No Fixed Address · Episode 6 of 11 · 42 min
Housing First: Does Giving People Homes Actually Work?
For decades the American system asked homeless people with mental illness and addiction to earn housing by getting sober first. In the early 1990s psychologist Sam Tsemberis inverted the sequence, and Canada's randomized At Home/Chez Soi trial later showed large gains in housing stability. The verdict is measured: proven for what it promises, but necessary, not sufficient.
Who's who
- Sam TsemberisPsychologist who founded Pathways to Housing and originated Housing First
- Stephen Eide+1 more episodeManhattan Institute fellow and leading critic of rigid Housing First mandates
Where it happens
- New York City, New York+3 more episodesWhere Pathways to Housing began in 1992
- Vancouver, Winnipeg, Toronto, Montreal and Moncton, CanadaFive cities of the At Home/Chez Soi trial
Timeline
- 1992Tsemberis founds Pathways to Housing on the principle that housing comes first
- 1992-1997About 88% of Pathways participants stay housed, versus roughly 47% in the standard system
- 2009-2013The At Home/Chez Soi randomized trial enrolls roughly 2,300 to 2,500 adults
- 2010The Obama administration's Opening Doors plan embraces Housing First
- 2019Lancet Psychiatry publishes a longer-term extension study
Still debated
Evidence for housing stability is strong, but gains in substance use and psychiatric symptoms are modest and mixed. Disputes include whether to judge high-fidelity programs or what is actually funded, whether it scales where housing is scarce, and how it fares in the overdose era.