Homelessness: More Evidence on the Wisdom of Housing First

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Abstinence always seems like the easiest way to end behavior we don’t like, but studies with homeless alcoholics finds that a little leeway leads to lots of savings.

In the current edition of Miller-McCune magazine Frank Kosa’s “The Homemakers,” looks at three gentlemen whose efforts to tackle persistent homelessness in the United States “has greatly reduced — and just might end — homelessness.” A study just published in the Journal of the American Medical Association has provided further evidence that this ambitious contention might not be all that wide of the mark.

The study’s findings aren’t too surprising if you read the magazine piece, but they’re revolutionary if you haven’t. In short, giving alcoholics living on the street a place to stay and some health and other social services — and not requiring them to give an almost-certain-to-be-broken pledge to lay off the sauce — can save the public purse thousands of dollars per subject. Plus, once the homeless are in a decent place, on average they start drinking less anyway.

There are a lot of moving parts to the paragraph above, so let’s hear a quote from the lead author of the JAMA paper, psychiatry professor Mary E. Latimer of the University of Washington. “Our study suggests that homeless alcoholics who qualify to take part in Housing First can stay out of jails and emergency rooms, and cost the taxpayer a lot less money as a result. We also found that these benefits increase over time and that they are possible without requiring that participants stop drinking. And yet, the longer the participants stay in the housing program, the less they drink.”

The subjects of our article — policy analyst Dennis Culhane, New York psychologist Sam Tsembris, and bureaucrat Philip Mangano — could have told you this, and did in our article, but this study “represents the first U.S. controlled assessment of the effectiveness of Housing First specifically targeting chronically homeless alcoholics,” according to a news release from the Robert Wood Johnson Foundation’s Substance Abuse Policy Research Program, which paid for the study.

With April 15 annoyingly close, what kind of savings numbers are we talking about?

The study looked at 95 residents of a Housing First program in downtown Seattle and compared them with 39 other homeless alcoholics (on a waiting list for the program) for six-month periods beginning in November 2005 (the study ended in March 2007). The subjects were drawn from a list of Seattle’s “most expensive users” of hospitals, jails and sobering centers.

In the first year, government costs per subject in the program ranged from $2,067 to $8,264 a month, with a median cost of $4,066. If you’re currently laid off or making less than say $50,000 a year, that might stick in your craw. But after six and then 12 months in housing, median costs fell to $1,492 and $958 a month respectively.

Those of us with cold little hearts might balk at spending even that on homeless alcoholics, but the study found that it was on average $2,449 a month less than what was already being spent anyway.

Parsing the numbers another way, Larimer is quoted in the release, “Each (enrollee) had cost state and local governments an average of $86,062 per year before being housed, compared to an average of $13,440 it costs per person per year to administer the housing program.”

And so at the end of a longer period, the subjects never drink and go on to win fame and fortune? Maybe, maybe not. To draw again from the release, “Because health care and criminal justice system costs for the participants continued to decrease over time, as did their alcohol use, Larimer says, she and her co-authors concluded that permanent housing may be necessary in order to take full advantage of the cost-savings identified in the study.”

Nonetheless, Seattle saved $4 million in the program’s first year, and that was for just 95 people.

So returning to the big picture, “In most U.S. cities, people with behavioral health disabilities die on the streets far more frequently than any other subset of the homeless population,” said William G. Hobson, executive director of Seattle’s Downtown Emergency Service Center and a paper co-author. “Before they die, they use large amounts of taxpayer-funded services in our health care and criminal justice systems. The housing program, known in Seattle as the 1811 Eastlake project, was created to stabilize people and stop them from endlessly cycling through emergency rooms, prisons and other crisis institutions, reducing the amount of taxpayer money spent on them.”

So there’s something to like here even if you do have a cold little heart.

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