The Next Best Thing
Imagine you live in a small to medium sized city. I also want you to imagine that you have had a heart attack. You get rushed to the emergency room in an ambulance. Paramedics have been keeping you alive with really intensive assistance.
Given the nature of your situation, you are a top priority when you arrive at the ER. Oodles of resources are allocated to your condition. ER nurses, doctors and other health staff have applied their expertise to your immediate needs. It is the best your small to medium sized city has to offer.
They page for a cardiologist. One is not available. They are busy with other people with heart issues. Now what? I know, let us put you on a waiting list. If you are still alive and it can be confirmed that your heart is still unwell when a cardiologist is available, then you will be seen. In the meantime, we will have you fill out a bunch of forms and paperwork, a lot of which have nothing to do with your heart condition.
No?
There are going to be people in your community that you think will benefit from Permanent Supportive Housing. Like most communities, you will not have enough PSH, or your existing PSH is filled with many tenants that do not actually require PSH. What happens in most of these communities is that they create waiting lists for PSH.
Let us be clear: waiting lists are a game of survivor. Waiting lists favour people with lower acuity. Waiting lists are cumbersome and administratively expensive to maintain. Waiting lists do not work for households that need the resource the most. People deteriorate and even die while on waiting lists. They languish in shelters or receive survival supports on the street. Their homelessness and dependency becomes even more institutionalized and normalized.
If you had a heart attack and a cardiologist was not available, you would want the next best thing. It may be an ears, nose and throat specialist, or a gynaecologist, or a paediatrician, or an oncologist, or generalist, or any type of medical doctor. It may be that this person is keeping you alive until the cardiologist is available. But the point is: you get served and you get the next best thing.
In the delivery of housing resources to people experiencing homelessness, we have to get into the mindset of delivering the next best thing. When there is not a PSH unit available, we need to think creatively: what would a more intensive Rapid ReHousing program look like? What could a re-think of transitional housing as intensive interim housing look like? Would might master leasing of a couple of apartments as bridge housing look like? Is there a possibility of converting a shelter or part of a shelter to be more housing like?
The point is people with deepest needs require service as immediately and as intensely as is feasible, with a strong housing focus (the only known cure to homelessness). Waiting lists are not in anyone’s best interest, whether that be looked at from the service providers perspective of the end users perspective. We need to have a solution-focused, action-orientation and not a waiting list, bureaucratic orientation.