Wet Shelters Still a Tough Sell

It may seem counter-intuitive: help addicts get off the streets with shelters that allow drugs and alcohol. If substance abuse is the root of the problem, why allow it?

To folks in the homelessness biz, the concept of housing addicts through a strategy known as housing first is so five years ago. But for those just becoming acquainted with the world of homelessness policy, the mere mention of this approach will get you a perplexed "HUH!?" every time.

But housing homeless substance abusers in shelter (or better yet: in permanent housing) makes sense for a couple of reasons. Not only is living under a roof (like, with a bed and regular meals) more stable, it's where all of the services are located. From a case management perspective, serving someone with a regular place to sleep each night is by far more effective than trying to help someone living on the streets.

But that's only half the explanation for the widespread adoption of this idea. Housing homeless people with the most severe problems (a.k.a. "chronically homeless") is more practical from a cost benefit perspective. An article from Tampa Bay Online explains:

"It goes against conventional wisdom," said Jerry Thompson, president of Coastal Behavioral Health Care, the nonprofit group running the program. "But in the worst-case scenario, someone stays for two years and continues using, it's still cheaper to taxpayers than all the nights in jail and all the trips to the emergency room if they were out on the street."

The theory behind the center is rooted in a tenet of psychology that has only recently taken root in efforts to address underlying causes of chronic homelessness: that rehabilitation cannot be forced. Stable housing, consistent meals and access to doctors and counseling will hopefully lead residents to get help, Thompson said.

Many studies in the past decade have shown the savings of housing chronically homeless people to be substantial, though substance abusers they may be. I'm talking $40-60K per person, per year (mostly accrued from emergency room visits and law enforcement). That's nothing to shake a stick at.

So it tickles me to find articles like this one from Florida, which calls a shelter allowing drugs and alcohol "controversial." In fact, despite the preponderance of evidence and vast bipartisan support for this approach, many folks still aren't sold:

Robert Piper, a mental health counselor and administrator of Sarasota County's primary addiction rehabilitation program, First Step, called the Kelly Hall program "brave."

"It's the kind of idea you agree with, but you're afraid to say you're in favor of. A lot of people out there think, if you're not going to stop drinking or using, why should we spend a dollar on you? They think it's molly-coddling reprobates," Piper said.

(Aside: I had to look up "molly-coddling.")

This article is a good reminder for those of us in the homeless services field. While the benefits of a proven approach like Housing First are widely accepted among practitioners, the public education piece should never be assumed. Community buy-in will always be a necessary part of combating homelessness.