In New York, ‘Housing First’ Approach Helps Unhoused People Find Stability
In New York, ‘Housing First’ Approach Helps Unhoused People Find Stability
By: Meryl Davids Landau, MindSite News, November 17, 2022
Photos usable. (2258 words)
Ronnie Hodge and her young son were living in her uncle’s apartment in the Bronx when the uncle suddenly moved upstate, leaving mom and baby with no place to go. She moved into a city family shelter along with her son and boyfriend of 15 years and spent three years there, struggling to cope with little personal space and no kitchen to cook in.
For Hodge, the stress was sadly familiar. As a child, she had lived in more than 30 foster homes, and as an adult, her alcohol addiction often left her unemployed. Shelter life contributed to a break-up with the boyfriend and left Hodge with depression and anxiety. Her son was also stressed and lost weight because he wouldn’t eat the food the shelter provided.
Then, in September 2020, a nonprofit called HousingPlus transformed her life. The organization arranged for Hodge and her son to rent a heavily subsidized, two-bedroom apartment in the East New York section of Brooklyn.
This summer, Hodge, 39, who has been sober for several years, showed me around the brightly lit unit in a newly constructed building, proudly pointing out the new furniture, clean linens and kitchen supplies provided by the nonprofit.
Having her own home has dramatically improved Hodge’s quality of life and her mental health. “Staying in other people’s places, I was always walking on eggshells,” she told me as we sat on her comfortable couch. “Now I don’t have to worry about anybody kicking me out of the house. I feel so safe.”
Her son is thriving, Hodge says, and is devouring the home-cooked lasagna, curried goat, and salmon she now gets to cook in her own kitchen. Her depression and anxiety have not resurfaced since the move, and the stability has enabled her to get and keep a full-time job cleaning city subway cars. “The people at HousingPlus don’t know how much they’ve changed my life,” she said.
Except, of course, they do. Helping women like Hodge has been the 20-year mission of HousingPlus and its founder Rita Zimmer. She had noticed that most shelters were created for men, and she wanted to offer permanent homes to women and, by extension, their children. “When they’re homeless, the children are homeless,” Zimmer said.
Her work to house homeless women earned her an award – the 2022 AARP Purpose Prize.
HousingPlus currently holds leases for 150 apartments, from studios to three bedrooms, in scattered sites around Brooklyn. Another 100 or so units are under construction. Rents for HousingPlus tenants are capped at 30 percent of their annual income, with the balance coming from federal, state and local grants and charitable donations. The tenants pay their share to the organization, which in turn pays the landlords, who benefit by receiving a single on-time rent check for everyone in the program.
Tenants are expected to meet at least monthly with their assigned case manager, who can help connect them to resources for their mental health or substance abuse issues. But the women are not required to use them, and they don’t lose their housing if they continue their addiction or shun psychological services.
Still, most tenants struggling with mental illness make dramatic improvements once they have their own apartments, said Sandra Delice Maurent, HousingPlus’ clinical care manager. “You have to create a sense of safety: ‘I have a key, I can close my door, I am safe.’ Only then will someone truly open themselves up to services that address their mental health needs, family conflicts, traumas, addiction, and the like,” Maurent said.
The organization’s work is modeled on the “Housing First” approach developed by Sam Tsemberis, a clinical psychologist at New York University who started the Pathways to Housing program in New York City in 1992. While that term can be used for any effort that provides chronically homeless people a permanent home, it is generally reserved for subsidized homes granted without condition, along with voluntary supportive services.
“It’s not housing only, but housing first,” said Margot Kushel, director of the Benioff Homelessness and Housing Initiative at the University of California San Francisco. She has researched the approach and said that services, including mental health referrals, are a crucial element of a well-done initiative.
The method contrasts with the conventional “staircase” approach to homelessness. That approach treats permanent housing as the top step, provided after a person demonstrates they can live first in a shelter and then transitional housing – and requires them to successfully treat their mental illness and/or addictions. Zimmer and others believe that housing is such a basic human need it must come first, even if treatment never follows.
“Housing First is a humane approach, but it is also a practical one,” said Deborah Padgett, a professor of social work at New York University who served on the Pathways board for several years and co-authored a book, Housing First, with Tsemberis. A bed in a New York City shelter costs the city $3,000 a month, she noted. “You could rent a decent apartment for that.”
Some critics worry that if mental illnesses remain untreated in people who have spent years living on and off the streets, they’ll be unable to keep their housing.
But Padgett says that’s not the case. She points to a study that compared hundreds of formerly homeless Pathways participants – many with severe psychiatric disabilities and addictions – with a citywide sample of those in more conventional programs. After five years, 88 percent of the Pathways tenants remained housed, while only 47 percent of the others did.
HousingPlus tenant Makeda Knight, 41, told me the stability of having her own apartment has finally helped her banish the post-traumatic stress disorder that has plagued her since age 15, as well as the depression and anxiety that followed.
In 2019, Knight was sentenced to up to seven years in prison for using a stranger’s credit card. She attended a boot-camp style program at the prison and was released after nine months – only to find that she and her 6-year-old daughter had no place to go. Through a program for incarcerated women funded by the mayor’s office, HousingPlus offered Knight a two-bedroom apartment in the same building where Ronnie Hodge lives.
“Walking in here the first day, seeing that it was mine, I was awed,” she said as her daughter, now 9, alternated drawing pictures and dancing around the living room.
Knight said she was determined to use the opportunity to improve her life. She enrolled in Hunter College and wants to attend medical school to become a psychiatrist. She can afford college tuition only because she doesn’t have to pay New York’s exorbitant market rent.
Knight hasn’t taken advantage of psychological services offered by her case manager, but she plans to. “There are things I need to address to continue down the road of being mentally healthy,” she told me. One is how to be in a satisfying relationship, since her experience with her daughter’s father did not end well.
If she does eventually become part of a couple, she’d be permitted to have her partner move into the apartment with her, although Zimmer encourages tenants who move in as singles to keep only their name on their lease, even if they marry. “Having the stability of the apartment is important in case things don’t work out,” she said.
From the HousingPlus Twitter feed
The Housing First model has been successfully deployed across the U.S. and internationally, NYU’s Padget said, in places as different as Houston, Milwaukee and several cities in Canada.
A comprehensive 2014 report of the “At Home (Chez Soi)” initiative in Canada tracked more than 2,000 tenants in five cities who previously had been homeless an average of five years. Over the next two years, 62 percent of them remained continually housed, compared with 31 percent of homeless Canadians who took part in typical staircase programs. Improvements in mental-health and substance-related issues were similar for both groups, even though the Housing First tenants were not required to address them.
Not everyone is enamored with these programs.
“A person struggling with addiction or living with mental illness will not be sustainably helped when the government [or nonprofit] simply gives them a house,” said Wayne Winegarden, a senior fellow at the free-market think tank Pacific Research Institute. Instead, he says, the troubles they struggle with are simply brought to the house.
Winegarden co-authored a recent report with another institute fellow, Kerry Jackson, that takes specific aim at Project Homekey, California’s Covid-era initiative to convert hotels, motels and vacant apartments into permanent housing.
“Although Project Homekey has spent large sums, it has failed to reach its goals while, as measured by the numbers of homeless, the problem continues to worsen,” Weingarden and Jackson wrote. Jackson told me that leveraging the resources of private sector charities and providing institutionalized temporary shelter while treating mental illness and addiction, “the top factors driving homelessness,” is a more effective approach.
But California’s housing shortage – recently pegged at nearly a million units by the nonprofit Up for Growth – and the cost overruns of that program do not change the fact that real people are helped when they get a stable home, said UCFS’s Kushel. Not every program across the country has been executed well, she said, especially when they don’t offer sufficient or easily accessible services for tenants who need them. “People are not services-resistant, but services can be people-resistant,” she said.
Housing stability is especially crucial for those with bipolar disorder or schizophrenia, Kushel said, because these illnesses thrive on instability. Her study of chronically homeless people, many with these illnesses, found that those given permanent housing were much less likely than others to continue to require emergency psychiatric care.
“There’s nothing more unstable than being homeless. For a critic to say, ‘You have to get better before we give you an apartment,’ is structured to produce failure. And it does, time and again,” Kushel said.
At HousingPlus, each case manager is responsible for fewer than 20 tenants, a manageable load that allows them to be responsive. Some tenants check in only monthly, while others call case managers for help with everything from filling out a job application to learning how to use a computer, said case manager La’Kenya Overton. Since some women had been homeless for decades before signing their lease, even small things can challenge them.
“For some tenants, the first step towards becoming a productive member of society might be encouraging them to keep their apartment clean or calling me back if I leave a message,” Overton said.
Cassandra McKeever, a HousingPlus case manager, works with many female veterans, and PTSD is common. Knowing they won’t be evicted by HousingPlus if they are not able to work is calming, she said. And because some tenants choose to remain in their apartments for years, McKeever knows they’re making progress.
“I often see a big difference from when I first start working with someone, in terms of their behaviors, attitudes, and how they keep their home,” she said.
Traci Washington, 51, is one of those veterans. She was sexually assaulted during her first posting in Germany, and it compounded the binge drinking she traces to a chaotic childhood. She moved to New York City a decade ago with her teenage daughter and ended up in a family shelter and an inpatient alcohol treatment program, struggling to cope with a diagnosis of military sexual trauma.
Seven years ago, she was sitting outside on a bench when a HousingPlus staff member walked up and asked if she was a veteran. Washington couldn’t believe her good fortune. She has since lived in several HousingPlus apartments, most recently moving into a three-bedroom unit so she could live with her daughter, who is now 27, and her daughter’s sons, ages 6 and 3.
Health issues have left Washington unemployed so she helps care for her grandchildren while her daughter is in school training to be a radiology technologist. Because of the subsidy, their monthly rent is less than $350. That figure will rise when her daughter graduates and starts working, or if Washington reenters the workforce.
In the meantime, Washington says her HousingPlus caseworkers have helped her discover her self-worth – and stop drinking. “I had to learn that if a man was abusing me, stealing from me, using me, that it’s okay to cut ties and let him go, rather than reach for a drink,” she said.
HousingPlus tenants who don’t become sober – and especially their children – still benefit from being housed, Zimmer said. She pointed to the case of a woman who relapsed many times after moving into an apartment more than a decade ago.
“In the meantime, her three children have grown up and graduated from high school, and one is currently in college,” Zimmer said. “Even when she has fallen apart, her kids have had stable housing.”
The biggest challenge for any Housing First program is finding enough apartments for all who need them, especially when some tenants stay on for decades. HousingPlus has grown by constantly adding to its housing stock, Zimmer said. This means working with affordable housing developers to rent some of their units.
It also means staying open when opportunities present themselves. In 2005, Zimmer was walking down the street when she saw a man unloading construction materials outside a new six-unit building. “I said, ‘Are you the owner, and are these rentals?’” Zimmer recalled. “He said, ‘Yeah, do you want an apartment?’
“I said, ‘Actually, I’d like all six.’” Traci Washington and her daughter and grandsons are pleased she did.
