People who are chronically homeless—defined as being without shelter four times a year or more—and who often have addiction or mental health problems are well served by a philosophy called Housing First, which finds them what’s called permanent supportive housing that provides access to services as well as shelter. Until recently, even homeless advocates found this idea radical. Best practice was first to get people off drugs if they were addicted or on them if they were mentally ill—before they were eligible for housing. That’s not the state of the science anymore. “You basically come as you are,” Kushel says. “There is no assumption you’ll be clean and sober or take psychiatric medications. Once you’re in housing, the supportive services wrap around you.”
The trick, though, is that there has to be enough housing available to make all this happen. You need enough homes for people who can afford to rent or buy them, and then enough on top of that to provide room for people with vouchers—by definition below market rate—and permanent supportive units, by definition way below market rate. It’s expensive.