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The evidence shows that housing-first policies applied to the worst cases (chronically homeless single people with addiction) is effective and lowers costs, in

The evidence shows that housing-first policies applied to the worst cases (chronically homeless single people with addiction) is effective and lowers costs, in fact more so than for easier clients (families who have become homeless more recently). However popular outrage culture insists on targeting folks who have addiction with sweeps and incarceration instead, even though the law-and-order response is more expensive and less humane. It seems our urge to punish defeats our willingness to tolerate less retributive evidence-based approaches. Source: https://www.npr.org/2019/05/17/724462179/episode-913-counting-the-homeless https://www.npr.org/2019/05/17/724462179/episode-913-countin...

drak0n1c 7y ago
In Rhode Island they actually prosecute addicts and mentally ill who commit crimes, and offer them the alternative of drug and rehab courts that entail mandatory internment in decent facilities and rehabilitation. They emerge with no record, and no debt to be paid. Many going through the process say it saved their life. The same drug courts and facilities exist on the west coast, but they are underutilized because there is no incentive. No criminal or civil justice funnel. People are just set loose. Intervention helps those who are beyond helping themselves. A free place with no strings attached does not do nearly as much to help those who truly need help.
tmh79 7y ago
I am for the "housing first" approach, but there is a clear moral hazard when you provide free housing to the lowest rung, and then say that the minimum cost of housing for the next group is like 1.5k/bedroom/month.
- hguant 7y ago
  It's important to note that "moral hazard", while not quite a term of art, has a specific meaning in economics that isn't associated with ethics or morality. The quick google definitions: "a lack of incentive to guard against risk where one is protected from its consequences" Wikipedia: https://en.wikipedia.org/wiki/Moral_hazard https://en.wikipedia.org/wiki/Moral_hazard
  - nostrademons 7y ago
    He's using it correctly here though: the risk is that if you provide housing to the lowest rung while making the next group down pay $1.5K/bedroom/month, some of the next group down will decide that they would rather become part of the "lowest rung" group rather than pay the money. It's like the phenomena of people committing petty crimes so that they can get a warm bed and food in jail.
    - Latteland 7y ago
      Your example illustrates to me why moral hazard isn't the best title for this. We should provide free housing to people in need so they don't do things like commit a crime to go to jail.
      - deleted 7y ago
        [deleted]
    - dclowd9901 7y ago
      You mean like all those millionaires who decide to become thousandaires so they don't pay more taxes? Give me a break.
      - esyir 7y ago
        First, that is a terrible analogy. If I'm interpreting the ops statement correctly, this is more analogous to a system where post-tax income decreases with rising income instead.
  - robocat 7y ago
    The moral hazard is for those renting: the free housing is equivalent to an insurance payout. A renter can do risky things (like lose their job) because they are protected from the consequences of not being able to pay the rent. They get housed anyway.
    - rebuilder 7y ago
- lazyasciiart 7y ago
  Disregarding the factual issues there, what about the moral hazard of not doing so and turning people into Safe Seattle members who literally advocate shooting them or driving them into the forest and leaving them there?
- rdtwo 7y ago
  Honestly the housing first is a bad idea for the visibly homeless. Might work Ok for the invisible homelessness but the property damage costs can easily be factors lager than even the rent cost.
  - WhatIsDukkha 7y ago
    Citation needed. I think you should seriously reconsider your position. There is a chronic inebriate apartment building downtown Seattle that makes no moral judgements about "stopping drinking" etc that LOWERS COSTS (with studies to back it up) for the community. People with problems get a permanent address. Ambulance and police calls drop as they aren't chasing these guys all over town. Think again. MAYBE your position is more about being judgemental about their moral state then actually whats good for them and the rest of us. EDIT - Just to be clear. If someone is too far gone (and many of these guys are) then we need to start funding involutanry commitment beds.
    - rdtwo 7y ago
      Might be marginally effective but at what cost. If it costs more a year to house one of the chronically homeless than incarcerate then then I’d go with the cheaper option. The money is better used to help the invisible homeless after that point
  - fasthandle 7y ago
    Wealthy part of the richest country in the world cannot home it's citizens because NIMBY property prices?
- jbob2000 7y ago
  This is what’s keeping me living at home with my parents. I tried to move out a few years ago, found an apartment that was $1,100 a month and plenty of parking. 6 months after moving in, after having multiple bad experiences with tenants, I realized I moved in to a “subsidized housing” apartment. There was lots of parking available because 90% of the tenants weren’t allowed to drive. It hurts to work all day to pay for stuff, only to come home to half your neighbors lazing about drunk and stoned getting a free ride. It fucking sucks, I could never escape the thought that I could just quit my job and smoke weed all day and live pretty much the same as I was. If I wanted to live in a condo, which doesn’t have subsidized housing, I’d have to pay rents upwards of $2,200. So I moved back in with my folks until I can buy something.
  - neonate 7y ago
    Good luck. Hope you get there soon.
  - vkou 7y ago
    > It hurts to work all day to pay for stuff, only to come home to half your neighbors lazing about drunk and stoned getting a free ride. I hear this all the time - yet I don't see many people particularly keen on dropping out, and getting onto the free ride bus. One of the problems with that free ride bus is that it doesn't go to great places. It didn't sound like you were looking forward to the prospect of living in subsidized housing for the rest of your life very much.
    - michaelt 7y ago
      I don't see many people particularly keen on dropping out, and getting onto the free ride bus. I don't either - but maybe those people just don't hang out on Hacker News.
    - freyr 7y ago
      > yet I don't see many people particularly keen on dropping out Just open your eyes. Look around Seattle, or San Francisco, or Los Angeles, or San Diego or any other city with mild weather, lenient law enforcement, and generous welfare benefits. The number of homeless and housed "drop outs" is astonishing.
malandrew 7y ago
I could support the housing first policy if it were somewhere where the cost of living is dirt cheap. It makes zero sense to set dollars on fire by housing people in one of the highest cost of living markets in the world.
- Kalium 7y ago
  There's a disconnect here. Individuals experiencing homelessness have already chosen to do so somewhere expensive. Generally they have reasons for this that they find compelling. How would you propose to convince them to relocate to this hypothetical cheap homelessness-warehousing center elsewhere?
  - isoskeles 7y ago
    I don't think any convincing would be necessary if the help were simply cut off in high cost of living areas and only available in lower cost areas. This will probably not happen any time soon because it's politically incorrect to effectively admit homeless people don't deserve to live in high cost of living areas, but it would certainly be more effective in helping people materially. Not to mention, people in lower cost, yet populated, areas probably don't want them there either and will fight to prevent this from happening (NIMBY).
    - istjohn 7y ago
      The hypocrisy! NIMBY is precisely the name for this entire thread of self-pitying heartless belly aching.
  - munificent 7y ago
    I have compelling reasons to choose to live in a penthouse suite in Manhattan. It has a beautiful view. Gorgeous amenities. Private parking. Really, it's the best. However, I can't afford to, so the way society persuades me not to live there is that they kick me out, since I didn't pay for the place and don't have any claim to it. This does not seem entirely unreasonable to me. I get your point: it seems like a moral good in America for people to have some inalienable (i.e. "not required to pay for") right to have some control over where they live. But it makes zero sense to have a black and white rule that everyone has a right to live anywhere they want. Do I have a right to take up residence inside your living room? Your home? Your porch? A public school's playground? The middle of an interstate? A public park? I think the reasonable answers to all of those are "no". The US is geographically sorting itself by wealth. You used to have pricy neighborhoods but any given city generally had some amount of property available across a range of income levels. With the transition to a service economy, this is less true over time. Now entire cities are becoming uniformly expensive. The reality is that I no longer think it's tenable to say that someone has a right to live in Manhattan regardless of their income level. The way things are going, it's probably going to be the case that the entire city limits of SF, Seattle, and NYC will go that way. Does it suck? Yes. Can it be solved at the city level? I don't think so.
chongli 7y ago
The evidence shows that housing-first policies applied to the worst cases (chronically homeless single people with addiction) is effective and lowers costs I would like to dispute that. This WaPo [1] article paints a far less rosy picture. Addiction is a symptom of mental illness (and in all likelihood may be genetic). Look at the rates of smoking among people with schizophrenia [2], they're much higher than the general population, and the usual purported causes fall flat. [1] https://www.washingtonpost.com/local/dc-politics/dc-housed-the-homeless-in-upscale-apartments-it-hasnt-gone-as-planned/2019/04/16/60c8ab9c-5648-11e9-8ef3-fbd41a2ce4d5_story.html https://www.washingtonpost.com/local/dc-politics/dc-housed-t... [2] https://slatestarcodex.com/2016/01/11/schizophrenia-no-smoking-gun/ https://slatestarcodex.com/2016/01/11/schizophrenia-no-smoki...
- tcj_phx 7y ago
  I really like your link [2]: > A dose-dependent relationship was found between smoking and protection from schizophrenia. This is really interesting. The study found smoking protects against schizophrenia. The blog author skewers later science for completely misrepresenting this study in their review. Nicotine is sort of similar to niacin/niacinamide (vitamin b3), which is probably why it protects against schizophrenia. I recommended niacinamide to a young woman who’d just quit smoking, “again”. She says the vitamin is great, is still taking it 1.5 years later and recommends it to all her coworkers who want to quit smoking. And it calmed down some of her “personalities”.
jelling 7y ago
Frontline did a piece on that approach and it was a retrospective on how it had gone wrong in notable cases. Not stating an opinion here, but highlighting that even sympathetic coverage thinks the approach is a mixed bag in practice.
- sgift 7y ago
  > was a retrospective on how it had gone wrong in notable cases. > highlighting that even sympathetic coverage thinks the approach is a mixed bag in practice. You mean "how a statistically non-significant number of cases lead to the usual results in our modern outrage culture"? You will always have cases where it doesn't work. That's why statistics are important. But statistics don't sell, what sells is "SEE, WE GAVE THIS GUY FREE HOUSING AND HE DID THIS HORRIBLE THING"
  - silexia 7y ago
    I believe the homeless (and everyone else), should be prosecuted in full for crimes they commit. I think there are two types of homeless - those who are sane and normal but down on their luck - once they get a job and support they can be contributing members of society. These individuals need all the support we can give them. The second type of homeless, sometimes referred to as homeless by choice, those individuals who are drug addicted or mentally unstable to the point they can't even keep it together to get a government check need to be handled differently. I think we should have some form of long term holds for these people until they truly show they can survive and flourish without it. Cities are becoming overrun with the second type of homeless. These people are generally filthy, spread disease, commit various crimes of opportunity even including assault and murder and rape, and abuse drugs and alcohol until they die. I suggest we categorize the second type of homeless by issue involved and severity and have mandatory facilities to either help them recover or simply hold them long term. Categories could include various levels of drug addiction rehab, mental health, etc.
ducktypegoose 7y ago
A lot of those people who are the worst offenders, routinely bouncing from the hospital, to the jail, to the streets, have problems that aren't solved by a house. They need a group-home that isn't jail but is capable of saying, "no, you aren't fit to go into public yet until you can meet these criteria." A lot of these people need others to make decisions for them, when to take medications, when to bathe, how to navigate the bureaucracy, etc. God knows it would save a lot of money and keep them off the streets. I feel like for a lot of people they'd find community and purpose in life, eventually solving the problem that created their circumstances to begin with. Jail doesn't work, the streets doesn't work, leniency doesn't work, just handing someone a house isn't realistic. We have to try something else.
- lonelappde 7y ago
  You are describing institutionalization. Mandatory institutionalization is ripe for abuse, and voluntary institutionalization doesn't work when it's intended use is to serve people whose defining characteristics is inability to mak good choices consistently.
cco 7y ago
It isn’t housing first, I’ve never agreed with that name for their approach, it is disingenuous at best. The policies, as described in any “housing first” policies I’ve encountered, are more reasonably described as “supportive housing first”. If you place a chronically homeless, bi-polar, heroin addict into an apartment they will not get better, they will continue their previous life until they’ve broken their lease and are evicted; none of the “housing first” programs aimed at the “visibly homeless” we’re talking about do this, they provide housing along with a robust support system to get these people medical and mental healthcare as well as addiction recovery. It is a good model but I’ve too frequently seen them mischaracterized as just providing free rent, that isn’t what they do and that would fail. They are essentially just a reimagined mental health institute with far more freedom for the patients.

drak0n1c 7y ago

In Rhode Island they actually prosecute addicts and mentally ill who commit crimes, and offer them the alternative of drug and rehab courts that entail mandatory internment in decent facilities and rehabilitation. They emerge with no record, and no debt to be paid. Many going through the process say it saved their life. The same drug courts and facilities exist on the west coast, but they are underutilized because there is no incentive. No criminal or civil justice funnel. People are just set loose. Intervention helps those who are beyond helping themselves. A free place with no strings attached does not do nearly as much to help those who truly need help.

tmh79 7y ago

I am for the "housing first" approach, but there is a clear moral hazard when you provide free housing to the lowest rung, and then say that the minimum cost of housing for the next group is like 1.5k/bedroom/month.

hguant 7y ago
It's important to note that "moral hazard", while not quite a term of art, has a specific meaning in economics that isn't associated with ethics or morality. The quick google definitions: "a lack of incentive to guard against risk where one is protected from its consequences" Wikipedia: https://en.wikipedia.org/wiki/Moral_hazard https://en.wikipedia.org/wiki/Moral_hazard
- nostrademons 7y ago
  He's using it correctly here though: the risk is that if you provide housing to the lowest rung while making the next group down pay $1.5K/bedroom/month, some of the next group down will decide that they would rather become part of the "lowest rung" group rather than pay the money. It's like the phenomena of people committing petty crimes so that they can get a warm bed and food in jail.
  - Latteland 7y ago
    Your example illustrates to me why moral hazard isn't the best title for this. We should provide free housing to people in need so they don't do things like commit a crime to go to jail.
    - deleted 7y ago
      [deleted]
  - dclowd9901 7y ago
    You mean like all those millionaires who decide to become thousandaires so they don't pay more taxes? Give me a break.
    - esyir 7y ago
      First, that is a terrible analogy. If I'm interpreting the ops statement correctly, this is more analogous to a system where post-tax income decreases with rising income instead.
- robocat 7y ago
  The moral hazard is for those renting: the free housing is equivalent to an insurance payout. A renter can do risky things (like lose their job) because they are protected from the consequences of not being able to pay the rent. They get housed anyway.
  - rebuilder 7y ago
lazyasciiart 7y ago
Disregarding the factual issues there, what about the moral hazard of not doing so and turning people into Safe Seattle members who literally advocate shooting them or driving them into the forest and leaving them there?
rdtwo 7y ago
Honestly the housing first is a bad idea for the visibly homeless. Might work Ok for the invisible homelessness but the property damage costs can easily be factors lager than even the rent cost.
- WhatIsDukkha 7y ago
  Citation needed. I think you should seriously reconsider your position. There is a chronic inebriate apartment building downtown Seattle that makes no moral judgements about "stopping drinking" etc that LOWERS COSTS (with studies to back it up) for the community. People with problems get a permanent address. Ambulance and police calls drop as they aren't chasing these guys all over town. Think again. MAYBE your position is more about being judgemental about their moral state then actually whats good for them and the rest of us. EDIT - Just to be clear. If someone is too far gone (and many of these guys are) then we need to start funding involutanry commitment beds.
  - rdtwo 7y ago
    Might be marginally effective but at what cost. If it costs more a year to house one of the chronically homeless than incarcerate then then I’d go with the cheaper option. The money is better used to help the invisible homeless after that point
- fasthandle 7y ago
  Wealthy part of the richest country in the world cannot home it's citizens because NIMBY property prices?
jbob2000 7y ago
This is what’s keeping me living at home with my parents. I tried to move out a few years ago, found an apartment that was $1,100 a month and plenty of parking. 6 months after moving in, after having multiple bad experiences with tenants, I realized I moved in to a “subsidized housing” apartment. There was lots of parking available because 90% of the tenants weren’t allowed to drive. It hurts to work all day to pay for stuff, only to come home to half your neighbors lazing about drunk and stoned getting a free ride. It fucking sucks, I could never escape the thought that I could just quit my job and smoke weed all day and live pretty much the same as I was. If I wanted to live in a condo, which doesn’t have subsidized housing, I’d have to pay rents upwards of $2,200. So I moved back in with my folks until I can buy something.
- neonate 7y ago
  Good luck. Hope you get there soon.
- vkou 7y ago
  > It hurts to work all day to pay for stuff, only to come home to half your neighbors lazing about drunk and stoned getting a free ride. I hear this all the time - yet I don't see many people particularly keen on dropping out, and getting onto the free ride bus. One of the problems with that free ride bus is that it doesn't go to great places. It didn't sound like you were looking forward to the prospect of living in subsidized housing for the rest of your life very much.
  - michaelt 7y ago
    I don't see many people particularly keen on dropping out, and getting onto the free ride bus. I don't either - but maybe those people just don't hang out on Hacker News.
  - freyr 7y ago
    > yet I don't see many people particularly keen on dropping out Just open your eyes. Look around Seattle, or San Francisco, or Los Angeles, or San Diego or any other city with mild weather, lenient law enforcement, and generous welfare benefits. The number of homeless and housed "drop outs" is astonishing.

malandrew 7y ago

I could support the housing first policy if it were somewhere where the cost of living is dirt cheap. It makes zero sense to set dollars on fire by housing people in one of the highest cost of living markets in the world.

Kalium 7y ago
There's a disconnect here. Individuals experiencing homelessness have already chosen to do so somewhere expensive. Generally they have reasons for this that they find compelling. How would you propose to convince them to relocate to this hypothetical cheap homelessness-warehousing center elsewhere?
- isoskeles 7y ago
  I don't think any convincing would be necessary if the help were simply cut off in high cost of living areas and only available in lower cost areas. This will probably not happen any time soon because it's politically incorrect to effectively admit homeless people don't deserve to live in high cost of living areas, but it would certainly be more effective in helping people materially. Not to mention, people in lower cost, yet populated, areas probably don't want them there either and will fight to prevent this from happening (NIMBY).
  - istjohn 7y ago
    The hypocrisy! NIMBY is precisely the name for this entire thread of self-pitying heartless belly aching.
- munificent 7y ago
  I have compelling reasons to choose to live in a penthouse suite in Manhattan. It has a beautiful view. Gorgeous amenities. Private parking. Really, it's the best. However, I can't afford to, so the way society persuades me not to live there is that they kick me out, since I didn't pay for the place and don't have any claim to it. This does not seem entirely unreasonable to me. I get your point: it seems like a moral good in America for people to have some inalienable (i.e. "not required to pay for") right to have some control over where they live. But it makes zero sense to have a black and white rule that everyone has a right to live anywhere they want. Do I have a right to take up residence inside your living room? Your home? Your porch? A public school's playground? The middle of an interstate? A public park? I think the reasonable answers to all of those are "no". The US is geographically sorting itself by wealth. You used to have pricy neighborhoods but any given city generally had some amount of property available across a range of income levels. With the transition to a service economy, this is less true over time. Now entire cities are becoming uniformly expensive. The reality is that I no longer think it's tenable to say that someone has a right to live in Manhattan regardless of their income level. The way things are going, it's probably going to be the case that the entire city limits of SF, Seattle, and NYC will go that way. Does it suck? Yes. Can it be solved at the city level? I don't think so.

chongli 7y ago

The evidence shows that housing-first policies applied to the worst cases (chronically homeless single people with addiction) is effective and lowers costs I would like to dispute that. This WaPo [1] article paints a far less rosy picture. Addiction is a symptom of mental illness (and in all likelihood may be genetic). Look at the rates of smoking among people with schizophrenia [2], they're much higher than the general population, and the usual purported causes fall flat. [1] https://www.washingtonpost.com/local/dc-politics/dc-housed-the-homeless-in-upscale-apartments-it-hasnt-gone-as-planned/2019/04/16/60c8ab9c-5648-11e9-8ef3-fbd41a2ce4d5_story.html https://www.washingtonpost.com/local/dc-politics/dc-housed-t... [2] https://slatestarcodex.com/2016/01/11/schizophrenia-no-smoking-gun/ https://slatestarcodex.com/2016/01/11/schizophrenia-no-smoki...

tcj_phx 7y ago
I really like your link [2]: > A dose-dependent relationship was found between smoking and protection from schizophrenia. This is really interesting. The study found smoking protects against schizophrenia. The blog author skewers later science for completely misrepresenting this study in their review. Nicotine is sort of similar to niacin/niacinamide (vitamin b3), which is probably why it protects against schizophrenia. I recommended niacinamide to a young woman who’d just quit smoking, “again”. She says the vitamin is great, is still taking it 1.5 years later and recommends it to all her coworkers who want to quit smoking. And it calmed down some of her “personalities”.

jelling 7y ago

Frontline did a piece on that approach and it was a retrospective on how it had gone wrong in notable cases. Not stating an opinion here, but highlighting that even sympathetic coverage thinks the approach is a mixed bag in practice.

sgift 7y ago
> was a retrospective on how it had gone wrong in notable cases. > highlighting that even sympathetic coverage thinks the approach is a mixed bag in practice. You mean "how a statistically non-significant number of cases lead to the usual results in our modern outrage culture"? You will always have cases where it doesn't work. That's why statistics are important. But statistics don't sell, what sells is "SEE, WE GAVE THIS GUY FREE HOUSING AND HE DID THIS HORRIBLE THING"
- silexia 7y ago
  I believe the homeless (and everyone else), should be prosecuted in full for crimes they commit. I think there are two types of homeless - those who are sane and normal but down on their luck - once they get a job and support they can be contributing members of society. These individuals need all the support we can give them. The second type of homeless, sometimes referred to as homeless by choice, those individuals who are drug addicted or mentally unstable to the point they can't even keep it together to get a government check need to be handled differently. I think we should have some form of long term holds for these people until they truly show they can survive and flourish without it. Cities are becoming overrun with the second type of homeless. These people are generally filthy, spread disease, commit various crimes of opportunity even including assault and murder and rape, and abuse drugs and alcohol until they die. I suggest we categorize the second type of homeless by issue involved and severity and have mandatory facilities to either help them recover or simply hold them long term. Categories could include various levels of drug addiction rehab, mental health, etc.

ducktypegoose 7y ago

A lot of those people who are the worst offenders, routinely bouncing from the hospital, to the jail, to the streets, have problems that aren't solved by a house. They need a group-home that isn't jail but is capable of saying, "no, you aren't fit to go into public yet until you can meet these criteria." A lot of these people need others to make decisions for them, when to take medications, when to bathe, how to navigate the bureaucracy, etc. God knows it would save a lot of money and keep them off the streets. I feel like for a lot of people they'd find community and purpose in life, eventually solving the problem that created their circumstances to begin with. Jail doesn't work, the streets doesn't work, leniency doesn't work, just handing someone a house isn't realistic. We have to try something else.

lonelappde 7y ago
You are describing institutionalization. Mandatory institutionalization is ripe for abuse, and voluntary institutionalization doesn't work when it's intended use is to serve people whose defining characteristics is inability to mak good choices consistently.

cco 7y ago

It isn’t housing first, I’ve never agreed with that name for their approach, it is disingenuous at best. The policies, as described in any “housing first” policies I’ve encountered, are more reasonably described as “supportive housing first”. If you place a chronically homeless, bi-polar, heroin addict into an apartment they will not get better, they will continue their previous life until they’ve broken their lease and are evicted; none of the “housing first” programs aimed at the “visibly homeless” we’re talking about do this, they provide housing along with a robust support system to get these people medical and mental healthcare as well as addiction recovery. It is a good model but I’ve too frequently seen them mischaracterized as just providing free rent, that isn’t what they do and that would fail. They are essentially just a reimagined mental health institute with far more freedom for the patients.