Housing First is among the most expensive ways to address homelessness and apparently one of the least successful.

From Housing Boston’s Chronically Homeless Unsheltered Population, 14 Years Later by Jill S. Roncarati, et al.  It is important to note that the research is conducted by a team of Harvard PhDs.  Not a demographic noted for radical conservative views.  Or any conservative views.  

I have done a lot of research on the unsheltered homeless in the context of Atlanta where urban camping raters are seven times those of the state and of the nation.  The rate is between 4 and 6 times higher than adjacent suburbs, exurbs and counties.  In other words, homelessness in Atlanta is very much a function of jurisdictional policies and not the economy or the region or the weather or what not.  Different jurisdictions choose how much homelessness they want via the policies they implement.  Yet another way to put it, given the outcomes, is that jurisdictions choose the rate of homelessness they want based on the false beliefs they wish to indulge underpinning the policies they choose.  

A very popular approach, stretching back to Los Angeles in the late 1980s, is Housing First.  Most jurisdictions focus on getting the unsheltered homeless into appropriate programs or into shelters where those programs can be made readily available.  In some progressive circles there has been the argument that temporary shelter simply exacerbates the problems, that the homeless need to sheltered immediately, usually in apartments, sometimes in purpose built housing.  San Francisco and some other cities such as Boston also have adopted this strategy.

Housing First is one of the strategies Atlanta is pursuing despite, as the City acknowledges, there being no known example where Housing First has actually reduce homelessness.  

Despite it being extraordinarily expensive and completely ineffective at reducing the urban unsheltered population, Atlanta proceeds with the conviction that it is worth trying.  Rigorous studies of Housing First are relatively scarce because they are ideologically popular in government, academic, and advocacy circles.  The above research is one of the more rigorous studies.  That it occurs in Boston is interesting because, among all the progressive cities and states, Boston and Massachusetts tend to be more successful at making progressive policies work.  

If it can't work in Boston, it is unlikely to work anywhere.

From the Abstract:

Objective: 

The long-term outcomes of permanent supportive housing for chronically unsheltered individuals, or rough sleepers, are largely unknown. We therefore assessed housing outcomes for a group of unsheltered individuals who were housed directly from the streets after living outside for decades.

Methods: 

Using an open-cohort design, 73 chronically unsheltered individuals were enrolled and housed in permanent supportive housing directly from the streets of Boston from 2005 to 2019. Through descriptive, regression, and survival analysis, we assessed housing retention, housing stability, and predictors of survival.

Results: 

Housing retention at ≥1 year was 82% yet fell to 36% at ≥5 years; corresponding Kaplan-Meier estimates for retention were 72% at ≥1, 42.5% at ≥5, and 37.5% at ≥10 years. Nearly half of the cohort (45%) died while housed. The co-occurrence of medical, psychiatric, and substance use disorder, or “trimorbidity,” was common. Moves to a new apartment were also common; 38% were moved 45 times to avoid an eviction. Each subsequent housing relocation increased the risk of a tenant returning to homelessness. Three or more housing relocations substantially increased the risk of death.

Conclusions: 

Long-term outcomes for this permanent supportive housing program for chronically unsheltered individuals showed low housing retention and poor survival. Housing stability for this vulnerable population likely requires more robust and flexible and long-term medical and social supports.

Later in the paper, the researchers note:

Consistent with previous housing studies, 82% were still housed after 1 year. However, housing retention dropped precipitously in the following years with 36% in housing at ≥5 years and 12% at ≥10 years. 

Across the paper, they document these outcomes for the Housing First strategy.

86% of the cohort had the co-occurrence of medical, psychiatric, and substance use disorder, or “trimorbidity.”

45% died while housed.

Only 36% were still housed after five years and 12% after ten years.

38% had to rehoused at least once.  

Urban campers are a complex problem to address but Housing First is among the most expensive ways to do so and. apparently, one of the least successful.