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What’s Behind New City Plan to Help Chronic Homeless?

Scores of eager volunteers are fanning out all over Albuquerque this week to identify through completion of a survey the city’s 75 most “chronic homeless.”

Respondents to the survey, which includes questions on hospital emergency room visits and drug and alcohol use and abuse, will be whittled down to 75. Those individuals will be offered housing in as yet undetermined different parts of the city.

Albuquerque Mayor Richard J. Berry has called the program one of the most comprehensive plans ever to help the homeless. But is it?

The theory upon which Albuquerque’s Heading Home Program is based is known as “Housing First.” It claims that if homeless people have their basic needs met, they will be more likely to seek treatment. Housing First has achieved a lot of attention, being endorsed twice by the U.S. Conference of Mayors.

However, one report (Milbank Q. 2009 Jun;87(2):495-534.Housing first for homeless persons with active addiction: are we overreaching? Kertesz SG, Crouch K, Milby JB, Cusimano RE, Schumacher JE at www.ncbi.nlm.nih.gov/pubmed/19523126) says that perhaps there a tendency to overreach the research from studies supporting the Housing First approach.

Researchers in the study comparing Housing First with a more traditional approach wrote, “For homeless individuals with a prominent and active problem of addiction, the data on Housing First are mixed and unsettled.”

The same study stated that “Policymakers should be cautious about generalizing the results of Housing First studies to persons with active addiction when they enter housing programs.”

There’s also been a lot said by proponents of Albuquerque Heading Home that placing the city’s most chronic homeless in homes will save expensive trips to the emergency rooms and local jail and other services, thus saving taxpayers a lot of money.

But will it? The study referred to before pointed out that while there was a cost saving in a New York, New York program, “It did not equal the cost of the housing intervention.”

In addition, an other section of the report pointed out, “A policy of helping people with complex needs usually involves new costs, unless communities decide to house just a few stratospherically expensive individuals…”

A similar program to the one proposed by Albuquerque city government is in the works for Los Angeles under the name “Home for Good.”

In a recent Los Angeles Times article, County Supervisor Michael D. Antonovich called the approach “warehousing without healing.”

A New York Times article said “Home for Good,” which aims to end homelessness in five years, “was embraced by political and civic leaders even as it served as a reminder of how many of these plans have failed over the years.”

Here’s what Los Angeles Times writer Adam Nagourney wrote in a recent article titled, “Los Angeles Confronts Homeless Reputation.”

He said the issue of homelessness “has become an acute embarrassment to some civic leaders” … and there is “concern in the business and political communities that the epidemic is threatening to tarnish Los Angeles’ national image and undercut a campaign to promote tourism, particularly in downtown …”

So why would Albuquerque city leaders embrace what could be called a cosmetically attractive, but in my opinion for many a structurally defective and inadequately researched approach, to tackle the growing issue of homelessness?

Could it be that they’ve been sold a bill of (popular but inadequately researched) goods and are reaching for what appears to be a multi-faceted solution? That would, of course, be the approach by which Housing First and its many variations are often sold to lawmakers-save money by cutting down on emergency room and jail visits (and get the most chronic and “embarrassing” homeless off city sidewalks and the streets of the often “homeless-cluttered” downtown Albuquerque?)

I don’t think the reason for this interest in our city’s homeless springs from compassion. After all, remember there hasn’t been a whole lot of compassion offered by political officials when it comes to dealing with the homeless in downtown Albuquerque.

For example. Remember that we are a city with an almost total lack of downtown restroom facilities for the homeless. When one former city official was asked about this (at a meeting I attended), excuses offered for the absence of portable restrooms ranged from “they encourage prostitution and drug dealing” to they would be an issue for tourists.

So where do I stand? Rest assured that both as a long-time Albuquerque resident and founder and CEO of Joy Junction, New Mexico’s largest emergency homeless shelter, I will do anything I can to ensure the success of Albuquerque Heading Home for the good of the homeless.

However, while I hope Albuquerque Heading Home lives up to the claims made by its verbally vigorous advocates, I have serious doubts and concerns about the program, its operational philosophy and its motivation.

One Albuquerque Heading Home proponent told me that he has research attesting to the success of programs similar to Albuquerque Heading Home.

Well, other researchers say when quoting statistics to prove your philosophical point of view-great care needs to be exercised , whether it’s for a more traditional recovery approach or for Housing First based programs. “Not to do so,” the researchers say, “risks long term disappointment should a program’s results fail to match the public expectation .”

In the end, I can do no better than quote the words of a colleague who directs a rescue mission on the East Coast. In a recent e-mail he told me, “We feel that life change needs to happen before a person is ready for a sustainable lifestyle. We agree that housing is a critical component of success; we just feel that the order is reversed, ‘change first, then housing,’ rather than ‘housing first, then change.’”

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