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Pathways to housing the homeless

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In the hallway of Pathways to Housing, a loud, chaotic office in East Harlem, Hughes Smith can't stop talking about his furniture: "It's unbelievable," he says.

It's not often that someone brags about 10-year-old futons. But for Mr. Smith, shuffling down the hall wearing a tan baseball cap and yellow headphones, permanence is something to celebrate. "After being homeless so long," he explains, "you just don't believe it." His L-shaped studio, blocks from the East River and boasting three big closets, still dumbfounds him.

Since 1993 – "nine years, March 31st," he announces – Smith has been a client of Pathways to Housing, which offers apartments to mentally ill homeless New Yorkers.

Pathways doesn't require medication, abstinence from drugs or alcohol, or use of social services – a leniency that flies in the face of conventional demands that the homeless demonstrate "housing readiness" through sobriety, psychiatric visits, even cooking skills before they're provided with a place to live.

Instead, Pathways runs on a "housing first" model, with the philosophy that before someone can work toward recovery or employment, a safe, comfortable home is necessary.

Such programs as Pathways, which offer permanent housing with optional support, gained a foothold in the 1990s – bursting from almost none in the 1980s to 114,000 beds nationally in 1996.

Sam Tsemberis launched his program in 1992 with 50 apartments, a PhD in clinical community psychology, and a $500,000 grant from the New York State Office of Mental Health.

Today, the grants total $7.2 million and the program has an 85 percent success rate, he says.

Struggle to obtain housing

Each night, about 800,000 Americans are homeless, and 31 percent of homeless adults report both mental-health and substance-abuse problems; an additional 32 percent struggle with one or the other. Those with addictions generally go through detoxification programs an average of 11 times. These are, typically, the hardest to house: Turned away by programs that demand sobriety or a clean bill of health, many people with these problems have spent years on the streets or in psychiatric hospitals.

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