Everyone has seen homeless people on the street, some pushing or carrying everything they own. They stand at freeway exits or street corners bearing cardboard signs with heartbreaking pleas. Many are veterans of war, some have a dog for company, others are obviously quite old and some are accompanied by children. How do these people get enough to eat? Where do they go at night or in bad weather?
A common stereotype is that all homeless people must be drug or alcohol abusers. The truth is that although a high percentage of homeless people are substance abusers, they are suffering from disorders which require treatment. Substance abuse is both a cause and a result of homelessness. An existing disorder can lead to loss of income and home and for some; losing one’s home can trigger substance abuse.
It’s difficult to estimate the number of homeless people in the United States. The National Alliance to End Homelessness estimates it is 20 people per 10,000 and 29 people per 10,000 for veterans in the population. Addictive disorders disrupt relationships with family and friends and often are the cause of job loss. For people who are barely managing to stay financially afloat, the onset of addiction can push them over the edge when they are no longer able to pay a mortgage or rent.
In many situations, substance abuse is a result of homelessness rather than a cause. People who have become homeless often turn to drugs or alcohol in an effort to cope. This of course makes matters worse, decreasing chances of employment and a potential way off the street. Overcoming addiction is difficult even with the best professional help, for homeless substance abusers it is much more difficult to find the motivation when food and shelter are their highest priority.
For many homeless people there is also the likelihood of underlying mental illness. Such people are easy prey and become victims of violence and abuse. The truly sad news is that most programs for the homeless with mental illness do not accept substance abusers and programs for substance abusers do not accept those with mental illness. Since both conditions frequently co-occur, shouldn’t we be providing centers which treat both conditions simultaneously?
In 2005, Utah began to solve a problem that many thought impossible. The state had almost 2,000 chronically homeless people. Most of them had mental health disorders or substance abuse problems, or both. Disregarding the usual gradual process of shelters, halfway houses and treatment, Utah thought out-of-the-box. The state implemented Housing First which quite simply gave homes to the homeless.
The cost of shelters for the homeless, emergency room visits, ambulances, police services and so on adds up very quickly. Lloyd Pendleton, director of Utah’s Homeless Task Force, said that one individual’s care for one year cost nearly one million dollars and that using the traditional approach, the average chronically homeless person used to cost Salt Lake City more than twenty thousand dollars a year. Putting someone into permanent housing costs the state just eight thousand dollars and that includes the cost of case managers who work with the formerly homeless to help them adjust.
Contrary to popular belief, providing permanent housing and help works better than the step-by-step method formerly used. It was found that the stability a home provides was a much better incentive to do well than attempting to change people’s behavior while living on the streets. Utah’s first pilot program placed seventeen people in homes around the Salt Lake area, twenty two months later, not one of them was back on the streets. In the years since, the number of chronically homeless has fallen by seventy four percent! A study in Georgia found that a person who stayed in an emergency shelter as opposed to rapid re-housing was five times as likely to become homeless again.
Such programs have bi-partisan support on Capitol Hill. As Pendleton says, “People are willing to pay for this, because they can look at it and see that there are actually solutions. They can say ‘ah, it works’ and it saves money.” The system has not been pre-emptive; it spends more on disaster relief than disaster preparedness for example and huge sums on treating disease while prevention is underfunded.