Government News
Coordinated Services Key to Solving Chronic Homelessness
Psychiatric News
Volume 39 Number 16 page 9-34

Efforts to find solutions to homelessness increasingly are focusing on the development of ways to help people with chronic mental illness and substance abuse disorders stay housed and on increasing the stock of affordable housing.

More than 1,000 homeless advocates and service providers gathered in Washington, D.C., in late July at a conference sponsored by the National Alliance to End Homelessness (NAEH) to discuss what works and how to create the political will necessary to end homelessness.

One way of creating that political will, according to Philip Mangano, executive director of the Interagency Council on Homelessness (ICH), is to collect the data that will make a cost-effectiveness argument.

He told attendees, "Do your homework on the economic arguments to end homelessness. Right now in difficult times at every level of government, no argument—not moral, not spiritual, not even quality of life—is as compelling as the economic arguments to end homelessness."


In background material, the NAEH distinguished between two subgroups of homeless people.

Eighty percent of those who experience homelessness each year enter the homeless system and exit it again relatively quickly. They do not differ in most characteristics from other people who are poor. They have similar rates of mental disorders including substance abuse, physical ailments, and domestic violence experience. They need housing that is affordable and can be assisted with various kinds of housing subsidies.

"Housing First" is an approach that can be effective with this group.

Tanya Tull, president of Beyond Shelter Inc., in Los Angeles, described the goal as "to move homeless families, including those who are vulnerable and at risk, into permanent, affordable, rental housing as quickly as possible, followed by time-limited support services after they have been relocated out of the homeless services system."

She wrote in a fact sheet, "The methodology is premised on the belief that vulnerable and at-risk homeless families are more responsive to interventions and social services support after they are in their own housing, rather than while living in temporary/transitional facilities or housing programs."

The model, as practiced by Beyond Shelter, requires six months to one year of individualized, home-based case management after the move.

Beyond Shelter produced positive outcomes for homeless families on measures such as reduction of domestic violence, participation in educational activities, improvement in depression, and willingness to pay rent.


The NAEH points out, however, that the availability of affordable housing for this population is declining. The organization wrote in "Policy Papers," prepared for the conference, that in 1970, there were 300,000 more affordable housing units available nationally than there were low-income families that needed them. In 2001 there were 4.7 million more low-income households in need of housing than there were affordable units.

The other subgroup, approximately 20 percent of the homeless population," differs quite significantly from the general population of poor people in that they almost all have chronic disabilities, including mental illness, chronic substance abuse disorders, physical disabilities, and HIV/AIDS."

They need supported housing that is linked to services.

"Harm reduction" is a model being used with that group. With that model, an individual who might otherwise be ineligible because of criminal activity, substance abuse, or an unwillingness to accept treatment can be placed in housing. The approach contrasts with one in which there is zero tolerance for substance abuse or a refusal to serve people with mental illness who will not take medication.

Service providers try to establish a trusting relationship with the person so that he or she voluntarily accepts services.


The Department of Housing and Urban Development (HUD), Department of Veterans Affairs, and Department of Health and Human Services have collaborated on a program that encourages cooperation among local service providers and governmental entities to serve people with chronic homelessness.

The program, which was developed by the ICH, restricts eligibility to individuals with mental illness or a substance abuse disorder, as well as specified experiences with homelessness.

In fact, ICH's executive director, Philip Mangano, testified before a congressional committee, "Persons experiencing chronic homelessness generally have a disability, [such as] mental health [problems], posttraumatic stress disorder, substance abuse, [or] developmental or physical disabilities."

Eleven communities, selected from 106 applicants, received a total of nearly $35 million to provide housing and supportive services.

Mangano went on to urge passage of HR 4057, the Samaritan Initiative, which would authorize $70 million to expand and improve on that collaborative effort among the three federal agencies.

Within a week of the end of the conference, advocates had scored a significant victory. Many of them headed to Capitol Hill at the close of the meeting to lobby for restoration of money to fund Section 8 vouchers, which are provided through HUD and enable people to secure housing in the private market. Service providers frequently link their services to the housing provided by the vouchers.

In Fiscal 2004, HUD changed the way money was distributed to housing authorities in such a way that it reduced the number of vouchers. The Bush administration's Fiscal 2005 budget proposed an "underfunding" of the program by at least $1.6 billion, resulting in the loss of vouchers for 250,000 families.

On July 22, the House Appropriations Subcommittee on Veterans Affairs, HUD, and Independent Agencies restored the funds to the Fiscal 2004 level.

Numerous publications about homelessness are posted online at<www.naeh.org>.

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