Chronic homelessness first gained widespread attention in the United States in the late 1970s and early 1980s. A major cause of its increased frequency was the de-institutionalization movement designed to get the mentally ill out of institutions and into community settings. For a variety of reasons, including lack of funding, many people ended up homeless instead. During the 1990s, a second wave of homeless people appeared in shelters: families who couldn't afford the skyrocketing cost of housing. And the homeless population ticked steadily upward.
Initially, shelters focused on helping people with psychiatric needs and drug addictions first, and worried about getting them homes afterward. With families, too, social service workers focused on job training and other help before placing them in homes.
Management vs. prevention
Homeless experts began to question that approach when they realized they were managing the homeless problem, not solving it. That's when they pioneered the Housing First concept, targeting the toughest homeless cases, the mentally ill and drug addicts who cycled through homeless shelters, emergency rooms, detox centers, and psychiatric hospitals. Professor Culhane's studies in the 1990s found this population accounted for about 10 percent of the people in shelters – but used more than 50 percent of the resources Moving these people into apartments with rent subsidies and support services was not only more humane, but more cost effective.
"It was a less expensive response than having these people being out on the street or in long-term shelter," says Philip Mangano, executive director of the Unites States Interagency Council on Homelessness. "That's because this is a population that randomly ricochets into very expensive primary and behavioral health systems costing between $30,000 and $150,000 per person per year."
Providing supportive housing, on the other hand, costs between $13,000 and $25,000 a year, says Mr. Mangano.