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The Honolulu Advertiser

Posted on: Sunday, November 16, 2003

Housing First can work for Hawai'i

Once, as a social worker reaching out to the homeless, Sam Tsemberis was limited to offering clients a cup of coffee. Now, he can approach the most desperate transient and say, "How would you like an apartment?" Imagine how good that feels.

As we enter National Hunger and Homeless Awareness Week today, we'd like to stress the importance of dignity and autonomy when it comes to helping get the homeless off the streets. This thought covers a wide range of situations from those who find themselves homeless through a temporary financial setback or loss of a job, through those who are on the street because of profound mental difficulties or addiction.

As Advertiser urban Honolulu writer James Gonser suggests in his article on homelessness today, we need more than stopgap measures to cope with the burgeoning homeless population. We need a long-term plan, particularly for the chronic homeless.

And that's where Tsemberis and "Housing First" programs come in. He was recently in Hawai'i as a guest of the Institute for Human Services, which runs O'ahu's only emergency homeless shelter that — we're horrified to say — can get so crowded the women's division has to operate a lottery for its beds some nights.

In 1992, Tsemberis, armed with a Ph.D. in clinical community psychology, launched a program in New York called Pathways to Housing, which operates under the philosophy that the odds of getting the mentally ill homeless permanently off the streets are higher if you give them apartments first and then work on their problems.

That might seem radical given the prevailing mindset that requires the homeless to demonstrate "housing readiness" by first participating in drug, job or counseling programs.

For starters, however, there's no guarantee they'll get housing once they've jumped through all the hoops. Plus, it's hard to complete a recovery or employment program when you're in survival mode.

That's why "Housing First" makes sense. And it's not as though clients are just handed an apartment and left to fend for themselves.

Pathways to Housing, for example, offers "supportive housing." The agency pays the client's rent from the welfare checks it receives, and gives the client the remaining money for food and other needs.

Social workers regularly check on the tenants and are on hand to mediate disputes with neighbors or landlords.

"We can put somebody in an apartment, pay 80 percent of the rent with government funding, and provide treatment for $5,000 a year cheaper than it costs) to put them in a shelter cot," Tsemberis said.

Hawai'i has a fledgling "housing first" program known as Shelter Plus Care, which is run by IHS and Health Care for the Homeless. But the rental market is tight, and many landlords aren't comfortable taking on mentally ill homeless tenants.

Tsemberis faced the same issues in New York when he launched Pathways to Housing. He started out with 50 apartments and a $500,000 grant from the New York State Office of Mental Health. Today, the grants exceed $7 million, the agency works with more than 200 landlords and more than 80 percent of its clients stay off the streets.

To make "housing first" work in Hawai'i, we are all going to have to let go of our fears and prejudices and not expect people with mental health problems and addictions to pull themselves up by their bootstraps before we give them a break. They have to feel safe before they can change the behaviors they developed to survive.