Housing First

Based on Wikipedia: Housing First

Here's a counterintuitive idea that has quietly revolutionized how we think about homelessness: what if the solution to being homeless is simply to give people homes?

That's it. No prerequisites. No sobriety tests. No psychiatric evaluations. No proving you're "ready" for housing. Just a key to an apartment, and then we'll figure out the rest together.

This approach is called Housing First, and over the past three decades it has moved from a radical experiment in New York City to official government policy in countries across the Western world. The results have been remarkable—not just morally satisfying, but pragmatically effective. Cities that have embraced it have seen homelessness plummet. Helsinki and Vienna in Europe. Medicine Hat in Canada. Columbus and Salt Lake City in the United States.

The approach works. And perhaps more surprisingly to budget-conscious policymakers, it saves money.

The Old Way: Climbing the Staircase

To understand why Housing First represents such a dramatic shift, you need to understand what came before it.

For most of the twentieth century, the conventional approach to homeless people—especially those with mental illness—was psychiatric hospitalization. The assumption was straightforward: if someone couldn't maintain housing, they must be incapable of functioning independently. They needed round-the-clock supervision. They needed to be fixed before they could be trusted with something as significant as their own front door.

By the 1980s, experts began questioning these assumptions. A new model emerged, often called the "staircase" approach or the Continuum of Care model. Think of it as a ladder the homeless person must climb, rung by rung.

First rung: the street. Second rung: an emergency shelter. Third rung: transitional housing with rules and programs. Fourth rung: maybe, eventually, your own apartment.

Each step up required proving you were ready for the next level. Were you taking your medication? Were you staying sober? Were you following all the rules? Only by demonstrating compliance at each stage could you advance toward the ultimate prize of independent housing.

The philosophy seemed logical. You wouldn't give car keys to someone who hadn't learned to drive, right? Why give an apartment to someone who hadn't demonstrated the life skills to maintain it?

But here's the thing about that analogy: you can actually practice driving without a car. You cannot practice living in a home without a home.

Where the Staircase Breaks

The staircase model had a fundamental flaw: people kept getting stuck on the stairs.

The requirements for advancement were demanding—often more demanding than what we'd expect of any "typical citizen." You had to be something close to a perfect citizen to progress. No substance use. Full compliance with psychiatric treatment. Following shelter rules that often dictated when you could eat, when you could sleep, when you had to leave the building during the day.

What happens when you're struggling with addiction and your housing depends on staying clean? You hide your struggles. You get kicked out. You end up back on the street. What happens when you're dealing with trauma and you're required to share a room with strangers, follow rigid schedules, and store your belongings in a locker? Many people, understandably, prefer the streets.

The staircase model was particularly cruel in its logic: the people who needed the most help were the least likely to get it, because they couldn't meet the requirements. The chronically homeless—those with serious mental illness, addiction, or both—became permanently stuck. They cycled through shelters and hospitals and jails, never reaching that top rung.

And that cycling was extraordinarily expensive. Emergency room visits. Psychiatric hospitalizations. Nights in jail. Ambulance calls. Police interventions. The same individuals, consuming vast amounts of public resources, without ever getting better.

Flipping the Script

Sam Tsemberis had a different idea.

A faculty member in the Department of Psychiatry at New York University School of Medicine, Tsemberis observed something that should have been obvious: it's extremely difficult to address your mental health or addiction issues when you're sleeping on the street. How do you keep medication on a consistent schedule when you don't know where you'll be tomorrow night? How do you attend therapy appointments when you're spending all day figuring out how to survive?

In 1992, Tsemberis founded an organization called Pathways to Housing in New York City. The model was simple and radical: give people housing first. Not housing last, as a reward for good behavior. Housing first, as a foundation for everything else.

There were no prerequisites. You didn't have to be sober. You didn't have to agree to psychiatric treatment. You just had to want a place to live.

Once housed, mobile support teams would visit you at home. They'd offer services—mental health treatment, addiction counseling, help with job training, assistance navigating benefits—but nothing was mandatory. If you wanted to drink, you could drink. In your apartment. With a door you could close.

This was the crucial philosophical shift: housing is a human right, not a reward for good behavior.

And here's the part that surprised even some supporters: if someone lost their housing—because of behavior issues, or failure to pay rent, or any other reason—the program didn't abandon them. Pathways would help them find another place and continue the support. The commitment was to the person, not conditional on perfect outcomes.

The Evidence Piles Up

In the late 1990s, researcher Dennis Culhane and his colleagues began systematically studying outcomes. What they found was striking.

Housing First worked. Not just for the relatively easy cases—people who were briefly homeless due to a temporary crisis—but for the hard cases. The chronically homeless. People with serious mental illness and addiction. People who had been on the streets for years.

Participants in Housing First programs stayed housed at rates of eighty to ninety percent. Compare that to the staircase model, where many participants never reached stable housing at all.

But here's what really got policymakers' attention: it was cheaper.

That seems paradoxical at first. How could giving people free apartments be cheaper than making them earn their way up a ladder? The answer lies in all those emergency services the chronically homeless consume. Every night in an emergency shelter costs money. Every ambulance call costs money. Every emergency room visit, every night in jail, every psychiatric hospitalization—it all adds up.

Studies consistently showed that Housing First reduced these costs dramatically. Participants spent fewer days in hospitals, made fewer emergency room visits, had fewer encounters with police. In many cases, the savings from reduced emergency service use exceeded the cost of providing housing and support.

The Medicine Hat Miracle

Perhaps no example illustrates Housing First's potential more dramatically than Medicine Hat, a modest city of about sixty thousand people in the Canadian province of Alberta.

In 2009, the city's mayor declared an ambitious goal: end homelessness entirely. Not reduce it. End it. Medicine Hat would become the first city in Canada where no one slept on the streets.

They adopted Housing First principles rigorously. When someone became homeless, they were housed within ten days—often faster. Support services followed, but housing came first.

By 2015, the city announced success. Homelessness had been functionally ended. This didn't mean no one ever became homeless—people still lost jobs, left abusive relationships, faced crises. But when they did, they were housed almost immediately. The experience of homelessness became brief and rare rather than chronic and visible.

The phrase "functionally ended homelessness" is important here. It means that homelessness, when it occurs, is brief, rare, and non-recurring. People don't fall through the cracks and stay there for years. The system catches them quickly.

Canada Goes National

Medicine Hat wasn't an isolated success story. The Canadian government had been watching closely.

In 2008, Canada launched an ambitious five-year research project called At Home/Chez Soi, testing Housing First in five cities: Vancouver, Winnipeg, Toronto, Montreal, and Moncton. The project specifically targeted people with serious mental illness who were experiencing homelessness—historically the most difficult population to help.

Over more than three years, the project housed more than one thousand Canadians. The results were compelling enough that in 2013, the federal government committed six hundred million dollars to renew its Homelessness Partnering Strategy with Housing First as the centerpiece.

Sue Fortune, who directed Calgary's Housing First program, reported remarkable numbers. Less than one percent of clients returned to shelters or street sleeping. Police interactions dropped by thirty percent. Emergency room visits declined by thirty-eight percent. Days spent in jail plummeted by seventy-nine percent. Hospitalization days dropped by sixty-six percent.

These weren't just humanitarian victories. They were fiscal ones. The people who used to cycle through emergency rooms and jails at enormous public expense were now living in apartments, receiving support that cost a fraction of the emergency alternative.

The Nordic Approach

While North America was developing Housing First through nonprofit innovation, the Nordic countries approached it somewhat differently—as national policy from the start.

Finland is perhaps the clearest example. In 2007, the government of Prime Minister Matti Vanhanen launched what was sometimes called the "four wise men" program, with an explicit goal: eliminate long-term homelessness by 2015.

The Finnish approach focused on the hardest cases—people assessed as having serious social, health, and financial challenges. This was the hard core of homelessness, the people who cycle through systems for years without finding stability.

The program concentrated on Finland's ten biggest urban growth centers, where most homelessness was concentrated. Emergency shelters were converted into supported housing. New units were built specifically for Housing First clients.

The results transformed Finland's approach to homelessness. While other European countries saw homelessness rising, Finland's numbers dropped year after year. The country became a case study for policymakers around the world.

Helsinki in particular became a showcase. The city essentially stopped treating homelessness as a problem to be managed and started treating it as a problem to be solved. By providing permanent housing with support, they found that the supposedly "unsolvable" population of chronically homeless people could, in fact, be housed successfully.

How It Actually Works

Housing First sounds simple, but the details matter.

There are two main implementation models: scattered-site and project-based.

In scattered-site Housing First, participants receive apartments throughout a community—a unit here, a unit there, integrated into regular apartment buildings alongside other tenants. The advantage is normalization: you're not living in a "homeless building." You're just a tenant, like everyone else in your building. Mobile support teams visit you at home, but your neighbors might never know you were previously homeless.

In project-based Housing First, multiple participants live in the same building or complex. This makes support services more efficient—staff don't have to travel across a city to visit clients. But it can concentrate poverty and create buildings with reputations, which some see as undermining the normalization goal.

Both approaches share core principles. Participants sign normal leases. They pay rent—typically thirty percent of whatever income they have, which might be disability benefits or wages from employment. They have the same rights and responsibilities as any other tenant. If they violate their lease seriously enough, they can be evicted—but the Housing First program will then help them find another place, rather than returning them to the streets.

The support services are voluntary but persistent. Staff members visit regularly—often weekly—to check in, offer help, and maintain connection. They'll help with mental health treatment, addiction recovery, benefits navigation, job training, family reconnection, health care—whatever the individual needs. But nothing is mandatory. The housing doesn't depend on accepting services.

This is the philosophical heart of Housing First: housing is unconditional. It's not a tool to coerce behavior change. It's the stable foundation that makes behavior change possible.

What About Domestic Violence?

One important adaptation has been tailoring Housing First for survivors of domestic violence.

This population has unique needs. Often, fleeing an abusive relationship means leaving behind not just a person but an entire housing situation. The survivor may have no lease history in their own name, damaged credit, and an abuser who might try to find them.

Housing First programs for domestic violence survivors emphasize safety planning alongside rapid housing placement. The goal is the same—get the person housed quickly and then provide support—but the support includes safety considerations that other populations may not need.

The success of these adapted programs suggests that the Housing First philosophy is flexible enough to address different causes of homelessness while maintaining its core principle: stable housing first, everything else second.

Spreading Globally

Housing First has now spread far beyond its origins in New York City.

The Czech Republic launched its first pilot project in 2016, housing fifty families in the city of Brno. The families received municipal apartments and support from a nonprofit organization for two years. More than eighty percent maintained their housing successfully—impressive enough that the project won the SozialMarie, an international prize for social innovation.

That success led to expansion. By 2017, a second project in Brno began serving long-term homeless singles. In 2019, the Czech government and European Union together funded thirteen new Housing First projects across the country. By 2024, there were twenty-four projects operating nationwide.

Brazil implemented a national program based on Housing First principles in 2024, called Citizen Housing. Deborah Padgett, one of the leading American researchers on Housing First, advised the country's Ministry of Human Rights as they designed a multi-year plan to phase in the approach nationally.

Denmark has embedded Housing First into its national homeless strategy, though the country has faced barriers common to many places: a shortage of affordable housing limits how many people can actually be served, regardless of political will.

The Limits and Challenges

Housing First is not magic. It has limitations and faces real obstacles.

The most obvious challenge is housing supply. You cannot house people first if there's nowhere to house them. Many cities that embrace Housing First philosophy still struggle with a fundamental shortage of affordable units. Denmark's national homeless strategy includes Housing First as its core approach, but the intervention serves only a small fraction of the homeless population because there simply aren't enough affordable apartments.

There's also a question of scale. Housing First has been most successful with the chronically homeless—people with serious disabilities who have been homeless for extended periods. Some critics argue that it's less clearly necessary for other homeless populations, like families who became homeless due to a temporary financial crisis. Do they really need ongoing support services, or just an affordable apartment?

Fidelity to the model matters as well. Some programs adopt the "Housing First" label while watering down the principles—adding requirements, making services less voluntary, failing to provide adequate support. These diluted programs often show worse outcomes, which can then be unfairly attributed to Housing First itself.

And there's political resistance. The idea of giving housing to people who are actively using drugs or refusing treatment strikes some as enabling bad behavior. Why should someone who won't help themselves get free housing when law-abiding working people struggle to pay rent? This objection reflects a philosophical divide about whether housing should be a right or a reward.

The Philosophical Divide

At its heart, the debate over Housing First is a debate about human nature and human rights.

The staircase model rested on certain assumptions: that behavior change should precede housing, that people need to demonstrate readiness before receiving resources, that conditional support motivates improvement. These assumptions align with a broader philosophy that views social benefits as rewards for good behavior.

Housing First rests on different assumptions: that stable housing is a basic human need that shouldn't be denied to anyone, that chaotic circumstances make behavior change nearly impossible, that unconditional support creates the conditions for improvement even when that improvement isn't immediate or linear.

The empirical evidence has generally supported Housing First, at least for chronically homeless populations with serious disabilities. People do better when they have stable housing. They're more likely to engage with treatment, reduce substance use, maintain mental health stability. The housing doesn't guarantee these outcomes, but it makes them possible in ways that street life or shelter cycling never can.

Perhaps more importantly for policy discussions, Housing First costs less. The chronically homeless consume enormous public resources through emergency services. Stable housing with support is genuinely cheaper than the alternative—not as a temporary measure, but as ongoing policy.

Historical Echoes

There's a footnote worth exploring: Housing First's core philosophy wasn't actually invented in the 1990s.

In the late nineteenth century, an Italian priest named Don Bosco developed an approach to helping homeless youth that shared key elements with what we now call Housing First. Rather than requiring young people to prove their worthiness before receiving help, Bosco provided immediate material support—food, shelter, education—with spiritual and moral guidance offered alongside rather than as a prerequisite.

Bosco's approach influenced Dorothy Day, who founded the Catholic Worker Movement in 1933. The movement's Houses of Hospitality offered shelter without means-testing or moral requirements—radical for its time and still radical today in some contexts.

Bosco himself was inspired by Francis de Sales, a sixteenth and seventeenth century French bishop who insisted that basic needs should be met first, without various rules and regulations. The philosophy that people need stability before they can improve isn't new. It's been rediscovered repeatedly throughout history, often in religious contexts that viewed shelter and sustenance as expressions of human dignity rather than earned rewards.

Where We Are Now

Housing First has moved from radical experiment to mainstream policy in much of the Western world. The research base is substantial. The success stories are numerous. The cost savings are documented.

And yet homelessness persists, even in places that have adopted Housing First principles. Why?

Part of the answer is that Housing First addresses chronic homelessness more effectively than it prevents new homelessness. It's a treatment, not a vaccine. People keep becoming homeless due to rising housing costs, stagnant wages, mental health crises, domestic violence, substance abuse, and a dozen other factors that Housing First doesn't directly address.

Another part of the answer is implementation. Adopting Housing First as policy is different from fully funding and implementing it. Many jurisdictions have embraced the philosophy while underfunding the programs, creating waiting lists that defeat the "first" in Housing First.

And housing supply remains a fundamental constraint. You can have the best-designed Housing First program in the world, but if there aren't enough affordable units, people will remain unhoused. Housing First requires housing.

Still, the progress is real. Cities that have fully committed to Housing First have seen dramatic reductions in chronic homelessness. The model works, when it's actually implemented. It represents a genuine paradigm shift—away from punishment and prerequisites, toward support and unconditional access to shelter.

The question is no longer whether Housing First is effective. The evidence on that point is clear. The question is whether societies have the political will and the housing supply to actually implement it at scale.

A key to an apartment. It sounds so simple. And in a way, it is.