Friday, August 3, 2012

With "Housing First" it's all about what comes next.

I've been in a lot of email conversations recently about problems in supportive housing, in part because of my posts on this blog and on Twitter. What's depressing is how little has changed since I last wrote professionally on this subject five years ago.

It's all reminding me that there is serious advocacy -- and serious data journalism -- to be done on the subject of neglect, bad management, and unsupportive "supportive services" in buildings that are labeled and funded as "supportive housing." Not all such buildings are bad, but enough of them have enough problems to be worth attention.

You hear a lot of happy talk that promotes the "Housing First" philosophy, but much of it cheats the original spirit behind the phrase. Properly understood, "Housing First" programs allow people who lack housing to have housing, so they can work on next steps in their lives while living in stable housing indoors. That's wonderful by comparison if you remember the dominant homeless-housing philosophies of the 1990s. Those tended to require people to earn stable housing by enduring a purgatory of short- and long-term shelter beds and "transitional housing" placements, to be rewarded with the prize of an ordinary hotel room or apartment. (There are still elements of that purgatory process in San Francisco's "Shelter Plus Care" program.)

The bad part is when "Housing First" gets used to mean that genuinely fragile people are warehoused in "supportive" buildings that don't really provide individualized service or attention. Misapplied "Housing First" policies have resulted in segregating people together who have particular kinds of troubled histories, treating them as equivalent to each other, creating conditions where vulnerable people who need services don't get them and nastier-minded neighbors prey on the rest. That doesn't always happen but it happens often enough.

(I should say here that I don't practice law for supportive housing tenants very actively now, but I'm still linked to the subject through a long-term pro bono representation that is not discussed here for ethical reasons.) 

These recent conversations I've been having started in an exchange with "bluoz" (@auweia1 on Twitter) who posts videos of drug activity around his residential hotel on San Francisco's Sixth Street. Apparently his building wasn't a supportive housing property when he moved in, but then some units were rented to "Care Not Cash" tenants who, in his view, get too little support and supervision, and the result, he reports, is both lively and unpleasant.

And then this past week I was contacted by a tenant of "supportive housing" who, after similar kinds of problems in her building, is trying to organize a group of NYC-area supportive housing tenants to call for better conditions.

She found my name because of an article I wrote for Shelterforce in 2007, "When Supportive Housing Isn't." It's a very angry article. It came out of a grindingly horrible experience involving callous management behavior toward formerly homeless tenants in a building that was badly run at the time but has since improved. The decision to publish it stretched the limits of editorial open-mindedness at Shelterforce, which in general publishes in support of supportive housing, mainly for very good reasons.

Of course on some level any writer is glad when a article strikes a chord with a reader, but it is not cheering to find confirmation that supportive housing continues to be as hellish for others as what I was seeing in 2007.

For a while in 2008, I made some efforts toward conducting a census of deaths and unhappy departures in supportive housing. Before realizing the project was too big for one person (or rather two -- a colleague had offered to help at the time), I obtained an initial set of public records from San Francisco's Dept of Public Health, for reports dated 2002-2007 that would show, among other things, tenants' "reasons for leaving" certain types of federally funded supportive housing. The resulting imperfect data set is described in this earlier weblog item.

This past week, "bluoz" became the first person to take me up on an offer to send out a DVD of the scanned federal reports in non-OCR'd PDF form. He was kind enough to post the 2006 part of the data set.

If anyone else would like to have these docs, or if anyone is interested in working on this idea of tabulating deaths and unhappy departures in San Francisco supportive housing, or maybe just deaths, do please let me know. It strikes me as a kind of "data journalism" that would interest and inform the public -- I'm just not sure where to start with a rigorous approach to the project, nor who might sponsor it. (Except -- T.J., you reading this? Any thoughts?)

In a search revisiting the subject, I found an interesting wide-ranging discussion about supportive housing in a third location -- Knoxville, Tennessee. Someone there had quoted my article as an argument against "Housing First" supportive housing.
I posted a reply at the end of the comment thread there today, just to clarify that in my view "Housing First" isn't the problem: the problem is when people who have serious case management, medical and psychiatric needs get stuck into housing with the primary goal of getting visible poverty off the streets. The problem is when "supportive housing" is only just supportive enough to reassure the benevolent but incurious that "those people are getting the help they need."

What results from "Neglect Next" can range from unpleasant to deadly. Sometimes it's that a former member of a "homeless" but stable community of campers is separated from friends and informal support network and stuck in an apartment or hotel room in an unfamiliar and possibly unsafe part of town. Sometimes it's that a sober person gets stuck next to crack smokers. Sometimes it's that an addicted person is left to thrash around alone, turning the room that represents "housing" into a barren cave, without the kind of respect, opportunity or constructive attention that leads toward saving alternatives.

It's sad to see there are still arguments about whether people with addictions and mental health issues should be allowed to live indoors in the community. Housing is a right, independently from whether individual people may need (or are arguably entitled to) professional case management or treatment. A lot of cruelty has been practiced in the name of "let them hit bottom". While it's true addicts shouldn't be allowed to manipulate would-be helpers, I don't believe that the fact of addiction should be used to justify neglect of a whole person.

On the other hand, having personally lived upstairs from drug dealers twice (the first time was in Harvard University student housing), I don't believe in radical tolerance either.

All boils down to dealing with people as individuals, not as members of imposed categories. Doesn't it always?


  1. Thanks, Attorney Bridegam. You came to my support during a very stressful period. Let's move on to ensure that supportive housing is a dynamic blessing to residents and to the community, and not a system of government-supported drug houses. -M. King

  2. As I said offline, "Martha," please. Not sure how I've helped exactly, though glad to keep comparing notes.

    I do think supportive housing is a good thing when properly managed. I do think it's better for drug users to live indoors than outdoors. Banishment is not the right approach to difficult people or problems. The world is too small for that.

    What seems wrong is the warehousing problem -- when tenants are embedded in a basically institutional setting that becomes difficult to leave, but without needed services nor protection from bad neighbors.

  3. Great piece.
    I did a small project looking at supportive housing in Hamilton (Canada) last year, and it's the same falsely dichotomous views, imo. We know there is a spectrum of housing-types, with various degrees of support. But politicians always only champion one at the expense of the others (eg. the climate now is housing first and keeping elderly in their own home)
    And in terms of human rights and housing- it would be nice if regulations targeted specific measures of safety, afforability, appropriateness.. instead of arbitrary categories eg supportive, supported, residential...
    ... Looking forward to more posts from you!

  4. Thanks much for kind words. Are you the "@dollylinmh" who has just followed me on Twitter?