Kansas officials see a solution to chronic homelessness and the burden placed on state institutions, jails and law enforcement in the work of a psychiatrist who believes mentally ill people can help themselves without any strings attached.
The idea is to provide those who need treatment with unconditional housing and the support services they need, even if they are substance abusers who are likely to violate traditional program requirements for curfew and sobriety.
Sam Tsemberis, a Columbia University faculty member and proponent of the Housing First concept, is working with Kansas Aging and Disability Services to refine and possibly expand this approach from three communities to a statewide campaign. His initiative is internationally acclaimed, although it has some critics.
“I think there’s a misunderstanding of people’s capabilities,” Tsemberis said. “What we’re doing with a program like this is essentially leveling the playing field so that people who have for some reason become homeless have the same opportunity to have and keep housing as the rest of us. Most people in Kansas don’t have sobriety and treatment requirements in order to stay housed. And if they did, we’d be in a lot more trouble on the homelessness front.”
KDADS for three years has operated Housing First programs in Wichita, Shawnee County and Wyandotte County. Initially supported by federal grant money, the agency secured legislative support last year to maintain the programs. This year, the agency is asking for an additional $250,000 to target homeless communities elsewhere in Kansas.
The state recruits participants in the program and works with landlords at the lower end of the real estate market, who are given assurance that rent will be paid. So far, 322 Kansas residents have entered the Housing First program, and 244 have found a permanent home.
Misty Bosch-Hastings, KDADS housing and homelessness project coordinator, has approached individuals living under bridges in Topeka to offer food, water, shoes, blankets, jackets or bus tickets. If they are receptive to help and chronically homeless, she can get them into housing within a week or so.
“You do have to let go of the stereotype,” Bosch-Hastings said, “because a lot of people are still actively using when they move into housing, and that’s OK with the Housing First program. A lot of people would think that’s going to be a failure right off the bat, but it’s not.”
Melissa Bogart, who works in housing employment and benefits for KDADS, said the program has found success in Wichita, which has the state’s largest homeless population.
“What we’ve seen is persons being housed at a much quicker rate — people with a roof over the head, people being safe, people being up off the street,” Bogart said.
In a typical program, Tsemberis said, people spent a lot of time in treatment and suffer recurring lapses with addiction and other problems. As a result, they spend years in the treatment phase without reaching independent living.
If that model worked, he said, he wouldn’t be here having conversations about how to solve the homeless problem. Last year’s count found 2,067 homeless people statewide.
Housing First relies on people to form their own plans, and the assumption that self-determination will prevail.
Programs like this raise concerns about those who might be incapable of caring for themselves. Last year, ProPublica, Frontline and the New York Times co-published an investigation into an ambitious housing program in New York City that found many participants living in perilous conditions. About 4 percent of the people who moved into private apartments died.
Tim Aubry, a psychology professor at the University of Ottawa in Ontario, Canada, who researched large-scale Housing First results, said the New York program failed because it didn’t provide support to residents. Case managers weren’t regularly checking on people, he said.
When deployed with a diverse group of health professionals, Aubry said, the program has proven successful in Canada, Europe and pockets of communities in the United States.
Further research could provide answers to how Housing First models could be integrated with group homes and other programs, Aubry said, but those who need mental health care prefer independent living.
“Here in 2019 we’re not going to turn the clock back and start institutionalizing people,” he said.
Tsemberis, 70, said his ideas were shaped by his experience decades ago when working at Bellevue psychiatric hospital in New York City. On his way to work, he passed people on the sidewalk he had just treated as patients, still wearing the hospital pajamas they were dispatched in.
“A community’s social structure is impaired when people can walk by somebody who is homeless on the street,” Tsemberis said. “It’s not just the person who is homeless, who is isolated and disconnected. It’s everybody else who walks past them that also has to cut off a part of their humanity in order to tolerate being able to walk past another human being who is sitting there.”
Andy Brown, interim commissioner for behavioral health services at KDADS, and agency spokeswoman Angela de Rocha are hopeful the program can help reduce the number of patients at overcrowded state hospitals.
“What this lets us do,” de Rocha said, “is get these folks who need help out of this cycle where they’re in the state hospital, they get discharged, and then pretty soon they end up back on the street. It can happen to people over and over and over again. This intervenes in that cycle and stops it.”