Housing Doesn’t Solve Homelessness

People want homelessness solved. Homeless people want homelessness solved. In a society that values quick, easy wins, we’ve come up with concepts and metrics that are pure lunacy. Incarcerating poor people is despicable. Moving folks from my neighborhood to your neighborhood is dumb. Claiming someone got housed when they leave after a couple days is political. Housing alone is not a panacea, and it is certainly not a metric.

We need to reframe the conversation of homelessness altogether. It’s not a housing problem, it’s a support system failure. You can’t just move someone into housing and hope for the best. Whether you believe in Housing First (getting folks into housing without preconditions) or Housing Last, the reality is the same: people need consistent support services both before and after they’re housed to drive real, long-term stability. These services not only keep people housed longer, but they directly drive down the exorbitant societal costs associated with ambulance transports, ER visits, hospitalizations, behavioral health, police engagements and incarceration.

Pre-Housing Services

The work begins with multi-disciplinary outreach teams that not only help people stay alive, get well and participate in meaningful activities, but also create long-term stability, build trust and connect people to other services. Services like these drive 59% more days housed per dollar spent than the costly, revolving door of the shelter system. (Journal of Poverty, 2021) This early connection to medical, behavioral and case services is crucial, immediately reducing the reliance on expensive Emergency Room visits. For example, when people received behavioral health support before being housed, even those with the most complex psychosis challenges were successfully housed 74 percent of the time, compared to only 13 percent without that support. (PubMed) By helping people on the street get well and engage with others, we transform an individual's readiness for stability. And evidence proves the leverage: Assertive Community Treatment, an intensive outreach model, leads to a 37 percent greater reduction in homelessness compared with standard case management, increasing the likelihood that housing placements are sustained over the long term. (PubMed)

Getting Housing Services

Securing housing is an administrative obstacle course, requiring individuals to navigate fragmented systems, complex applications and rigid eligibility rules. You can imagine this is a nearly impossible task for someone in crisis. Dedicated case managers must function as essential navigators, cutting through bureaucratic red tape to rapidly connect vulnerable individuals to the specific housing subsidies and units they qualify for, guaranteeing successful placement.

Post Housing Services

Once that key is handed over, the support must continue. Permanent Supportive Housing (PSH) paired with continuous, wraparound services is the only thing that breaks the crisis cycle. Programs like Housing First consistently demonstrate higher housing retention, fewer emergency interventions, and better quality-of-life outcomes for participants.

In Santa Clara County, participants in a supportive housing program remained housed for nearly all of the follow-up period. Compared with a control group receiving usual care, they had about 38 percent fewer psychiatric emergency visits and roughly 70 percent fewer shelter days. The program also increased use of outpatient mental health services, helping participants address underlying behavioral health needs. These results show that providing permanent housing paired with continuous support not only stabilizes living situations but also reduces reliance on costly emergency and shelter services. (PubMed)

The Cost of Not Providing Services

Supportive housing with case management often leads to dramatic public‑system cost reductions. One landmark analysis of chronically homeless people with severe mental illness found they used about $40,451 per year in publicly funded services before housing. After placement in supportive housing, service use dropped by about $16,282 per person per year, nearly offsetting the annual cost of that housing, according to the study’s estimates (shnny.org). Adjusted for inflation, these figures roughly double for today, highlighting the ongoing financial impact of supportive housing programs.

We save on ER visits, ambulance costs and police bandwidth and contact costs. And think about this math, to over-index on the construction of single units that could cost around $600,000 each, the tradeoff are the services that are necessary. Lawmakers must mandate a dual funding stream that aligns spending with this reality. Moreover, this lack of essential pre- and post-housing support complicates the intake process so profoundly that units often sit vacant while the chronically homeless remain on the street. We must stop managing a crisis by building empty, expensive houses and instead fund the service pathways that turn a physical unit into a permanent, supported home.

Conclusion

We must fundamentally reject the dinner party crowd politically convenient metrics of success like housing units built and number of people housed which offer only a false veneer of progress. Solving the problem mandates understanding the problem you are solving. The simple reality is this: empathy is great, housing is important, but supportive services are the actual key to the front door.

Mark Casanova, Executive Director of Homeless Health Care Los Angeles, graduated from UCLA in 1984 with a BA in Latin American history. He later received his MA in marriage, family therapy. Mark has always worked with the unhoused population through clinical service, training, advocacy, and administration. He began his clinical work in 1985 with the Salvation Army. Two years later, he joined HHCLA as a clinician and stayed through various organizational transitions to become the Executive Director in 1994. He now heads a staff of 300 and administers a budget of $40 million. His responsibility as Executive Director is to inspire staff and motivate his co-workers to carry out HHCLA’s crucial mission. Mark is committed to a harm reduction model of treatment because he believes that caring about people means caring about them wherever they find themselves. Mark’s expertise lies in homelessness, clinical services, harm reduction, syringe exchange, alternative substance use treatments for opioids and other drugs, and overdose prevention, including Naloxone distribution.