When the Trump administration announced plans last month to redistribute billions of dollars in federal homelessness aid, it capped a sustained conservative attack on Housing First, a policy approach that for decades enjoyed bipartisan support.
According to an article this week by Jason DeParle in the NY Times, Administration officials described Housing First as permissive and blamed it for rising homelessness, while supporters pointed to a large body of research showing the model is effective at getting people housed.
Housing First provides chronically homeless people long-term subsidized housing and offers, but does not require, treatment for mental illness or addiction. It stands in contrast to treatment-first or sobriety-first approaches, which condition assistance on compliance and which Trump officials have said they want to expand, despite far less evidence demonstrating their effectiveness.
Few social policies have been studied as extensively as Housing First, and the intensity of the current debate reflects that record. Extensive research shows that Housing First places a large share of participants into housing, particularly in the short to medium term. It also appears to have played a major role in reducing homelessness among veterans, a population whose unhoused numbers have fallen by more than half over the past 15 years.
“The primary goal of Housing First is to get people out of homelessness, and that’s what it does,” said Dennis P. Culhane, a professor at the University of Pennsylvania.
At the same time, the evidence is more mixed on whether Housing First reliably improves mental or physical health outcomes.
The National Academies of Sciences, Medicine and Engineering found “no substantial evidence” that permanent supportive housing improves health outcomes, and a Lancet review found “no measurable effect” on the severity of psychiatric symptoms or substance use.
While some programs have shown specific benefits, such as reductions in detoxification service use or improved health outcomes for people living with H.I.V., broad patterns have not consistently emerged.
Skeptics argue that this gap undercuts the claims often made on Housing First’s behalf.
“The phrase I often hear is ‘evidence based’ or ‘we know what works,’” said Judge Glock of the Manhattan Institute (a conservative think-tank). “But we don’t know what works. There’s a lot of debate — not just about what the evidence shows but what counts as success.”
Those debates have taken on legal and political stakes. In seeking to impose new rules governing $3.9 billion in federal homelessness grants, the Trump administration would sharply limit Housing First and promote treatment-focused alternatives. Two federal lawsuits challenge that shift, and a judge in December temporarily blocked the policy changes.
The research record is clearest on one point: Housing First helps people get housed, at least initially. A Lancet analysis of 15 studies found that the model “significantly improved housing stability,” while another academic review of 26 studies found that Housing First programs “more effectively reduce homelessness” than alternative approaches. In Santa Clara County, California, 86 percent of participants randomly assigned to Housing First obtained housing, compared with 36 percent of those receiving usual care.
These findings matter because they show that people with untreated addiction or mental illness can be housed successfully, particularly when intensive case management is provided. They also challenge the premise of treatment-first models, which risk leaving people unhoused indefinitely if they cannot comply with program requirements.
Longer-term results are more complicated. Some studies suggest that the early advantages of Housing First narrow over time. A six-year study in Toronto found diminishing differences between Housing First and other approaches, and a small Boston study that followed participants for more than a decade found that housing retention fell substantially. Even among people who remain housed, many require extensive ongoing support, and frequent moves are common.
“I question how much housing retention tells us about how people are doing,” said Stephen Eide of the Manhattan Institute.
Claims that Housing First saves lives are also difficult to substantiate.
Multiple studies, including evaluations of large programs in Canada, Santa Clara County and Denver, found no statistically significant difference in mortality rates between Housing First participants and people receiving other services. Mortality among chronically homeless populations remains high regardless of intervention.
“If the person in the program is just as likely to die, then what’s the case for Housing First?” Glock said.
But the alternative being promoted by the administration fares no better under scrutiny. Treatment-first models have not been studied nearly as rigorously, and direct comparisons show they house fewer people.
“There’s nothing that shows that what they’re putting forward works,” said Samantha Batko, a researcher at the Urban Institute.
The strongest evidence for Housing First comes from the veteran homelessness system. The HUD-VASH program, which combines housing vouchers with intensive casework from the Department of Veterans Affairs, dramatically expanded over the past 15 years and coincided with a steep decline in veteran homelessness.
“Think of what we could achieve if we summoned the same political will to support other homeless people,” Culhane said.
Researchers who have examined the program’s effects across hundreds of localities concluded that “veterans’ homelessness would have risen substantially” without the expansion, despite arguments that demographic trends alone would have reduced the numbers.
Critics counter that Housing First has failed to reduce homelessness at the community level. Some economists estimate that large investments in supportive housing produce relatively modest population-wide reductions, and they argue that high per-unit costs crowd out cheaper interventions.
Glock contends that prioritizing permanent housing left less money for alternatives such as managed sleeping sites with services and security.
Housing First supporters respond that this critique misses the central driver of homelessness: housing costs.
Across the country, rents have soared while wages stagnated and federal housing assistance shrank, now reaching fewer than one in four eligible households. Researchers have identified clear thresholds beyond which homelessness rises sharply.
“As the share of low-income households with severe rent burdens grows, so does their risk of homelessness,” said Thomas Byrne of Boston College.
Studies comparing cities reinforce that conclusion. Gregg Colburn of the University of Washington found that Seattle and San Francisco, with high rents, had homelessness rates four to five times those of Cleveland or Detroit. California’s homelessness rate was more than five times Mississippi’s.
“If we had scaled Housing First — with fidelity to the evidence-based model — we wouldn’t have had such a big problem,” Colburn said.
Housing First did not fail. It was never designed to overcome a nationwide collapse in housing affordability on its own. The evidence shows that it can house people, particularly those with complex needs, when adequate resources exist.
What failed was the political will to build and fund housing at the scale required. Replacing an imperfect but evidence-supported approach with largely untested alternatives will not fix that underlying failure.
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I think the entire focus of this effort has been misrepresented. It’s not about providing housing so that people get off drugs; it’s about providing housing (or some kind of shelter) REGARDLESS of whether or not they then cease using drugs.
Just don’t do it where neighborhoods already exist. And where it does exist, some kind of authority is going to need to be present 24/7/365 for the safety of their own residents. (And it’s probably going to need to include more than namby-pamby social workers.)
(First time that namby-pamby has been used on here, I suspect.)
Housing First is scam that perpetuates homelessness and drug addiction and goes against everything that works. And by the way, by ‘works’, I mean occasionally, because drug addiction is so often a personal death sentence that people don’t find their way out of, and giving them a warm place to shoot up and kill themselves more efficiently is not the answer. But keep on pumping the billions, and as Journey sang, “Don’t Stop Believing”, and I’ll add, even if it kills people and fuels the Homelessness Industrial Complex.