing us in state services, health-care costs, jail time, police time, about $20,000 per person. Now we spend $12,000 per person.” Simply put, the model produced both better individual outcomes and significant overall cost-savings.

Today, Tsemberis runs a non-profit, Pathways to Housing, that focuses on the expansion of the Housing First model both nationally and internationally. It’s mission:  “To transform lives by ending homelessness and supporting recovery for those with mental health challenges.”

Sam Tsemberis is our Grounded Leader of the Week for taking on the seemingly intractable challenge of homelessness, and doing so by honoring the dignity and desires of those he seeks to serve. So simple.