Giving homeless people stable housing was federal policy for decades. Trump is ending it
She finally moved into an apartment in 2008, thanks to a rental voucher with mental health treatment and support services attached through a non-profit organization.
'Once I got the housing stabilization and the foundation underneath my feet, I was able to work on myself,' Ellison said.
Ellison benefited from Housing First, a policy that moves chronically homeless people into permanent housing, without requiring them to be sober or in treatment beforehand. Housing First programs then offer services for drug abuse, mental illness, education and employment.
Housing First has enjoyed bipartisan support for more than two decades. But the Trump administration wants to cut funding, claiming the model is ineffective, contributing to 'crime and disorder' and the record number of people sleeping on the streets. Instead, Trump wants to fund programs with stiffer sobriety or work requirements, and commit more homeless people with mental health issues without their consent. Trump ordered federal troops to forcibly remove homeless people from Washington, DC, this week.
It's a major change for the federal government. Since the George W. Bush administration, giving people a home with social services has been the government's main policy to combat homelessness.
Leading researchers and homelessness advocates say the move away from Housing First will have dire consequences for people struggling and unhoused.
After landing an apartment, Ellison began treatment for drug use and mental health disorders, stemming from abuse as a child. For years, she worked to maintain sobriety with a team of mental health and drug treatment counselors.
'I had to fail quite a few times, and then finally I got tired, and I had a roof over my head,' she said. 'I've been clean and sober ever since.'
Ellison, now a national advocate on homelessness, said that 'Housing First actually saved my life.'
Housing First emerged in the early 2000s, replacing a treatment-first model of addressing homelessness. The approach mandated people become sober or participate in programs before they got housing, which was often emergency shelters or transitional housing.
Several studies have found that Housing First programs offer greater long-term housing stability than treatment-first, and may even lower overall costs by reducing hospital and ER visits, according to a HUD review of evidence in 2023.
The Department of Veterans Affairs has used Housing First to decrease veterans' homelessness by 55% since 2009. Houston, Denver and other cities have successfully used the approach to drive down homelessness.
But a White House executive order last month seeks to bring back the old model, directing federal agencies to end funding for organizations that offer housing to people without first requiring treatment for substance abuse or serious mental illnesses.
The Trump administration is 'proposing to turn the clock back to transitional housing model of 1990s. We did that and it failed. It's the whole reason Housing First came about,' said Dennis Culhane, a professor of social policy at the University of Pennsylvania whose research on chronic homelessness laid the groundwork for Housing First programs.
'What the administration will find out is exactly what happened before: The people who need the most extensive supports get evicted' from transitional housing, Culhane said.
Trump's executive order also calls for local jurisdictions to use civil commitment laws to remove people living on the streets who 'cannot care for themselves' or 'pose risks to themselves or the public.'
The administration wants to shift these people into 'long-term institutional settings,' but it may run into a shortage of mental health hospital beds in America. Trump has also cut funding for Medicaid and grants for drug addiction and mental health programs, which may make it harder for people to get treatment.
'What we're seeing is a total lack of investment in solutions we do know work,' said Lara Pukatch, the chief advocacy officer at Miriam's Kitchen, a housing and social services nonprofit in Washington, DC. 'The executive order certainly doesn't address issues of homelessness or make access to health and mental health care any easier.'
Mass street homelessness is a relatively recent phenomenon in America.
A number of factors contributed, including de-institutionalization without provisions for housing or social services starting in the 1950s, government cuts to housing, and an underfunded, patchwork mental health care system.
Results of the treatment-first approach during the 1980s and 1990s 'were not very positive,' Dennis Culhane said. 'People who entered were often discharged for failing to comply with sobriety requirements, and so they ended up back on the streets.'
George W. Bush's administration began to tackle chronic homelessness, spurred by advocates and Culhane's research that found New York City was spending $40,000 a year for each chronically homeless person due to time in detox centers, prisons and hospitals. Supportive housing reduced costs annually by $16,000.
In 2003, Bush announced a 10-year plan to end homelessness as part of its 'compassionate conservatism' agenda, adopting Housing First as the model.
'The shift came during the Bush administration, where they began to recognize that there was real value in addressing chronic homelessness,' said Frederick Shack, the CEO of Urban Pathways, a housing and social services provider in New York City. 'You can do that best by helping people address their core housing need and surrounding them with services.'
The Obama administration continued the approach and in 2009 launched a goal of ending veteran homelessness built around Housing First. Congress that year passed legislation that accelerated funding to Housing First programs.
The first Trump administration initially continued the Housing First approach, praising the model.
But the administration began shifting its position as unsheltered homelessness became more visible, especially in Democratic-run cities on the West Coast.
Housing First also became a larger target of the right. Conservative think tanks and policy institutes such as the Cicero Institute and Manhattan Institute opposed Housing First, arguing that housing without treatment requirements has not worked.
'Housing First was oversold, it became far more dominant than it deserved, and homelessness reached historic levels. What you're going to see under Trump is simply a rebalancing of priorities,' said Stephen Eide, a senior fellow at the Manhattan Institute who studies homelessness. 'For too long, the GOP neglected Housing First's influence.'
Republicans in Congress introduced legislation to redirect funding away from Housing First programs to providers that require job training, addiction treatment or other services. Florida, Georgia, Missouri and other Republican-led states also passed laws restricting Housing First programs.
But Housing First proponents say the model is not the problem — it's a lack of funding. Both to keep up with rising homelessness and counter a crippling affordable housing shortage.
'Housing First has failed because we haven't fully invested in Housing First,' Shack from Urban Pathways said. 'You can't solve the problem without the resources.'
Only about 15% of people experiencing homelessness get into a Housing First program, according to Dennis Culhane's research. In 2022, he and other researchers conservatively estimated it would cost $9.6 billion to provide Housing First to every household in US shelters.
Most homelessness service providers employ Housing First principles. They fear the loss of federal funding and a retreat back to policies they abandoned years ago.
Ellison said Trump's approach will make it harder for homeless people to get housing, deepening the cycle of criminal justice interactions and trips to the hospital she experienced while living on the streets.
'Housing is the only solution to homelessness, along with wraparound services, if needed,' she said. 'The new executive order is going to make this so much harder, and it's going to add more unhoused people to the population.'
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