Community development

An Ambitious Approach to Homelessness

Late last year, Hamilton County Sheriff Jim Hammond announced a plan to reduce the number of inmates suffering from mental illness and addiction.

Individuals who fit this description are often incarcerated for minor infractions that might not have occurred if they had better access to housing, medication, or supportive services. This group comprises nearly 40 percent of the Hamilton County jail’s inmate population.

The sheriff proposed “finding a mental health provider that will offer housing and services for the mentally ill to keep them out of the jail,” the Times Free Press reports. He asked the county commission to match a $25,000 donation from BlueCross BlueShield of Tennessee for the effort.

Hammond’s proposal is ambitious but not radical.

National homeless rates began increasing last year. Policymakers are turning away from treatment-first initiatives and toward ones that take care of this group’s most pressing need first.

A Housing First approach places homeless people immediately into permanent housing without preconditions of sobriety. Participants are required to spend 30 percent of their income on rent and meet regularly with a case worker. Cities adopting this model agree to provide permanent, stable housing for individuals who pose the toughest cases without requiring them to change their behavior or give up destructive habits.

This approach is an obvious solution to homelessness, but it can be uncomfortable upon first consideration. It runs counter to long-dominant strategies of graduating a homeless person through a series of treatment and rehabilitative programs before providing permanent housing.

Since its debut in the early 1990s, Housing First has gained international attention. It encourages participants to live independently, even while dealing with substance abuse or mental illness. Advocates say it interrupts a treatment-first cycle where strict standards tend to weed out participants, who consequently become the heaviest users of shelters, emergency rooms, and jail cells.

It has also been successful at reducing the costs associated with chronically homeless people’s use of public facilities and social service providers.

New York City created the program with Pathways to Housing in 1992 and tracked its results with a four-year study. Two hundred and fifty-five homeless individuals with diagnoses of serious mental illness were divided into two groups: ninety-nine were assigned to the treatment group (Housing First), and 126 were assigned to a control group (behavior-based programs). Participants were interviewed every six months for four years. Researchers tracked participants’ use of substances, treatment programs, and emergency services.

In the final six months of the study, 75 percent of those in the Pathways to Housing program remained stably housed, compared to 50 percent of those participating in treatment-first programs.

In Seattle, the program showed similar retention rates, and, though not a requirement, participants reduced their alcohol consumption. Researchers studied the results of housing a group of ninety-five homeless people with severe alcohol abuse problems. A year prior, this group accrued a median cost per month of $4,066 through the use of jails, shelters, hospitalizations, and detox services. Monthly costs per individual dropped to $1,492 after six months. That figure dropped to $958 after twelve months.1

Positive results were also evident in Portland, Maine. Two social service agencies, Preble Street and Shalom House, agreed to house ninety-nine individuals. After one year of tenancy, emergency room costs among this cohort dropped 62 percent. Overall health care costs dropped 59 percent. These decreases amounted to an estimated $128,000 and $497,000, respectively. In interviews, Portland participants reported greater satisfaction with their housing situation, improved relationships with family members, and increased prioritization of their own well-being.

Although there are proven success stories, it’s important to remember that homelessness is a complicated problem that cannot be solved with a simple formula.

Kevin Corinth, research fellow at the American Enterprise Institute, writes in an op-ed, “The philosophy’s fundamental mistake is imposing a one-size-fits-all solution that measures success simply by how many tenants remain housed.”

Mark Williams, interim executive director at the Chattanooga Regional Homeless Coalition, said in an interview that Housing First should not be construed to mean “housing only.” Instead, it should incorporate heavy community and case management services once people are placed into housing.

This approach has appeared in various forms in Chattanooga.

The city’s Blueprint to End Chronic Homelessness in the Chattanooga Region outlines the need for a Housing First approach to mitigate the effects of veteran, family, and chronic homelessness. The Chattanooga Community Kitchen currently houses forty-nine people in single and family units. The Helen Ross McNabb Center offers 140 housing units for homeless people who experience mental illness symptoms in Knox and Hamilton counties, according to its website.

The success of Housing First will depend on improvements in other areas. More affordable housing units are needed. Additionally, Williams says more funding is needed for case management positions and an extension of case managers’ roles within the homeless service sector. A case manager typically works with an individual for a year. That short period is unconducive to a model that requires lasting trust between housing and service providers and the people who use them.

Success also depends on broad public support. In a BBC interview, Sam Tsemberis describes the skepticism he encountered when he first proposed the idea in New York:

At first it was misunderstood, and I think people were very uncomfortable because they thought of it as enabling something that should be earned, but if you back up from moral judgments, homeless people are already suffering, and providing them with a house actually gets us much closer to the goal that we all want.

We all want people off the streets and living a productive, meaningful life. This is just a much quicker, more effective, and cost-saving way of getting to exactly that goal.

When paired with a concerted community effort to reintegrate the homeless population into existing social networks, the positive outcomes can be appreciated by more than just the targeted population.


  1. A note about methodology is important here. Housing First study participants are not chosen randomly because it is considered unethical not to provide housing when available. In addition, several studies depend on self-reports to measure alcohol and substance use. Participants may underreport this measure because they fear it might endanger their housing eligibility. Researchers consider these limitations and potential biases in their respective studies. Nonetheless, Housing First studies consistently contradict the driving philosophy behind treatment-first models that require sobriety as a prerequisite for housing. 

Megan Gienapp

Research associate

Megan graduated from Covenant College with degrees in French and international studies. The Chattanooga native joined Metro Ideas Project in 2017 and was promoted to research associate in 2018.