Does Everybody that Experiences Chronic Homelessness Need Permanent Supportive Housing?
I have heard many well-intentioned service providers speak of Permanent Supportive Housing as the only housing option for persons that have experienced chronic homelessness. Permanent Supportive Housing is an important housing option for all communities to have, and many persons that have experienced chronic homelessness may choose this option. But let me repeat: may choose this option.
Let us also be clear about chronic homelessness and use the HUD definition:
An unaccompanied homeless individual with a disabling condition who has either been continuously homeless for a year or more OR has had at least four (4) episodes of homelessness in the past three (3) years. The individual must have been on the streets or in an emergency shelter (not transitional housing) during these episodes.
Where there is error is thinking that Permanent Supportive Housing, whether it is through a scattered-site model of supports or a congregate model of supports, is the only housing model that will work for people that have experienced chronic homelessness. That type of mentality reinforces a housing placement mindset rather than a housing choice mindset. If we believe in client-centered service delivery then we need to wrap our heads around what it means to offer meaningful choices, not on thinking we know what is best for the people that we serve.
A 2007 study examined what Housing First means to people served through a Housing First program. It shows a very strong relationship between housing satisfaction and whether the individual felt they had a choice in where they live. Altogether, 55% of service participants that felt they had a choice in where they live were very happy with their housing. By comparison, 15% of the respondents that felt they had no choice in where they live reported being very happy with their housing. Only 2% of those surveyed in the report that felt they had a choice in where they live reported being very unhappy in their housing.
Some service providers will make statements that sound convincing as to why people that have experienced chronic homelessness require Permanent Supportive Housing.
One of the claims is that many of these individuals have a mental illness. As a person who lives with a mental illness, this line of argument doesn’t personally ring true for me. I don’t live in Permanent Supportive Housing. Lest you dismiss my line of reasoning because I am only a sample size of one, consider that most people with a mental illness do not experience chronic homelessness. That is a fact. Many people that have experienced mental illness may engage in some form of supports for the rest of their lives, but those supports are most often found in community, not through Permanent Supportive Housing and housing case managers.
Another of the claims is that many of these individuals have experienced addiction to alcohol or other drugs. Let’s take a poll: raise your hand if you or someone you know has had one or more drinks of alcohol in the last 30 days. Most survey data on substance use would reveal that most of you probably raised your hand. I’m not asking for the keys to your place. Even when you consider persons with problematic substance use, most of these individuals do not experience chronic homelessness. Those who choose sobriety may be linked into an array of community resources to help support them in this regard for the rest of their lives, but that does not mean they need Permanent Supportive Housing in all instances.
My last example is related to life skills. Often I have heard service providers claim that one of the reasons chronically homeless individuals require Permanent Supportive Housing is because they lack the life skills to be housed without permanent supports in community. While some people will take longer than others to learn and retain skills, it is untrue and defeatist to think that chronically homeless people cannot (re)learn the life skills necessary for more independent living. Some may want and benefit from the additional life skills support available in most Permanent Supportive Housing, but not all chronically homeless people that have compromised life skills have to be in Permanent Supportive Housing.
Fundamentally, in a lot of instances the focus on having people move into Permanent Supportive Housing rather than an approach with supports that promotes greater independence over time is because we are so fixated on the deficits in the lives of a chronically homeless person that we fail to see the strengths that they possess. Having a disabling condition and a history of long periods of homelessness fails to see future potential nor does it embrace recovery.
No doubt, some individuals have rather substantial life issues such as frail medical conditions, reduced cognitive functioning, developmental delays and the like. But what do each of these – and others – bring to the table that we can build off of in our service delivery and then put this in the context of a service plan offer that focuses on housing stability rather than thinking our mission is to somehow fix or heal people? I would argue that one of the major impediments is that the assessment tools used in many communities (those that have assessment tools anyway) glob onto a deficit orientation rather than a strength-based orientation. Higher acuity should not be a life sentence to Permanent Supportive Housing if that is not what the individual wants. Furthermore, any acuity assessment used in housing programs should focus to areas where people have strengths that can be built off of for housing stability.
None of this is an argument against Permanent Supportive Housing. It is an awesome, life-changing experience for many who choose it. There are some phenomenal Permanent Supportive Housing providers in the world. And I hope there are more of them. More Permanent Supportive Housing can and should be created in every community. This is why so many of the Alliance’s resources on re-tooling Transitional Housing (which does not have discernibly different housing stability outcomes and costs upwards of 10 times more than permanent housing) hold such promise. In fact, even when an individual is choosing to go the Permanent Supportive Housing route it is best to offer choices amongst different models and approaches to Permanent Supportive Housing.
What I don’t want is a very narrow mindset that sees Permanent Supportive Housing as the only option to chronic homelessness. We cannot and should not pigeonhole people in that way. (Plus, if we look at the numbers of chronically homeless people there is absolutely no way to financially afford Permanent Supportive Housing as the only option.)
Undoubtedly, Permanent Supportive Housing tendencies in many communities reinforce that there can be a difference between what we think and what we know. I also think that it demonstrates why, in some communities, there is a difference between being committed to ending homelessness and simply wanting to end homelessness. I’d ask communities that have Permanent Supportive Housing to best determine how to maximize the potential of this type of housing when they are working on coordinated access and common assessment tools. And I would beg communities to reinforce Permanent Supportive Housing as a choice for people that have experienced chronic homelessness, but not the only option.
